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OC07: OUTCOMES OF FETAL CARDIAC. EVALUATION. OC07.01. Fetal echocardiographic measurements and the need for neonatal surgical intervention in ...
22nd World Congress on Ultrasound in Obstetrics and Gynecology

Methods: Stored 4D STIC-HDF volume data from ovaries from 34 women diagnosed as having PCOS and evaluated by transvaginal ultrasound were assessed retrospectively. The first step in calculations for every STIC record was to move the region of the highest signal within the ovarian volume to the center of the screen. Then we activated STIC loop in order to work with a chain of 3D volumes. Calculations were performed in two ways: in the first one all 3D volumes from the chain were consecutively activated and the center of a 1-cc virtual sphere was placed in the center of the displayed picture. Histograms were automatically calculated for each 3D volume of the complete STIC chain. We calculated the mean VI and mean FI values based on the results from all chain volumes. In the second way, the examiner subjectively selected the two volumes with the highest and lowest color signals, respectively. Then, instead of using the mean VI and mean FI values from all 3D volumes, we just averaged VI maximum and VI minimum. The same was done with FI calculations. A single expert examiner performed all calculations. Agreement of measurements was estimated by calculating the intra-class correlation coefficient (ICC). Results: ICC for VI was 0.999 (95% CI: 0.999–1.000). Mean difference was −0.09. Limits of agreement: −0.620 to 0.800. ICC for FI was 0.998 (95% CI: 0.997–0.999). Mean difference was −0.170. Limits of agreement: −0.780 to 0.440. Mean time consumed for calculating mean VI and mean FI using the whole STCI chain was significantly longer than using average values from the volumes selected by operator (20 minutes versus 4 minutes). Conclusions: There is a significant agreement between both methods. Using average VI and FI from maximum and minimum values found is less time consuming that using mean VI and FI from the whole STIC chain.

OC06.04 How does IVF affect cyclical changes in subendometrial vascularity S. Sur, B. Campbell, N. J. Raine-Fenning School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom Objectives: To compare cyclical changes in subendometrial vascularity measured with 3D power Doppler in the same women during their natural menstrual cycle and IVF cycle. We hypothesized IVF would result in increased vascularity throughout the cycle, and these changes would be more profound in women who conceived. Methods: 154 women with reg menstrual cycles were prospectively recruited. They were seen in late follicular phase (LFP: ovuln-1to2) and mid-luteal phase (MLP: ovuln +5 to +6) of the natural cycle and on the day of final follicular maturation (FFM) and prior to embryo transfer (EMT) in the IVF cycle. Blood was drawn for estradiol (E) and progesterone (P) levels and TV USS scan performed to acquire 3D power Doppler data of the uterus. VOCAL used to define the endometrium and subendometrium (3, 5 and 7 mm shells) and the values corrected for depth by standardising (sVI, sFI, sVFI). Repeated measures ANOVA used to compare pre-ovulatory (POV) measures at LFP to tho FFM and implantation (IMP) measures at MLP to EMT to see whether these predicted conception. Results: 128 women included. Mean vascular indices in the 5 mm subendometrial shell shown in table Rptd measures ANOVA showed the pattern of sVI, sFI and sVFI in the IVF cycle was sig different from that seen in the menstrual cycle (P < 0.001). The change in POV sFI between the IVF and menstrual cycle was significantly different between women who conceived (+1.55%) and those who did not (−1.33%). Conclusions: In the IVF cycle the difference between POV and IMP vascular indices was exaggerated compared to the natural cycle, resulting in the subendometrium being relatively more hypoxic in the IVF cycle implantation window. Conception was associated with a higher preovulatory increase in sFI rendering the subendometrium relatively more hypoxic at the time of implantation.

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Oral communication abstracts

OC06.04: Table 1. Subendometrial vascular indices in the same women across their menstrual & IVF cycle

sVI sFI sVFI

LFP

MLP

FFM

EMT

18.2 32.4 6.1

13.0 32.1 4.1

24.6 30.7 8.5

7.7 29.0 2.2

OC07: OUTCOMES OF FETAL CARDIAC EVALUATION OC07.01 Fetal echocardiographic measurements and the need for neonatal surgical intervention in tetralogy of Fallot B. Arya1 , K. Woldu2 , S. Levasseur1 , J. S. Glickstein1 , I. A. Williams1 1 Department of Pediatrics, Division of Cardiology, Morgan Stanley Children’s Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA; 2 Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA

Objectives: To assess the ability of fetal echocardiography (echo) to predict neonatal outcomes in tetralogy of Fallot (TOF). Methods: We conducted a retrospective review of prenatally diagnosed TOF infants admitted from 1/2004 to 6/2011. Aortic valve (AoV), pulmonary valve (PV), main pulmonary artery (MPA), and left and right pulmonary artery diameters were measured on the first fetal and neonatal echo and converted to z-scores based on gestational age (GA) (fetus) or body surface area (neonate). Subject details including need for prostaglandin (PGE) and timing of surgery (sx) were recorded. Associations between fetal and neonatal measurements were assessed using Pearson’s correlation coefficient. Differences between subjects who required neonatal sx and those who did not were tested using a student’s t test. Sensitivity and specificity of fetal echo z-scores to predict need for neonatal sx were calculated using ROC curve. Results: We identified 68 TOF infants born at 38.0 ± 2.4 weeks GA with a fetal echo at a mean GA of 25.6 ± 5.3 weeks. At neonatal echo, TOF/pulmonary atresia (PA) was present in 8 (11.8%), TOF/PA with multiple aortopulmonary collateral arteries in 7 (10.3%), and absent PV in 4 (5.8%). We excluded TOF absent PV from analysis. There was a strong correlation between the fetal and neonatal AoV (r = 0.35; P < 0.01) and MPA z-scores (r = 0.54; P < 0.001). Of 64 patients, 19 were PGE dependent and required neonatal sx. Subjects who required neonatal sx had smaller fetal PV (−5.65 ± 2.48 vs. −3.69 ± 1.83; P < 0.01) and MPA (−3.89 ± 1.59 vs. −2.73 ± 1.83; P < 0.05) z-scores and smaller neonatal PV (−3.66 ± 0.88 vs. −1.95 ± 0.89; P < 0.001) and AoV (3.48 ± 1.32 vs. 2.59 ± 1.66; P < 0.05) z-scores. A fetal PV z-score of −5 predicted need for neonatal sx with 83% sensitivity and 80% specificity (P < 0.001); PV z-score of −3.5 provided 92% sensitivity and 41% specificity. Conclusions: In TOF, fetal PV and MPA z-scores are helpful in predicting the need for neonatal sx. Patients with fetal PV z-score of less than −3.5 should be delivered at a tertiary care medical center.

Ultrasound in Obstetrics & Gynecology 2012; 40 (Suppl. 1): 1–54