Objectives To investigate the rate and outcome of emergency Cesarean delivery (CD) in women with placenta previa with or without placenta accreta spectrum disorders (PAS) and to elucidate the diagnostic accuracy of ultrasound in predicting emergency CD. Methods This was a secondary analysis of a multicenter prospective study involving 16 referral hospitals in Italy (ADoPAD study). Inclusion criteria were women with placenta previa minor (< 20 mm from the internal cervical os) or placenta previa major (covering the os), aged >= 18 years, who underwent transabdominal and transvaginal ultrasound assessment at >= 26 + 0 weeks of gestation. The primary outcome was the occurrence of emergency CD, defined as the need for immediate surgical intervention performed for emergency maternal or fetal indication, including active labor, cumulative maternal bleeding > 500 mL, severe and persistent vaginal bleeding such that maternal hemodynamic stability could not be achieved or maintained, or category-III fetal heart rate tracing unresponsive to resuscitative measures. The primary outcome was reported separately in the population of women with placenta previa and no PAS confirmed after birth and in those with PAS. The secondary aim was to report on the strength of association and to test the diagnostic accuracy of ultrasound in predicting emergency CD. Univariate, multivariate and diagnostic accuracy analyses were used to analyze the data. Results A total of 450 women, including 97 women with placenta previa and PAS and 353 with placenta previa only, were analyzed. In women with placenta previa and PAS, emergency CD was required in 20.6% (95% CI, 14-30%), and 60.0% (12/20) delivered before 34 weeks of gestation. The mean gestational age at delivery was 32.3 +/- 2.7 weeks in women undergoing emergency CD and 34.9 +/- 1.8 weeks in those undergoing elective CD (P < 0.001). Women undergoing emergency CD had a higher median estimated blood loss (2500 (interquartile range (IQR), 1350-4500) vs 1100 (IQR, 625-2500) mL; P = 0.012), mean units of blood transfused (7.3 +/- 8.8 vs 2.5 +/- 3.4; P = 0.02) and more frequent placement of a mechanical balloon (50.0% vs 16.9%; P = 0.002) compared with those undergoing elective CD. On univariate analysis, the presence of interrupted retroplacental space, interrupted bladder line and placental lacunae was more common in women not experiencing emergency CD. No comprehensive multivariate analysis could be performed in this subgroup of women. Ultrasound signs of PAS, including presence of interrupted retroplacental space, interrupted bladder line and placental lacunae, were not predictive of emergency CD. In women with placenta previa but no PAS, emergency CD was required in 31.2% (95% CI, 26.6-36.2%), and 32.7% (36/110) delivered before 34 weeks of gestation. The mean gestational age at delivery was lower in women undergoing emergency CD compared with those undergoing elective CD (34.2 +/- 2.9 vs 36.7 +/- 1.6 weeks; P < 0.001). Pregnancies complicated by emergency CD were associated with a lower birth weight (2330 +/- 620 vs 2800 +/- 480 g; P < 0.001) and had a higher risk of need for blood transfusion (22.7% vs 10.7%; P = 0.003) compared with those who underwent elective CD. On multivariate analysis, only placental thickness (odds ratio (OR), 1.02 (95% CI, 1.00-1.03); P = 0.046) and cervical length < 25 mm (OR, 3.89 (95% CI, 1.33-11.33); P = 0.01) were associated with emergency CD. However, a short cervical length showed low diagnostic accuracy for predicting emergency CD in these women. Conclusion Emergency CD occurred in about 20% of women with placenta previa and PAS and 30% of those with placenta previa only and was associated with worse maternal outcome compared with elective intervention. Prenatal ultrasound is not predictive of the risk of emergency CD in women with these disorders. (c) 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Objective To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa. Methods This was a prospective multicenter study of pregnant women aged >= 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at >= 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms. Results A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta. Conclusions Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. (c) 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Introduction/Background The ADNEX (Assessment of Different NEoplasias in the adneXa) model was developed using parameters collected by experienced (level III) ultrasound examiners. Our primary aim was to externally validate the ADNEX model, when applied by level II examiners in an academic-women-hospital. The discriminatory performance of ADNEX was compared with the two-step strategy and subjective assessment by an experienced ultrasound operator. Methodology From February 2013 to January 2017, all patients who were scheduled for surgery for an adnexal mass at the Sant'Anna Hospital in Turin were enrolled. Preoperative transvaginal sonography was performed, and the two-step strategy was applied. Two ultrasound examiners applied the ADNEX model to all the collected masses based on the ultrasound reports. Finally, an experienced operator assigned the subjective assessment based on recorded ultrasound images. The discrimination and calibration performance of ADNEX were evaluated. The AUC was calculated for the basic discrimination between benign and malignant tumours Results A total of 577 patients were included in the analysis: the overall prevalence of malignancy was 25%. With ADNEX, the AUC to differentiate between benign and malignant masses was 0.9111 (95% CI 0. 8788–0.9389). At risk cut-offs of 1%, 10% and 30%, sensitivities were 100%, 89.6% and 79.2%, respectively, and specificities were 2.8%, 76.2% and 89.6%, respectively. Discrimination between benign and stage II–IV tumours was good (AUC 0.935). The model had the most difficulties discriminating between borderline and stage I tumours, and between stages II-IV invasive and secondary metastatic tumours. ADNEX proved to be equally or more accurate than the subjective assessment or the two-step strategy in the discrimination between benign and malignant adnexal masses. Conclusion The ADNEX model could probably be successfully applied when a level III examiner is not available and, therefore both a subjective assessment and the two-step strategy cannot be performed. Disclosure Nothing to disclose.

Objectives: To compare the different classifications in use for mullerian anomalies (ASRM, Salim, ESHRE/ESGE, CUME) in the diagnosis of normal/ arcuate/ septate uterus and to correlate the diagnosis with reproductive outcomes. Methods: Retrospective observational study conducted on 664 patients with 3D ultrasound diagnosis of arcuate/subseptate uterus (3-30 mm indentation). For each patient the uterine morphology was evaluated offline on the coronal plane and the following measurements were recorded: uterine cavity width (W); septal length (L); uterine wall thickness (M); fundal indentation angle (α). Each uterus was subsequently subclassified according to the following classifications: ASRM (1988), Salim (2003), ESHRE/ESGE (2013), CUME (2018). The reproductive history of each patient was correlated to the cavitary measurements and the type of malformation according to the four classifications. Results: 38% of patients were infertile, 62% had at least one pregnancy with 75% of abortion, 23% of secondary infertility and 13% of preterm labour. Primary infertility was greater in patients with narrow cavities (W), less uterine wall thickness (M) and greater indentation angle (α). Preterm birth was associated with longer septa (L), recurrent abortion with small and narrow septa (L, W). The current classifications are not homogeneous in the definition of subseptate uterus and are not correlated with reproductive outcomes. This correlation becomes significant by imposing an indentation cutoff ≥ 5mm to the ESHRE classification. Conclusions: According to our results the presence of a partial septum carries a negative effect on reproductive impacts. We identified certain uterine morphological features that seem to have a greater association with negative outcomes. Current classifications don’t seem to correlate with reproductive outcomes. In our opinion, the determination of a minimum indentation cut-off could standardise the existing classifications by clearly defining the criteria for corrective surgery.

To evaluate the diagnostic performance of obstetric ultrasound in detecting clinically significant placenta accreta spectrum disorder (PAS) in women with placenta previa (PP; < 2 cm from the internal orifice of the uterus, 26+0/7gestational weeks) and at least two previous Caesarean sections. Prospective observational multicentric study. PAS was suspected in presence of at least one of the the following ultrasound signs: irregularity of the hypoechoic space between uterus and placenta, disruption of the hyperechoic uterine/bladder wall interface, turbulent placental lacunae with high-speed flow (> 15 cm/s). PAS was defined clinically significant if, in addiction to histological confirmation of placenta accreta, at least one of the following procedures was performed: haemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation, uterine artery embolisation. 64 women were included in the study. The diagnostic performances of ultrasound for PAS are reported in table 1. With at least two Caesarean sections and anterior PP the normality of the hypoechoic space is superior to the other signs to rule out PAS. With posterior PP the simultaneous finding of lacunae and irregularity of the hypoechoic space is superior to the other signs for the diagnosis of PAS. OC30.02: Table 1.

To evaluate the diagnostic performance of different ultrasound signs in the 3rd trimester, for the diagnosis of clinically significant placenta accreta spectrum (PAS) disorders in women with placenta previa (< 2 cm from the internal uterine orifice, > 26+0/7gestational weeks) without previous Caesarean section. Prospective observational multicentre study. Ultrasound suspicion of placental accretism was raised in the presence of at least one of: obliteration/irregularities of the hypoechogenic space between uterus and placenta, interruption of the hyperechogenic interface between uterine serous-membrane and bladder wall or turbulent placental lacunae with high speed flow (> 15cm/sec). The placental accretism was defined as clinically significant if, in addiction to histological confirmation of placenta accreta, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation, uterine artery embolisation. For each ultrasound sign and their combination we calculated diagnostic performance. 258 women were included. Diagnostic performances of ultrasound for PAS are shown in table 1. In case of anterior placenta previa, the presence of all of three ultrasound signs is the best way to confirm the presence of PAS, whereas a normal hypoechogenic space between uterus and placenta is more suitable than the other ultrasound signs to exclude the presence of PAS. In case of posterior placenta previa, turbulent placental lacunae are the best predictor for the diagnosis of PAS.

Objectives Uterine smooth muscle tumors of uncertain malignant potential (STUMP) represent a group of rare and challenging myometrial neoplasms. STUMPs that are followed by a recurrence are biologically low-grade leiomyosarcomas, but using current methods of analysis, this diagnosis cannot be made with certainty until a recurrence has developed. Our objective is to describe ultrasound findings in women with STUMP. Methods We retrospectively evaluated preoperative sonographic data of patients with histopathological STUMP diagnosis between 2014 and 2018 in Turin S. Anna Hospital, a tertiary center. The tumors were characterized on the basis of ultrasound images and ultrasound reports using the terms and definitions of the Morphological Uterus Sonographic Assesment (MUSA) group. Results Thirteen patients with STUMP (19 lesions, of which 17 pure STUMP and 2 STUMP with LMS associated) were identified. Using the MUSA terms and definitions most STUMP were poorly or moderately vascularized (69%) and almost all had both circumferential and intra-lesional flows (82%). Only three (16%) STUMP showed shadowing. Outline were well-defined in sixteen cases (84%). All STUMP had non-uniform echogenicity. Eleven (58%) STUMP were isoechoic, two (11%) hyperechoic and six (31%) had mixed echogenicity. Thirteen (68%) STUMP had microcystic anechoic areas. Over 30% of patients had multiple stumps and almost 80% associated myomas. Conclusions The suspicion of STUMP is supported by the ultrasound finding of a single or multiple lesion, isoechoic or with mixed echogenicity, without shadowing, with regular borders, internal microcystic anechoic areas and vascularization from minimal to high both circumferential and intralesional.

The aim of this study was to evaluate the role of HE4 in the management of adnexal masses in women in pre- and post-menopause. This was a retrospective study. It considered patients with a suspect of adnexal mass or treated for ovarian pathology. 392 patients were included: they were examined on ultrasound between April 1st 2015 and March 1st 2016. Ovarian masses were described using the terms and definitions of IOTA group; the examiner classified every mass using simple rules when applicable. After ultrasound examination we evaluated the peripheric blood circulating level of HE4. Of 392 patients, 285 pz (73%) were eligible for evaluation. Examiner didn't apply simple rules in 27% of women (underwent surgery before, patients in follow-up for ovarian cancer, patient during chemotherapy for ovarian cancer, women without adnexal mass). 141 (50,5%) patients were in pre-menopause: 103 masses were classified as benign lesion and 22 as malignant lesion. 144 patients were in menopause: 85 masses were classified as benign lesion and 45 as malignant lesion. Simple rules were inconclusive in 30 pz (10.5%, 16 patients in pre-menopause and 14 patients in menopause). In these patients we evaluated level of HE4. The cut off for malignancy was ≥ 70 pmol/L in pre menopause and ≥ 140 pmol/L in menopause. In pre menopause the value of HE4 was correlated with histological diagnosis in 92% of cases. Among the group of women in menopause HE4 didn't found a significant correlation with final pathological diagnosis. In this group we founded a correlation between diagnosis of malignancy with simple rules and value of HE4 (VPP 60%). In the management of adnexal masse we can use tumour marker HE4 in pre menopause when simple rules were non applicable: it can help to formulate a diagnosis, to decide the ultrasound follow up and to reduce the over treatment. HE4 in our study seems to be not reliable among the group of menopause to orient diagnosis when simple rules were inconclusive.

Array-Comparative Genomic Hybridization Analysis in Fetuses with Major Congenital Malformations Reveals that 24% of Cases Have Pathogenic Deletions/Duplications / Di Gregorio, Eleonora; Gai, Giorgia; Botta, Giovanni; Calcia, Alessandro; Pappi, Patrizia; Talarico, Flavia; Savin, Elisa; Ribotta, Marisa; Zonta, Andrea; Mancini, Cecilia; Giorgio, Elisa; Cavalieri, Simona; Restagno, Gabriella; Ferrero, Giovanni B; Viora, Elsa; Pasini, Barbara; Grosso, Enrico; Brusco, Alfredo; Brussino, Alessandro. In: CYTOGENETIC AND GENOME RESEARCH. ISSN 1424-8581. 147:1(2015), pp. Original Citation: Array-Comparative Genomic Hybridization Analysis in Fetuses with Major Congenital Malformations Reveals that 24% of Cases Have Pathogenic Deletions/Duplications

ABSTRACTObjectiveTransvaginal sonography (TVS) and serum biomarkers are used widely in clinical practice to triage women with adnexal masses, but the effectiveness of current biomarkers is weak. The aim of this study was to determine the best method of diagnosing patients with adnexal masses, in terms of diagnostic accuracy and economic costs, among four triage strategies: (1) the International Ovarian Tumor Analysis group's simple rules (SR) for interpretation of TVS with subjective assessment (SA) by an experienced ultrasound operator when TVS results are inconclusive (referred to hereafter as SR ± SA), (2) SR ± SA and cancer antigen 125 (CA 125), (3) SR ± SA and human epididymis protein 4 (HE4) and (4) SR ± SA and the risk of malignancy algorithm (ROMA). Our main hypothesis was that the addition of the biomarkers to SR ± SA could improve triaging of these patients in terms of diagnostic accuracy (i.e. malignant vs benign). As secondary analyses, we estimated the cost effectiveness of the four strategies and the diagnostic accuracy of SR ± SA at the study hospitals.MethodsBetween February 2013 and January 2015, 447 consecutive patients who were scheduled for surgery for an adnexal mass at the S. Anna and Mauriziano Hospitals in Turin were enrolled in this multicenter prospective cohort study. Preoperative TVS was performed and preoperative CA 125 and HE4 levels were measured. Pathology reports were used to assess the diagnostic accuracy of the four triage strategies and the cost of each strategy was calculated.ResultsA total of 391 patients were included in the analysis: 57% (n = 221) were premenopausal and 43% (n = 170) were postmenopausal. The overall prevalence of malignancy was 21%. SR were conclusive in 89% of patients and thus did not require SA; the overall performance of SR ± SA showed a sensitivity of 82%, specificity of 92% and positive and negative predictive values and positive and negative likelihood ratios of 74%, 95%, 10.5 and 0.19, respectively. In premenopausal women, mean cost among the four triage strategies varied from €36.41 for SR ± SA to €70.12 for SR ± SA + ROMA. The addition of biomarkers to SR ± SA showed no diagnostic advantage compared with SR ± SA alone and was more costly. Among postmenopausal women, mean cost among the four triage strategies varied from €39.52 for SR ± SA to €73.23 for SR ± SA + ROMA. Among these women, SR ± SA + CA 125 and SR ± SA + ROMA had a higher sensitivity (both 92% (95% CI, 85–99%)) than SR ± SA (81% (95% CI, 71–91%)), but SR ± SA had a higher specificity (84% (95% CI, 77–91%)). SR ± SA + CA 125 and SR ± SA + ROMA improved diagnostic accuracy, each diagnosing a third more malignant adnexal masses. In postmenopausal women, compared with SR ± SA alone, SR ± SA + CA 125 showed a net reclassification improvement (NRI) of 28.8% at an extra cost of €13.00, while the extra cost for SR ± SA + ROMA was €33.71, with a comparable gain, in terms of NRI, as that of SR ± SA + CA 125.ConclusionsIn our study sample, SR ± SA seems to be the best strategy to triage women with adnexal masses for surgical management. Among postmenopausal women, SR ± SA + CA 125 increased the NRI at a reasonable extra cost. Our data do not justify the use of HE4 and ROMA in the initial triage of women with adnexal masses. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

OBJECTIVE:To evaluate whether prenatal diagnosis of intestinal midgut volvulus (a rare condition due to the small bowel loops twisting) can improve the prognosis of the newborns.METHODS:In our Prenatal Diagnosis Center, eight cases of intestinal volvulus observed between 2007 and 2014 were retrospectively considered. Ultrasonographic signs can be direct and specific (whirlpool sign, coffee bean sign) or indirect and non-specific (abdominal mass, dilated bowel loops, pseudocysts, ascites, polyhydramnios).RESULTS:Prenatal diagnosis was performed at 20-34 weeks of gestation. All newborns were exposed to an emergency surgery: the major complication was due to cystic fibrosis.CONCLUSIONS:An early suspicion of intestinal volvulus allows the clinician to refer the patient to a tertiary center so to confirm the diagnosis and perform an appropriate follow-up in order to identify the proper time of delivery. The prognosis of the babies with prenatal intestinal volvulus depends on the length of the segment involved, on the level of intestinal obstruction, on the presence of meconium peritonitis and on the gestational age at birth. Our experience, according with the literature, suggests that ascites and absence of abdominal peristalsis are ultrasonographic signs that, in the third trimester of pregnancy, correctly lead to an immediate delivery intervention.

To construct reference limits for gestation of fetal biometric parameters stratified by chorionicity and customised for obstetrical and parents' characteristics. Fetal biometric measurements derived from serial ultrasound examinations obtained from uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG). The measurements acquired in each fetus at each examination included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex and mode of conception were also considered. Models for each parameter were constructed stratified by fetal chorionicity and compared to our previously constructed growth curves from singleton. The dataset included 1781 twin pregnancies (dichorionic 1289; monochorionic diamniotic 492) with 8923 ultrasonographic examination with a median of 5 (range 2–11) observations per pregnancy. Growth curves of twin pregnancies differ from those of singletons, and differences were more marked in MCDA and during the third trimester. A significant influence of parents' characteristics was found as in singleton pregnancies. Curves of fetal biometric measurements in twins are influenced by parents' characteristics. There is a reduction in growth rate during the third trimester. The reference limits for gestation constructed in this study from uncomplicated twin pregnancies may provide a useful tool for the identification of fetal growth abnormalities in twin pregnancies.

Objectives To evaluate the accuracy of ultrasound in the diagnosis of placenta accreta and its variants, and to assess the impact of prenatal diagnosis in our population.Methods A total of 314 women with placenta previa were enrolled prospectively and underwent transabdominal and transvaginal ultrasound examinations. An ultrasound diagnosis (grayscale and color/power Doppler) of placental attachment disorder (PAD) was based on the detection of at least two of the following ('two-criteria system'): loss/irregularity of the retroplacental clear zone, thinning/interruption of the uterine serosa-bladder wall interface, turbulent placental lacunae with high velocity flow, myometrial thickness <1 mm, increased vascularity of the uterine serosa-bladder wall interface, loss of vascular arch parallel to the basal plate and/or irregular intraplacental vascularization. Definitive diagnosis was made at delivery by Cesarean section. Maternal outcome in cases diagnosed antenatally was compared with that in cases diagnosed at delivery.Results There were 37/314 cases of PAD (29 anterior and eight posterior). The two-criteria system identified 30 cases of placenta accreta, providing a sensitivity of 81.1% and specificity of 98.9%. When anterior and posterior placentae were considered separately, the detection rates of PADwere 89.7 and 50.0%, respectively. Maternal outcome was better in women with prenatal diagnosis of PAD, as seen by less blood loss and shorter hospitalization.Conclusions Our data confirmed that gray-scale and color Doppler ultrasound have good performance in the diagnosis of PAD and that prenatal diagnosis improves maternal outcome. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.

To construct fetal biometric charts between 16 and 40 weeks of gestation customised for parents' characteristics, race and parity. In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low risk pregnancies, between 16 and 40 weeks of gestation, were analysed. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Quantile regression was used to examine the impact of parents' height and weight, parity and race across biometric percentiles of the fetal measurements considered. Paternal and maternal height were significant covariates for all the measurement considered. Maternal weight significantly influenced HC, AC and FL. Parity was significantly associated with BPD and HC values. Central African race was associated with HC and FL while North African race only with FL. In this study we constructed customised biometric growth charts using quantile regression in a large cohort of low risk pregnancies. These charts offer the advantage to define individualised normal ranges of fetal biometric parameters at each specific percentile corrected for parent's height and weight, parity and race. This support the importance of including this variables in routine ultrasound screening for fetal growth abnormalities.

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S513-S514 Free communication (oral) presentations O719 HOW MANY WOMEN FAIL TO COMPLETE THE INTEGRATED TEST? D. Dall'Amico, Search for more papers by this authorE. Muccinelli, Search for more papers by this authorE. Pavanello, Search for more papers by this authorV. Guaraldo, Search for more papers by this authorS. Bastonero, Search for more papers by this authorG. Errante, Search for more papers by this authorE. Gullino, Search for more papers by this authorA. Sciarrone, Search for more papers by this authorT. Todros, Search for more papers by this authorE. Viora, Search for more papers by this author D. Dall'Amico, Search for more papers by this authorE. Muccinelli, Search for more papers by this authorE. Pavanello, Search for more papers by this authorV. Guaraldo, Search for more papers by this authorS. Bastonero, Search for more papers by this authorG. Errante, Search for more papers by this authorE. Gullino, Search for more papers by this authorA. Sciarrone, Search for more papers by this authorT. Todros, Search for more papers by this authorE. Viora, Search for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61149-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S513-S514 RelatedInformation

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S513-S513 Free communication (oral) presentations O718 PIEDMONT EXPERIENCE IN SCREENING TEST FOR DOWN'S SYNDROME SINCE 2004 TO 2010: RESULTS OF INTEGRATED TEST, COMBINED TEST AND TRIPLE TEST D. Dall'Amico, D. Dall'AmicoSearch for more papers by this authorE. Viora, E. VioraSearch for more papers by this authorC. Bollati, C. BollatiSearch for more papers by this authorE. Muccinelli, E. MuccinelliSearch for more papers by this authorS. Bastonero, S. BastoneroSearch for more papers by this authorV. Guaraldo, V. GuaraldoSearch for more papers by this authorE. Pavanello, E. PavanelloSearch for more papers by this authorA. Sciarrone, A. SciarroneSearch for more papers by this authorE. Gullino, E. GullinoSearch for more papers by this authorT. Todros, T. TodrosSearch for more papers by this author D. Dall'Amico, D. Dall'AmicoSearch for more papers by this authorE. Viora, E. VioraSearch for more papers by this authorC. Bollati, C. BollatiSearch for more papers by this authorE. Muccinelli, E. MuccinelliSearch for more papers by this authorS. Bastonero, S. BastoneroSearch for more papers by this authorV. Guaraldo, V. GuaraldoSearch for more papers by this authorE. Pavanello, E. PavanelloSearch for more papers by this authorA. Sciarrone, A. SciarroneSearch for more papers by this authorE. Gullino, E. GullinoSearch for more papers by this authorT. Todros, T. TodrosSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61148-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S513-S513 RelatedInformation

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S293-S293 Free communication (oral) presentations O092 ACCESS TO PRENATAL DIAGNOSIS: RATE OF IDENTIFICATION OF TRISOMY 21, 18 OR 13 AND EFFICIENCY OF SELECTION CRITERIA S. Bastonero, S. BastoneroSearch for more papers by this authorM.G. Alemanno, M.G. AlemannoSearch for more papers by this authorD. Dall'Amico, D. Dall'AmicoSearch for more papers by this authorI. Dusini, I. DusiniSearch for more papers by this authorP. Gaglioti, P. GagliotiSearch for more papers by this authorE. Gullino, E. GullinoSearch for more papers by this authorM. Pagliano, M. PaglianoSearch for more papers by this authorA. Sciarrone, A. SciarroneSearch for more papers by this authorS. Sdei, S. SdeiSearch for more papers by this authorE. Viora, E. VioraSearch for more papers by this author S. Bastonero, S. BastoneroSearch for more papers by this authorM.G. Alemanno, M.G. AlemannoSearch for more papers by this authorD. Dall'Amico, D. Dall'AmicoSearch for more papers by this authorI. Dusini, I. DusiniSearch for more papers by this authorP. Gaglioti, P. GagliotiSearch for more papers by this authorE. Gullino, E. GullinoSearch for more papers by this authorM. Pagliano, M. PaglianoSearch for more papers by this authorA. Sciarrone, A. SciarroneSearch for more papers by this authorS. Sdei, S. SdeiSearch for more papers by this authorE. Viora, E. VioraSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60522-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S293-S293 RelatedInformation