To examine the relationship between abnormalities in uterine (UtA) and/or umbilical artery (UA) Doppler velocimetry and maternal plasma concentrations of soluble endoglin (sEng) in patients with pre‐eclampsia (PE).

Objectives To validate a new sonographic technique for the display and measurement of fetal iliac crest angle (ICA), and to determine the relative contribution of standardized fetal pelvic measurements for estimating risk of Down syndrome during the second trimester of pregnancy.Methods Three-dimensional ultrasonography of the fetal pelvis was performed during a second-trimester scan for genetic amniocentesis. A coronal view of the 'virtual pelvis' was obtained by applying a maximum intensity projection algorithm to visualize both iliac wings. Two different ICAs were measured from a coronal projection of the fetal pelvis (ICA-coronal 1 and ICA-coronal 2); the latter approach relied on using ischial tuberosities as reference landmarks. Next, a coronal projection of the fetal pelvis was rotated to demonstrate a rendered view of the axial fetal pelvis. Axial inner (ICA-inner), middle (ICA-middle) and outer (ICA-outer) ICAs were measured. The maximum anterior iliac distance measurement was defined as the widest separation between the most anterior points of the rendered iliac crests. The reproducibility of each ICA method was analyzed using Bland-Altman statistics. Simple and multiple logistic regression analysis determined the relative contribution of each parameter as a prenatal predictor of Down syndrome.Results Ninety-four normal fetuses and 19 fetuses with Down syndrome were examined. The ICA-middle and ICA-coronal 2 parameters were the most reproducible angle measurements. The mean +/- SD ICA-middle measurement for fetuses with Down syndrome was significantly greater than that for normal subjects (94.5 +/- 9.8 degrees vs. 83.1 +/- 6.5 degrees; P < 0.001). The mean +/- SD ICA-coronal 2 angle measurement for fetuses with Down syndrome was slightly greater than that for normal subjects (57.9 +/- 5.5 degrees vs. 51.9 +/- 7.1 degrees; P =0.0014). A multiple logistic regression model including ICA-middle and ICA-coronal 2 provided a predictive ability of 88.1% based on the area under the receiver-operating characteristics curve. This combination bad a sensitivity of 94.4% for a false-positive rate of 5% in the detection of Down syndrome.Conclusions Standardized iliac crest measurements of the fetal pelvis can be used to identify some fetuses at risk for trisomy 21 during the second trimester of pregnancy. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Objective The aim of this study was to determine whether the risk of early spontaneous preterm delivery (PTD) in asymptomatic women with a sonographic cervical length of <= 15 mm in the mid-trimester changes as a function of gestational age at diagnosis.Methods This cohort study included 109 asymptomatic patients with a sonographic cervical length of <= 15 mm diagnosed at 14-24 weeks of gestation. Women with a multifetal gestation, cerclage and a cervical dilatation of > 2 cm were excluded. The study population was stratified by gestational age at diagnosis (< 20 weeks vs. 20-24 weeks) and by cervical length (<= 10 mm vs. 11-15 mm). The primary outcome variables were PTD at < 28 and < 32 weeks of gestation and the diagnosis-to-delivery interval.Results The median gestational age at diagnosis of a short cervix before 20 weeks and at 20-24 weeks was 18.9 and 22.7 weeks, respectively. Women diagnosed before 20 weeks had a higher rate of PTD at < 28 weeks (76.9% vs. 30.9%; P < 0.001) and at < 32 weeks (80.8% vs. 48.1%; P = 0.004), and a shorter median diagnosis-to-delivery interval (21 vs. 61.5 days, P 0.003) than those diagnosed at 20-24 weeks. The rate of amniotic fluid sludge was higher among patients diagnosed with a short cervix at < 20 weeks of gestation than in those in whom it was diagnosed between 20 and 24 weeks (92.3% vs. 48.2%; P < 0.001).Conclusions Asymptomatic women with a sonographic cervical length of < 15 mm diagnosed before 20 weeks of gestation have a dramatic and significantly higher risk of early preterm delivery than women diagnosed at 20-24 weeks. These findings can be helpful to physicians in counseling these patients, and may suggest different mechanisms of disease leading to a sonographic short cervix before or after 20 weeks of gestation. Copyright (C) 2010 ISUOG. Published by John Wiley & Sons, Ltd.

Objectives The main goals were to provide normal reference ranges for fractional limb volume as a new index of generalized fetal nutritional status, to evaluate the reproducibility of fractional fetal limb volume measurement during the second and third trimesters of pregnancy, and to demonstrate technical considerations for this technique.Methods This was a prospective, cross-sectional study of gravid women during mid to late pregnancy. Fractional limb volumes were based on either 50%, of humeral or femoral diaphysis length. Each partial volume was subdivided into five equidistant slices that were centered along the mid-arm or mid-thigh. Slices were traced manually to obtain fractional arm (AVol) or fractional thigh (TVol) volume. Reproducibility studies were performed, using Bland-Altman plots, to assess blinded interobserver and intraobserver measurement bias and agreement. Selected images were chosen to demonstrate technical factors for the acquisition mid analysis of these parameters. Reference charts were established to describe normal ranges for A Vol and TVol.Results Three hundred mid eighty-seven subjects were scanned to include 380 AVol (range, 1.1-68.3 mL) and 378 TVol (range 2.0-163.2 mL) measurements between 18.0 and 42.1 weeks' menstrual age. No gender differences were found in these soft tissue measurements (A Vol, P = 0.90; TVol, P = 0.91; Mann-Whitney test). Intraobserver mean bias +/- SD mid 95% limits of agreement (LOA) for fractional limb volumes were: 2.2 +/- 4.2% (95%, LOA, -6.0 to 10.5%) for A Vol and 2.0 +/- 4.2%, (95%, LOA, -6.3 to 10.3%,) for TVol. Interobserver bias and agreement were -1.9 +/- 4.9%, (95%, LOA, -11.6 to 7.8%) for AVol and -2.0 +/- 5.4% (9.5% LOA, -12.5 to 8.6%,) for TVol. Technical factors were related to image optimization, transducer pressure, fetal movement, soft tissue compression and amniotic fluid volume.Conclusions Fractional limb volume assessment may improve the detection and monitoring of malnourished fetuses because this soft tissue parameter can be obtained quickly and reproducibly during mid to late pregnancy. Careful attention should be placed on technical factors that can potentially affect optimal acquisition and analysis of these volume measurements. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

The aim of this study was to determine if the angiogenic and anti-angiogenic plasma profiles of women who subsequently develop preeclampsia (PE) was a function of the presence or absence of abnormalities in uterine artery Doppler velocimetry (UTDV) in the midtrimester (MT). This was a secondary analysis of a cohort study that included 1,622 singleton pregnant women to examine the value of plasma placental growth factor (PlGF), soluble endoglobin (sEng) and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) concentrations in the identification of patients destined to develop PE. Only patients who had a blood sample obtained within 3 days of UTDV interrogation in the MT (20–25 weeks) were included (n = 448). 1) Among patients destined to develop PE, only those with an abnormal UTDV had a significantly higher median plasma sEng concentration than women without PE [either normal (p = 0.004) or abnormal UTDV (p = 0.016)]; 2) there was no significant difference in the median plasma concentrations of sVEGFR-1, sEng and PlGF between patients with and without abnormal UTDV in the MT (P > 0.05); 3) 15/16 patients with normal UTDV and sEng had late-onset PE (> 34 weeks). The combination of UTDV and maternal anti-angiogenic profile in the MT did not improve the detection of late-onset PE.

It has been proposed that thickness of chorioamniotic membranes is a predictor of preterm delivery (UOG 2008; 32 : 205). The objective was to evaluate sonographic membrane thickness (MT) throughout gestation in 3 different sites: chorionic plate (CP), uterine free wall (FW), and cervix. A prospective, cross-sectional study was performed in patients with singleton pregnancies who underwent transabdominal and transvaginal US. MT was measured in 3 sites: CP, uterine FW (area free of placenta), and cervix (at or within 2 cm of internal os). Three measurements were taken per site. Exclusion criteria were: short cervical length (< 2.5 cm), funneling, positive response to transfundal pressure, presence of sludge, vaginal infections, medical complications, and fetal anomalies. Data analysis was done using linear regression. P < 0.05 was considered significant. Intra-observer variability was assessed by 1 operator in 10 patients (for each of the 3 sites), and % coefficient of variation (CV) was computed. MT could be measured at the CP and cervix in all patients (n = 40). Membranes could not be visualized at the FW in 57.5% (n = 23). Mean ( ± SD) MT (mm) at the CP, FW, and cervix differed significantly among these sites: 1.28 ± 0.17, 0.97 ± 0.14, and 0.55 ± 0.08, respectively (P < 0.0001). MT at the CP increased as a function of gestational age (P = 0.005); however, a similar change was not detected for FW or cervix. CV for MT measurements ranged from 9.8 to 14.4% for intra-observer variability. Observations were made between 15–34.4 (median 25.4) weeks. 1) Mean MT throughout gestation differed significantly among CP, FW, and cervix; 2) FW membranes could not be visualized in 57.5%; 3) MT at the CP increased as a function of gestational age; 4) intra-observer variability was acceptable and was similar among sites; 5) reference values reported herein may be used to assess MT in cases of preterm labor and/or suspected intra-amniotic infection/inflammation.

The purpose of this study was to determine the changes in transvaginal sonographic (TVS) cervical length with gestational age in nulliparous and parous women. The justification for this study is the conflicting evidence about cervical length according to parity and the importance of a longitudinal study to characterize changes in cervical length over time. This study included 5,186 singleton pregnancies (3,398 multiparous and 1,788 nulliparous) with ≥3 TVS cervical length measurements who delivered at term. All patients had the first cervical length measurement between 14–24 weeks. A Generalized Estimating Equations model was used to fit TVS cervical length measurements versus gestational age (and its square), as well as parity, maternal age, and the interaction term between gestational age and parity. A “moving window” approach was used to determine the gestational age at which there was a statistically significant difference in the mean TVS cervical length between both groups. 1) 25,224 TVS cervical length measurements were obtained (mean: 4.9 per patient); 2) Nulliparous women had a shorter TVS cervical length than multiparous women (p<0.0001), and this difference increased with advancing gestational age (p<0.0001); 3) The difference in the mean TVS cervical length between nulliparous and multiparous women became and remained statistically significant from 24.7 weeks onward; and 4) In both nulliparous and multiparous women, there is shortening of cervical length in the third trimester, and the slope is greater than in the second trimester. 1) Nulliparous women had a shorter cervical length than multiparous women throughout gestation; and 2) this longitudinal study characterized the shortening over time in cervical length.

Develop new fetal weight estimation models that combine fractional limb volume with conventional 2D biometry. A cross-sectional study of 271 fetuses used 3DUS to acquire biparietal diameter (BPD), abdominal circumference (AC), femoral diaphysis length (FDL), fractional arm volume (AVol) and fractional thigh volume (TVol) within 4 days of delivery. Weighted multiple linear regression was used to develop ‘modified Hadlock’ models for comparison to new models using natural logarithmic (Ln) transformed parameters for birth weight (BW). Predicted and observed weights were compared using mean % difference between predicted and actual BW (systematic error) and SD of the % differences (random error). The proportion of newborns with EFW within 5 or 10% of BW, were compared using McNemar's test. More precise fetal weight estimations are possible by combining fractional limb volume with 2D biometry. Substitution of FDL by fractional limb volume, use of Ln transformations with weighted regression analysis, and selective application of squared transformed parameter terms reduced the random error to 6.6%. New fetal weight estimation models, that incorporate soft tissue parameters, may offer new insight regarding the body composition of malnourished fetuses.

Objectives The main goal was to investigate the relationship between prenatal sonographic parameters and birth weight in predicting neonatal body composition.Methods Standard fetal biometry and soft tissue parameters were assessed prospectively in third-trimester pregnancies using three-dimensional ultrasonography. Growth parameters included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), mid-thigh circumference and femoral diaphysis length (FDL). Soft tissue parameters included fractional arm volume (AVol) and fractional thigh volume (TVol) that were derived from 50% of the humeral or femoral diaphysis lengths, respectively. Percentage of neonatal body fat (%BF) was determined within 48h of delivery using a pediatric air displacement plethysmography system based on principles of whole-body densitometry. Correlation and stepwise multiple linear regression analyses were performed with potential prenatal predictors and %BF as the outcome variable.Results Eight-seven neonates were studied with a mean +/- SD %BF of 10.6 +/- 4.6%. TVol had the greatest correlation with newborn %BF of all single-parameter models. This parameter alone explained 46.1% of the variability in %BF and the best stepwise multiple linear regression model was: %BF = 0.129 (TVol) - 1.03933 (P < 0.001). Birth weight similarly explained 44.7% of the variation in %BF. AC and estimated fetal weight (EFW) accounted for only 24.8% and 30.4% of the variance in %BF, respectively. Skeletal growth parameters, such as FDL, (14.2%), HC (7.9%) and BPD (4.0%), contributed the least towards explaining the variance in %BF.Conclusions During the late third trimester of pregnancy %BF is most highly correlated with TVol. Similar to actual birth weight, this soft tissue parameter accounts for a significant improvement in explaining the variation in neonatal %BF compared with fetal AC or EFW alone. Copyright (C) 2009 ISUOG, Published by John Wiley & Sons, Ltd.

Objectives The main goal of this study was to determine the accuracy and precision of new fetal weight estimation Models, based on fractional limb volume and conventional two-dimensional (2D) sonographic measurements during the second and third trimesters of pregnancy.Methods A prospective cross-sectional study of 271 fetuses was performed using three-dimensional ultrasonography to extract standard measurements - biparietal diameter (BPD), abdominal circumference (AC) and femoral diaphysis length (FDL) - plus fractional arm volume (AVol) and fractional thigh volume (TVol) within 4 days of delivery. Weighted multiple linear regression analysis was used to develop 'modified Hadlock' models and new models using transformed predictors that included soft tissue parameters for estimating birth weight. Estimated and observed birth weights were compared using mean percent difference (systematic weight estimation error) and the SD of the percent differences (random weight estimation error). The proportion of newborns with estimated birth weight within 5 or 10% of actual birth weight were compared using McNemar's test.Results Birth weights in the study group ranged from 235 to 5790 g, with equal proportions of male and female infants. Six new fetal weight estimation models were compared with the results for modified Hadlock models with sample-specific coefficients. All the new models were very accurate, with mean percent differences that were not significantly different from zero. Model 3 (which used the natural logarithms of BPD, AC and AVol) and Model 6 (which used the natural logarithms of BPD, AC and TVol) provided the most precise weight estimations (random error = 6.6% of actual birth weight) as compared with 8.5% for the best original Hadlock model and 7.6% for a modified Hadlock model using sample-specific coefficients. Model 5 (which used the natural logarithms of A C and TVol) classified an additional 9.1% and 8.3% of the fetuses within 5% and 10% of actual birth weight and Model 6 classified an additional 7.3% and 4.1% of infants within 5% and 10% of actual birth weight.Conclusion The precision of fetal weight estimation can be improved by adding fractional limb volume measurements to conventional 2D biometry. New models that consider fractional limb volume may offer novel insight into the contribution of soft tissue development to weight estimation. Copyright (C) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

To determine whether or not increased PVR is associated with changes in fetal cardiac function A cross-sectional study was conducted including fetuses with abnormal umbilical artery Doppler (PI > 95%; ABN). Volume estimates were obtained in systole and diastole from STIC datasets using VOCAL and “Contour Finder: Trace”. For each ventricle (RV, LV), cardiac output (CO), CO adjusted by head circumference (CO(HC), and ejection fraction (EF) were determined and compared to normal fetuses (NL; Hamill et al, ISUOG 2008; n=184) 34 fetuses were evaluated (median: 28.3 wks, range: 20.6–36.9); 1) ventricular volumes were lower for ABN than NL, especially LV in systole (LVS); 2) mean RVCO, LVCO, RVCO (HC), and LVCO(HC) were lower while RVEF and LVEF were higher for ABN compared to NL with proportionally greater changes for LV than RV; 3) in the setting of increased PVR, RVCO exceeded LVCO while LVEF was strikingly greater than RVEF (table) 1) Fetal LV and RV hemodynamic responses to increased PVR differ; 2) the dramatically lower LVS and greater EF indicate increased inotropy while the decreased CO suggests that, even with increased inotropy, the LV ability to compensate has been exceeded, and thus subclinical cardiac failure has occurred.

To prospectively validate new fetal weight estimation models that include fractional limb volume and 2D biometry. 3DUS was used to measure BPD, AC, FDL, fractional arm volume (AVol) and fractional thigh volume (TVol) within 4 days of delivery. Systematic (mean % difference) and random errors (SD % differences) of new regression models were compared to the original Hadlock model (1985) and a “modified” Hadlock formula that was derived from sample specific model coefficients. Systematic errors (SE) and random (RE) errors were evaluated using Student's t-test or Sign test and Pitman test, respectively. The proportion of newborns with EFW within 10% BW were also classified for each method. Log10 BW = 1.4035 + 0.0441 (AC) + 0.177 (FDL) − 0.0037 (AC)(FDL) + 0.0027 (BPD)2 Ln BW = 0.5046 + 1.9665 (Ln BPD) − 0.304 (Ln BPD)2 + 0.9675 (Ln AC) + 0.3557 (Ln AVol) Ln BW = −0.8297 + 4.0344 (Ln BPD) − 0.782 (Ln BPD) 2 + 0.7853 (Ln AC) + 0.0528 (Ln TVol)2 To date, 106 of 250 fetuses have been scanned (BW 390–5,426 g). The original Hadlock model demonstrated the greatest SE (+5.9%). The TVol model had the lowest RE (6.7%) despite a small systematic error of +2.6%. The original Hadlock model demonstrates increased SE for our local patient sample. The precision of EFW can be improved by the inclusion of TVol as compared to other models that only use 2D biometry of the head, trunk, and limb. The overall impact of our preliminary findings, especially for different weight classes, will be better understood upon completion of this prospective investigation. P19.08: Table

MicroRNAs (miRNAs) are involved in the post‐transcriptional regulation of gene expression during development. This study was performed to determine gestational age‐dependent changes in miRNA expression in the chorioamniotic membranes and to assess the significance of miRNAs in human pregnancy and parturition. The expression profile of 455 miRNAs was compared between patients at term without labour (TNL: n = 10), in labour (TL: n = 10), and preterm labour (PTL: n = 10) using microarrays. A total of 39 miRNAs were differentially expressed between term and preterm cases, of which 31 (79.5%) were down‐regulated at term. Expression of ten miRNAs, including miR‐338, differentially expressed between PTL and TL groups was decreased at term. Computational analyses using miRBase Targets have identified PLA2G4B, a phospholipase implicated in parturition, as a putative target of miR‐338. Inhibition of endogenous miR‐338 with anti‐miR‐338 increased the mRNA and protein expression of PLA2G4B in decidual cells. Luciferase assay with reporter constructs confirmed that the suppression of PLA2G4B occurs through binding of miR‐338 to the 3′UTR of PLA2G4B. Interestingly, the expression of Dicer, a key miRNA‐processing enzyme, was markedly decreased at term, particularly with labour in the chorioamniotic membranes. Collectively, the novel findings reported herein strongly suggest that post‐transcriptional regulation of genes by miRNAs, coupled with the changes of miRNA processing machinery in the chorioamniotic membranes, plays a role in pregnancy and parturition. Furthermore, the expression level of Dicer in the chorioamniotic membranes dichotomizes pathological preterm labour and physiological spontaneous labour at term. Published in 2008 by John Wiley & Sons, Ltd.

The sonographic finding of amniotic fluid (AF) “sludge” is associated with spontaneous preterm delivery, preterm PROM, intra-amniotic infection (IAI) and histologic chorioamnionitis. Moreover, microbial biofilms have been reported in AF “sludge”. The aim of this study was to determine the sonographic, microbiologic and histologic characteristics of particulate matter in AF during term and preterm labor. Particulate matter in AF was classified into: 1) AF “sludge” (n = 13, 1 at term); and 2) “pseudo-sludge” (n = 9, 7 at term). AF was retrieved transvaginally by needle amniotomy under direct visualization during active labor. AF “sludge” was defined as free-floating hyperechogenic dense and irregular material in close proximity to the cervix. In contrast, “pseudo-sludge” was diagnosed when free-floating hypoechogenic transparent particulate matter. AF interleukin (IL)-6 concentration, Gram-stain, aerobic/anaerobic bacteria and genital mycoplasmas cultures, 16S rDNA for bacteria, and placental histologic studies were performed. 1) The gestational age at AF collection was lower in patients with AF “sludge”; 2) intra-amniotic infection was more common in patients with AF “sludge”; and 3) fetuses delivered from mothers with AF “sludge” had a significantly higher systemic inflammatory response (see Table). The microbiologic, molecular and cytologic studies of AF “sludge” suggest that this sonographic finding is significantly associated with microbial invasion of the amniotic cavity and a marked fetal inflammatory response.

Several investigators have used 2DUS to measure mid-arm fat mass (MAFM) and mid-thigh fat mass (MTFM) for the assessment of fetal soft tissue development (Bernstein, 1997: Galan, 2001; Larciprete, 2003). Our study examined relationships between fetal limb soft tissue, estimated fetal weight (EFW), birth weight (BW) and neonatal % body fat (%BF). 3DUS was used to scan 97 normal fetuses within 4 days of delivery. Standard biometry included BPD, HC, AC, FDL, mid-arm circumference (ArmC), and mid-thigh circumference (ThC). Volume data was also used to quantify MAFM and MTFM by subtracting traced mid-limb lean mass area from total mid-limb circumference area. Fractional arm and thigh volumes (AVol) and TVol) were derived from 50% of diaphyseal bone length. EFW was based on BPD, AC, and FDL (Hadlock, 1985). Air displacement plethysmography (Peapod) provided neonatal %BF within 48 hours of delivery. Relationships between parameters and infant body composition were evaluated using Pearson's correlation (r) and linear regression (R2) analyses. 51 female and 46 male infants delivered at 38.8 ± 1.3 weeks (mean BW 3433 ± 569 g). Weight distribution was (Alexander, 1995: SGA 7, AGA 73, LGA 17). The mean neonatal %BF was 10.5 ± 4.6%. Significant correlations (r) between %BF and dependent parameters were: TVol (0.66), BW (0.64), MTFM (0.64), ThC (0.60), AVol (0.59), ArmC (0.57), AC (0.50), EFW (0.47), MAFM (0.47), and FDL (0.22) (p < 0.001). Using %BF as the dependent variable, the highest R2 values were TVol (0.44), BW (0.41), MTFM (0.41), AVol (0.35), ThC (0.35), ArmC (0.32), AC (0.25), MAFM (.22), and EFW (0.22). Similar to BW and TVol, MTFM accounted for 41% of the total variance in neonatal %BF. Fetal ThC, arm soft tissue parameters, AC, and EFW contributed relatively less. Our results may be particularly relevant for those who use AC alone or EFW, to detect and monitor malnourished fetuses.

The aim of this study was to examine if maternal plasma concentrations of placental growth factor (PlGF), soluble vascular endothelial growth factor receptor − 1 (sVEGFR-1) and soluble endoglin (sEng) in the first trimester (1T) were associated with the subsequent development of abnormal uterine artery Doppler velocimetry (UTDV) in the second trimester (2T). This study is based on a cohort study design to examine the predictive value of PlGF, sEng and sVEGFR-1 plasma concentrations in the identification of patients destined to develop PE. Only patients that had samples obtained between 8–13 weeks and subsequently had UTDV between 20–25 weeks were included (n = 1,316). 1) Women destined to have abnormal UTDV in the 2T had a lower median 1T plasma PlGF concentration than those with normal UTDV; 2) 1T plasma PlGF concentration of < 26.8 pg/ml (derived by ROC analysis) was associated with abnormalities in UTDV in the 2T (odd ratio 3.2; 95% CI 1.8–5.5) after adjusting for confounders; and 3). Women with abnormal UTDV, with and without subsequent PE, had a lower median 1T plasma PLGF concentration than those with normal UTDV and no PE. A low 1T plasma PlGF concentration is associated with increased impedance to flow in the uterine circulation in the 2T, regardless of whether or not the patient developed PE. These findings suggest that PlGF plays an important role in early placentation.

genitourinary malformations (7%); 15 gastrointestinal anomalies (6%) and 71 miscellaneous (26%). In 244 (89%) both ultrasound and MRI findings were in agreement with postnatal diagnoses. MRI changed the US diagnosis in 16 (5,8%) cases. Relevant additional information were provided in 7 (2,5%) cases: 3 central nervous system anomalies; 3 thoracic defects; 1 abdominal malformations. Ultrasound was more accurate than MRI in 4 (1,4%) cases: 1 case of placenta previa; 1 exomphalos; 1 CCAM in a twin pregnancy; 1 hypoplasia of corpus callosum. In 9 (3,2%) cases, the diagnoses at both US and MR imaging were not correlated with postnatal outcome. Conclusions: Prenatal US remains the primary fetal imaging modality. Prenatal diagnosis of even complex malformations was accurate in over 90% of cases. In a few selected patients in our experience, particularly in late pregnancy, MRI may however add relevant information.

To determine the pregnancy outcome of asymptomatic patients with a sonographic “complete funnel” (SCF) of the cervical canal without sonographic bulging membranes diagnosed in the mid-trimester. Asymptomatic patients with a “SCF” (defined as funneling with a non-measurable closed cervical canal) diagnosed at 14–28 weeks gestation were identified from our ultrasound database. Patients with a multiple gestation, cervical cerclage, sonographic complete effacement of the cervix, or bulging membranes were excluded. 48 patients met inclusion criteria. Subjects were further stratified by gestational age (GA) at diagnosis (< 24 weeks and 24–28 weeks). 1) Patients diagnosed < 24 weeks (n = 23) had a median GA at diagnosis 21.9 weeks (IQR 20.5–23.1) and GA at delivery of 24.3 weeks (22.2–27.8); 2) patients diagnosed at > 24 weeks had a median GA at diagnosis of 25.7 (24.8–27.3) and a median GA at delivery of 34.9 weeks (30.6–37.7), (n = 25); 3) Patients diagnosed at < 24 weeks had a shorter median diagnosis-to-delivery interval than those diagnosed at 24–28 weeks (16.5 days, IQR 5.8–40 vs. 60 days, 29–86, p < 0.001); 4) The rate of delivery within 7 and 14 days of diagnosis and less than 32 weeks of gestation was 26.1%, 43.5% and 95.7%, respectively, among patients diagnosed < 24 weeks, and 0%, 8% and 40%, respectively, among those diagnosed at 24–28 weeks (p < 0.01 for all comparisons); 5) 18.2% of the patients, all diagnosed < 24 weeks, had intra-amniotic inflammation (AF-WBC > 50). Almost all (96%) asymptomatic women with a sonographic “complete funnel” but without sonographic bulging membranes diagnosed < 24 weeks delivered at < 32 weeks of gestation. In contrast, patients diagnosed with such a cervix at 24–28 weeks' gestation have a more favorable outcome and none delivered within 7 days from diagnosis.

Sonographic volume measurements (VM) have been derived using geometric formulas which do not correspond to the real structure shape; however, 3D US makes it possible to obtain VM without using geometric assumptions. The objective was to compare volume estimations using SonoAVC™ (Sonography-based Automated Volume Count), VOCAL™ (Virtual Organ Computer-aided AnaLysis), and inversion mode (IM) from 3D US datasets acquired from fetuses. Volume datasets of the fetal stomach or bladder were obtained in uncomplicated pregnancies (15–37 weeks). For each dataset, VM were performed by a single operator using 3 techniques: SonoAVC™, VOCAL™, and IM. Inter-technique variability was assessed using repeated measures ANOVA with adjustment for post-hoc comparisons. P < 0.05 was considered significant. 90 volume datasets of either the fetal stomach (n = 69) or bladder (n = 21) were obtained. A total of 270 measurements were derived. VM ranged from 0.04 to 7.19 cm3. Mean ( ± SD) volumes (cm3) for SonoAVC™, VOCAL™, and IM were: 1.84 ( ± 1.53), 1.77 ( ± 1.49), and 1.82 ( ± 1.49), respectively. Mean VM were not significantly different among the techniques (P = 0.956). The table shows pair-wise comparisons of the 3 techniques to each other. 1) Volume estimates of fluid-filled fetal structures could be obtained using any of the 3 techniques, and results were comparable; 2) mean VM using SonoAVC™ were higher than those of either VOCAL™ or IM, but the difference was not significant; 3) mean VM using IM were higher than those obtained by VOCAL™, but the difference was not significant; and 4) SonoAVC™ has the advantage of providing automatic volume calculations, while VOCAL™ and IM require active participation of the operator, and thus, are more time-consuming. P10.11: Table