- Email: [email protected]
O356 High sensitivity CRP – Is it a marker of polycystic ovarian syndrome or obesity?
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
their work at risk. We found many risk factors for maternal health in this group which is why we recommend focusing their education on issues such as contraception, self-care practices and female empowerment. O353 Evaluation of ultrasound needs in first trimester medical abortion with misoprostol
S193
O355 Evolution of ultrasonographically detected non-complex adnexal cysts in asymptomatic postmenopausal women A. Gorostiaga1 , I. Villegas1 , F. Mozo de Rosales2 , I. Brouard2 . 1 Hospital San Francisco Javier, University of the Pays Basque, Bilbao, Spain, 2 Hospital de Basurto, Bilbao, Spain
O354 Application of B-lynch suturing in postpartum hemorrhage during Cesarean section
Objective: To determine the evolution of non-complex adnexal cysts in postmenopausal women. Methods: 3378 asymptomatic postmenopausal women (at least one year from last period) underwent transvaginal ultrasound (Phillips HDI 4000) as part of annual routine gynaecological exploration at our institutions between January 2004 and December 2007. All patients to whom a non-complex adnexal cyst was diagnosed were offered surgical treatment or expectant management with serial transvaginal ultrasound at 3–6 month intervals. The median follow-up time was 1 year. CA-125 was always determined in the first recognition, being the cut-off 35 UI/ml. All women sent to our Hospitals out of this annual screening program were not included. Results: 209 cysts in 207 women of the 3378 recruited were diagnosed (prevalence:6.6%). 21 women (10.1%) were lost and 186 patients were finally studied. 44 (21.2%) underwent laparoscopy (33 initially and 11 during the follow-up period). 142 patients were managed conservatively (follow-up time:12–60 months). 11 patients were operated during this period due to growth in size of the cyst (10) or abdominal pain (1). Table 1 show the characteristics of the groups. 49 cysts were finally excised. There was one case of Ia stage ovarian carcinoma and one serous “border-line”. Histopathological findings were: 36 (73.5%) serous cystadenomas, 5 (10.2%) mucinous cystadenomas, 2 (4.1%) cystadenofibromas, 3 (6.2%) paraovarian cyst, 1 (2%) teratoma, 1 (2%) serous carcinoma and 1 (2%) serous “border-line” tumour. The mean time till discharge was 1.9 days (0.5–16). Conclusions: Our study does not solve the problem of what to do with non-complex adnexal cysts in postmenopause women, but encourages us to continue with our protocols and also show these points of interest: 1. Prevalence of non-complex adnexal cysts is 6.6% while the prevalence of ovarian carcinoma in our population is 0.059% (like other authors) 2. The risk of “hidden” ovarian cancer in these cysts is <1% (2 en 209 cysts excised), confirming findings of other authors (citar) 3. These results allows us to offer a very secure conservative management (low false negative) 4. When decided, surgical management can be done laparoscopically in the majority of the cases (10% in our series) with a short stay till discharge (1.9 days).
X. Gong, L. Ma, X. Bian, J. Liu, J. Gao. Department of Ob/Gyn, Peking Union Medical College Hospital, Beijing
Table 1
1
2
3
3
R. Gomez Ponce de Leon , L. Salas , A. Velazco , D. Yi , K. Andersen Clark4 , R. Garrido3 . 1 Senior Health System Adviser, Ipas, USA, 2 Hospital America Arias, Havana, Cuba, 3 Hospital America Arias, Havana, Cuba, 4 Senior Research Associate, Ipas Chapel Hill, USA Objective: The aim of the clinical trial was to test concordance between clinical evaluation and ultrasound to confirm completion in first trimester medical abortion with misoprostol. Patients and Methods: A longitudinal prospective clinical trial was conducted in 2007, including 1452 pregnant women, between 5 to 11 weeks, from 2 hospitals in Havana Cuba that voluntarily requested first trimester medical abortion. After counseling and informed concent women received two doses of 800 micrograms of misoprostol to be used at home, vaginally. A diary of bleeding and syntoms was recorded and printed instructions with the alarm signs were given. The follow up was designed at 4th day to determine patient well being and progress of the abortion process with an interview and clinical evaluation. The second visit at the 14th day consisted in a clinical evaluation with physical examination and an abdominal ultrasound. Both evaluations were independent and blinded and the final decision was made by a 3rd evaluator if an uterine evacuation procedure was required. We analyzed the correspondence between both diagnosis. From the total, 90% were diagnosed as complete abortions, 8% as incomplete and 2% as ongoing pregnancies. While clinical diagnosis of incomplete abortion agreed with ultrasound in 87% of cases, clinical diagnosis of complete abortion agreed with ultrasound in 99% of cases. The overall chance-adjusted agreement between clinical diagnosis and ultrasound was 98.9%. Conclusion: These findings shows significant agreement between ultrasound and clinical evaluation eliminating the need of routine post abortion ultrasound when misoprostol is used in first trimester abortions. De-medicalizing the process increase women access to safe services with high potential to reduce maternal mortality and morbidity originated in unsafe abortion.
Objectives: To evaluate the efficacy of B-lynch suture in treating with postpartum hemorrhage during Cesarean section. Materials and Methods: During Dec 2006 to Dec 2008. There are 14 B-lynch suture were done in the department of ob/gyn, Peking Union Medical College Hospital. We search the case record and fellow the patients with phone call. Results: All the 14 primigravida patients had postpartum hemorrhage due to atonic uterus. Drug therapy with pitocin and hemobate and massage failed to stop the bleeding. They were all successfully treated with B-lynch suturing. All patients had regular mensturation after the delivery. One patient had a second delivery with the recurrence of postpartum hemorrhage. Conclusions: B-lynch suture is an effective method to treat postpartum hemorrhage during Cesarean section. It has little influence on menstruation.
Age CA-125 Cyst size (cm) Color flow detected
Surgery
Conservative
57.3 10.1 5.7 37%
56.4 10 4.7 19%
O356 High sensitivity CRP – Is it a marker of polycystic ovarian syndrome or obesity? V. Gowri, A. Al-Futaisi, S. Shabnam, S. Rizvi. Sultan Qaboos University Objective: The aim of the study was to clarify if high sensitivity C-reactive protein (HS-CRP) a marker of chronic inflammation, is elevated in all women with polycystic ovarian syndrome (PCOS). Methods: This was a prospective study of 57 age and body mass index matched patients with Polycystic syndrome and 57 normal women with regular periods. High sensitivity CRP was measured in 57 subjects with PCOS (2 of three Rotterdam criteria) and age
S194
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
and BMI matched controls. None of the controls or cases had co morbid conditions like diabetes, hypertension or any other medical illnesses. Results: High sensitivity CRP was elevated in all obese women irrespective if they were PCOS or not. Mean HS CRP in controls were 4.76±4.54 and in cases were 5.41±4.84 which was not found statistically significant (P = 0.461). The mean BMI was 28.75±5.22 and 28.65±5.63 for the cases and controls respectively. A significant positive relationship was observed between BMI & HS CRP (P < 0.001), the degree of relationship was stronger among cases (r = 0.632) than controls (r = 0.482) and was found more stronger among cases aged ≥30 years (r = 0.796). Conclusion: HS CRP is more a marker of obesity than PCOS itself, particularly among the females ≥30 years.
measure included the diagnostic accuracy of both tests regarding the prediction of PTD <37 weeks. Results: Shortened CL was found in 7.7% (24/308) whereas the positive EMG activity was recorded in 6.8% (21/308). The overall incidence of PTD <37 weeks was 7.4% (23/308). Shortened CL and positive EMG activity had statistically significant accuracy regarding the prediction of PTD <37 weeks (likelihood ratio for positive results (LR+) weighted for prevalence for shortened CL 2.42 95% CI [1.23–4.76] and LR for positive EMG activity 8.5 95% CI [2.52–35.72]. Combined shortened CL and positive EMG activity had the highest LR+ regarding the prediction of PTD LR 9.5 95% CI [2.48–58.44]. Conclusion: Both CL measurement and positive EMG activity in second trimester had statistically significant accuracy regarding the prediction of PTD in a low-risk population.
O357 Maternal deaths at home: The hidden burden W. Graham1 , M. Newell2 , A. Kany Kany Luabeya2 . 1 Immpact, University of Aberdeen, United Kingdom, 2 Africa Centre for Health and Populations Studies, University of Kwa-Zulu Natal, South Africa
O359 Three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) in assessing infertile women
Objectives: Confidential enquiries into maternal deaths are being set-up in an increasing number of developing countries, primarily to identify avoidable factors. Many such enquiries are based only on deaths reported at health facilities. Selection bias in these maternal deaths reports may be assessed by complementing facility-based data with periodic population-based sources. This study demonstrates such an approach in South Africa. Materials and Methods: Data relate to the population in the Africa Centre’s Demographic Surveillance Area, in Hlabisa sub-district in northern Kwa-Zulu Natal Province, which included in mid-2006 nearly 86,000 people in about 11,000 households. Results: For 2000 to 2007 the majority (63.5%) of maternal deaths in the DSA occurred at home. For the same period, there were 19,643 live births, yielding a maternal mortality ratio (MMR) of 769 maternal deaths per 100,000 live births. The South African National Confidential Enquiry for 2002–04 reported 3,296 maternal deaths occurring in health facilities. If it is crudely assumed that the national percentage of deaths at home is similar to that in the Hlabisa sub-district, then the national MMR would be around 382 maternal deaths per 100,000 live births rather than the reported figure of 147. Whilst recognising the crude nature of our projection, the figure of 382 is close to the modelled estimate of 400 from WHO for 2005. Conclusions: The fraction of maternal deaths occurring outside facilities and omitted from confidential enquiries in developing countries may be considerable, with major implications for policy and practice. Novel methods are needed to periodically ascertain the missing fraction, such as key informant reporting using mobile phones. O358 Electrical uterine activity and shortened cervical length could predict preterm delivery in low risk population O. Grgic1 , R. Matijevic2 . 1 Department of O & G, University hospital for tumors, Ilica 197, 10000 Zagreb, Croatia, 2 Department of O & G, Sveti Duh hospital, Sveti Duh 64, 10000 Zagreb, Croatia Objective: To compare diagnostic accuracy of cervical length (CL) measurement assessed by transvaginal ultrasound and uterine electomyographic (EMG) activity in mid trimester, regarding prediction of preterm delivery (PTD) in low-risk population. Study design: Prospective cohort study of 308 low-risk, asymptomatic, nulliparous women with singleton pregnancies. CL and EMG were evaluated between 16 and completed 23 weeks. Cervical length <5th percentile for our population (<25 mm) was defined as shortened. The positive EMG activity was defined as presence of >20 action potentials during the 20 minutes of evaluation (>95th percentile for our population). Primary outcome
M. Grigore, C. Cojocaru, A. Mares Objective: The aim of the study was to evaluate the usefulness of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes. Materials and Methods: Hysterosalpingo-contrast sonography (HyCoSy) using saline solution was performed on 40 women with infertility. We performed 2D ultrasound and 3D power Doppler ultrasound and we compared the results. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates the flow of the medium through the tube. Results: The passage of saline produced prominent signals on the 3D-PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 34 (85%) tubes using the 3D-PDI technique and in 18 (45%) of tubes using conventional HyCoSy. The positive predictive value, negative predictive value, sensitivity and specificity of predicting tubal patency by 3D-PDI were 100, 33.3, 84.4, and 100%, respectively. The mean duration of the imaging procedure was less with 3D-PDI. A significantly lower volume of saline was used for 3D-PDI in comparison with that used for conventional 2D HyCoSy. Conclusion: Color 3D-PDI with surface rendering allowed visualization of the flow of contrast substance through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D-PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. The 3D-PDI technique allowed better storage of the information for re-analysis and archiving than conventional HyCoSy. In addition, the procedure of 3D-HyCoSy appears to be better tolerated, requiring no sedation or anesthesia. In conclusion we can say that 3D-HyCoSy with saline solution as a contrast medium is feasible and could comprise a routine outpatient procedure in the initial evaluation of infertile women. O360 Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography M. Grigore, C. Cojocaru, A. Mares Objective: To evaluate if there are any differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler (3D-PD) between women with polycystic ovaries (PCO) and women with normal ovaries (NO). Material and Methods: 64 (sixty four) women were classified in two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 34) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 30) with oligo/an-ovulation, clinical and/or biochemical features of hyper-androgenism, and polycystic ovary morphology at
their work at risk. We found many risk factors for maternal health in this group which is why we recommend focusing their education on issues such as contraception, self-care practices and female empowerment. O353 Evaluation of ultrasound needs in first trimester medical abortion with misoprostol
S193
O355 Evolution of ultrasonographically detected non-complex adnexal cysts in asymptomatic postmenopausal women A. Gorostiaga1 , I. Villegas1 , F. Mozo de Rosales2 , I. Brouard2 . 1 Hospital San Francisco Javier, University of the Pays Basque, Bilbao, Spain, 2 Hospital de Basurto, Bilbao, Spain
O354 Application of B-lynch suturing in postpartum hemorrhage during Cesarean section
Objective: To determine the evolution of non-complex adnexal cysts in postmenopausal women. Methods: 3378 asymptomatic postmenopausal women (at least one year from last period) underwent transvaginal ultrasound (Phillips HDI 4000) as part of annual routine gynaecological exploration at our institutions between January 2004 and December 2007. All patients to whom a non-complex adnexal cyst was diagnosed were offered surgical treatment or expectant management with serial transvaginal ultrasound at 3–6 month intervals. The median follow-up time was 1 year. CA-125 was always determined in the first recognition, being the cut-off 35 UI/ml. All women sent to our Hospitals out of this annual screening program were not included. Results: 209 cysts in 207 women of the 3378 recruited were diagnosed (prevalence:6.6%). 21 women (10.1%) were lost and 186 patients were finally studied. 44 (21.2%) underwent laparoscopy (33 initially and 11 during the follow-up period). 142 patients were managed conservatively (follow-up time:12–60 months). 11 patients were operated during this period due to growth in size of the cyst (10) or abdominal pain (1). Table 1 show the characteristics of the groups. 49 cysts were finally excised. There was one case of Ia stage ovarian carcinoma and one serous “border-line”. Histopathological findings were: 36 (73.5%) serous cystadenomas, 5 (10.2%) mucinous cystadenomas, 2 (4.1%) cystadenofibromas, 3 (6.2%) paraovarian cyst, 1 (2%) teratoma, 1 (2%) serous carcinoma and 1 (2%) serous “border-line” tumour. The mean time till discharge was 1.9 days (0.5–16). Conclusions: Our study does not solve the problem of what to do with non-complex adnexal cysts in postmenopause women, but encourages us to continue with our protocols and also show these points of interest: 1. Prevalence of non-complex adnexal cysts is 6.6% while the prevalence of ovarian carcinoma in our population is 0.059% (like other authors) 2. The risk of “hidden” ovarian cancer in these cysts is <1% (2 en 209 cysts excised), confirming findings of other authors (citar) 3. These results allows us to offer a very secure conservative management (low false negative) 4. When decided, surgical management can be done laparoscopically in the majority of the cases (10% in our series) with a short stay till discharge (1.9 days).
X. Gong, L. Ma, X. Bian, J. Liu, J. Gao. Department of Ob/Gyn, Peking Union Medical College Hospital, Beijing
Table 1
1
2
3
3
R. Gomez Ponce de Leon , L. Salas , A. Velazco , D. Yi , K. Andersen Clark4 , R. Garrido3 . 1 Senior Health System Adviser, Ipas, USA, 2 Hospital America Arias, Havana, Cuba, 3 Hospital America Arias, Havana, Cuba, 4 Senior Research Associate, Ipas Chapel Hill, USA Objective: The aim of the clinical trial was to test concordance between clinical evaluation and ultrasound to confirm completion in first trimester medical abortion with misoprostol. Patients and Methods: A longitudinal prospective clinical trial was conducted in 2007, including 1452 pregnant women, between 5 to 11 weeks, from 2 hospitals in Havana Cuba that voluntarily requested first trimester medical abortion. After counseling and informed concent women received two doses of 800 micrograms of misoprostol to be used at home, vaginally. A diary of bleeding and syntoms was recorded and printed instructions with the alarm signs were given. The follow up was designed at 4th day to determine patient well being and progress of the abortion process with an interview and clinical evaluation. The second visit at the 14th day consisted in a clinical evaluation with physical examination and an abdominal ultrasound. Both evaluations were independent and blinded and the final decision was made by a 3rd evaluator if an uterine evacuation procedure was required. We analyzed the correspondence between both diagnosis. From the total, 90% were diagnosed as complete abortions, 8% as incomplete and 2% as ongoing pregnancies. While clinical diagnosis of incomplete abortion agreed with ultrasound in 87% of cases, clinical diagnosis of complete abortion agreed with ultrasound in 99% of cases. The overall chance-adjusted agreement between clinical diagnosis and ultrasound was 98.9%. Conclusion: These findings shows significant agreement between ultrasound and clinical evaluation eliminating the need of routine post abortion ultrasound when misoprostol is used in first trimester abortions. De-medicalizing the process increase women access to safe services with high potential to reduce maternal mortality and morbidity originated in unsafe abortion.
Objectives: To evaluate the efficacy of B-lynch suture in treating with postpartum hemorrhage during Cesarean section. Materials and Methods: During Dec 2006 to Dec 2008. There are 14 B-lynch suture were done in the department of ob/gyn, Peking Union Medical College Hospital. We search the case record and fellow the patients with phone call. Results: All the 14 primigravida patients had postpartum hemorrhage due to atonic uterus. Drug therapy with pitocin and hemobate and massage failed to stop the bleeding. They were all successfully treated with B-lynch suturing. All patients had regular mensturation after the delivery. One patient had a second delivery with the recurrence of postpartum hemorrhage. Conclusions: B-lynch suture is an effective method to treat postpartum hemorrhage during Cesarean section. It has little influence on menstruation.
Age CA-125 Cyst size (cm) Color flow detected
Surgery
Conservative
57.3 10.1 5.7 37%
56.4 10 4.7 19%
O356 High sensitivity CRP – Is it a marker of polycystic ovarian syndrome or obesity? V. Gowri, A. Al-Futaisi, S. Shabnam, S. Rizvi. Sultan Qaboos University Objective: The aim of the study was to clarify if high sensitivity C-reactive protein (HS-CRP) a marker of chronic inflammation, is elevated in all women with polycystic ovarian syndrome (PCOS). Methods: This was a prospective study of 57 age and body mass index matched patients with Polycystic syndrome and 57 normal women with regular periods. High sensitivity CRP was measured in 57 subjects with PCOS (2 of three Rotterdam criteria) and age
S194
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
and BMI matched controls. None of the controls or cases had co morbid conditions like diabetes, hypertension or any other medical illnesses. Results: High sensitivity CRP was elevated in all obese women irrespective if they were PCOS or not. Mean HS CRP in controls were 4.76±4.54 and in cases were 5.41±4.84 which was not found statistically significant (P = 0.461). The mean BMI was 28.75±5.22 and 28.65±5.63 for the cases and controls respectively. A significant positive relationship was observed between BMI & HS CRP (P < 0.001), the degree of relationship was stronger among cases (r = 0.632) than controls (r = 0.482) and was found more stronger among cases aged ≥30 years (r = 0.796). Conclusion: HS CRP is more a marker of obesity than PCOS itself, particularly among the females ≥30 years.
measure included the diagnostic accuracy of both tests regarding the prediction of PTD <37 weeks. Results: Shortened CL was found in 7.7% (24/308) whereas the positive EMG activity was recorded in 6.8% (21/308). The overall incidence of PTD <37 weeks was 7.4% (23/308). Shortened CL and positive EMG activity had statistically significant accuracy regarding the prediction of PTD <37 weeks (likelihood ratio for positive results (LR+) weighted for prevalence for shortened CL 2.42 95% CI [1.23–4.76] and LR for positive EMG activity 8.5 95% CI [2.52–35.72]. Combined shortened CL and positive EMG activity had the highest LR+ regarding the prediction of PTD LR 9.5 95% CI [2.48–58.44]. Conclusion: Both CL measurement and positive EMG activity in second trimester had statistically significant accuracy regarding the prediction of PTD in a low-risk population.
O357 Maternal deaths at home: The hidden burden W. Graham1 , M. Newell2 , A. Kany Kany Luabeya2 . 1 Immpact, University of Aberdeen, United Kingdom, 2 Africa Centre for Health and Populations Studies, University of Kwa-Zulu Natal, South Africa
O359 Three-dimensional hysterosalpingo-contrast sonography (3D-HyCoSy) in assessing infertile women
Objectives: Confidential enquiries into maternal deaths are being set-up in an increasing number of developing countries, primarily to identify avoidable factors. Many such enquiries are based only on deaths reported at health facilities. Selection bias in these maternal deaths reports may be assessed by complementing facility-based data with periodic population-based sources. This study demonstrates such an approach in South Africa. Materials and Methods: Data relate to the population in the Africa Centre’s Demographic Surveillance Area, in Hlabisa sub-district in northern Kwa-Zulu Natal Province, which included in mid-2006 nearly 86,000 people in about 11,000 households. Results: For 2000 to 2007 the majority (63.5%) of maternal deaths in the DSA occurred at home. For the same period, there were 19,643 live births, yielding a maternal mortality ratio (MMR) of 769 maternal deaths per 100,000 live births. The South African National Confidential Enquiry for 2002–04 reported 3,296 maternal deaths occurring in health facilities. If it is crudely assumed that the national percentage of deaths at home is similar to that in the Hlabisa sub-district, then the national MMR would be around 382 maternal deaths per 100,000 live births rather than the reported figure of 147. Whilst recognising the crude nature of our projection, the figure of 382 is close to the modelled estimate of 400 from WHO for 2005. Conclusions: The fraction of maternal deaths occurring outside facilities and omitted from confidential enquiries in developing countries may be considerable, with major implications for policy and practice. Novel methods are needed to periodically ascertain the missing fraction, such as key informant reporting using mobile phones. O358 Electrical uterine activity and shortened cervical length could predict preterm delivery in low risk population O. Grgic1 , R. Matijevic2 . 1 Department of O & G, University hospital for tumors, Ilica 197, 10000 Zagreb, Croatia, 2 Department of O & G, Sveti Duh hospital, Sveti Duh 64, 10000 Zagreb, Croatia Objective: To compare diagnostic accuracy of cervical length (CL) measurement assessed by transvaginal ultrasound and uterine electomyographic (EMG) activity in mid trimester, regarding prediction of preterm delivery (PTD) in low-risk population. Study design: Prospective cohort study of 308 low-risk, asymptomatic, nulliparous women with singleton pregnancies. CL and EMG were evaluated between 16 and completed 23 weeks. Cervical length <5th percentile for our population (<25 mm) was defined as shortened. The positive EMG activity was defined as presence of >20 action potentials during the 20 minutes of evaluation (>95th percentile for our population). Primary outcome
M. Grigore, C. Cojocaru, A. Mares Objective: The aim of the study was to evaluate the usefulness of three-dimensional power Doppler imaging (3D-PDI) in the assessment of the patency of the Fallopian tubes. Materials and Methods: Hysterosalpingo-contrast sonography (HyCoSy) using saline solution was performed on 40 women with infertility. We performed 2D ultrasound and 3D power Doppler ultrasound and we compared the results. The first technique visualizes positive contrast in the Fallopian tube; the second demonstrates the flow of the medium through the tube. Results: The passage of saline produced prominent signals on the 3D-PDI image. Free spill from the fimbrial end of the Fallopian tubes was demonstrated in 34 (85%) tubes using the 3D-PDI technique and in 18 (45%) of tubes using conventional HyCoSy. The positive predictive value, negative predictive value, sensitivity and specificity of predicting tubal patency by 3D-PDI were 100, 33.3, 84.4, and 100%, respectively. The mean duration of the imaging procedure was less with 3D-PDI. A significantly lower volume of saline was used for 3D-PDI in comparison with that used for conventional 2D HyCoSy. Conclusion: Color 3D-PDI with surface rendering allowed visualization of the flow of contrast substance through the entire tubal length and free spill of contrast was clearly identified in the majority of cases. The 3D-PDI method appeared to have advantages over the conventional HyCoSy technique, especially in terms of visualization of spill from the distal end of the tube, which was achieved twice as often with the 3D technique. The 3D-PDI technique allowed better storage of the information for re-analysis and archiving than conventional HyCoSy. In addition, the procedure of 3D-HyCoSy appears to be better tolerated, requiring no sedation or anesthesia. In conclusion we can say that 3D-HyCoSy with saline solution as a contrast medium is feasible and could comprise a routine outpatient procedure in the initial evaluation of infertile women. O360 Assessment of ovarian vascularization in the polycystic ovary by three-dimensional power Doppler ultrasonography M. Grigore, C. Cojocaru, A. Mares Objective: To evaluate if there are any differences in ovarian echogenicity and vascularization as assessed by three-dimensional power Doppler (3D-PD) between women with polycystic ovaries (PCO) and women with normal ovaries (NO). Material and Methods: 64 (sixty four) women were classified in two groups according to the 2003 Rotterdam consensus criteria. The NO group comprised women (n = 34) with regular menstrual cycles and proven fertility, whereas the PCO group comprised women (n = 30) with oligo/an-ovulation, clinical and/or biochemical features of hyper-androgenism, and polycystic ovary morphology at