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P204 Mid trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high risk pregnant women
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
antibiotics and failed to show resolution of pelvic examination findings and turned up positive for TB-PCR/ granuloma on endometrial biopsy or further testing were recruited. Results: A total of 35 cases were evaluated. The mean age and standard deviation was 32.68±11.75 years and mean Ca-125 was 451.05 units/ml, the main symptoms were chronic pelvic pain in 15 (42.85%), distension of abdomen in 6 (17.14%) cases, infertility in 8 (22.85%) women. Diagnosis was made on PCR in all cases prior to CT-scan. The various findings were bilateral to masses in 14 cases (40%), unilateral TO mass in 15(42.85%), non specific enlargement of ovary in 3 (8.57%), encysted ascitis 11(31.42%), peritoneal inclusion cyst 5 (14.28%), omental thickening in 5 (14.28%), fibroid 3 (8.57%) cases. Conclusion: CT-scan is a non invasive modality to evaluate suspected tubercular tubovarian masses. P201 Interesting anomalies in monochorionic twin pregnancy S. Rao Patri Aim and Objectives: Three cases of interesting anomalies in monochorionic twin pregnancy are being presented here with. Materials and Methods: Case 1: 24 yr oldG2P1 has been subjected to USG at 6 months of pregnancy when she first reported for ANC. USG showed one normal fetus & the other with no head, heartacephalus acardius. Case 2: 26 yr old primi who never had USG till 7 months showed conjoint twins attached at thorax – Thoracopagus. Case 3: 30 yr old G2P1 who never had ANC was operated by caesarean for lack of progress at term clinically diagnosed as IUD. She had a rare anomaly – where asmall fetus is attached like a parasite to another large fetus – Duplicata incompleta dipygus. Results: Case 1: Pt went into spontaneous labor expelling both normal fetus & acardiac twin. Case 2: Operated by casarean as the heads of the conjoint twins were hyperextended and the presentation was breech. It survived for an hour. Case 3:The fetus Duplicata incompleta dipygus showed absence of head in the parasitic fetus. It was stillborn. Conclusion: The above anomalies are all specific to monochorionic twin pregnancy and are relatively rare. P202 Vessel diameters in intrauterine growth restriction 1
1
2
1
L. Story , M. Damodaram , G. Paramasivam , M. Rutherford , S. Kumar2 . 1 Imperial College London, 2 Queen Charlotte’s and Chelsea Hospital London Introduction: It is believed that fetuses with intrauterine growth restriction (IUGR) have compensatory cerebral redistribution of blood flow however there is little known regarding other vasculature tree compensatory mechanisms. Vasodilatory factors such as nitric oxide, Vasoactive Intestinal Polypeptide (VIP) and adrenomedullin have been shown to be increased in placentas and umbilical cord blood of fetuses with intrauterine growth restriction [1–4]. However, no study to date has provided an in vivo assessment of vessel diameters in growth restricted fetuses. Methods: 72 appropriate for gestational age (AGA) fetuses, and 11 IUGR fetuses underwent serial ultrasound examinations between 24 and 36 weeks gestation. Fetal biometry, estimated fetal weight, amniotic fluid index and Doppler analysis were calculated at each visit. Maximal vessel diameter for the umbilical, middle cerebral, carotid, ascending aorta, descending aorta, renal and femoral arteries was measured using power Doppler during systole utilizing the cine loop function. Vessel diameters were then standardized per kilogram for each measurement. ANCOVA statistical analysis was performed to assess the impact of gestational age and IUGR on vessel diameter/kilogram. Results: Vessel diameters/kg were significantly larger in all vessels in IUGR fetuses in comparasion to AGA fetuses. Umbilical
S469
p = 0.008, middle cerebral p = 0.005, femoral p = 0.023, renal p = 0.021 descending aorta p = 0.008, ascending aorta p = 0.004. Conclusions: Although mechanisms are thought to exist in the IUGR fetus whereby blood flow is preferentially diverted to essential organs this is the first study that has shown that generalized vasodilatation occurs in the growth restricted fetus. Reference(s) [1] Rizzo, G., et al., Blood levels of vasoactive intestinal polypeptide in normal and growth retarded fetuses: relationship with acid-base and haemodynamic status. Early Hum Dev, 1995. 41(1): p. 69–77. [2] D’Anna, R., et al., Neurokinin B and nitric oxide plasma levels in preeclampsia and isolated intrauterine growth restriction. BJOG, 2004. 111(10): p. 1046–50. [3] Di Iorio, R., et al., Adrenomedullin is increased in the fetoplacental circulation in intrauterine growth restriction with abnormal umbilical artery waveforms. Am J Obstet Gynecol, 2000. 182(3): p. 650–4. [4] Tikvica, A., et al., Nitric oxide synthesis in placenta is increased in intrauterine growth restriction and fetal hypoxia. Coll Antropol, 2008. 32(2): p. 565–70.
P203 Ultrasound features of fetal peritonitis due to bowel obstruction – case report L. Tammemae1 , F. Szirko. 1 East-Tallinn Central Hospital,
2
A 20 years old primigravida was hospitalised at 34 weeks of gestation with uterine contractions. Ultrasound exam revealed distended foetal stomach and bowels, small for gestational age head and femur. Two days later on repeated ultrasound exam thrombosis of one umbilical artery was discovered. The second artery showed higher than usual diastolic flow. There were no other abnormal findings. Decision was made to deliver the foetus by means of caesarean section. The newborn boy 2310 g, 47 cm was in satisfactory general condition, the blood gas analysis did not show any hypoxia. The newborns belly was remarkably distended. The baby was transferred to paediatric surgery department. On surgery wide bowel necrosis was found due to a volvulus. The affected bowel was removed and stoma created. After an episode of sepsis on third operation end-to-end anastomosis was created. The baby has recovered without any serious sequale. P204 Mid trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high risk pregnant women D. Thangamani, N. Jayasankar. Obstetrics & Gynecology Objective: To assess the value of uterine artery Doppler ultrasound screening, when performed in a clinical setting, to predict complications of impaired uteroplacental blood flow in high-risk women. Design: A Retrospective study. Methodology: A total of 55 pregnancies, high risk of pre-eclampsia and/or small-for-gestational-age (SGA) babies attending Apollo first med hospital, Chennai, during the year sept 2002 to april 2006 were studied and uterine artery Doppler done at 20 – 22 weeks as a part of clinical practice. A resistance index (RI) was calculated from each uterine artery and the presence or absence of a notch was determined. An RI of >0.50 was defined as abnormal. Result: Out of 55 pregnancies, the uterine artery Doppler was normal in 32 cases and abnormal in 23 cases. Among the normal uterine artery doppler group, 5 patients had PIH, 4s patient had IUGR, 23 patients had uneventful pregnancy. Those who had abnormal uterine artery doppler (presence of diastolic notch in the uterine arteries or RI > 0.5) 5 patient had PIH, 6 patients had IUGR, 2 patients had premature delivery less than 34 weeks and 10 patients had normal pregnancy outcome. The sensitivity, specificity, PPV & NPV of abnormal Doppler (presence of diastolic notch in the uterine arteries or RI > 0.5) for
S470
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
detecting PIH in this study is 50%, 60%, 21.7% & 84.3% respectively and for predicting IUGR is 60%, 62.2%, 26.08% & 87.5% respectively. Conclusion: In high-risk women, uterine artery Doppler waveform analysis performed best in the prediction of severe adverse outcome and was better than clinical risk assessment in the prediction of pre-eclampsia and SGA babies. Further studies are necessary to determine how information from uterine artery Doppler studies should modify current practice in high-risk women.
Conclusion: Altered DV proved to be a good predictor of poor fetal/neonatal prognosis, being associated with fetal morphological alterations and chromosome diseases (Down and Turner).
P205 A diagnostic error: fetal isolated and severe ventriculomegaly
Objective: Evaluate the efficiency of risk assessment for chromosomopathies using maternal serum biochemistry and fetal ultrasound; assessment of patient compliance. Methods: Patients were offered nuchal translucency measurement and maternal seum biochemistry (PAPP-A and beta-HCG) at 11–14 weeks and quadruple test (beta-HCG, AFP, inhibin A and uE3) after 15 weeks. The cut-of value for recomanding an invasive diagnostic procedure (amniocentesis) was 1/250. Results: 80% of patients accepted the screening procedures. The detection rate for Down syndrome was 70%. Risk was evaluated separated for each twin based on maternal biochemistry and fetal NT. Compliance was lower than in singleton patients for invasive procedures. Conclusion: Risk assessment using serum biochemistry and ultrasound is efficient but there is lower patient compliance for all steps of the procedures than in in singleton pregnancies.
G. Noia1 , M. Tintoni1 , I. Mappa1 , M. D’Errico1 , C. Greco1 , D. Visconti1 , L. Manganaro2 . 1 Catholic University of the Sacred Heart – Department of Gynecology and Obstestric, 2 Sapienza University of Rome – Department of Radiological Sciences The patient came to our observation at 35 weeks and 5 days of gestational age with an US diagnosis of ventriculomegaly (right AW = 22.7 mm); fetal development was normal. Fetal MRI was carried out the day after, confirming the same diagnosis: right AW = 20 mm. There was a mild enlargement of the third ventricle (6 mm). According to MRI, signs of bleeding, previous or acute, were absent. An US assessment at 37 weeks confirmed the normal development of the fetus, including the measurement of the fetal head. Right AW was 22 mm, third ventricle was 3.8×13.9 mm. The delivery was decided at 38w; at birth the cranial circumference was 36 cm and frontal alopecia was present. Neurologist diagnosed an asymmetrical posture; eyes following was correctly performed with left eye and only partially with right eye. Cranial US evaluation pointed out a temporal dysplasia of right hemisphere. EEG showed a symmetrical background activity, with prevalence of slow component at right side. MRI after birth confirmed ventriculomegaly, within a complex encephalic endangerment. A growing mass was noticed beside the spinal cord (from 5th cervical to 9th dorsal vertebra), probably a lipoma. The mass grew and reached the foramen at 45 day of life. The child needed a partial removal of the mass at 50 day of life. In spite of that and the further growing of the lipoma, post-surgical neurobehavioural follow-up was not so severe as suggested by instrument diagnosis. Conclusion: Prenatal diagnosis has some limitations, and often it is not possible to diagnosticate anomalies of late pregnancy, especially if worsening fast. Late, severe and isolated ventriculomegaly is an example of this. P206 Association of the perinatal prognosis with Doppler velocimetry pattern of the ductus venosus during the first trimester of pregnancy H. Torres, E. Figueiro-Filho, ´ L. Coelho, V. Oliveira, I. Breda, M. Goes, L. Melo, P. Turine-Neto. Faculty of Medicine of Federal University of Mato Grosso do Sul Objective: To determine the association between altered Doppler velocimetry pattern of the ductus venosus (DV) and chromosome diseases, fetal morphological alterations and a poor fetal/neonatal prognosis. Methods: Forty-eight pregnant women submitted to 1st trimester ultrasonographic evaluation whose fetuses presented alteration of nuchal translucency (NT) measure and/or DV pattern were submitted to amniocentesis for fetal karyotyping and screened for the presence of chromosome diseases, fetal morphological alterations detected by ultrasound, fetal/neonatal complications, abortions, fetal/neonatal deaths, and preterm deliveries. Results: Mean gestational age at identification of NT and DV alterations was 12.3±0.9 weeks. Altered DV was significantly associated with fetal morphological alterations (P = 0.003), a poor fetal/neonatal prognosis (P = 0.003), and fetal chromosome diseases (Down and Turner) (P = 0.03), but not with an altered NT measure.
P207 Screening for chromosomopathies in twin pregnancies S. Tudorache1 , A. Comanescu1 , D. Iliescu2 , N. Cernea2 . 1 SCJU Craiova, 2 UMF Craiova
P208 Cost effectiveness of ultrasound scan by middle grade doctors in Gynae Assessment Unit (GAU) M. Vachhani, F. Hamer, F. Clarke. Burnley General Hospital (East Lancashire Hospitals NHS Trust) Objectives: Evaluating Benefits of Scan by middle grade doctor in Management of GAU & savings due to reduce number of beds, Scans and SBHCG by Dept. Background: 90–95% of Patients in GAU come with early pregnancy problems. Bleeding, pain and waiting time is of considerable anxiety. Materials and Methods: A prospective survey was done on patients attending GAU. Performa was filled when scan done. Follow-up BHCG, Scan and theatre records were followed to reach at diagnosis and outcome. Results: Of 86 patients 52 reassured with Viable pregnancy and complete miscarriage 11 –Treatment expedited. 15 – missed miscarriage 4 – laparoscopic management for Ectopic 1 Laparoscopy – ruptured Corpus luteal cyst. 1 Negative laparoscopy. 2 DNA Savings: • One night stay in hospital cost 400 pounds. 29 reassured-not admitted • One slot of ultrasound appointment cost 95 pounds. 44 cases done out of hours. • One BHCG costs 5 pounds. 35 diagnosed as Ectopic on preliminary diagnosis – BHCG not required and not done in 11 cases with scan findings. • No calculated cost for reassurance to patient when fetal heart and fetal movement seen – less litigation • More Slots available – fulfilling national target. New service provision – screening for cleft lip, nasal bone, cardiac outflow & nuchal translucency. • More cases given expectant treatment as patients well monitored with scan & BHCG. • Training experience to Middle-Grade Doctors. Recommendations: Encouraging Middle grade doctors to get accredited in scan module for early pregnancy complications which sits with the Acute Gynae ATSM.
antibiotics and failed to show resolution of pelvic examination findings and turned up positive for TB-PCR/ granuloma on endometrial biopsy or further testing were recruited. Results: A total of 35 cases were evaluated. The mean age and standard deviation was 32.68±11.75 years and mean Ca-125 was 451.05 units/ml, the main symptoms were chronic pelvic pain in 15 (42.85%), distension of abdomen in 6 (17.14%) cases, infertility in 8 (22.85%) women. Diagnosis was made on PCR in all cases prior to CT-scan. The various findings were bilateral to masses in 14 cases (40%), unilateral TO mass in 15(42.85%), non specific enlargement of ovary in 3 (8.57%), encysted ascitis 11(31.42%), peritoneal inclusion cyst 5 (14.28%), omental thickening in 5 (14.28%), fibroid 3 (8.57%) cases. Conclusion: CT-scan is a non invasive modality to evaluate suspected tubercular tubovarian masses. P201 Interesting anomalies in monochorionic twin pregnancy S. Rao Patri Aim and Objectives: Three cases of interesting anomalies in monochorionic twin pregnancy are being presented here with. Materials and Methods: Case 1: 24 yr oldG2P1 has been subjected to USG at 6 months of pregnancy when she first reported for ANC. USG showed one normal fetus & the other with no head, heartacephalus acardius. Case 2: 26 yr old primi who never had USG till 7 months showed conjoint twins attached at thorax – Thoracopagus. Case 3: 30 yr old G2P1 who never had ANC was operated by caesarean for lack of progress at term clinically diagnosed as IUD. She had a rare anomaly – where asmall fetus is attached like a parasite to another large fetus – Duplicata incompleta dipygus. Results: Case 1: Pt went into spontaneous labor expelling both normal fetus & acardiac twin. Case 2: Operated by casarean as the heads of the conjoint twins were hyperextended and the presentation was breech. It survived for an hour. Case 3:The fetus Duplicata incompleta dipygus showed absence of head in the parasitic fetus. It was stillborn. Conclusion: The above anomalies are all specific to monochorionic twin pregnancy and are relatively rare. P202 Vessel diameters in intrauterine growth restriction 1
1
2
1
L. Story , M. Damodaram , G. Paramasivam , M. Rutherford , S. Kumar2 . 1 Imperial College London, 2 Queen Charlotte’s and Chelsea Hospital London Introduction: It is believed that fetuses with intrauterine growth restriction (IUGR) have compensatory cerebral redistribution of blood flow however there is little known regarding other vasculature tree compensatory mechanisms. Vasodilatory factors such as nitric oxide, Vasoactive Intestinal Polypeptide (VIP) and adrenomedullin have been shown to be increased in placentas and umbilical cord blood of fetuses with intrauterine growth restriction [1–4]. However, no study to date has provided an in vivo assessment of vessel diameters in growth restricted fetuses. Methods: 72 appropriate for gestational age (AGA) fetuses, and 11 IUGR fetuses underwent serial ultrasound examinations between 24 and 36 weeks gestation. Fetal biometry, estimated fetal weight, amniotic fluid index and Doppler analysis were calculated at each visit. Maximal vessel diameter for the umbilical, middle cerebral, carotid, ascending aorta, descending aorta, renal and femoral arteries was measured using power Doppler during systole utilizing the cine loop function. Vessel diameters were then standardized per kilogram for each measurement. ANCOVA statistical analysis was performed to assess the impact of gestational age and IUGR on vessel diameter/kilogram. Results: Vessel diameters/kg were significantly larger in all vessels in IUGR fetuses in comparasion to AGA fetuses. Umbilical
S469
p = 0.008, middle cerebral p = 0.005, femoral p = 0.023, renal p = 0.021 descending aorta p = 0.008, ascending aorta p = 0.004. Conclusions: Although mechanisms are thought to exist in the IUGR fetus whereby blood flow is preferentially diverted to essential organs this is the first study that has shown that generalized vasodilatation occurs in the growth restricted fetus. Reference(s) [1] Rizzo, G., et al., Blood levels of vasoactive intestinal polypeptide in normal and growth retarded fetuses: relationship with acid-base and haemodynamic status. Early Hum Dev, 1995. 41(1): p. 69–77. [2] D’Anna, R., et al., Neurokinin B and nitric oxide plasma levels in preeclampsia and isolated intrauterine growth restriction. BJOG, 2004. 111(10): p. 1046–50. [3] Di Iorio, R., et al., Adrenomedullin is increased in the fetoplacental circulation in intrauterine growth restriction with abnormal umbilical artery waveforms. Am J Obstet Gynecol, 2000. 182(3): p. 650–4. [4] Tikvica, A., et al., Nitric oxide synthesis in placenta is increased in intrauterine growth restriction and fetal hypoxia. Coll Antropol, 2008. 32(2): p. 565–70.
P203 Ultrasound features of fetal peritonitis due to bowel obstruction – case report L. Tammemae1 , F. Szirko. 1 East-Tallinn Central Hospital,
2
A 20 years old primigravida was hospitalised at 34 weeks of gestation with uterine contractions. Ultrasound exam revealed distended foetal stomach and bowels, small for gestational age head and femur. Two days later on repeated ultrasound exam thrombosis of one umbilical artery was discovered. The second artery showed higher than usual diastolic flow. There were no other abnormal findings. Decision was made to deliver the foetus by means of caesarean section. The newborn boy 2310 g, 47 cm was in satisfactory general condition, the blood gas analysis did not show any hypoxia. The newborns belly was remarkably distended. The baby was transferred to paediatric surgery department. On surgery wide bowel necrosis was found due to a volvulus. The affected bowel was removed and stoma created. After an episode of sepsis on third operation end-to-end anastomosis was created. The baby has recovered without any serious sequale. P204 Mid trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high risk pregnant women D. Thangamani, N. Jayasankar. Obstetrics & Gynecology Objective: To assess the value of uterine artery Doppler ultrasound screening, when performed in a clinical setting, to predict complications of impaired uteroplacental blood flow in high-risk women. Design: A Retrospective study. Methodology: A total of 55 pregnancies, high risk of pre-eclampsia and/or small-for-gestational-age (SGA) babies attending Apollo first med hospital, Chennai, during the year sept 2002 to april 2006 were studied and uterine artery Doppler done at 20 – 22 weeks as a part of clinical practice. A resistance index (RI) was calculated from each uterine artery and the presence or absence of a notch was determined. An RI of >0.50 was defined as abnormal. Result: Out of 55 pregnancies, the uterine artery Doppler was normal in 32 cases and abnormal in 23 cases. Among the normal uterine artery doppler group, 5 patients had PIH, 4s patient had IUGR, 23 patients had uneventful pregnancy. Those who had abnormal uterine artery doppler (presence of diastolic notch in the uterine arteries or RI > 0.5) 5 patient had PIH, 6 patients had IUGR, 2 patients had premature delivery less than 34 weeks and 10 patients had normal pregnancy outcome. The sensitivity, specificity, PPV & NPV of abnormal Doppler (presence of diastolic notch in the uterine arteries or RI > 0.5) for
S470
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
detecting PIH in this study is 50%, 60%, 21.7% & 84.3% respectively and for predicting IUGR is 60%, 62.2%, 26.08% & 87.5% respectively. Conclusion: In high-risk women, uterine artery Doppler waveform analysis performed best in the prediction of severe adverse outcome and was better than clinical risk assessment in the prediction of pre-eclampsia and SGA babies. Further studies are necessary to determine how information from uterine artery Doppler studies should modify current practice in high-risk women.
Conclusion: Altered DV proved to be a good predictor of poor fetal/neonatal prognosis, being associated with fetal morphological alterations and chromosome diseases (Down and Turner).
P205 A diagnostic error: fetal isolated and severe ventriculomegaly
Objective: Evaluate the efficiency of risk assessment for chromosomopathies using maternal serum biochemistry and fetal ultrasound; assessment of patient compliance. Methods: Patients were offered nuchal translucency measurement and maternal seum biochemistry (PAPP-A and beta-HCG) at 11–14 weeks and quadruple test (beta-HCG, AFP, inhibin A and uE3) after 15 weeks. The cut-of value for recomanding an invasive diagnostic procedure (amniocentesis) was 1/250. Results: 80% of patients accepted the screening procedures. The detection rate for Down syndrome was 70%. Risk was evaluated separated for each twin based on maternal biochemistry and fetal NT. Compliance was lower than in singleton patients for invasive procedures. Conclusion: Risk assessment using serum biochemistry and ultrasound is efficient but there is lower patient compliance for all steps of the procedures than in in singleton pregnancies.
G. Noia1 , M. Tintoni1 , I. Mappa1 , M. D’Errico1 , C. Greco1 , D. Visconti1 , L. Manganaro2 . 1 Catholic University of the Sacred Heart – Department of Gynecology and Obstestric, 2 Sapienza University of Rome – Department of Radiological Sciences The patient came to our observation at 35 weeks and 5 days of gestational age with an US diagnosis of ventriculomegaly (right AW = 22.7 mm); fetal development was normal. Fetal MRI was carried out the day after, confirming the same diagnosis: right AW = 20 mm. There was a mild enlargement of the third ventricle (6 mm). According to MRI, signs of bleeding, previous or acute, were absent. An US assessment at 37 weeks confirmed the normal development of the fetus, including the measurement of the fetal head. Right AW was 22 mm, third ventricle was 3.8×13.9 mm. The delivery was decided at 38w; at birth the cranial circumference was 36 cm and frontal alopecia was present. Neurologist diagnosed an asymmetrical posture; eyes following was correctly performed with left eye and only partially with right eye. Cranial US evaluation pointed out a temporal dysplasia of right hemisphere. EEG showed a symmetrical background activity, with prevalence of slow component at right side. MRI after birth confirmed ventriculomegaly, within a complex encephalic endangerment. A growing mass was noticed beside the spinal cord (from 5th cervical to 9th dorsal vertebra), probably a lipoma. The mass grew and reached the foramen at 45 day of life. The child needed a partial removal of the mass at 50 day of life. In spite of that and the further growing of the lipoma, post-surgical neurobehavioural follow-up was not so severe as suggested by instrument diagnosis. Conclusion: Prenatal diagnosis has some limitations, and often it is not possible to diagnosticate anomalies of late pregnancy, especially if worsening fast. Late, severe and isolated ventriculomegaly is an example of this. P206 Association of the perinatal prognosis with Doppler velocimetry pattern of the ductus venosus during the first trimester of pregnancy H. Torres, E. Figueiro-Filho, ´ L. Coelho, V. Oliveira, I. Breda, M. Goes, L. Melo, P. Turine-Neto. Faculty of Medicine of Federal University of Mato Grosso do Sul Objective: To determine the association between altered Doppler velocimetry pattern of the ductus venosus (DV) and chromosome diseases, fetal morphological alterations and a poor fetal/neonatal prognosis. Methods: Forty-eight pregnant women submitted to 1st trimester ultrasonographic evaluation whose fetuses presented alteration of nuchal translucency (NT) measure and/or DV pattern were submitted to amniocentesis for fetal karyotyping and screened for the presence of chromosome diseases, fetal morphological alterations detected by ultrasound, fetal/neonatal complications, abortions, fetal/neonatal deaths, and preterm deliveries. Results: Mean gestational age at identification of NT and DV alterations was 12.3±0.9 weeks. Altered DV was significantly associated with fetal morphological alterations (P = 0.003), a poor fetal/neonatal prognosis (P = 0.003), and fetal chromosome diseases (Down and Turner) (P = 0.03), but not with an altered NT measure.
P207 Screening for chromosomopathies in twin pregnancies S. Tudorache1 , A. Comanescu1 , D. Iliescu2 , N. Cernea2 . 1 SCJU Craiova, 2 UMF Craiova
P208 Cost effectiveness of ultrasound scan by middle grade doctors in Gynae Assessment Unit (GAU) M. Vachhani, F. Hamer, F. Clarke. Burnley General Hospital (East Lancashire Hospitals NHS Trust) Objectives: Evaluating Benefits of Scan by middle grade doctor in Management of GAU & savings due to reduce number of beds, Scans and SBHCG by Dept. Background: 90–95% of Patients in GAU come with early pregnancy problems. Bleeding, pain and waiting time is of considerable anxiety. Materials and Methods: A prospective survey was done on patients attending GAU. Performa was filled when scan done. Follow-up BHCG, Scan and theatre records were followed to reach at diagnosis and outcome. Results: Of 86 patients 52 reassured with Viable pregnancy and complete miscarriage 11 –Treatment expedited. 15 – missed miscarriage 4 – laparoscopic management for Ectopic 1 Laparoscopy – ruptured Corpus luteal cyst. 1 Negative laparoscopy. 2 DNA Savings: • One night stay in hospital cost 400 pounds. 29 reassured-not admitted • One slot of ultrasound appointment cost 95 pounds. 44 cases done out of hours. • One BHCG costs 5 pounds. 35 diagnosed as Ectopic on preliminary diagnosis – BHCG not required and not done in 11 cases with scan findings. • No calculated cost for reassurance to patient when fetal heart and fetal movement seen – less litigation • More Slots available – fulfilling national target. New service provision – screening for cleft lip, nasal bone, cardiac outflow & nuchal translucency. • More cases given expectant treatment as patients well monitored with scan & BHCG. • Training experience to Middle-Grade Doctors. Recommendations: Encouraging Middle grade doctors to get accredited in scan module for early pregnancy complications which sits with the Acute Gynae ATSM.