OC14.08: Transperineal ultrasound assessment of fetal head elevation by manoeuvres used for managing umbilical cord prolapse

Full text

31st World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts
OC14.06
Maternal and fetal Doppler in low-risk term pregnancy in
early labour: can we screen for intrapartum fetal distress
leading to obstetric intervention?
A. Dall’Asta1,T.Ghi
1,G.Rizzo
2,E.diPasquo
1,
G. Morganelli1,C.Lees
3,F.Figueras
4,T.Frusca
1
1Department of Medicine and Surgery, Obstetrics and
Gynecology Unit, University of Parma, Parma, Italy;
2Obstetrics and Gynecology, University of Roma Tor Vergata,
Rome, Italy; 3Imperial College Healthcare NHS Trust,
London, United Kingdom; 4Department of Medicine and
Surgery, University of Barcelona, Barcelona, Spain
Objectives: To evaluate the performance of maternal and fetal
Doppler in early labour in the screening of intrapartum fetal distress
(IFD) leading to obstetric intervention (OI).
Methods: Multicentre prospective study conducted at four Euro-
pean maternity units including low risk term pregnancies term with
cephalic presenting fetus and spontaneous onset of labour. Cases
were submitted to Doppler measurement of the umbilical artery
(UA), middle cerebral artery (MCA) and of the uterine arteries
(UtA) in early labour. All recordings were performed in between
uterine contractions and according to international standards. The
cerebroplacental ratio (CPR) was computed by dividing MCA and
UA pulsatility index. Multiple of Median (MoM) for each Doppler
index was calculated. The primary outcome was the accuracy of
the different Doppler parameters alone and in combination in the
prediction of OI due to IFD.
Results: 804 patients were included, of whom 659 (82.0%) had
spontaneous vaginal delivery (SVD). OI due to IFD was performed
in 54 (6.7%) cases. When evaluating the baseline risk for OI due to
IFD by means of logistic regression analysis and a model including
antepartum and intrapartum characteristics, all abnormal Doppler
indices proved to be independently associated with OI for IFD. The
addition of the CPR MoM <10th percentile to the baseline risk
model showed the highest AUC of 0.748, 95%CI (0.678-0.818),
p<0.001 for a single Doppler parameter. However, the model
combining baseline characteristics, CPR MoM <10th percentile
andmeanUtAPIMoM>95th percentile was associated with the
highest AUC (0.783, 95%CI (0.712-0.855), p <0.001). This model
was associated with 78% sensitivity, 68% specificity, 15% PPV and
98% NPV for OI due to IFD.
Conclusions: Within a low-risk population in early labour the
highest sensitivity in the identification of IFD leading to OI can
be achieved by adding the CPR MoM<10th percentile and mean
UtA PI MoM >95th percentile to baseline maternal characteristics.
OC14.07
Prediction of delivery after 40 weeks in singleton multiparous
women by antepartum ultrasound
G. Rizzo1,2,I.Mappa
1,P.Maqina
1,R.Nale
1,
A. Makatsariya2, F. D’Antonio3
1Division of Maternal Fetal Medicine, Ospedale Cristo Re
Roma, Universita degli Studi di Roma Tor Vergata, Rome,
Italy; 2Department of Obstetrics and Gynecology, First I.M.
Sechenov Moscow State Medical University, Moscow, Russian
Federation; 3Department of Obstetrics and Gynecology,
University of Chieti, Chieti, Italy
Objectives: The aim of this study was to test the diagnostic accuracy
of ultrasound in predicting delivery ≥40 weeks of gestation in
singleton parous women.
Methods: Prospective cohort study of singleton parous women
undergoing a dedicated ultrasound assessment at 36-38 weeks of
gestation. The primary outcome was spontaneous vaginal delivery
≥40 weeks of gestation. Cervical length (CL), posterior cervical
angle (PCA), sonoelastographic hardness ratio (HR), angle of
progression (AoP) and head perineal distance (HPD) were measured.
Multivariate logistic regression and area under the curve (AUC)
analyses were used to test the diagnostic accuracy of different
maternal and ultrasound characteristics in predicting delivery
≥40 weeks.
Results: 518 singleton pregnancies were included in the analysis and
235 (45.4%) delivered ≥40 weeks. CL (29 vs 19 mm; p =≤0.0001)
and HPD (50 vs 47 mm; p =0.001) were longer, HR higher (38.9
vs 35.5 p =0.04), while PCA (98◦vs 104◦;p=≤0.0001) and AOP
narrower (93◦vs 98◦;p=0.029) in pregnancies delivered compared
to those not delivered after 40 weeks of gestation. At multivariable
logistic regression analysis, CL (aOR 1.206; 95% CI 1.164-1.250),
HPD (aOR 1.127; 95% CI 1.066-1.191) and HR (aOR 1.022; 95%
CI 1.003-1.041 were the only variables independently associated
with delivery ≥40 weeks. CL showed had an AUC of 0.863 in
predicting delivery ≥40 weeks of gestation, with an optimal cut-off
of 23.5 mm. Integration of HPD and HR did not significantly
improve the diagnostic performance of CL alone to predict delivery
≥40 weeks (AUC 0.870; p =0.472).
Conclusions: Cervical length at 36-38 weeks has a good diagnostic
accuracy to predict spontaneous vaginal delivery at ≥40 weeks.
Universal assessment of CL in the third trimester of pregnancy may
help in identifying those women who may benefit of elective IOL at
39 weeks.
OC14.08
Transperineal ultrasound assessment of fetal head elevation
by manoeuvres used for managing umbilical cord prolapse
A.H. Kwan1, P. Chaemsaithong2,L.Wong
1,A.W.Tse
1,
S. Hui1, L.C. Poon1,T.Leung
1
1Department of Obstetrics and Gynecology, Chinese Uni-
versity of Hong Kong, Shatin, Hong Kong; 2Maternal Fetal
Medicine Division, Department of Obstetrics and Gynecol-
ogy, Mahidol University Ramathibodi Hospital, Bangkok,
Thailand
Objectives: To objectively assess the degree of fetal head elevation
by different manoeuvres, including maternal buttocks wedging, knee
chest position, Trendelenburg position and maternal urinary bladder
filling.
Methods: A prospective observational study on 20 pregnant women
at term before elective Caesarean delivery. A baseline assessment of
fetal head station was made when they were in supine position using
transperineal ultrasound scanning by measuring psAoP, HSD and
HPD. The transperineal measurement of fetal head station were
repeated when different manoeuvres were applied.
Results: When compared to baseline (median psAOP 103.6),
knee-chest position gave the strongest elevation effect, with the
greatest reduction in psAOP (80.7; p <0.001), followed by filling
the bladder with 500ml (89.9; p =<0.001) and 300ml normal
saline (94.4; p <0.001). Filling with 100ml normal saline (96.1;
p=0.001), Trendelenburg position (96.8; p =0.014) and wedging
the maternal buttocks (98.3; p =0.033) gave modest elevation
effect. Similar findings were reported using HSD and HPD. The
elevation effect of knee-chest position was independent of the initial
fetal head station, but that of bladder filling was greater when the
initial head station was low.
Conclusions: To elevate the fetal presentation, knee-chest position
provides the best effect, followed by filling the maternal urinary
bladder with 500ml and 300ml fluid respectively. Filling the bladder
with 100ml, Trendelenburg position and wedging the maternal
buttocks have modest effect.
©The Authors 2021
42 ©Ultrasound in Obstetrics & Gynecology 2021; 58 (Suppl. 1): 1–57.

15–17 October 2021, Virtual Oral communication abstracts
OC14.08: Table 1. Comparison between baseline transperineal parameters measured at supine position and those measured with different
manoeuvres applied
Baseline Wedging Trendelenburg
Bladder
filling 100 ml
Bladder
filling 300 ml
Bladder
filling 500 ml
Knee-chest
position
Median (IQR) Median (IQR) Median (IQR) Median (IQR) Median (IQR) Median (IQR) Median (IQR)
psAOP 103.6 (93.6– 108.1) 98.3 (88.9– 108.6) 96.8 (93.1– 102.3) 96.1 (89.7– 102.4) 94.4 (89.2– 98.0) 89.9 (85.0– 98.0) 80.7 (71.9– 89.9)
pRef 0.033 0.014 0.001 <0.001 <0.001 <0.001
HSD 3.99 (3.58– 4.73) 4.53 (4.17– 5.04) 5.17 (4.50– 5.67) 5.43 (4.40– 6.24) 6.99 (5.59– 7.40) NA NA
pRef <0.001 <0.001 <0.001 0.001
HPD 5.79 (5.33– 6.23) 6.08 (5.84– 6.72) 6.68 (6.11– 7.04) 6.82 (6.05– 7.58) 7.91 (7.26– 8.28) 9.26 (8.11– 10.22) NA
pRef 0.028 0.002 0.001 <0.001 <0.001
OC15: WHAT’S NEW ON CMV AND
COVID-19?
OC15.01
What does ‘‘halo’’ sign mean in fetal CMV infection?
A.M. Hawkins-Villarreal1, K.P. Castillo1,E.Eixarch
1,
A. Nadal2,A.Alarc
´
on-Allen1,S.Planas
1,F.Figueras
1,
A. Gonc´
e1
1Barcelona Center for Maternal Fetal and Neonatal Medicine,
Hospital Cl´
ınic and Hospital Sant Juan de D´
eu, Barcelona,
Spain; 2Hospital Clinic of Barcelona, Barcelona, Spain
Objectives: Periventricular hyperechogenicity ‘‘halo’’ sign, is one
of the most frequent US abnormalities in CMV-infected fetuses.
It has been defined as a sign of ventriculitis and white matter
injury. However, there are few reports about postmortem in
targeted histological examination. Our objective was to obtain more
information about its significance and prognostic value.
Methods: Two experienced pathologists reviewed histological slides
of central nervous system (CNS) from 26 CMV-infected fetuses
following termination of pregnancy in 2nd (N=19) or 3rd trimester
(N=7). A fetal neurology specialist reanalysed blindly, the images
from the neurosonographies.
Results: ‘‘Halo’’ sign was found in 23/26 fetuses (88%) and
associated with earlier gestational age at diagnosis (mean 25 vs
33 wks, p =0.004). In most cases from 2nd trimester (15/19:
79%), and all cases from 3rd trimester, ‘‘halo’’ was associated
with severe CNS abnormalities [microcephaly (74%), cerebellar
hypoplasia (64%), corpus callosum agenesis/dysgenesis (52%),
abnormal sulcation/gyration (50%)]. However, the 3 fetuses
without ‘‘halo’’ showed similar abnormalities. Severe and extensive
histological lesions were found in 14/23 (61%) fetuses, and they
did not differ according to presence/absence of US ‘‘halo’’ sign.
Microglial nodes suggesting immune-mediated damage (75% vs
67%), polymicrogyria (65% vs 33%; p =0.75), and cortical necrosis
(46% vs 33%) were observed similarly. There were no differences
with regard to ventriculitis (56% vs 67%). Although white matter
necrosis was observed exclusively among fetuses with ‘‘halo’’, it
was detected in less than 50% of cases. Among the 4 second
trimester fetuses with isolated ‘‘halo’’, histological findings showed
no CNS lesions in one, diffuse microglial nodes in two, and focal
polymicrogyria and cortical necrosis in the remaining one.
Conclusions: Among CMV infected fetuses with ‘‘halo’’ sign,
a specific pattern of histological brain damage could not be
determined. ‘‘Halo’’ sign could be an early marker of poor outcome,
though its prognostic value when observed alone needs confirmation.
OC15.02
Increased levels of soluble FMS-like tyrosine kinase-1 are
associated with adverse outcomes in pregnant women with
COVID-19
J. Torres-Torres2,1, R.J. Martinez-Portilla2,3 ,S.Espino-y-
Sosa2,3, G. Estrada-Gutierrez2,A.Juarez
1,J.Solis-Paredes
2,
P. Mateu-Rogell2,3, J. Villaf ´
an-Bernal3, A. Ortiz-Calvillo2,
L. Rojas3, L.C. Poon4
1Maternal-Fetal Medicine, General Hospital of Mexico,
Mexico City, Mexico; 2Clinical Research, National Insti-
tute of Perinatology, Mexico City, Mexico; 3Iberoamerican
Research Network in Obstetrics, Gynecology and Trans-
lational Medicine, Mexico City, Mexico; 4Obstetrics and
Gynecology, Chinese University of Hong Kong, Shatin, Hong
Kong
Objectives: This study aimed to investigate the association between
serum concentrations of soluble FMS-like tyrosine kinase-1 sFlt-1
and the severity of COVID-19 among pregnant women.
Methods: Prospective cohort study. Inclusion criteria were pregnant
women with positive rt-PCR COVID-19 between July 2020-January
2021. The outcome was severe COVID-19, defined as a composite
adverse outcome of pneumonia, ICU admission, sepsis, and death.
Forward and backward stepwise logistic regression analysis was
performed to assess the association between independent variables
and outcome. Adjusted model’s performance after logistic regression
was evaluated by a receiver-operating-curve (ROC) analysis along
with an area under the curve (AUC).
Results: Among the 113 included women, 31 (27.43%) had severe
COVID-19, including 5 (4.42%) maternal deaths. There was a statis-
tically significant difference in the gestational age at hospital admis-
sion (35.2 vs 30.2; p =0.002) between groups. A cut-off of 1.66
sFlt-1 MoMs had an odds ratio [OR] of 1.81 (95%CI:1.36-2.41) for
a composite severe adverse outcome. The predictive performance
of sFlt-1 for severe COVID-19 achieved an AUC of 0.71 (95%CI:
0.58-0.82) and maternal death of 0.97 (95%CI: 0.95-1.00) (figure
1). The detection rates for maternal death at 5% and 10%
false-positive-rates were 80% and 100%, respectively.
Conclusions: sFlt-1 is a potential predictor of COVID-19-related
adverse events such as pneumonia, ICU admission, sepsis, and
death. Further research in a larger prospective cohort is needed to
validate the association and accuracy of sFlt-1 for the prediction of
adverse events among pregnant women with COVID-19.
Supporting information can be found in the online
version of this abstract
©The Authors 2021
©Ultrasound in Obstetrics & Gynecology 2021; 58 (Suppl. 1): 1–57.43