REPORT FROM ISUOG CONGRESS

IN SYDNEY 2013IN SYDNEY 2013

To Mai Xuan Hong

1Dr. To Mai Xuan Hong

1st trimester assessment of aneuploidy

• US markers

– NT, NB, Facial angle

– Doppler of DV (a-wave)*

– Doppler of tricuspid valve*

– Intra-cranial translucency (IT)*– Intra-cranial translucency (IT)*

• Biochemical markers

– Fß-hCG and PAPP-A

• Non-invasive prenatal test (NIPT)

– Decision of invasive test in the intermediate risk (<1/10-1/1000 followed CFTS)

2Dr. To Mai Xuan Hong

1st trimester assessment of aneuploidy

3Dr. To Mai Xuan Hong

• Oral presentations

– Screening for adverse pregnancy outcomes at 12ws

(Audibert, Francois)

– Combined first trimester biochemistry, NIPT or both?

1st trimester assessment of aneuploidy

– Combined first trimester biochemistry, NIPT or both?

(Johnson, Jo-An)

– Sequencing for NIPT: techniques, technologies,

applications and limitations (Johnson, Jo-An)

– First trimester screening for neural tube defect (Meaghen,

Simon)

4Dr. To Mai Xuan Hong

1st trimester assessment of growth and Doppler

• Crown-rump length measurement

• Increased Uterine artery Doppler indices (PI

> 90th or 95th centile) associated with

– Reduced fetal movement

– Superimposed pre-eclampsia– Superimposed pre-eclampsia

– SGA < 10th centile

– SGA < 3rd centile

– Still birth

• Low PAPP-A level (<0.3 MoM) or both of

PAPP-A and free ß-hCG (<0.5MoM)

– related to poor placentation (low birth weight and still birth)

5Dr. To Mai Xuan Hong

• Oral presentations

– Assessment of crown-rump length measurement variability (McLennan, Andrew)

– Clinical evaluation of a first trimester algorithm predicting the risk of

hypertension disease of pregnancy (Park, Felicity)

– First trimester screening of pregnancy complication (Hyett, Jon)

– Assessment of 1st trimester uterine artery pulsatility index in Hongkong Chinease

1st trimester assessment of growth and Doppler

– Assessment of 1 trimester uterine artery pulsatility index in Hongkong Chinease

pregnant women(Sahota, Daljit)

– Pulsatility index of the uterine arteries between 11 and 13.6 weeks: comparison

of measurement by transvaginal and transabdominal Doppler ultrasound (Cafici,

Daniel)

– Reduced fetal movement at term association to first trimester uterine artery

Doppler assessment (G Pagani)

– Reduced fetal movement at term: association to first trimester PAPP-A level (G

Pagani)

– Outcomes in cases of low PAPP-A and free ß-hCG in maternal serum at 1st

trimester screening (Deloison)

6Dr. To Mai Xuan Hong

2nd trimester assessment

• Ratio of prenasal thickness (PT) and nasal bone length (NBL) (Down

syndrome)

• Fetal facial shape

– Facial height (FH) and facial width (FW) (FH/FW ratio)

– Forehead assessment (Profile line) (Down syndrome)

• Short femur length associated with• Short femur length associated with

– Chromosomal abnormalities

– SGA

– Early preterm delivery

• Increased 2nd trimester uterine artery Doppler indices (> 90th centile)

associated with placental dysfunction)

• Femoral metaphyseal-epiphyseal angle (> 130◦ in achondroplasia)

• Asymptomatic short cervix length is a predictor of intra-amniotic

inflammation

7Dr. To Mai Xuan Hong

2nd trimester assessment

8Dr. To Mai Xuan Hong

• Oral presentations

– The prenasal thickness to nasal bone length ratio: 2D versus 3D ultrasound (E

de Jong)

– Fetal facial shape: 3D study of height and width in the 2nd and 3rd trimester of

pregnancy (A De Boagent)

– Forehead assessment in normal and pathological fetuses by the fetal profile

2nd trimester assessment

– Forehead assessment in normal and pathological fetuses by the fetal profile

line (E de Jong)

– Outcome of fetuses with short femur length detected at 2nd trimester

malformation scan: a national survey (JM Mathiesen)

– Reduced fetal movement at term: association to second trimester uterine

artery Doppler assessment (G Pagani)

– Femoral metaphyseal-epiphyseal angle: a new prenatal ultrasound finding in

achondroplasia (A Khalil)

– Non-invasive prediction of intra-amniotic infection and/or inflammation in

patient with cervical insufficiency or an asymptomatic short cervix (<15mm) (E

Jung)9Dr. To Mai Xuan Hong

IUGR: detection and management

• Late-onset IUGR = SGA+(EFW<P3, Abnormal

MCA-UtA-UA)

– Poor outcome (neonatal morbility)

– Possible choosing an induction

• TRUFFLE study (Trial of Umbilical and Fetal Flow

in Europe)

– Decision the best timing of delivery in preterm

pregnancies complicated IUGR

– Surveillance test: CTG, UA and DV Doppler

• Aortic intima-media thickness (aIMT) (> 0.8mm)

– Higher SBP and glomerular dysfuction 10Dr. To Mai Xuan Hong

• Oral presentations

– Are all late-onset IUGR the same? (E Gratacos)

– Clinical lessons from the TRUFFLE study (C Bilardo)

IUGR: detection and management

– Clinical lessons from the TRUFFLE study (C Bilardo)

– The use of charts in detecting late-onset IUGR (A

Papageorghiou)

– Prenatal scale for cardiovascular risk in IUGR (E Cosmi)

11Dr. To Mai Xuan Hong

Cervical assessment

• Preterm delivery

– Intra-amniotic sludge

• Induction of labor• Induction of labor

– TVS assessment

– Comparison of funneling,

length and Bishop’s score

12Dr. To Mai Xuan Hong

Cervical assessment

• Oral presentations

– Intra-amniotic sludge observed at cervical ultrasound

and the risk of preterm delivery (F. Audibert)

– Sonographic funneling of uterine cervix as predictor

for success of labor induction (E Kim)

– Pre and post-ripening sonographic assessment of

cervix for predicting successful induction of labor (M

Cordoba)13Dr. To Mai Xuan Hong

Fetal neurosonography

• Probst Bundle

– Agenesis of the corpus callosum

• Pericallosal lipoma

– Shows in 3rd trimester– Shows in 3rd trimester

– Increased echogenicity in corpus callosum

– Invisualised corpus callosum

• MRI in conjunction with US

– www.fetalmri2014.org ( 15-20 Mars 2014,

Canada)14Dr. To Mai Xuan Hong

Fetal neurosonography

• Oral presentations

– Disorders of axonal guidance as visualised by fetal MRI

(D Prayer)(D Prayer)

– Periventricular leukomalacia in fetus: prenatal imaging

and diagnostic features (D Pugash)

– US volume navigation with fusion MRI imaging: a

novel approach for prenatal diagnosis (G Malinger)

15Dr. To Mai Xuan Hong

• Main IOTA model

IOTA classification(International Ovarian Tumor Analysis)

16Dr. To Mai Xuan Hong

17Dr. To Mai Xuan Hong

Simple rule for identifying a benign or malignant tumor

18Dr. To Mai Xuan Hong

Simple rule for identifying a benign or malignant tumor

19Dr. To Mai Xuan Hong

• Oral presentations

– Predictive value of subjective assessment, IOTA simple

rule, IOTA logistic regression model 1 (LR1), Alcazar’s

GI-RAD model and risk of malignancy (RMI) model in

IOTA classification(International Ovarian Tumor Analysis)

GI-RAD model and risk of malignancy (RMI) model in

the preoperative discrimination of adnexal mass (A

Czekierdowski)

– The additive value of HE4 novel tumor marker to the

IOTA simple rules in the management of ovarian

masses (B Erdoli)20Dr. To Mai Xuan Hong

Thank you!Thank you!

21Dr. To Mai Xuan Hong