Background and Objectives: In this study, we aimed to describe the clinical and ultrasound (US) features and the outcome in a group of patients suspected of or diagnosed with early onset intrauterine growth restriction (IUGR) requiring iatrogenic delivery before 32 weeks, having no structural or genetic fetal anomalies, managed in our unit. A secondary aim was to report the incidence of the condition in the population cared for in our hospital, data on immediate postnatal follow-up in these cases and to highlight the differences required in prenatal and postnatal care. Materials and Methods: We used as single criteria for defining the suspicion of early IUGR the sonographic estimation of fetal weight <p10 using the Hadlock 4 technique at any scan performed before 32 weeks’ gestation (WG). We used a cohort of patients having a normal evolution in pregnancy and uneventful vaginal births as controls. Data on pregnancy ultrasound, characteristics and neonatal outcomes were collected and analyzed. We hypothesized that the gestational age (GA) at delivery is related to the severity of the condition. Therefore, we performed a subanalysis in two subgroups, which were divided based on the GA at iatrogenic delivery (between 27+0 WG and 29+6 WG and 30+0–32+0 WG, respectively). Results: The prospective cohort study included 36 pregnancies. We had three cases of intrauterine fetal death (8.3%). The incidence was 1.98% in our population. We confirmed that severe cases (very early diagnosed and delivered) were associated with a higher number of prenatal visits and higher uterine arteries (UtA) pulsatility index (PI) centile in the third trimester—TT (compared with the early diagnosed and delivered). In the very early suspected IUGR subgroup, the newborns required significantly more NICU days and total hospitalization days. Conclusions: Patients with isolated very early and early IUGR—defined as ultrasound (US) estimation of fetal weight <p10 using the Hadlock 4 technique requiring iatrogenic delivery before 32 weeks’ gestation—require closer care prenatally and postnatally. These patients represent an economical burden for the health system, needing significantly longer hospitalization intervals, GA at birth and UtA PI centiles being related to it.

Background: Preeclampsia (PE), one of the classes of hypertensive pregnancy disorders, is one of the three causes of maternal morbidity and mortality worldwide. The angiogenic and anti-angiogenic factors are useful markers in predicting and diagnosing PE. Aim: This study aims to detect and measure the serum level of some biomarkers [hypoxia-inducible factor-1 subunit alpha (HIF-1A), vascular endothelial growth factor (VEGF), interferon-gamma-inducible protein of 10 kDa (IP-10), matrix metalloproteinase-13 (MMP-13)] in patients with PE and their correlation with the severity of the disease, to find a good predictor for PE. Patients, Materials and Methods: This prospective study aims to monitor 48 pregnant women who address obstetric consultation and who present risk factors for PE, and a control group with characteristics similar to the study group. Patients were divided into three groups: Group I (n=15) including normal pregnant (NP) women with blood pressure <140/90 mmHg, without proteinuria, Group II (n=18) including patients with mild PE (MildPE), Group III (n=15) including patients with severe PE (SeverePE). The analysis of serum biomarkers was based on a quantitative sandwich enzyme-linked immunosorbent assay (ELISA), according to the manufacturer's instructions. Results: In our study, we found that all biomarkers investigated have higher concentrations in the serum of patients with SeverePE and MildPE than those in the control subjects (Group I, NP), the concentrations were increasing along with the disease activity. The means concentrations of HIF-1A, VEGF, IP-10, MMP-13, better correlated with indices in SeverePE group than in MildPE group. We found that VEGF was the biomarker that best correlates with indices that assess the severity of PE. The best separation of patients with SeverePE from those with MildPE can be done with the help of MMP-13 (82% accuracy), followed by VEGF (80.40% accuracy) and the least good detection being done by dosing IP-10. Conclusions: We can say that, due to high specificity diagnostic accuracy, determination of serum concentrations of MMP-13 and VEGF, could be useful in the diagnosis and distinguishing of patients with SeverePE and may prove useful in the monitoring of the disease course.

It is well known that first-trimester miscarriages are associated with chromosome abnormalities, with numerical chromosome abnormalities being the ones most commonly detected. Conventional karyotyping is still considered the gold standard in the analysis of products of conception, despite the extended use of molecular genetic techniques. However, conventional karyotyping is a laborious and time-consuming method, with a limited resolution of 5–10 Mb and hampered by maternal cell contamination and culture failure. The aim of our study was to assess the type and frequency of chromosomal abnormalities detected by conventional karyotyping in specimens of sporadic first-trimester miscarriages in a Romanian cohort, using QF-PCR to exclude maternal cell contamination. Long-term cultures were established and standard protocols were applied for cell harvesting, slide preparation, and GTG banding. All samples with 46,XX karyotype were tested for maternal cell contamination by QF-PCR, comparing multiple microsatellite markers in maternal blood with cell culture and tissue samples. Out of the initial 311 specimens collected from patients with sporadic first-trimester miscarriages, a total of 230 samples were successfully analyzed after the exclusion of 81 specimens based on unsuitable sampling, culture failure, or QF-PCR-proven maternal cell contamination. Chromosome abnormalities were detected in 135 cases (58.7%), with the most common type being single autosomal trisomy (71/135—52.6%), followed by monosomy (monosomy X being the only one detected, 24/135—17.8%), and polyploidy (23/135—17.0%). The subgroup analysis based on maternal age showed a statistically significant higher rate of single trisomy for women aged 35 years or older (40.3%) compared to the young maternal age group (26.1%) (p = 0.029). In conclusion, the combination of conventional karyotyping and QF-PCR can lead to an increased chromosome abnormality detection rate in first-trimester miscarriages. Our study provides reliable information for the genetic counseling of patients with first-trimester miscarriages, and further large-scale studies using different genetic techniques are required.

Malformations of the lower extremities are rare and poorly described. Although fibular agenesis is the most common lower extremity malformation, there are few published cases of prenatal diagnosis. We report a clinical case of fibular agenesis that was presented at the Hospital de Carabineros de Chile and its subsequent discussion.Supporting information can be found in the online version of this abstract EP10.05 Relationship between absent or hypoplastic fetal nasal bone at 20-23 +6 weeks of gestation and chromosomal defects in an unselected Chinese population L. CaoUltrasonic Diagnosis Department of Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China Objectives: To investigate the relationship between absent or hypoplastic fetal nasal bone and chromosomal defects during the second trimester in an unselected Chinese population. Methods: From January 2012 to December 2015, included were 58133 pregnant women who underwent routine ultrasound examination between 20 and 23+6 gestational weeks as a screening test. We collected all the cases of absent or hypoplastic fetal nasal bone, followed up the results of karyotype analysis and the information on neonatal development. Results: (1)150 fetuses were found to have absent or hypoplastic fetal nasal bone in the 58651 fetuses(2.56‰), of which 57636 were singleton,476 were twins and 21 were triplets. With 14 cases of misdiagnosis, missing or incomplete data excluded,136 cases were included in the study. 113 underwent interventional prenatal diagnostic test, and fetal chromosomal defects were detected in 24 cases (17.6%), including 18 cases (75%) of Trisomy 21, 3 cases (12.5%) of Trisomy 18, 1 case (4.2%) of Klinefelter syndrome and 2 cases (8.3%) of microdeletion syndrome. (2) There was no significant difference in the incidence of chromosomal defects between absent fetal nasal bone and hypoplastic fetal nasal bone[22.5%(16/71) vs 12.3%(8/65),x2=2.442, P=0.118]. (3) The incidence of chromosome defects in fetuses without other structural defects was significantly lower than that with structural defects [3.9%(3/76) vs 35.0% (21/60), corrected x2=22.247,P=0.000]. (4)A total of 38 cases of Down syndrome were found in 56707 cases of delivery or induced labour in our hospital. When the fetal nasal bone dysplasia was used as an indicator of Down's syndrome, the sensitivity was 47% and the specificity was 99.8%. Conclusions: The absent and hypoplastic fetal nasal bone are closely related to fetal chromosomal defects. When combined with other sonographic defects, it is necessary to carry out a detailed prenatal diagnosis to exclude fetal chromosomal defects. Objectives: In our routine examinations we noticed that we could follow fetal swallowing using colour Doppler -we tried to study if this technique could be used to monitor the contour of the fetal palate in order to screen for posterior palate defects. Methods: We shared the idea with our team in the Prenatal Diagnosis Unit and we monitored the accessibility of HD -Flow in assessing the contour of the f...

Oral communication abstractsMethods: A retrospective cohort study of women who underwent a laparoscopic myomectomy at University College London Hospital between December 2014 and November 2017 was carried out.Ultrasound images and operation notes were reviewed. The size and minimum distance of the fibroid from the endometrial cavity in a 2-dimensional longitudinal plane were determined from ultrasound images (negative distance was scored when the fibroid protruded into the cavity).Endometrial cavity breaches at the time of surgery were identified from the operation notes. Women who did not have a preoperative ultrasound and those who had more than two fibroids removed were excluded. Results: 74 women who had laparoscopic myomectomy and a preoperative ultrasound were identified.The median age was 36.0 (IQR 33 -39.8) and the median fibroid diameter was 68.2mm (IQR 47.7 -80.6).10/74 (13.5%, 95% CI 5.7 -21.3) had a breach of the endometrial cavity. Women who suffered a breach had a fibroid that was close to or within the endometrial cavity (distance from cavity -9.9 vs. 8.9mm, p=0.001, degree of protrusion 17% vs. 0.0% and intracavitary surface area 1463mm2 vs. 0.0).A logistic regression model with cavity breach as independent variable and ultrasonic variables as predictors selected minimum distance from cavity as the best predictor of cavity breach (OR 0.79, 95% CI 0.73 -0.92).10/19 (52.6%, 95% CI 30.2 -15.1) of women with a submucosal component to their fibroid did not have a cavity breach. No women with a fibroid further than 5.2mm from the cavity had a breach identified at surgery. Conclusions: Identifying patients who are at increased risk of endometrial cavity breach based on ultrasound facilitates appropriate preoperative counselling regarding the risk of intrauterine adhesions and the need for Caesarean section.