Objectives To assess uptake and success of expectant management of first-trimester miscarriage for a finite 14-day period, in

Oral communication abstractson the pain during insertion, in the following 3 days and at 4 to 6 weeks. Methods: A prospective cohort of 331 women in whom a Mirena was inserted. At the day of insertion they completed a first questionnaire including a pain assessment score from 0 to 10. A second questionnaire was handed to them to record pain experienced in the following 3 days and in the last 14 days before routine followup ultrasound 6 weeks after insertion. At ultrasound the position of the uterus was recorded and the position of the Mirena was assessed with 2D-and 3D-imaging. The sonographer was blinded as to the answers to the questionnaire. The pain scores were compared to the ultrasound findings. The first 93 3D-volumes were also examined off-line to determine if the arms extended past the confines of the endometrial cavity. This was reported as 'embedded' (Benacerraf et al. UOG 2009;34:110-6). Results: The mean (SD) pain-score at insertion was 4.5 (2.6) versus 2.7 (2.7) in the first 3 days and 0.8 (1.7) 4 to 6 weeks after insertion. The uterus was anteflexed in 80% of cases, retroflexed in 17%, stretched in 2.5% and mobile in 0.5%. The localization of the Mirena stem was recorded as abnormal in 7.1% of cases and the arms were abnormally unfolded in another 3.4%. The right arm was considered embedded in 56.8% and the left arm in 56.3%. The position the uterus and of the LNG-IUS (both of the stem and of the arms) did not influence the pain scores, nor did the fact that the IUD arms were considered embedded on coronal 3D-volume reconstruction. Conclusions:The position of the uterus, the position of the LNG-IUS nor the ultrasound image that the IUS arms were embedded, did influence the pain score at insertion, in the first 3 days or at 4 to 6 weeks after insertion. Pain does not seem to be a reliable predictor of correct position. A routine ultrasound check seems therefore recommended 6 weeks after Mirena insertion. OC10.04Can we predict posterior compartment deep infiltrative endometriosis using sonovaginography in women undergoing laparoscopy for chronic pelvic pain? Nepean Hospital, Penrith, NSW, AustraliaObjectives: To use sonovaginography (SVG) to predict posterior compartment deep infiltrative endometriosis (DIE) in women undergoing laparoscopy for chronic pelvic pain. Methods: This is a continuing, prospective observational study, which began in June 2009. All women included in this study were of reproductive age, had history of chronic pelvic pain, and had a plan for laparoscopic endometriosis surgery. A history was obtained and SVG was performed on all women prior to laparoscopy. During SVG, a transvaginal (TV) ultrasound was performed with the introduction of gel into the posterior fornix of the vagina. The gel created an acoustic window between the TV probe and the surrounding structures of the vagina, allowing for visualization of the posterior compartment. SVG was then used to predict posterior compartment DIE. Women underwent laparoscopic surgery for diagnosis and, if necessary, surgical trea...

19th World Congress on Ultrasound in Obstetrics and Gynecology Oral communication abstracts irregular outline: some studies include only head and trunk and none consider the effect of midgut herniation. We introduce a novel semi-automated 3D technique which addresses these issues. Aim: To assess intraobserver reliability of the new semi-automated technique of embryo volumetry and to examine the relationship with CRL at different gestational age. Method: Power calculations suggested 52 subjects with viable, singleton pregnancies were required for reliability analysis. CRL of each embryo was analysed using 2D and a 3D dataset acquired using transvaginal USS (Voluson E8). VOCAL was used to calculate volume of gestation sac (GS) and yolk sac (YS). SonoAVC was used to quantify amniotic fluid (AF) volume. Embryo volume was calculated by subtracting the sum of AF and YS volumes from GS volume. Each dataset was measured twice. Reliability was assessed using Bland Altman plots and intraclass correlation coefficient (ICC). Results: 74 subjects were recruited to provide the 52 datasets required for analysis. Median embryo volume was 1.819cm 3 (0.026-8.129cm 3). Median gestational age was 7 + 6 weeks based on CRL of 13mm (2-29mm). Limits of agreement showed mean difference of 0.020cm 3 (95% CI −0.308 to 0.370); ICC was 0.998 (95% CI 0.996-0.999) confirming high level of intraobserver agreement. Regression analysis showed good correlation (R2=0.76) between embryo volume and gestational age. Conclusions: The new semi-automated 3D technique provides reliable measures of embryo volume. Further work is required to assess interobserver agreement and validity.

Objective: To generate and validate individually fitted first-trimester growth curves using a new growth model. Secondary aims were to compare this new model with actual recorded embryonic measurements and validate its predictive accuracy. Methods: A prospective study of women presenting to the Early Pregnancy Unit in the first trimester. Women with viable singleton pregnancies at the end of the first trimester who had had at least two crown-rump length (CRL) measurements were selected. An individual power function of CRL was derived from serial CRL measurements. Individual curves were fitted using computer software to estimate a dating adjustment factor (‘k’), and a growth coefficient (‘P’) for each case. The predictive accuracy of the growth curves was then tested in a validation subset of the population that had a third CRL measurement. The population average curve from the developed model was also extrapolated to day 27 menstrual age (Carnegie stage 6), day 30 menstrual age (Carnegie stage 7) and day 84 menstrual age, and values were compared to previously reported measurements. Results: 326 viable pregnancies were selected for CRL growth curve development. The mean time interval between CRL measurements was 20.5 days (range 2–44). The mean value for ‘P’ was 2.058, and for ‘k’ 24.6. Testing the model on a subset of 81 cases showed that the average error in predicting a third CRL measurement was 1% (SD 9.1%). Conclusions: These new, individually fitted growth curves for the first trimester correlate more closely with the recorded embryonic lengths than other standards.