Objectives: To study feasibility and reproducibility of a new image-scoring method for angle of progression (AOP) measurement by transperineal ultrasound (TPU). Methods: TPU was performed for 55 singleton pregnancies at term in second stage of labour. 55 images obtained by TPU were recorded and interpreted independently by three reviewers. A quality score on 8 points was defined for AOP measurement. Three criteria were ascertained as major, (2 points): line in the axis of the symphysis parallel with the pubic rami, fetal skull clearly visible, correct positions of callipers. Two criteria were ascertained as minor given (1 point): symphyseal capsule visible, zoom enough. No point was given when a criteria was not visualized. Using final scores, AOP measurements were classified into three groups of quality: good (6-8), intermediate (4-5), unacceptable (0-3). Agreement for distributions in quality groups were evaluated between pairs of reviewers. Triplets of values were used to assess the inter-observer agreement for AOP scoring in each quality group. ICC according quality groups were calculated to assess the effect of quality measurement on inter-observer agreement for AOP measurement. Results: Among all AOP measured, 12.7% were classified as unacceptable. Distributions in the three quality groups were not significantly different between the reviewers. There were no statistical difference for agreement between the three pairs of reviewers (Fisher test, p = 0.33). 19 triplets of values for good scores and 26 triplets of values for intermediate scores were used to calculate ICC. Inter-observer agreement for the AOP was sligthly better in the good quality group than in the intermediate group, ICC 0.79 (CI95%; 0.64-0.89) and ICC 0.59 (CI95%; 0.33-0.80), respectively. Conclusions: Using a reproductible image-scoring method for AOP, we demonstrated that non optimal measurement of AOP could affect its reliability. As 12.7% of AOP were classified as unacceptable, future studies should implement an image-scoring method to insure quality of AOP measurement.

Objectives: Different authors have reported multiple risk factors that favour avulsions of LAM: forceps, prolonged second stage of labour, fetal head circumference and no epidural.To establish what factors influence in the occurrence of lesions in the levator ani muscle (LAM) during vaginal delivery. To determine the changes that occur when there are injuries postpartum. Methods: We conducted a prospective observational study including 73 primiparous with vaginal delivery. We did 3 volumetric capture each patient (rest / valsalva / contraction) (48h postpartum).The study and image processing was done at the level of minimum dimensions (PMD) (Dietz), assessing avulsion by the use of the multi-slice (Multiview) from PMD (2.5 mm intervals). Complete avulsion was considered if the lesion was present in the three central courts to PMD (partial the rest). Urogenital hiatus area was established at rest, valsalva, contraction. Statistics: T-Student's for p. parametric and U Mann-Whitney for non-parametric. Results: See table 1. Conclusions:We conclude that the fetal weight is the most important factor of occurrence of avulsions. Also we observe that the presence of avulsion entails an increase of hiatal area which in the future will favour risk of genital prolapse. OP14.11Transperineal 3D pelvic ultrasound in the assessment of voiding dysfunction following suburethral sling surgery Objectives: The mid-urethral synthetic sling (MUS) is the most commonly performed surgical procedure for treatment of female stress urinary incontinence. However, some patients (1-9%) may develop voiding dysfunction due to urethral obstruction which is often treated by sling division. We aimed to evaluate the utility of transperineal 3D pelvic ultrasound in the assessment of patients with persisting voiding dysfunction following MUS surgery. Methods: 12 patients with voiding dysfunction post retropubic MUS were studied. All patients had urethral obstruction on urodynamic evaluation. Transperineal pelvic ultrasound examinations were performed using a Philips IU22 ultrasound machine with X6-1MHz Matrix transducer. Dynamic 2D imaging was performed in the sagittal plane at rest and on Valsalva. 3D volumes were obtained and analysis performed on Qlab software to evaluate sling position relative to the urethra. Results: Of 12 patients with obstructive slings, 6 had undergone previous transvaginal surgery to relieve obstruction (4 had division of sling, 2 had excision of a suburethral sling segment). All slings were easily visualized on 2D transperineal imaging. Dynamic compression of the urethra by sling was observed on 2D imaging in all patients. 3D volume analysis in patients who had persistent voiding dysfunction despite previous sling division showed there was little separation of the ends of the divided sling (<3mm). In 2 patients who had undergone excision of a suburethral sling segment, 3D volume analysis showed there was incomplete excision with a small amount of sling continuity. 9 patients subsequently underwent urethrolysis with excision...

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Were analyzed the following data: reason for of MRI, GA at MRI, position of the stomach and jejunum in T2. Position of the jejunum was defined as normal if in the left flank below the stomach and abnormal otherwise, therefore classified into 3 groups : intra-thoracic (A), extra-fetal (B) and abnormal intrafetal (C). The position of the jejunum was studied by two independent operators. Antenatal data were correlated to postnatal imaging, surgical or autopsy findings. Results: 709 fetal MRI were performed during this period. The mean GA at MRI was 30 WG (22 min-37 max). In 64 cases (9%) jejunum was absent from the sub gastric area in the left flank on T2-weighted images. Forty-one fetuses (64 %) had a left diaphragmatic hernia with intrathoracic position of the proximal jejunum (group A). In 11 cases (17%), jejunum was extrafetal due to gastroschisis (group B). In 12 cases (19%) intra-abdominal proximal jejunum was in an abnormal position, i.e. in the middle or right flank, with a normally positioned stomach (group C). In only 2 cases of group C (16.6%), gastrointestinal abnormality was suspected on ultrasound. The two operators were concordant in 100 % of cases. All diagnoses of groups A and B (52 cases) were confirmed postnatally or at autopsy. In 10 cases (83%) of group C, malposition was also confirmed postnatally while it had not been suspected during prenatal ultrasounds. One case had a right jejunal deviation caused by a large duplication cyst but bowel position was normal at surgery. In the other one, jejunal position proved normal postnatally. Conclusions: due to T2-weighted sequences high contrast resolution, fetal MRI is a useful tool for prenatal diagnosis of digestive malposition, including in cases where fetal ultrasound did not suspect this diagnosis. P22.14 Early fetal morphological evaluation (12-14 weeks): abdominal ultrasonography approach

Oral communication abstractsultrasound data (n = 12), leaving 538 data sets for analysis. The mean age was 53 years . Prolapse symptoms were reported by 263 (49%). On PFUS mean bladder descent was −6.5mm (32 to −63.8), mean uterine descent +14.3mm (56.1 to −51.1), mean enterocele descent −0.92mm (0 to −48.6) and mean rectal descent was −7.26mm (39 to −54.1). ROC statistics suggested a cut-off 15mm above the symphysis pubis for diagnosing an abnormal degree of uterine descent on Valsalva, giving a sensitivity of 70% and a specificity of 57% for the prediction of symptoms of prolapse. The area under the curve was 0.68 (0.63−0.72). Conclusions:In this large retrospective study, the optimal cut-off for defining abnormal descent of the uterus was defined as 15 mm above the SP. This is much more cranial than previously defined cutoffs for bladder prolapse (10 mm below the SP) and rectal descent (15 mm below the SP). Clearly, a given degree of uterine descent is much more likely to lead to symptoms of prolapse than the same degree of bladder or rectal descent. OC09.04Determination of levator ani muscle lesions in instrumental delivery with vacuum using transperineal 3D-4D ultrasonography