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Conclusions:The attempt of an early sonographic imaging of the fetal cardiac anatomy is very important for a timely prenatal diagnosis of major congenital heart diseases. The examination conditions are often difficult and require well-experienced examiners. It is feasible to perform basic fetal heart examination during routine first trimester screening. P27.08First trimester cardiac screening for major CV anomalies performance using transabdominal simplified fetal echocardiography protocol M. Calomfirescu MMF, Cabinet Dr Calomfirescu Marius Vicea, Bucuresti, RomaniaObjectives: To assess the performance of first trimester screening for cardiac anomalies using transabdominal examination with power Doppler of atrioventricular flow and aorto-pulmonary flow without extending the time of exam. Methods: The study was conducted in a retrospective manner in single centre, single operator, GE Voluson E8 ultrasound machine, period 01.01.2015 -31.12.2016, 665 patients (615 single, 50 multiple) examined with first trimester screening for chromosomal and fetal structural abnormalities and were without chromosomal anomaly. Results: Good visibility with confident assigning of normal or suspect imaging was obtained in 530 patients (25 multiple). Normal images were obtained in 525. Three were confirmed on later echocardiography and 1 with Fallot pathology was missed.Aspects associated with poor visibility were adiposity, uterine pathology, previous pelvic surgery (including Caesarean), multiple pregnancy and advancing age. 3 major CV anomalies were in this group.For twin pregnancies extension of examination time was necessary in order to acquire interpreting images. In triplets (3) we were unable to have interpreting images for all fetuses using just the transabdominal exam. Conclusions: First trimester cardiac screening for major CV anomalies is feasible.In this rather short series major CV anomalies were more frequent in unsatisfactory images using transabdominal examination. This observation would argue in favour of transvaginal examination in the cases with suboptimal images on transabdominal exam. P27.09Diagnostic accuracy of basic fetal heart examination at 11-13 weeks' gestation of pregnancy Objectives: Investigate the diagnostic performance of a simplified fetal heart examination in a routine setting of first trimester ultrasound screening for aneuploidies. Methods: This was a prospective observational study, in which a basic cardiac examination applying the cross-sections of the 4-chamber and/or 3-vessels views using colour Doppler was performed at the 11 to 13 weeks ' gestation scan in a routine setting in single pregnancies.Results: A total of 1850 single fetuses performed first and second trimester ultrasound scans between January 1st 2016 and January 13th 2017. Overall, 1799 cases with second trimester scan, echocardiography or autopsy findings were included. In 1177 cases (65.4%) basic heart examination was not performed during first trimester because of difficult fetal position, maternal obesity with inadequate v...

Classification of CHDs in prenatal cardiology, related to perinatal management and neonatal outcome, in 2016 was such as: the most common were severe CHD 47%, non-urgent CHD 33%, critical CHD 20% and the most severe CHD 0,2%. In 2014 and 2015 the most common reason for fetal echo in tertiary centres was abnormal 4 chamber view (2014 -61,8%, 2015 -61,2%) and in 2016 abnormal 3 vessels view -43,2%. In 2016 Caesarean sections (CS) in Poland were performed in 70,4% and vaginal deliveries (VD) in 29,6%. In 2015 CS and VD were: 50% and 50%, and in 2014 were 56,1% of VD.

Objectives: The soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio has shown to be a useful tool for the diagnosis of pre-eclampsia (PE). An elevated sFlt-1/PlGF ratio is associated with adverse perinatal outcome (APO) in singleton pregnancies complicated by PE. Data on APO prediction in twin pregnancies using sFlt-1/PlGF ratio are scarce. We evaluated the predictive value of the sFlt-1/PIGF ratio regarding APO in twin pregnancies with suspected PE and/or HELLP syndrome. Methods: This is a single centre retrospective cohort study. All twin pregnancies with suspected PE/HELLP, in which sFlt-1/PIGF ratio was determined, were included. APO was defined as the presence of at least one of following outcomes: small for gestational age (SGA: birthweight below the 10th centile), respiratory distress syndrome (RDS), intubation, admission to neonatal intensive care unit (NICU), arterial umbilical cord pH value < 7.20, and 5min APGAR ≤ 7. Results: 51 twin pregnancies were included. Of these patients, 75% (38/51) were diagnosed with PE/HELLP. Mean sFlt-1/PIGF ratio was higher in patients with APO (79.4 ± 65.5 vs. 60.1 ± 40.1), without reaching statistical significance (p = 0.09). ROC analysis for individual APO indices showed a significant predictive value for sFlt-1/PIGF ratio and SGA at birth (AUC = 0.753, 95% CI: 0.578-0.929, p = 0.005). No significant association was found for other APO indices. Conclusions: In twin pregnancies with suspected PE and/or HELLP syndrome, sFlt-1/PIGF ratio may be helpful for APO prediction. However, further prospective studies are warranted to define the role of sFlt-1/PlGF ratio as APO predictor in twin pregnancies.

Biometric and Doppler parameter reference charts (RC) impact the diagnosis and clinical management of fetal growth abnormalities. We evaluated the variability of adopted RC at national level. Methods: A questionnaire was sent to 12 tertiary referral centres with expertise in the management of fetal growth restriction. Results: There are wide discrepancies among centres in RC used for antenatal biometric and Doppler parameters and birthweight (figure 1), especially for Crown-rump length, femur length, estimated fetal weight, umbilical and middle cerebral arteries (MCA) pulsatility index (PI), but also for other variables. The most uniform application of RC was for ductus venosus PI and peak systolic velocity in MCA, although not without variability. While all centres have a training program, no quality control or audit is contemplated. Conclusions: Despite the awareness that diagnosis, management and research results also depend on measurement quality and RC, there is wide heterogeneity among Italian referral centres. Urgent actions are needed to homogenize the adoption of RC for fetal biometric and Doppler parameters and birthweight, and to implement quality control.