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Methods: All medical articles and congress abstracts are included in the national review system, similar to PubMed. We searched this system using the terms ''abdominal pregnancy'' and identified 69 articles, including 95 cases of AP with sufficient clinical information, including our previously reported case. There were 86 early (E) APs and 9 advanced (A) APs. There were eight MTX-indispensable EAPs. Results: Among the EAPs, MTX was administered after primary surgery in eight (9%, 8/86). The patient's background, pregnancy weeks, implantation site, operation, blood loss, blood transfusion, reason for MTX therapy and MTX schedule are examined. Pregnancy weeks were documented in six cases and were 5 (2 cases), 6, 7, 8 and 10 weeks respectively. Implantation sites varied. Blood loss ranged from 225-2,000 g in five of the eight cases and blood transfusion was performed in one case. MTX was administered to one patient (12.5%) who did not undergo surgical extraction because of liver pregnancy, one patient (12.5%) without tumor extraction for fear of massive bleeding and to the remaining six patients (75%) because of incomplete extraction or residual pathological changes. MTX was mostly administered according to the usual regimen for trophoblastic disease. Conclusions: MTX-indispensable EAPs should be regarded as dangerous. Some EAPs cannot be managed only by operative dissections but MTX administration are required for additional therapy. P16.09Psychological acceptability of transvaginal scan among Nigerians attending for early pregnancy ultrasound

Results: The evidence from 10 studies examining 3,056 women showed a small benefit on live birth/ongoing pregnancy and on clinical pregnancy despite the heterogeneity observed. Subgroup analyses separating the studies by single/multiple doses of GnRH agonists or by ovarian stimulation with GnRH agonist/antagonist did not explained the heterogeneity. Conclusions: Adding GnRH agonist during luteal phase improves ongoing pregnancy. However, this evidence is of very low quality and there is no evidence about adverse perinatal outcomes and congenital malformations. We therefore believe that including this intervention in clinical practice would still be premature. OP19.03The evaluation and clinical value of the tubal patency through the application of real-time three dimensional hysterosalpingo-contrast sonography (HyCoSy) The difference between the evaluation of tubal patency under two modes was not statistically significant (P > 0.05). However, there was significant statistical disparity between the outcomes of the fallopian tube lines under the two modes (P < 0.05), which was assessed better with 3D HyCoSy rather than 2D HyCoSy. Conclusions:The method of TVS 3D HyCoSy with SonoVue has obvious advantages in evaluating the tubal patency and the fallopian tube line, a high value in clinical application and could be further expanded.Supporting information can be found in the online version of this abstract Objectives: To assess the efficacy of intramuscular pethidine in the reduction of pain during hysterocontrast sonography (HyCoSy). Methods: Six hundred and six patients undergoing HyCoSy were randomised to receive either 0.75 mg/kg intramuscular pethidine with NSAID or NSAID alone, 30 minutes before the procedure. Visual analogue pain scoring was carried out immediately after the procedure to ascertain the degree of pain felt during the procedure. The effect of tubal patency status on pain score was also ascertained. Results: There was a significant pain reduction with intramuscular pethidine compared to the group without pethidine administration (mild or less pain 44.9% versus 13.0%). In both treatment group, tubal patency was associated with reduced pain scores.

Poster discussion hub abstracts complicated pregnancy and in relation to situations where the maternal and fetal health interests conflict. Methods: A qualitative study design was employed and data were collected in 2013 through interviews with obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis. Results: The main category 'There are two sides of same the coin' illustrates the overall finding that although the obstetricians viewed the ultrasound as an essential and much valued tool in obstetric care, they experienced obstetric ultrasound simultaneously as having given rise to several challenging issues in the care of pregnant women. The challenges described were mainly related to expectant parents' lack of knowledge and preparedness for the potential results of the examination. Additionally, the increased focus on fetal health was recognised as sometimes entailing suffering for the pregnant women who at times were also exposed to health risks in association with interventions aiming to improve the condition of the fetus. Conclusions: The widespread use of ultrasound in obstetric care has entailed new challenges for the practitioner due to enhanced possibilities to diagnose and treat fetal conditions which in turn sometimes conflicted with the health interests of the pregnant woman. Further ethical discussion is needed about the pregnant woman's position in clinical management of situations where maternal and fetal health interests conflict. Developments in the use of ultrasound also raise demands on information and counselling. Practitioners need therefore to use methods and routines that enable expectant parents to make informed decisions regarding pregnancy management. P12.07 New approach to the exploration of internal genital fetal organs: an acoustic window to view the fetal uterusSexual differentiation of the external and internal genitalia depends on a complex process and involves several physiopathological mechanism.Primitive gonad will differentiate under the SRY effect in testis that will secrete testosterone and AMH causing regression of Müllerian ducts, persistence of Wolffian ducts and virilisation.In the absence of SRY, primitive gonad differentiate into ovaries, with regression of Wolffian ducts and persistence of Müllerian ducts responsible of uterus, salpinx and the third superior part of vagina. The external genitalia are female.The unusual aspect of the external genitalia is found in many pathology but also in Congenital Adrenal Hyperplasia (CAH) and Partial Androgen Insensitivity Syndrome (PAIS).A new exploration technique of internal genitalia and particularly the visualisation of the existence of a fetal uterus help to differentiate these two pathologies.An acoustic window through the proximal femoral epiphysis allows viewing the cervix when present.This exploration, easy to learn, provides a diagnostic aid in this exceptionality pathology when a multidisciplinary approach is necessary Supporting information can be fou...

Diffusion-weighted MRI was performed with a 1.5 T MRI and axial echoplanar diffusion sequence with 4 and 11 b-values respectively. Three different region of interest (ROI) were selected manually on the placenta, on 3 successive slides close to the cord insertion. These ROIs were analysed with different post processing algorithm: ADC (mono-exponential least square fitting), IVIM sequential approach (bi-exponential least square fitting). We analysed the changes in parameters (ADC, f, D* and D) across GA and according to z-score of fetal birthweight and placental weight. Results: A total of 55 patients were analysed using diffusion-weighted MRI. There was a significant linear correlation between ADC and z-score of fetal birthweight (p = 0.004) and a significant quadratic correlation between ADC and GA (p = 0,001). On the IVIM sequential approach, there was also a significant linear correlation between f (perfusion fraction) and z-score of fetal birthweight (p = 0.008) and placental weight (p = 0.05) as well as a significant quadratic correlation with GA (p = 0.04). Conclusions: Our study suggests that placental function can be studied in vivo based on MRI diffusion weighed imaging. IVIM may provide an interesting method to evaluate placental perfusion in humans, without using contrast agent nor radiation. The linear relationship between the perfusion fraction and z-score of the fetal weight suggests this might be a suitable tool to detect placental insufficiency and monitor patients at risk of IUGR. OP09.02Whatsapps ultrasound teleconsultation in a low-resource setting: feasibility, accuracy and patient's psychological acceptability