Well-trained operators do not seem to benefit from the use of the semiautomated measurement methods.

Objectives:To assess the added-value of a specific quality evaluation for crown-rump length (CRL) measurement at the first trimester ultrasound examination for Down syndrome screening. Methods: We analysed data collected as part of the national training program on first trimester prenatal screening conducted by the French College of Foetal Ultrasonography (CFEF). Prospective data for the initial 64 months of the training audit were examined. Using the CFEF new image scoring method (NISM) that comprises the nuchal translucency (NT) and the CRL measurements quality evaluations, 30 experts scored the ultrasound images. We determined categories of quality scores corresponding to those of Herman's, using both the full NISM, and a shortened version of the NISM that did not consider CRL quality. We compared CRL measurement quality for each category of the quality scores. Results: ,250 evaluations of ultrasound examinations from 1,913 sonographers were analyzed. Using the full NISM, the proportions of ''excellent'', ''reasonable'', ''intermediate'' and ''unacceptable'' images were 35%, 49%, 8.0% and 7.8%, respectively. Among the images considered ''excellent'' using the full NISM, 4.06% had an insufficient score for CRL quality. When the shortened NISM was used (excluding CRL quality), 9.24% of ''excellent'' images had an insufficient score for CRL measurement (RR = 2.27, 95% CI = [2.11-2.44]). Conclusions: Our results suggest than an image scoring method based on NT quality measurement only is not adequate for discriminating between good and insufficient quality of CRL measurements. Errors in CRL measurement can in turn lead to both inappropriate dating and risk assessment in the first trimester. Therefore, a specific evaluation of the quality of CRL measurement should be considered as an important part of best practice assessment and training programs. OP07.03Manual and semi-automated measurement of the nuchal translucency: are there any clinical significant differences?M. Bakker, P. B. Mulder, E. Birnie, C. M. Bilardo Fetal Medicine, University Medical Centre Groningen, Groningen, NetherlandsObjectives: Are the differences between the manual and semiautomated measurement of the nuchal translucency (NT) clinically relevant? Methods: Retrospectively 100 NT images from singleton pregnancies were selected, obtained at 11+0 to 13+6 weeks of gestation. All images had been acquired trans-abdominally using a Voluson E8 equipped with a 4-8 Hz probe (GE Medical Systems). Only images without measurements were used. For each image two trained operators obtained the manual measurements (according to FMF guidelines) and the semi-automated NT measurements (SONO-NT: inner-inner and inner-middle method). The respective NT measurements and the associated risk on trisomy 21, calculated in Astraia, were transformed into a low (< 1:200) Objectives: Assessment of repeatability of the CRL measurement and examine the effect on first trimester combined screening. Methods: Intra-and inter-operator repeatability of CRL measurement at 11-13 w...

Muscle ultrasound density (MUD) is a non-invasive parameter to indicate neuromuscular integrity in both children and adults. In healthy fetuses and infants, physiologic MUD values during development are still lacking. We therefore aimed to determine the physiologic, agerelated MUD trend of biceps, quadriceps, tibialis anterior, hamstrings, gluteal and calf muscles, from pre-to the first year of postnatal life. To avoid a bias by pregnancy-related signal disturbances, we expressed fetal MUD as a ratio against bone ultrasound density. We used the full-term prenatal MUD ratio and the newborn postnatal MUD value as reference points, so that MUD development could be quantified from early pre-into postnatal life. Results: During the prenatal period, the total muscle group revealed a developmental MUD trend concerning a fetal increase in MUD-ratio from the 2 nd trimester up to the end of the 3 rd trimester [median increase: 27% (range 16-45), p < .001]. After birth, MUD-values increased up to the sixth month [median increase: 11% (range-7-27), p = 0.025] and stabilized thereafter. Additionally, there were also individual MUD characteristics per muscle group and developmental stage, such as relatively low MUD values of fetal hamstrings and high values of the paediatric gluteus muscles. These MUD trends are likely to concur with analogous developmentally, maturation-related alterations in the muscle water to peptide content ratios.

Objectives:To know the perinatal outcome in patients with nuchal translucencies ≥ 1.8 Mom in the first trimester sonography and normal combined screening, and to determine whether in these cases, we have to propose a invasive test to parents despite a combined screening result ≤ 1/270. Methods: We have analized a total of 9280 combined screenings in our hospital over the last 4 years. For a false positive rate of 5%, 28 patients had a nuchal translucency ≥ 1.8 Mom, and despite that, the combined risk obtained was ≤ 1/270. The measurement of nuchal translucencies was between 3 and 3.9 mm. Results: Of these 28 patients, 2 were lost to follow-up. All amniocentesis performed have resulted in a normal karyotype. All fetuses had a normal echocardiogram, except a case of mild tricuspid insuficiencia. There was one case of unexplained antepartum stillbirth at 35 weeks. All infants were normal. Conclusions: Although the association of a sonoluscencia ≥ 3 mm in the ultrasound, and a combined screening of low risk is not frecuent, in our experience, this has not been accompanied by chromosomal abnormalitys. So, advise the parents performing a invasive test in this cases, is probably not correct, being perhaps more appropriate, intensify the ultrasonographic surveillance to search sonographic markers of heart disease, skeletal dysplasias or genetic anomalies. Objectives: To evaluate the pregnancy and pediatric outcome of the fetuses with septated nuchal cystic hygroma. Methods: We searched our perinatology unit records for cases with septated nuchal cystic hygroma. Data for structural abnormalities, karyotype analysis and pregnancy outcome were collected. Fetuses born with cystic hygroma were also evaluated for their pediatric outcome. P06Results: A total of 60 fetuses with nuchal septated cystic hygroma were enrolled in the study. Chromosomal abnormalities were present in 24 (40%). The most common aneuploidy was Turner syndrome (n = 11, 18.3%). The other common aneuploides were Down syndrome (n = 8, 13.3%) and Trisomy 18 (n = 3, 5%). 12 (20%) fetuses also had coexistent structural malformations. There were 38 (63.3%) elective pregnancy terminations and 10 (16.6%) spontaneous fetal intrauterine demise. 11 (18.3%) fetuses were born alive. Of these 7 (11.6%) had normal pediatric outcome, 2 (3.3%) had cardiac abnormality, 1 (1.6%) had chromosomal abnormality and 1 (1.6%) had developmental delay with motor retardation. Conclusions: Septated nuchal cystic hygroma is associated with poor perinatal outcome. Karyotype analysis and ultrasonography for anomaly screening should be performed as an initial step. Expectant management should be offered to pregnants who have euploid fetuses with normal morphology. .5% with NT of 3.5-4.4 mm, 36.4% with NT of 4.5-5.4 mm, 54.5% with NT of 5.5-6.4 mm and 95.5% with NT above 6.5 mm. 19% (45/237) had chromosomal disorders. The rate of aneuploidy was 61% in the group with skin edema and significantly higher compared to 10.2% in those without skin edema (P < 0.0001). In the group of fetuses with n...