Backgrounds/Aims: To assess the perinatal outcome of pregnancies with chorionic bump detected at the first trimester of pregnancy. Methods: This was a nested case-control study of pregnancies with chorionic bump identified at the first trimester ultrasound that was performed from October 2014 and October 2016. The control group consisted of the following 5 unaffected pregnancies after each case. From the first trimester ultrasound, maternal and perinatal characteristics were obtained and stored in a dedicated database. The primary outcome was defined as the presence of an alive new-born. Secondary outcome was defined as the presence of a composite adverse obstetric outcome. Results: Eleven first trimester pregnancies affected by a chorionic bump and 55 controls were identified. The primary outcome was observed in 72.7 and 89.1% of chorionic bump and controls respectively (p = 0.2). The secondary outcome was observed in 45.5% of pregnancies with a chorionic bump versus 12.7% in the unaffected group (p = 0.01). First trimester uterine artery Doppler demonstrated a non-significant trend to be higher in the chorionic bump group. Conclusions: The presence of a chorionic bump is associated with a significant higher risk of adverse perinatal outcome.

Objectives:To determine the detection capacity of early-onset pre-eclampsia (ePE) with a combined first and second trimester screening model. Methods: Longitudinal study in 4,063 singleton pregnancies that attended for an 11 + 0 -13 + 6 and 20 + 0 -24 + 6 weeks ultrasound, which included the prediction of ePE by combining maternal history and Uterine Artery Doppler (UtAD) at first trimester (1T) and only UtAD at second trimester (2T). Maternal characteristics were prospectively entered into a database. An ePE 1T predictive model created in our Unit was used (S:60%, FPR:10%, cut-off 2.1%). The same patients were assessed at 20 + 0 -24 + 6 weeks with UtAD and re-classified in a high risk group of ePE according to mean UtAD pulsatility index (PI), if 95th centile was reached. Final high risk patients were selected by combining both models. Results: During the study period 129 patients developed PE (3.2%), of these 26(0.6%) were ePE (delivery <34 weeks). Independently, the ePE predictive models in 1T and 2T demonstrated a sensitivity and FPR of 42.3% (n = 11/26) and 9.5% vs 80.8% (n = 21/26) and 5.2%, respectively. When both models were combined, 387 patients were assigned at risk of ePE (9.5%) during the 1T. When UtAD was evaluated in this group during the 2T, only 72 patients were re-classified as a high risk of ePE (1.7%).In the combined high risk group is the 90.9% (n = 10/11) of patients detected during the 1T of pregnancy. The only patient not identified with the 2T model was a patient with chronic hypertension and lupus. Combined sensitivity of the sequential model was 38.5% (n = 10/26) with a combined FPR of 11.2%. Conclusions: This study confirms that 2T UtAD is better than 1T screening for ePE. However, because ePE prevention is based in the use of aspirin before 16 weeks, 1T screening is the best strategy to detect this condition. The combined model demonstrated a sensitivity of about 40% and a FPR of 11%, but with a 5-fold reduction of any preventive strategy started during the 1T. Federal University of Minas Gerais, Belo Horizonte, BrazilObjectives: Hypertensive disorders in pregnancy, mainly pre-eclampsia (PE), are responsible for high rates of maternal mortality around the world, in particular in developing countries, among them, Brazil. A significant percentage of these deaths could be avoided with proper monitoring and satisfactory prediction of the clinical onset of PE. The flow-mediated dilation of the brachial artery (FMD) is a biophysical marker of endothelial dysfunction, known to be a key factor in the development of PE. The objective was to access the accuracy of flow-mediated dilation of the brachial artery (FMD), in the prediction of early and late PE. Methods: A total of 91 patients, considered at high risk for PE development were recruited at our institution's prenatal service and subjected to FMD between 24 and 28 weeks of gestation. Objectives: to determine whether first or second trimester uterine artery Doppler is a useful tool for identifying pregnancies with systemic lupus erythema...

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Electronic poster abstractsResults: The normalized estimated placental and brain resistances were respectively increased and reduced in IUGR fetuses (Fig).There was a trend towards an increased placental compliance, and dilatation of the arteries while maintaining vascular elasticity. Conclusions: Individual IUGR fetuses show marked differences in their vascular components with a higher placental resistance as major determinant for the observed changes in measured Doppler flows. The proposed computational model seems to be a good approach to assess hemodynamic parameters than cannot be measured clinically.Supporting information can be found in the online version of this abstract P13.12 Objectives: To estimate the combined value of the cerebral Doppler with the Bishop Score predicting perinatal outcome after labour induction in late-onset intrauterine growth restricted (IUGR) fetuses with normal umbilical artery Doppler. Methods: We conducted this prospective study in two tertiary centers with women attending to labour induction because of an estimated fetal weight below 10th percentile with normal Umbilical artery Doppler. The middle cerebral artery pulsatility index (MCAPI) and CPR was obtained in all cases. Cervical conditions were always assessed at admission by the Bishop score. Very unfavourable cervix was defined as a Bishop score below two. A predictive model for perinatal outcomes was constructed using the Decision Tree Analysis algorithm (SPSS 20.0). Results: We finally included in the study164 patients. Abnormal CPR cohort presented an increase rate of overall Caesarean section with respect to the normal CPR (25% vs 12.8%;p = 0.017). Caesarean for fetal distress was required in 28 cases (17.1%) in the abnormal CPR group, while only in 12 patients (7.3%) of normal CPR group (p = 0.016). Neonatal admission was twice in the abnormal CPR cohort (37.1% vs 21.3%;p = 0.028). Bishop score below two was the best isolated predictor for overall Caesarean (OR 5.32; 95% CI 2.32 -12.17) and Caesarean for fetal distress (OR 3.18; 95% CI1.28 -7.86). A decision tree analysis for the risk of overall and fetal distress Caesarean, stratified the risk by cervical conditions and later by CPR. Rates of overall and fetal distress Caesarean were 60.7% and 39.3% in those patients with unfavorable cervix and abnormal CPR, while in those with favorable cervix and normal CPR Caesarean rates were 12.5% and 8.3% respectively. The presence of brain redistribution increase twice the risk of Caesarean and fetal distress Caesarean after the cervical assessment. Conclusions: The combined use of cervical conditions and cerebral Doppler improves the predictive ability of Caesarean after labour induction in late IUGR.

Objectives:To determine the detection capacity of early-onset pre-eclampsia (ePE) with a combined first and second trimester screening model. Methods: Longitudinal study in 4,063 singleton pregnancies that attended for an 11 + 0 -13 + 6 and 20 + 0 -24 + 6 weeks ultrasound, which included the prediction of ePE by combining maternal history and Uterine Artery Doppler (UtAD) at first trimester (1T) and only UtAD at second trimester (2T). Maternal characteristics were prospectively entered into a database. An ePE 1T predictive model created in our Unit was used (S:60%, FPR:10%, cut-off 2.1%). The same patients were assessed at 20 + 0 -24 + 6 weeks with UtAD and re-classified in a high risk group of ePE according to mean UtAD pulsatility index (PI), if 95th centile was reached. Final high risk patients were selected by combining both models. Results: During the study period 129 patients developed PE (3.2%), of these 26(0.6%) were ePE (delivery <34 weeks). Independently, the ePE predictive models in 1T and 2T demonstrated a sensitivity and FPR of 42.3% (n = 11/26) and 9.5% vs 80.8% (n = 21/26) and 5.2%, respectively. When both models were combined, 387 patients were assigned at risk of ePE (9.5%) during the 1T. When UtAD was evaluated in this group during the 2T, only 72 patients were re-classified as a high risk of ePE (1.7%).In the combined high risk group is the 90.9% (n = 10/11) of patients detected during the 1T of pregnancy. The only patient not identified with the 2T model was a patient with chronic hypertension and lupus. Combined sensitivity of the sequential model was 38.5% (n = 10/26) with a combined FPR of 11.2%. Conclusions: This study confirms that 2T UtAD is better than 1T screening for ePE. However, because ePE prevention is based in the use of aspirin before 16 weeks, 1T screening is the best strategy to detect this condition. The combined model demonstrated a sensitivity of about 40% and a FPR of 11%, but with a 5-fold reduction of any preventive strategy started during the 1T.Objectives: Hypertensive disorders in pregnancy, mainly pre-eclampsia (PE), are responsible for high rates of maternal mortality around the world, in particular in developing countries, among them, Brazil. A significant percentage of these deaths could be avoided with proper monitoring and satisfactory prediction of the clinical onset of PE. The flow-mediated dilation of the brachial artery (FMD) is a biophysical marker of endothelial dysfunction, known to be a key factor in the development of PE. The objective was to access the accuracy of flow-mediated dilation of the brachial artery (FMD), in the prediction of early and late PE. Methods: A total of 91 patients, considered at high risk for PE development were recruited at our institution's prenatal service and subjected to FMD between 24 and 28 weeks of gestation.Results: From selected patients, 19 developed PE, 8 in its early form and 11 in its late form. Using a cut-off value of 6.5%, the sensitivity (S) of FMD for early PE prediction was 75.0%, with specificity (E) of 73.3%...