Summary. In a prospective study 32 leiomyomas (fibroids) in 29 pregnant women were examined with ultrasound every 3–8 weeks. Each patient had hetween 3 and 6 scans (mean 4.4) during the course of pregnancy, and 13 patients had a final scan at 6 weeks postpartum. An individual growth curve was established for each tumour and the patterns of growth were analysed. No increase in size during the pregnancy was observed in 25 fibroids (78%). Only 7 (22%) increased in size but by no more than 25% of the initial volume. At 4 weeks postpartum the size of the fibroids did not differ significantly from the size during pregnancy.

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In 37 consecutive twin pregnancies, monthly Doppler sonographic measurements were made of blood flow velocity waveforms of the internal carotid and umbilical artery of each fetus. A total of 197 Doppler studies were performed. Of the 74 infants, 23 were small for gestational age (SGA). Thirty-five of the SGA Doppler studies were abnormal, giving an overall sensitivity for predicting SGA fetus of 58% and a positive predictive value of 71%. These data are not as sensitive and specific as our earlier data; however, Doppler criteria preceded sonographic diagnosis of SGA by a mean interval of 3.7 weeks and demonstrated better sensitivity and specificity. A combination of these parameters improves sensitivity to 84%. We conclude that Doppler velocimetry complements real-time ultrasonography for the early diagnosis of abnormal growth in twin pregnancies.

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Objective: To investigate the role of power Doppler in differentiating septate and bicornuate uterus prior to perform office operative hysteroscopy. Methods: Ten patients with previous hystory of infertility were referred to our US Dept. At the admission, transvaginal US axial scan of the uterus showed that the endometrium was as divided in two parts separated by hypoechoic tissue. B scan alone was unable to differentiate bicornuate from septate uterus. No shows difference could be found in uterine fundal contour. Power Doppler evaluation of uterine vascularization was performed in all patients. All patients were submitted to diagnostic laparoscopy. Results: In six patients the main branches of uterine arteries appeared to converge, at the uterine midline, in a single median arterial vessel flowing between the two emiuteruses, mimicking the greak letter gamma. Irregular vascular spots, at the uterine midline, have been found in the remaining four patients. Laparoscopy revealed that thẽ a (gamma) sign was peculiar in case of bicornuate uterus. Median irregular vascular spots had been found in case of septate uterus. Conclusions: Power Doppler study of uterine malformations and the presence of the gamma sign seem to be able to differentiate bicornuate uterus from septate uterus. P04.25Subendometrial arterial blood flow assessment during IVF cycles and its correlation with treatment outcome Z. Leibovitz, R. Gorokhovsky, J. Tal, S. Degani, I. Shapiro, I. Calderon, Y. Paltiely, G. Ohel Bnai-Zion Medical Center, IsraelObjective: The influence of blood flow impedance in subendometrial arteries on embryo implantation rate was investigated by transvaginal Doppler study before embryo transfer. Methods: A total of 36 women undergoing in vitro fertilization procedures were evaluated 3 times during the treatment cycle: upon completion of pituitary desensitization (Day 1), on the day of hCG administration and on the day of oocyte pick-up (OPU day) The patients had no uterine abnormality and no uterine surgery. Power and spectral flow imaging of subendometrial arteries was obtained to calculate PI, RI and S/D ratio. These indices were longitudinally assessed according to the examination day. The correlation between the Doppler parameters, endometrial thickness and pregnancy achievement was analyzed. Patients were grouped according to whether pregnancy was achieved (group A -13 cases) or not (group B -26 cases). Results: No significant difference was found between the two groups in mean age, days of gonadotropin stimulation, peak serum estradiol level, endometrial thickness and number of embryos transferred. Doppler measurements of RI and S/D did not differ between group A and B on any of the days on which the studies were done. In patients who have conceived, PI was significantly lower on Day 1 (1.09 ± 0.17) compared to hCG day (1.25 ± 0.15) and OPU day (1.32 ± 0.21) (p < 0.02). PI measurements obtained on Day 1in group A (1.09 ± 0.17) were significantly lower compared to group B (1.29 ± 0.34) (P = 0.019). Conclusions: Lower P...