P12.07: The value of transvaginal sonography in surgical evacuation of retained products of conception

Abstract

Objective:The aim of this pilot study was to evaluate the safety and efficacy of ultrasound guided surgical evacuation of uterus compared to the conventional blind method of evacuation of retained products of conception (ERPC) currently being practised. It is not known whether routine use of intraoperative transvaginal ultrasound (TVS) improves the outcome of surgical management of first trimester miscarriage and surgical termination of pregnancy (TOP) in both primary as well as repeat procedures. Methods: A retrospective analysis over a six-month period was performed in a teaching hospital in London, UK in women who had either undergone surgical, medical or conservative management of miscarriage or TOP in the first trimester. The inclusion criteria were women who had retained products of conception (RPOC) after initial treatment of first trimester miscarriage or TOP and needed subsequent surgical evacuation of uterus. Outcome measures were the incidence of incomplete evacuation requiring further treatment and persistent vaginal bleeding. Results: Of 240 women, 30 had RPOC after initial treatment. 27% (8/30) opted for conservative management with weekly TVS, 33% (10/30) had repeat ERPC under TVS guidance and 40% (12/30) had ERPC without TVS. Amongst the TVS guided ERPC group, none required further intervention. In those who had ERPC without TVS guidance, 2 had RPOC requiring a third evacuation. Conclusion: Surgical evacuation under TVS guidance was associated with lower rate of complications compared to the conventional procedure without ultrasound. As this was a small, retrospective study, further prospective randomised controlled trials would be useful in showing further significance of these findings. P12.08 Prediction of fetal loss following ultrasound diagnosis of a live fetus at 6-10 weeks of gestationObjective: The purpose of this study was to evaluate the prediction value of demographic characteristics and ultrasound findings in subsequent fetal loss in pregnancies with live fetuses at 6-10 weeks of gestation. Methods: This was a prospective observational study of 428 pregnant women attending transvaginal examination at 6-10 weeks' gestation. The relation of demographic characteristics and ultrasound findings at the time of initial examination to subsequent fetal loss was assessed. Results: In the 491 singleton pregnancies with live fetuses and complete follow up, there were 34 (6.92%) fetal losses. There was statistically a significant increase incidence of fetal loss with increased maternal age, lower gestational age, history of vaginal bleeding, fetal bradycardia relative to crown-rump length, small gestational sac and large yolk sac. Conclusion: Maternal age, gestational age, history of vaginal bleeding and ultrasound findings of small gestational sac, large yolk sac and fetal bradycardia relative to crown-rump length have prognostic value for subsequent fetal loss in pregnancies with a live fetus at 6-10 weeks' gestation. P12.09 3D sonography in gestational and placental volume measurements in women ...