The document summarizes presentations from the ISUOG Congress in Sydney 2013 on various topics: 1) Assessment of aneuploidy in the 1st trimester using ultrasound markers, biochemical markers, and non-invasive prenatal tests. 2) Detection of IUGR in the 2nd trimester using femur length, uterine artery Doppler, and facial measurements. The TRUFFLE study on timing delivery for IUGR was also discussed. 3) Classification systems for ovarian tumors presented, including the IOTA simple rule for differentiating benign and malignant masses.

1. REPORT FROM ISUOG CONGRESS
IN SYDNEY 2013
To Mai Xuan Hong
Dr. To Mai Xuan Hong
1

2. 1st trimester assessment of aneuploidy
• US markers
–
–
–
–
NT, NB, Facial angle
Doppler of DV (a-wave)*
Doppler of tricuspid valve*
Intra-cranial translucency (IT)*
• Biochemical markers
– Fß-hCG and PAPP-A
• Non-invasive prenatal test
(NIPT)
– Decision of invasive test in the
intermediate risk (<1/10-1/1000
followed CFTS)
Dr. To Mai Xuan Hong
2

3. 1st trimester assessment of aneuploidy
Dr. To Mai Xuan Hong
3

4. 1st trimester assessment of aneuploidy
• Oral presentations
– Screening for adverse pregnancy outcomes at 12ws
(Audibert, Francois)
– Combined first trimester biochemistry, NIPT or both?
(Johnson, Jo-An)
– Sequencing for NIPT: techniques, technologies,
applications and limitations (Johnson, Jo-An)
– First trimester screening for neural tube defect (Meaghen,
Simon)
Dr. To Mai Xuan Hong
4

5. 1st trimester assessment of growth and Doppler
• Crown-rump length measurement
• Increased Uterine artery Doppler indices (PI
> 90th or 95th centile) associated with
–
Reduced fetal movement
–
Superimposed pre-eclampsia
–
SGA < 10th centile
–
SGA < 3rd centile
–
Still birth
• Low PAPP-A level (<0.3 MoM) or both of
PAPP-A and free ß-hCG (<0.5MoM)
– related to poor placentation (low birth weight and still birth)
Dr. To Mai Xuan Hong
5

6. 1st trimester assessment of growth and Doppler
• Oral presentations
– Assessment of crown-rump length measurement variability (McLennan, Andrew)
– Clinical evaluation of a first trimester algorithm predicting the risk of
hypertension disease of pregnancy (Park, Felicity)
– First trimester screening of pregnancy complication (Hyett, Jon)
– Assessment of 1st trimester uterine artery pulsatility index in Hongkong Chinease
pregnant women(Sahota, Daljit)
– Pulsatility index of the uterine arteries between 11 and 13.6 weeks: comparison
of measurement by transvaginal and transabdominal Doppler ultrasound (Cafici,
Daniel)
– Reduced fetal movement at term association to first trimester uterine artery
Doppler assessment (G Pagani)
– Reduced fetal movement at term: association to first trimester PAPP-A level (G
Pagani)
– Outcomes in cases of low PAPP-A and free ß-hCG in maternal serum at 1st
trimester screening (Deloison)
Dr. To Mai Xuan Hong
6

7. 2nd trimester assessment
• Ratio of prenasal thickness (PT) and nasal bone length (NBL) (Down
syndrome)
• Fetal facial shape
– Facial height (FH) and facial width (FW) (FH/FW ratio)
– Forehead assessment (Profile line) (Down syndrome)
• Short femur length associated with
– Chromosomal abnormalities
– SGA
– Early preterm delivery
• Increased 2nd trimester uterine artery Doppler indices (> 90th centile)
associated with placental dysfunction)
• Femoral metaphyseal-epiphyseal angle (> 130◦ in achondroplasia)
• Asymptomatic short cervix length is a predictor of intra-amniotic
inflammation
Dr. To Mai Xuan Hong
7

8. 2nd trimester assessment
Dr. To Mai Xuan Hong
8

9. 2nd trimester assessment
• Oral presentations
– The prenasal thickness to nasal bone length ratio: 2D versus 3D ultrasound (E
de Jong)
– Fetal facial shape: 3D study of height and width in the 2nd and 3rd trimester of
pregnancy (A De Boagent)
– Forehead assessment in normal and pathological fetuses by the fetal profile
line (E de Jong)
– Outcome of fetuses with short femur length detected at 2nd trimester
malformation scan: a national survey (JM Mathiesen)
– Reduced fetal movement at term: association to second trimester uterine
artery Doppler assessment (G Pagani)
– Femoral metaphyseal-epiphyseal angle: a new prenatal ultrasound finding in
achondroplasia (A Khalil)
– Non-invasive prediction of intra-amniotic infection and/or inflammation in
patient with cervical insufficiency or an asymptomatic short cervix (<15mm) (E
Jung)
Dr. To Mai Xuan Hong
9

10. IUGR: detection and management
• Late-onset IUGR = SGA+(EFW<P3, Abnormal
MCA-UtA-UA)
– Poor outcome (neonatal morbility)
– Possible choosing an induction
• TRUFFLE study (Trial of Umbilical and Fetal Flow
in Europe)
– Decision the best timing of delivery in preterm
pregnancies complicated IUGR
– Surveillance test: CTG, UA and DV Doppler
• Aortic intima-media thickness (aIMT) (> 0.8mm)
– Higher SBP and glomerular dysfuction Hong
Dr. To Mai Xuan
10

11. IUGR: detection and management
• Oral presentations
– Are all late-onset IUGR the same? (E Gratacos)
– Clinical lessons from the TRUFFLE study (C Bilardo)
– The use of charts in detecting late-onset IUGR (A
Papageorghiou)
– Prenatal scale for cardiovascular risk in IUGR (E Cosmi)
Dr. To Mai Xuan Hong
11

12. Cervical assessment
• Preterm delivery
– Intra-amniotic sludge
• Induction of labor
– TVS assessment
– Comparison of funneling,
length and Bishop’s score
Dr. To Mai Xuan Hong
12

13. Cervical assessment
• Oral presentations
– Intra-amniotic sludge observed at cervical ultrasound
and the risk of preterm delivery (F. Audibert)
– Sonographic funneling of uterine cervix as predictor
for success of labor induction (E Kim)
– Pre and post-ripening sonographic assessment of
cervix for predicting successful induction of labor (M
Cordoba)
Dr. To Mai Xuan Hong
13

14. Fetal neurosonography
• Probst Bundle
– Agenesis of the corpus callosum
• Pericallosal lipoma
– Shows in 3rd trimester
– Increased echogenicity in corpus callosum
– Invisualised corpus callosum
• MRI in conjunction with US
– www.fetalmri2014.org ( 15-20 Mars 2014,
Canada)
Dr. To Mai Xuan Hong
14

15. Fetal neurosonography
• Oral presentations
– Disorders of axonal guidance as visualised by fetal MRI
(D Prayer)
– Periventricular leukomalacia in fetus: prenatal imaging
and diagnostic features (D Pugash)
– US volume navigation with fusion MRI imaging: a
novel approach for prenatal diagnosis (G Malinger)
Dr. To Mai Xuan Hong
15

16. IOTA classification
(International Ovarian Tumor Analysis)
• Main IOTA model
Dr. To Mai Xuan Hong
16

17. Dr. To Mai Xuan Hong
17

18. Simple rule for identifying a benign or malignant tumor
Dr. To Mai Xuan Hong
18

19. Simple rule for identifying a benign or malignant tumor
Dr. To Mai Xuan Hong
19

20. IOTA classification
(International Ovarian Tumor Analysis)
• Oral presentations
– Predictive value of subjective assessment, IOTA simple
rule, IOTA logistic regression model 1 (LR1), Alcazar’s
GI-RAD model and risk of malignancy (RMI) model in
the preoperative discrimination of adnexal mass (A
Czekierdowski)
– The additive value of HE4 novel tumor marker to the
IOTA simple rules in the management of ovarian
masses (B Erdoli)
Dr. To Mai Xuan Hong
20

21. Thank you!
Dr. To Mai Xuan Hong
21