S200 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

The prenatal diagnosis of tuberous sclerosis is suspected at fetal ultra-sound on the discovery of multiple cardiac rhabdomyomas (CRs). Thepostnatal gene analysis can be confirmed the cause of the fetal abnor-mality. Further postnatal follow-up have to be arranged to survey theorgan involvement such as CNS and renal lesions.

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Ramathibodi Predictive Scoring System of PregestationalDiabetes OutcomesPanyu Panburana, Ramathibodi Hospital, Mahidol University, Thailand

Objective: To evaluate the Ramathibodi score in predicting the ma-ternal and perinatal outcomes in pregestational diabetesStudy Design: Prospective study was performed in 200 pregestationaldiabetes pregnant women by evaluating the uterine and umbilical arteryDoppler velocimetry at 28 weeks’gestation. The umbilical artery flowspectrum was divided into three scores (UmAS) while the uterine arteryDoppler flow spectrum was divided into five uterine artery scores (UtAS).Ramathibodi score (RS) was calculated by adding the UmAS with UtAS.The perinatal and maternal outcomes were studied.Results: The mean mother age was 34.18� 4.32 years. There were 152(76 %) normal labour, 10 (5 %) forceps delivery, 15 (7.5 %) vacuumdelivery and 23 (11.5 %)caesarean section. The mean gestational age atthe last examination was 36.12�1.99 completed weeks (range 28-39weeks) and at delivery 37.18� 2.19 weeks (range 30-40 weeks). Themean fetal weight was 2,889.95 � 646.63 grammes. The mean gravidawas 2.23 � 1.13.DM type 1 and type 2 were found 20% and 80%respectively.The insulin was required in 40% of cases.RS had the predicting capacity in adverse perinatal outcomes includingsmall for gestational age, low APGAR score, intrauterine fetal death,neonatal intensive care unit admission and also in adverse maternaloutcome including preeclampsia.Conclusion: The RS can predict the adverse perinatal and maternaloutcomes in GDM better than either UmAS or UtAS alone.

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Gestational Age Prediction by Femur Length in BangladeshSabrina Q Rashid, Bangladesh Institute of Ultrasound in Medicine& Research, Bangladesh

Objective: Fetal femur length is an important parameter for determin-ing gestational age. If we use tables based on our own population,gestational age estimation will be more accurate. This study wastherefore designed to determine the gestational age by fetal femurlength measurement in our country.Methods: Healthy gravid patients with optimal dates were included in aprospective study. Fetal femur length along with other parameters wasmeasured. A table and a graph were prepared by Polynomial regressionmodel. Previously established nomograms were compared with it.Results: The gestational age estimated from the femur length measure-ments of 1223 healthy gravid momen, from 13 to 40 weeks are presentedhere in a tabulated form. 3rd. 10th, 50th, 90th and 97th Percentiles, meanand standard deviations were also derived. The quadratic model showed agood fit to the data when superimposed on the scater diagram. It gave 95%confidence interval. Also model was fitted seperately to standard devia-tions as a function of gestational age. There was a gradual increase of thefemur length measurements up to 37th week. From 13 to 27 weeksgestation, there was no clinically important difference between this andwestern nomograms for predicting gestational age but after 32 weeks thedifference with western nomograms became significant.Conclusion: This nomogram is unique for Bangladeshi population. It willgive more accurate gestational age assessment than the western tables thatare still followed in our country, especially in the 3rd trimester.

Keywords: Gestational age, femur length, Bangladesh.

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Fetal Femur Length and Abdominal Circumference Ratio inBangladeshSabrina Q Rashid, Bangladesh Institute of Ultrasound in Medicine& Research, Bangladesh

Objective: The ratio of fetal femur length and abdominal circumfer-ence is one of the important ratios. But we do not have any study on itin our country so far. Therefore a study was conducted to prepare atable based on Bangladeshi population.Method: Well dated pregnancies with ultrasound confirmed dates wereincluded in a cross-sectional prospective study. By fitting Polynomialregression models to the mean and standard deviations seperately, tableand graphs were prepared. Nomograms of Caucasian population whichwere established before were compared with this study.Results: A chart of the raw data of 1223 subjects, with superimposedfitted centiles was produced. The quadratic model showed a good fit tothe data. 3rd, 10th, 50th, 90th and 97th percentiles, mean and twostandard deviations of the data were derived.Conclusion: These table and graphs can be useful for accurate assess-ment of fetal femur length/abdominal circumference ratio to detect thetype of fetal growth restriction. This study shows that there is similarityof this ratio with the western ratio unlike the individual parameters.Keywords: Femur length/ abdominal circumference ratio, Bangladesh.

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AFI as a Triage Tool for Post Date PregnanciesTalat Uppal, Northern Beaches Health, AustraliaBronwyn Andrew, Nepean Hospital Sydney, AustraliaMax Mongelli, Nepean Hospital Sydney, Australia

The management of postdates pregnancy varies from institution toinstitution. At Nepean Hospital we use AFI as a triage tool to organiseinduction of labour, in the low risk patient at a gestation of 40weeksplus 10 days. Women are reviewed in the postdates clinic at 41 weeksand have a cervical assessment done. The AFI is a simple test toperform, less time consuming than a CTG and works efficiently as partof a well structured programme, with dedicated staff. This has beenshown to increase spontaneous labour rates and decrease admissionnumbers. We have reviewed the details from our postdates service, thatinvolved 3000 women from 2001 – 2007 inclusive. We will present thedata regarding the neonatal outcomes, parity, gestation, Bishop’s scoreand mode of induction.

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Frontomaxillary Facial Angle in Normal Fetuses at 11� 0 to13� 6 Weeks in Chinese PopulationYing Yang, West China Second University Hospital, ChinaT Yang, West China Second University Hospital, China

Objective: To establish the normal range of the frontomaxillary facial(FMF) angle of the chineses fetuses at 11 � 0 to 13�6 weeks gestation.Methods: A prospective observational study was performed on 600cases of pregnancies at the first trimester ultrasound screening between11 and 13�6 weeks (crown-rump length between 45mm to84mm).Nuchal translucency thickness(NT), CRL,FMF angle weremeasured in first trimester screening and maternal serum free �-hCGand AFP were collected in the second trimester. Transabdominal ul-trasound examination was performed on a GE Voluson 730. The FMFangle measured in the midsagittal plane of the fetal profile. High riskcases underwent amniocentesis to demonstrate the fetus chromosoma-lly normal. In a subgroup of 350 cases the FMF angle was measured

using 3D ultrasound after 2D ultrasound.

Abstracts S201

Results: The mean FMF angle decreased with CRL. There was nosignificant correlation between the FMF angle and fetal NT or maternalserum biochemistry.In those cases with paired measurements there wasno statistical difference between 2D and 3D ultrasound measurement.Conclusions: This study demonstrates that at 11–13�6 weeks, the fetalFMF angle reduces with CRL and gestational age but is not related tofetal NT or maternal serum biochemistry.

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Ultrasonographically Estimated Fetal Growth During the ThirdTrimester of Pregnancy and Maternal Glucose Tolerance Test inthe Second TrimesterAtsushi Yoshida, Department of Obstetrics and Gynecology,Nishisaitama-Chuo National Hospital, JapanKenji Ishii, Department of Obstetrics and Gynecology, Nishisaitama-Chuo National Hospital, JapanKazuya Kudo, Department of Obstetrics and Gynecology,Nishisaitama-Chuo National Hospital, JapanKeiko Saito, Department of Obstetrics and Gynecology,Nishisaitama-Chuo National Hospital, JapanIsao Azuma, Department of Obstetrics and Gynecology,Nishisaitama-Chuo National Hospital, JapanManabu Narimiya, Department of Internal Medicine, Nishisaitama-Chuo National Hospital, Japan

Objective: We studied the difference in the ultrasonographically esti-mated fetal growth (UEFG) during the third trimester of pregnancybetween the group with maternal glucose tolerance test in the secondtrimester and the group without the screening test.Methods: In 774 pregnant women, glucose tolerance screening testwas performed between 24 and 29 weeks of pregnancy (S(�) group).In this group, occasional blood glucose (OBG) test was carried out andthose who showed OBG�100mg/dL took 75g oral glucose tolerancetest. In 123 pregnant women, glucose tolerance screening test was notdone (S(-) group). In all of these 897 pregnant women, ultrasonographi-cal estimation of fetal weight was made in the second trimester. Wedefined the UEFG as follows: UEFG � [birth weight] – [estimated fetalweight (EFW) in the second trimester]. The estimation of fetal weightwas made with the formula by Japan Society of Ultrasound in Medicine(EFW�1.07 x BPD^3 � 0.3 x AC^2 x FL).Results: In S(-) group, the weekly UEFG rate was significantly greaterthan that of S(�) group. In S(-) group, the rate of over-weight neonates(��1.5 SD) was also significantly larger than that of S(-) group.Conclusion: It was suggested that the implementation of the screeningtest using maternal glucose tolerance in the second trimester mighthave some effects on the fetal growth. We speculate that in S(-) group,patients’ nutritional guidance and interest in the proper diet wereinadequate, which might have caused fetal overgrowth in some cases.

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Aortic-left Ventricular TunnelJiao Chen, Ultrasonic Department, Sichuan University Huaxi 2ndHospital, ChinaHong Tang, Cardiovascular Department, Sichuan University HuaxiHospital, ChinaQi Zhu, Ultrasonic Department, Sichuan University Huaxi 2ndHospital, China

An 8-year-old boy was referred to our outpatient clinic where theclinical diagnosis of aortic regurgitation was made. His physical ex-amination revealed a severe aortic systolic-diastolic murmur. The trans-thoracic echocardiograms showed an abnormal tunnel-like structurearising from the right coronary sinus of Valsalva, but separate from the

right coronary artery, and connecting the left ventricle. The tunnel

measured 7 mm diameter and 20 mm length, the aortic end of the tunnelwas 7 mm and the ventricular was 11 mm. Color flow Doppler imagingshowed an aortic diastolic regurgitation through the tunnel to leftventricle. The left ventricle was enlarged, which was approximatelyfive times the size of the right ventricle. The aorta was enlarged toabove tow times the size of the pulmonary. The diagnosis of echocar-diography was: aortic-left ventricular tunnel.At operation, the aorticend was appeared in the aortic root to the left of the origin of the rightcoronary artery. And left ventricle was dilated remarkably. The aorticend of the tunnel was closed with an oval Teflon-felt patch. Postoper-atively, no aortic insufficiency was noted.aortic-left ventricular tunnelis a rare malformation in which a communication between the aorta andthe left ventricle bypasses the aortic valve. In the parasternal long axisview and the short axis view at the level of the aortic root, the ends ofthe tunnel can be detected and the way of it can be traced. Thecombination of tow-dimensional echocardiography and CDFI is theonly non-invasive method to diagnose aortic-left ventricular tunnel.

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Doppler Ultrasound (DUS) in Diagnosis of the AcuteIntussusception for Children in Emergency DepartmentWei-Hsi Chang, Department of Emergency, Tri-Service GeneralHospital, National Defense Medical Center, Taiwan

Introduction: Intussusception is the most common abdominal emergencysituation in the pediatric population and a potentially lethal condition withpoorly understood etiology, is also the most common cause of acuteintestinal obstruction in children younger than 5 years old.Case Report: We describe a 3- month -old male infant, vaginaldelivered full-term baby, he was robust in the past and did not have anyother systemic disease before. However, poor activity and decreasedoral intake had been noted, and then bloody stool for three times andintermittent irritable situation were found. We arranged the sonogramof abdomen for him that showed an obvious target sign was noted overthe left abdomen, and bowel wall thickening diameter about 0.5 cm andascites are also noted. Hence, Ileocecal intussusception was diagnosedfinally according to the operation & pathology under the Exploratorylaparotomy with segmental resection of terminal ileum, ileocecal valve,appendix, and ascending colon with ileocolostomy.Discussion: However, delay in diagnosis and treatment might lead todevastating complications such as bowel ischemia, perforation andperitonitis. In children, Ultrasound (US) has been shown to be thefirst-choice imaging technique in diagnosing intussusception for rea-sons of high accuracy, lack of radiation, no need for sedation and lowcosts. Regarding incidence of a pathologic lead point is up to 12% inmost pediatric series and increases directly with age. The most commonlead point for intussusception is Meckel’s diverticulum.

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High Resolution Sonographic Findings of Acute Bowel Diseasesin a Pediatric PopulationKwanseop Lee, Department of Radiology, Hallym University SacredHeart Hospital, KoreaA-Ram Choi, Department of Radiology, Hallym University SacredHeart Hospital, KoreaSu-Yeon Hwang, Department of Radiology, Hallym UniversitySacred Heart Hospital, KoreaMi-Yeon Lee, Department of Radiology, Hallym University SacredHeart Hospital, KoreaYul Lee, Department of Radiology, Hallym University Sacred HeartHospital, Korea

Sonography of the acute abdomen is an initial important diagnostic tool

in a pediatric population. Especially in acute bowel conditions of the