13 th World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts Methods: Prospective follow-up of women referred for evaluation of CDH in a tertiary referral center with availability of extra- corporeal membrane oxygenation (ECMO), NICU, fetal medicine specialists, and pediatric surgeons. Only those with available LHR measurements were included. Results: During the period of time from August 1999 to April 2003 there were 13 women with prenatal diagnosis of CDH with avail- able LHR measurements. The mean gestational age at diagnosis was 23 weeks (range 20–31 weeks), 11 (85%) were left sided CDH. There were no major associated anomalies. The mean LHR mea- surement was 1.32 (range 0.57–2.19). Two women terminated the pregnancy (LHR 0.57 and 1.02), and one suffered intrauterine fetal demise (LHR 1.35). The remaining ten neonates reached term, were delivered vaginally, and were operated within an average of 52 hours from delivery (range 26–72 hours). Only one neonate died, for a mortality rate of 10%. There are no additional deaths in this group for a mean follow-up of 18 months (range 7 – 36 months). The back- ground mortality rate for all CDH neonates in our institution is 35%. Conclusions: It appears that measurement of the LHR has created a highly selective group with an improved outcome within the total group of neonates with prenatal diagnosis of CDH. P259 The validity of using the lung-to-head-ratio in fetuses with congenital diaphragmatic hernia to predict the neonatal outcome K. S. Heling , K. D. Kalache, R. Wauer and R. Chaoui Charit´ e Hospital, Humboldt-University, Germany Introduction: The congenital diaphragmatic hernia (CDH) is one of the severe congenital malformations with a high morbidity and mortality. Displacement of the abdominal organs in the fetal thorax causes pulmonary hypoplasia, leading to high morbidity and mortality rates. The mortality in cases with isolated diaphragmatic hernia is 45–55% and in cases with associated malformations it reaches 80%. A number of studies have examined various prognostic parameters in fetuses with diaphragmatic hernia. The main interest in recent years has been in measurements of the lung-to-head ratio (LHR). Some studies presented very optimistic data using the lung-to-head ratio as a prognostic parameter in fetuses with CDH, especially as an indication for intrauterine surgery and special postnatal ventilation therapy. Methods: We examined prospectively between 1999 and 2003 22 fetuses with isolated CDH and optimal postnatal therapy. The diagnosis was made in 9 fetuses < 26 gestational weeks. In all cases we were able to measure the LHR and various postnatal ventilation parameter: pO2; pCO2; inspiratory oxygen saturation; inspiratory pressure; oxygenation index; occurrence of pulmonary hypertonia. Results: The survival rate was 59%. There was no significant relationship between the LHR and the outcome of the children. 5/7 children with a LHR < 1.0 are survived. 7/9 children with diagnosis < 26 gw are survived. Serial measurements shows an increase in lung size in 6 fetuses, but 5 of them died. There was also no significant relationship between the LHR and the postnatal ventilation parameter or the risk for developing pulmonary hypertonia. Conclusion: The estimation of the LHR allows us the measurement of the lung size. But there is no significant relationship between the severity of pulmonary hypoplasia and the postnatal outcome. Other method are need to predict the outcome in fetuses with CDH. P260 Fetal lungs image characterized on MRI. Correlation with pulmonary hypoplasia S. Cabr´ e *, A. Vela*, X. Alomar†, E. Ferre†, E. Miro*, E. Marimon* and J. Lailla* *Hospital Universitari Sant Joan de Deu. Barcelona, Spain and †Creu Blanca. Barcelona, Spain Introduction: The fetal lung image has not enough showed to determine pulmonary maturity and to predict lung hypoplasia at birth. Despite the recent advances in ultrasound and Doppler, the diagnosis of pulmonary hypoplasia is difficult. Objective: Using MRI to evaluate pulmonary images and correlated these findings with gestational age. Use this standard image to compare with fetuses that presented lethal hypoplasia at birth. Material and methods: 40 fetuses (19–35 weeks gestation) including major anomalies detected in ultrasound scan. 5 of these fetuses presented at birth lethal hypoplasia diagnosed by histology parameters. We used images of lot normal lungs and liver to take image characterization. A prefixed sequence was used in all cases in a longitudinal fetal scan. In the same slide to study we saw lung and liver. MR images were interpreted and analyzed by a function included in machine software that converts a region of interest (ROI) with 5 mm in mean of gray degrees. We establish a ratio between one ROI of lung and one of liver in the same slide, this region was free of vessels. Statistics analysis was made using correlation coefficients between images ratio and weeks of gestation. Results: A positive correlation between gestational age and image intensity measured by increasing of ratio was found. Fetuses that presented pulmonary hypoplasia at birth showed a low intensity image in lung and less ratio comparing with liver ROI. Discussion: In normal pulmonary development lung images grow in intensity, measured by MRI. The liver images rested more homogeneous during gestational time advanced. This increased intensity may be done for the water and normal secretions deposited in the lung going to maturity. The fetuses that presented a lung hypoplasia have less images intensity in lung, this may suggest the poor alveolar development saw in necropsy studies of this lungs and less water and secretions inside. P261 Sonographic assessment of the umbilical cord coiling index during the entire gestation A. Cromi *, L. Raio†, F. Ghezzi*, E. Di Naro*, P. Duerig†, H. Schneider† and J. Schmid† *University of Insubria – Varese, Italy and †University of Berne, Switzerland Objective: It has been reported that the number of umbilical vascular coils present in the first trimester and at term gestation is similar, supporting the concept that the umbilical cord (UC) coiling index decreases with advancing gestation due to a sort of stretching of the UC. However, prenatal reference ranges for the UC coiling index (UCI) during the entire gestation are not available in literature. The aim of this study was to investigate the temporal changes of the UCI during gestation. Methods: Consecutive singleton pregnancies were enrolled into the study. Colour flow mapping was used to enhance the definition of the UC vascular coils. The length of one complete UC vascular coil (distance between the right outer surface of consecutive arterial coils) was measured in a longitudinal mid-section of the UC. The coiling index, defined as the reciprocal value of that measurement, was calculated. Exclusion criteria were 1) fetal structural or chromosomal anomalies, 2) uncoiled UC, and 3) single umbilical artery. Spearman rank correlation and polynomial regression was used for statistical proposes. Results: 391 patients were included into the study. A significant correlation was found between gestational age and UCI (r =- 0.74, p < 0.0001). The decrease of the UCI was confined to the first half of gestation. Subsequently, no significant changes of the UCI were observed from 20 weeks to term gestation. Conclusions: The UCI decreases significantly throughout gestation. This phenomenon is particularly evident in the first half of gestation when the UC length increases rapidly. Thereafter, when the UC growth rate is only 3–6 cm per month, the UCI is minimally influenced by the lengthening of the UC. 140 Ultrasound in Obstetrics & Gynecology 2003; 22 (Suppl. 1): 71–175