15 th World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts P10.28 Ductus venosus velocimetry in the prediction of fetal acidemia: which is the best parameter? F. H. C. Carvalho, A. F. Moron, R. Mattar, C. G. V. Murta , R. M. Santana, M. M. Barbosa, M. R. Torloni Federal University of S ˜ ao Paulo State, Brazil Objectives: To evaluate the prediction of fetal acidemia using ductus venosus (DV) Dopplervelocimetry and to determine the best parameter and cut-off values for this prediction in pregnancies complicated with placental insufficiency. Patients and methods: This was a prospective cross-sectional study involving forty-seven patients with placental insufficiency managed in two Brazilian hospitals (Hospital S˜ ao Paulo and Maternidade-Escola Assis Chateaubriand) who were submitted to DV Dopplervelocimetry in the last 24 hours before delivery. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. Metabolic or mixed acidemia at birth were considered pathological. A ROC curve was calculated for each DV parameter (independent variable) and acidemia (dependent variable). A cut-off value was established and sensibility, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated. The MacNemar test was used to compare the parameters. Results: The DV S, D and A peak velocities were not good predictors of acidemia at birth. Pulsatility Index for Veins (PIV) was a good predictor of acidemia (ROC curve area 0.79, p = 0.003), as well as the S/A and (S-A)/S ratios (ROC curve area 0.818, p = 0.001). The cut off values were PIV = 0.76, S/A = 2.67 and (S-A)/S = 0.63. Conclusions: In this high-risk population angle-independent DV Doppler indexes were good predictors of birth acidemia. PIV, S/A and (S-A)/S ratios were statistically equivalent in this prediction. P10.29 Venous-arterial pulsatility index in the prediction of fetal acidemia in pregnancies with placental insufficiency F. H. C. Carvalho 1 , A. F. Moron 2 , R. Mattar 2 , C. G. V. Murta 2 , R. M. Santana 2 , M. M. Barbosa 2 , M. R. Torloni 2 1 Federal University of S ˜ ao Paulo State, Brazil, 2 Federal University of Espirito Santo State – Brazil Objectives: Investigate the prediction of fetal acidemia in pregnancies with placental insufficiency using the newly created venous-arterial pulsatility index (PI of the ductus venosus (DV) over PI of the middle cerebral artery (MCA) and establish cut-off values for this prediction. Patients and methods: This was a prospective cross-sectional study involving forty-seven patients with placental insufficiency managed in two Brazilian hospitals (Hospital S ˜ ao Paulo and Maternidade- Escola Assis Chateaubriand) who were submitted to DV and MCA Dopplervelocimetry in the last 24 hours before delivery. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. Metabolic or mixed acidemia at birth were considered pathological. A ROC curve was calculated for the venous-arterial index (independent variable) and acidemia (dependent variable). A cut-off value was established and sensibility, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated. Results: The DV/MCA PI index was related to fetal acidemia (area under the curve 0.785, p = 0.004). The cut-off value was: 0.582, sensibility 66.7%, specificity 77.1% and accuracy 74.5%. Conclusions: The DV/MCA PI ratio is adequate for the diagnosis of acidemia at birth in pregnancies with placental insufficiency. P10.30 Transverse cerebral sinus Doppler velocimetry in the prediction of birth acidemia M. M. Barbosa, A. F. Moron, F. H. C. Carvalho, C. G. V. Murta , R. M. Santana, M. R. Torloni, R. Mattar Federal University of S ˜ ao Paulo State – Brazil Objectives: Evaluate the prediction of acidemia at birth using the pulsatility index for veins (PIV) of the transverse cerebral sinus (TCS) and to determine the cut-off value for this prediction in pregnancies complicated with placental insufficiency. Patients and methods: This was a prospective cross-sectional study involving forty-seven patients with placental insufficiency managed in two Brazilian hospitals (Hospital S˜ ao Paulo and Maternidade-Escola Assis Chateaubriand) who were submitted to TCS Dopplervelocimetry in the last 24 hours before delivery. All pregnancies were singleton, over 26 weeks of age and without structural or chromosome anomalies. Metabolic or mixed acidemia at birth were considered pathological. A ROC curve was calculated for the PIV of the TCS (independent variable) and acidemia (dependent variable). A cut-off value was established and sensibility, specificity, positive and negative predictive values and positive and negative likelihood ratios were calculated. Results: The PIV of the TCS was a good predictor of acidemia (ROC curve area 0.72, p = 0.028). The cut off value was PIV = 0.86, sensibility 75%, specificity 75.9% and accuracy 75.7%. Conclusions: In this high-risk population the pulsatility index for veins of the transverse cerebral sinus was a good predictor of acidemia at birth. P10.31 Is Doppler reversed flow of the ductus venosus an indication for prompt delivery of the extremely IUGR fetus at less than 28 weeks’ gestation? G. Mari 1 , J. K. Nien 2 , P. Mittal 1 , E. Soto 1 , L. Goncalves 1 , W. Lee 3 , R. Romero 2 , J. Espinoza 1 1 Wayne State University School of Medicine, Detroit, MI, USA, 2 Perinatology Research Branch/NICHD/NIH/DHHS, USA, 3 William Beaumont Hospital, Royal Oak, MI, USA Objective: Limited information is available regarding the manage- ment of extremely low preterm growth-restricted (IUGR) fetuses (< 28 weeks and < 500 g). We determined the time-interval between ductus venosus (DV) reversed flow (RF) and delivery. Whenever possible this information was correlated to BPP and perinatal mor- tality. Methods: Four IUGR fetuses with an estimated weight below 500 g, and who were diagnosed with DV RF, were studied. One patient (1) had chronic hypertension; two patients (2 and 3) developed preeclampsia, whereas the fourth patient (4) had no detectable maternal pathology. Results: In patient 1, DV RF was diagnosed 11 days prior to delivery, which occurred at 28 weeks, despite a normal BPP, because the development of holosystolic tricuspid regurgitation. Birth weight was 467 g. The infant is currently at 68 days of his life and weighs 1128 grams, and the neurological assessment has been normal. In patient 2, DV RF was present for 10 days prior to the decision of performing a cesarean delivery at 28 weeks’ gestation, despite a normal BPP. Apgars were 7 and 9, at 1 and 5 minutes respectively. Birth weight was 450 g, and the infant was intubated, following which he was stable at day six of his life. The fetal DV in patient 3 became reversed when the maternal blood pressure started to rise and became difficult to control with either labetalol or hydralazine IV. The BPP also became abnormal. Delivery occurred at 24.6 weeks, and the infant died after one week. The fourth patient opted for no intervention: a DV RF was present for three weeks prior to fetal demise, which occurred at 28.6 weeks. Conclusions: These preliminary data show that DV RF may be present for weeks prior to the appearance of an abnormal BPP. Our 446 Ultrasound in Obstetrics & Gynecology 2005; 26: 376–471