16–18 September 2022, London, UK & Virtual
veins that bypass the capillary system. Acquired UAVMs can be an
enhanced myometrial vascularity (EMV) associated with retained
products of conception or other forms of uterine pathology. Accurate
clinical and radiological diagnosis is essential. A 35-year-old G5
P2 (two artificial abortion) was referred for a 20 week obstetrical
(OB) ultrasonography (US). OBUS demonstrated amorphic material
(figure 1A). Transvaginal (TV) US and Doppler (D) (figure 1B)
showed a tubular tortuous hypoechoic with mixed signal at colour
D and low resistance in uterine cavity. Hysteroscopy (figure 1C)
showed a vascular mass with amorphic tissue (confirmed by
histopathology). As the patient was asymptomatic, conservative
treatment was performed. Six months after the diagnosis, she
expelled an amorphous and calcified material through her vagina
(figure 1D-E). Another USTV was performed and showed no more
changes (figure 1F).
Uterine EMV can present massive hemorrhage, but in some
patients will be asymptomatic. Clinical and radiological diagnosis
is essential because uterine instrumentation can lead to massive
hemorrhage. The initial imaging modality of choice for EMV is US
and D analysis, especially where resources are low. It is suggested
that EMV in this setting is a transient phenomenon, and several
studies have proposed that, if asymptomatic, serial ultrasounds until
resolution may avoid unnecessary intervention.
Supporting information can be found in the online
version of this abstract
EP40.21
Medical management of early pregnancy failure with
misoprostol: echographic predictive factors of success
R. Bouhmida1 , H. Bettaieb1 , R. Boufarguin1 , N. Souayeh1 ,
M. Ouederni1 , H. Rouis2 , A. Chermiti1 , H. Laamiri1 ,
H. Oueslati1 , C. Mbarki1
1 Facultyof Medecine of Tunis, University of Tunis El Manar,
Tunis, Tunisia; 2 Faculty of Medicine of Sfax, University of
Sfax, Sfax, Tunisia
Objectives: The aim of this study was to identify potential
sonographic predictors for treatment success in medical management
with misoprostol for early pregnancy failure.
Methods: We conducted a prospective study. 269 women with
early pregnancy failure were selected at the day hospital of the
Department of Obstetrics and Gynecology at Ben Arous Hospital
during the period from December 2018 to December 2019. Medical
management consisted of administering 1200 μg of misoprostol
sublingually three times on the first day of the study. Clinical
and ultrasound monitoring was performed 48 hours later. A new
dose was indicated on the third day with the same protocol if
failure occurred. Success was defined as complete evacuation of the
intrauterine pregnancy without retention of products of conception.
Results: Of the 269 women who received misoprostol, 198 met
the criteria of success so a rate of 75%. Cervical length was
the only sonographic criteria predictive of success (p = 0,0001)
found in our study. The success rate was significantly higher if
vaginal ultrasound assessment of cervical length was under 33 mm.
However, the successful medical management is not significantly
related to gestational sac diameter p (0,582), Crown–rump length p
(0,602), the presence or the absence of either the yolk sac p (0,742)
or the fetal pole p (0,144).
Conclusions: medical management of early pregnancy failure is a
better option for women because it provides a timely treatment
and avoids undergoing surgery, anesthesia, and their potential
complications. Predictive sonographic and clinical modelling may
be possible in larger studies. It will be a useful tool to choose the
most effective option that can guarantee success.
© The Authors 2022
© Ultrasound in Obstetrics & Gynecology 2022; 60 (Suppl. 1): 85–315.
Electronic poster abstracts
EP40.22
Does an ultrasound diagnosis of ruptured ectopic on
transvaginal ultrasound scan correlate with operative and
histology findings?
S. Mitchell1 , L. Barfi2 , J. Hamilton1
1
Early Pregnancy and Acute Gynecology, St Thomas’ Hospital,
London, United Kingdom; 2 St Thomas’ Hospital, London,
United Kingdom
Objectives: To correlate the findings of suspected ruptured ectopic
pregnancies on TVUS with findings at operative laparoscopy and
final histology.
Methods: This was an 18-month retrospective review of all ruptured
ectopic pregnancies from November 2020 to March 2022 identified
on TVUS. The scans were performed by different sonographers and
clinicians. Cases were identified from our ectopic pregnancy records
and operating theatre database. The patients’ electronic patient
records were reviewed including their operation notes and the final
histology report.
Results: 19 cases of ruptured ectopic pregnancy were identified
on TVUS. Cases of suspected ruptured ectopic pregnancies that
underwent laparoscopy based on clinical findings were also
excluded. 1/19 cases were excluded as the operation notes were not
available. Ages of the patients ranged from 22-42 years and 15/18 of
the patients were nulliparous. 10/18 cases were described as ruptured
at laparoscopy and 2 cases described as leaking. All ectopics had a
salpingectomy performed and hemoperitoneum at operation ranged
from 50 to 2100mls. At histological diagnoisis,18/18 cases had
evidence of implantation site or trophoblastic tissue and 5/18 cases
had a histological diagnosis of a ruptured ectopic pregnancy. The
remaining 13 cases did not have a full thickness perforation and
diagnosis of ruptured ectopic.
Conclusions: True ruptured ectopic pregnancies on ultrasound
when correlated to final histology findings are difficult to diagnose.
The presence of blood on the ultrasound scan does not correlate to a
tubal rupture and the scan findings must be interpreted in the context
of the clinical situation to assess need for surgical intervention and
salpingectomy. It is very important that patients receive the correct
diagnosis and are appropriately counselled. The differing natural
histories of these pregnancies must also be appreciated and further
understanding of the pathophysiology behind the hemoperitoneum
or an alternative diagnosis such as tubal abortion is required.
EP40.23
Management of ectopic hepatic pregnancy: a case report
N. Febriastuti, A. Wibawa
Obstetrics and Gynecology, Universitas Indonesia Fakultas
Kedokteran, Jakarta, Daerah Istimewa Jakarta, Indonesia
A rare case of ectopic hepatic pregnancy is a life-threatening
condition. A 26-year-old pregnant woman, gravida 1, was referred
to hospital at her 25th week of gestation. Previously, she had
curettage at her 12th week gestation due to blighted ovum. After
three months, she still experienced amenorrhea and the qualitative
beta hCG was still positive. Ultrasound findings showed a live fetus
in the upper abdomen corresponding to 25 weeks of gestation and
the placenta was attached to right lobe of the liver. She showed no
signs of acute abdomen. One week later, the fetus was found to be
non-viable. Laboratory showed normal complete blood count, renal
and liver function tests. Quantitative β-hCG was 80.451 mIU/L. She
received 2 times of methotrexate 50 mg intramuscular injection 1
week interval and bromocriptine 2 times a day before underwent a
surgery. The baby along with the membrane were removed, however
the placenta was left in place. No postoperative complications were
observed.
273

32nd World Congress on Ultrasound in Obstetrics and Gynecology
In conclusion, this case draws our attention due to its rarity and
attention is drawn to the difficulty of preoperative diagnosis and
treatment.
EP40.24
Abstract withdrawn
EP40.25
Is vaginal ultrasound sufficient to recognise gestational
trophoblastic disease?
H. Rouis2 , H. Bettaieb1 , N. Souayeh1 , R. Bouhmida1 ,
H. Laamiri1 , M. Ouederni1 , A. Chermiti1 , H. Oueslati1 ,
C. Mbarki1
1
Faculty of Medecine of Tunis, University of Tunis El Manar,
Tunis, Tunisia; 2 Faculty of Medicine of Sfax, University of
Sfax, Sfax, Tunisia
Objectives: The primary aim of our study was to assess the role
of ultrasound in diagnosing gestational trophoblastic disease and to
correlate ultrasound imaging with histopathological findings.
Methods: this was a retrospective observational monocentric study
of findings of vaginal ultrasonography in histologically confirmed
trophoblastic diseases. This study was conducted during 18 years
from 2004 to 2021. We have excluded from this study all cases
of clinically suspected gestational diseases but not confirmed by
histopathology and all cases of miscarriage with triploidy but not
proving villous trophoblastic proliferation.
Results: We have collected 187 patients with confirmed gestational
disease (GTD). The mean of gestational age was 9,86 weeks of
gestation (WG) and the majority (81%) of patients were diagnosed
between 6 and 12 WG. The diagnosis of GTD were suspected,
before vacuum aspiration, in 40.2% of cases. The ‘‘snowstorm’’ or
‘‘clusters of grapes’’ appearance was detected in 26.9%, within these
cases: 54% were complete mole. Signs of myometrium invasion and
irregularity of myometrium were detected in 2 cases. In 52.9%
the ultrasound showed intrauterine pregnancy, eighty percent were
failed pregnancies. The ultrasound features found in cases of partial
mole were: thickened placenta with numerous anechoic cystic
lesions, an increase in the transverse diameter of the gestational sac,
fetal growth restriction, hyperechoic lesions showing an increased
colour power Doppler signal. Lutein cysts were found in 21 cases,
13 were bilateral and 8 were unilateral, their mean size was 6 cm.
Conclusions: Ultrasound is not sufficient to diagnose the gestational
trophoblastic disease, a histopathology analysis of the trophoblastic
tissu have to confirm the suspicion. The classic appearance of
snowstorm is becoming less frequent therefore detecting this
pregnancy disorder by ultrasound remains a diagnostic challenge.
EP40.26
Ressectoscopic approach in retained products of conception:
report of a series of cases
C.C. Silva1,2 , F. Castro2 , A. de Pinho2 , C. Oliveira2 , A. Mota
de Sousa2 , C. Oliveira2 , O. Carmo2
1 Gynecology and Obstetrics, Centro Hospitalar e Universi-
tario de Coimbra EPE, Coimbra, Coimbra, Portugal; 2 Centro
Hospitalar Tamega e Sousa EPE, Guilhufe, Porto, Portugal
Objectives: We aimed to describe and analyse the clinical cases
presenting to our facilities during the first two months of 2022
with suspected retained products of conception and managed with
ressectoscopy, after having completed medical treatment.
274
14690705, 2022, S1, Downloaded from https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.25857, Wiley Online Library on [12/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Electronic poster abstracts
Methods: Consultation of electronic patient file and video records
of ressectoscopic interventions.
Results: Between January and February of 2022, we reported three
cases of spontaneous abortions with suspected RPC and treated
with ressectoscopy. The case A presented after treatment with
misoprostol with persistent hemorrhage, anemia and endometrial
thickness of 27 mm, classified as Gutenberg type 0. Ressectoscopy
showed RPC inserted in anterior right uterine wall that was removed
with mechanical energy using ressectoscopic loop, with minimal
bleeding. In case B, after treatment with misoprostol, the patient
had no history of hemorrhage, but the ultrasound findings showed a
heterogeneous mass with 20 mm with vascularisation Gutenberg
0. The patient underwent hysteroscopy which confirmed RPC
inserted in posterior fundic uterine wall; in the same procedure
with ressectoscopic loop, the RPC was removed with minimal
bleeding and no harm to surround endometrium. Finally, patient C
was managed expectantly after diagnosis of spontaneous abortion
since intracavitary remains comprised about 12 mm of maximum
axis. During one month, she had no bleeding or other symptoms.
After menses, the ultrasound showed endometrial thickening and
hyperechogenic mass with 12 × 12 mm and a suspicion of RPC,
intracavitary myoma or endometrial polyp was made. During
ressectoscopy, a FIGO type 0 myoma inserted in posterior fundic
wall was seen and completely excised with bipolar loop.
Conclusions: In all cases, the minimally invasive approach allowed
precise diagnosis and complete treatment. The possibility of
intracavitary pathology was also be suspected and treated
accordingly, making this approach advantageous in a variety of
clinical entities.
EP40.27
Relevant ultrasonographic findings for timely surgical
management of ectopic pregnancy in Caesarean section scar
A.L. Esquivel1,3 , N. Rodrı́guez1 , N. Ramirez4 , C. Martinez3 ,
B. Cardoso1,3 , N. Rodriguez2,3
1 Gynecology, Santa Fe de Bogotá Foundation, Bogotá,
Colombia; 2 Gynecology and Obstetrics, Fundacion Santa Fe
de Bogotá University Hospital, Bogotá, Colombia; 3 School
of Medicine, University of Los Andes, Bogotá, Colombia;
4 Gynecology, El Bosque University, Bogotá, Colombia
Objectives: To evaluate the association between ultrasound findings
and the need for surgical management in patients with ectopic
pregnancy in the Caesarean section scar.
Methods: This observational study includes patients diagnosed with
ectopic pregnancy between January 2019 and February 2022 at the
Fundación Santa Fe de Bogotá University Hospital. Clinical, para-
clinical and ultrasonographic variables were evaluated. A descriptive
analysis of the patients was performed based on the means and
standard deviation (±). Additionally, a Chi2 test was obtained to
determine a possible association with a 95% confidence interval.
Results: Of 502 medical attentions regarding bleeding and pain
in the first trimester of pregnancy, 102 were diagnosed as ectopic
pregnancies, of which 8 (3.52%) received a diagnosis of ectopic preg-
nancy in the Caesarean scar, the maternal age was 37 (±) 4 years;
gestational age 6,4 (±) 2.6 weeks; all had a history of Caesarean
section; however, none had a history of ectopic pregnancy, their
level human chorionic gonadotropin hormone was 9172 (±) 4739
mlU/mL; by ultrasound, the mass had a diameter of 35 (±) 23 mm,
4 (50%) had the presence of an embryo and one (12.5%) had
embryocardia; 6 (75%) showed hypervascularisation in the ectopic
mass; 3 (37.5%) patients presented bulging of the serosa; 7 (87.5%)
patients presented involvement of more than 50% of the Caesarean
section scar; no patient has a ruptured ectopic pregnancy. Regarding
medical management, 6 (75%) patients received pharmacological
management with methotrexate, however 5 (83%) of these required
surgery; in 100% of the patients where bulging of the serosa was
evidence of a statistically significant association (p < 0.05).
© The Authors 2022
© Ultrasound in Obstetrics & Gynecology 2022; 60 (Suppl. 1): 85–315.