HE4 concentrations may be elevated in CKD patients with no ovarian and lung cancer. Thus, HE4 results should be interpreted cautiously in women with renal disorders.

The aim of this study was to compare maternal cardiac function in a cohort of women who were high risk for early (<34 weeks) pre-eclampsia (ePET) and subsequently had normal or adverse outcomes. Methods: This was a prospective study of maternal cardiac function in women deemed high risk of ePET by first trimester screening at 12 weeks. Serial echocardiographic assessment (Accuvix XG, Samsung Medison with P2-4BA probe, Seoul, Korea), of maternal cardiac output (CO) and total peripheral resistance (TPR) were calculated at 14, 18, 24 and 30 weeks. Pregnancy outcomes were recorded and defined as being normal or adverse (the development of hypertension, delivery of an infant of low birthweight (<5th centile) or preterm birth (<37 weeks' gestation). The cardiovascular parameters were compared between the two groups. Results: 31 women who had a high risk ePET screen participated; 18 with a normal and 13 (42%) with an adverse pregnancy outcome. The adverse outcome group included 3 (9.7%) pre-eclampsia, 3 (9.7%), gestational hypertension, 4 (12.9%) preterm birth and 4 (12.9%) infants with low birthweight. Mean CO (L/min) values were significantly lower in those with an adverse outcome; 4.99 vs 4.17: P=0.04 at 14 weeks and 5.35 vs 4.61: P<0.01 at 30 weeks gestation. The mean TPR (dyne/sec/cm-5) was significantly higher in the adverse outcome group at 14 weeks (1431 vs. 1722: P=0.04), 24 weeks (1316 vs. 1577: P<0.01) and 30 weeks (1323 vs. 1658: P<0.01) gestation. Conclusions: Women who are high risk for ePET and subsequently have an abnormal outcome have evidence of abnormal cardiac function with lower CO and higher TPR as early as 14 weeks gestation. These parameters may be useful as a second tier screening tool for pregnancies deemed 'high risk' by first trimester screening and may help reduce the false positive rate and increase the positive predictive value of the screening process.

Oral communication abstractsObjectives: Precise imaging diagnosis of ovarian tumor is a major issue for operative management. A combination of magnetic resonance imaging (MRI) images with real time high-resolution ultrasound known as fusion imaging may improve gynecologic pathologies investigations such as ovarian tumors. This study was undertaken to evaluate the feasibility of using fusion of MRI and ultrasound (US) in ovarian tumor characterisation. Methods: This prospective bicentric study included 25 patients referred for ovarian tumor diagnosed by US. All cases underwent 1.5 Tesla MRI protocol including at least 3 T2-weighted planes, with diffusion sequence and dynamic series. The Digital Imaging and Communications in Medicine volume dataset was then loaded into the US system for manual registration of the live US image and fusion imaging examination. The results of the fusion were then compared with US and MRI results alone. Results: Ovarian tumors could be investigated by fusion imaging. US was more efficient to characterise small vegetations whereas T2-weighted MRI was limited by the size of the vegetations. The use of the color Doppler added a vascular criteria which could help the interpretation of the fusion imaging. The diagnosis of malignant tumor was improved by the use of the fusion thank to the complementarity of US and MRI and the addition of the malignant criteria. Conclusions: Multimodality fusion imaging is feasible to investigate ovarian tumors, as US and MRI are complementary. The combination of real time MRI and US image fusion could help to characterise ovarian tumors when the interpretation was difficult by isolated US and MRI.OC03.02 * Does HE4 improve the diagnosis of pelvic masses in non-experienced examiners? Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, HungaryObjectives: To determine the additive diagnostic value of HE4 tumor marker to in the IOTA's three step strategy for managing adnexal masses focusing on non-experienced examiners. Methods: Imaging properties of ovarian masses were evaluated preoperatively using the IOTA terms and definitions. Two groups of patients were made: 1: premenopausal (PEM); 2: postmenopausal (POM). In both groups adnexal masses were characterised by the 'easy descriptors' and in cases where these were not applicable the IOTA Simple rules had been used. US results then were matched with the preoperative CA125 and HE4 tumor marker levels and histological findings. Results: Overall 285 patients with ovarian masses were recruited in the analysis (average: 42.0 yrs; range: 12-82 yrs). In the PEM group we had 199 cases (69.82%; range: 12-53 yrs; average: 33.12 yrs), * This presentation is eligible for the Young Investigator award (to be presented in the closing plenary).in the POM group 86 cases were involved (30.18%; range: 48-82 yrs; average: 63.09 yrs). In the PEM group 104 patients had the diagnosis based on easy descriptors (52.26%) while 76 patient of the rest fulfilled the requirements for the simple rules. In the POM grou...

Objectives: Assessment of the fetal head station is of crucial importance if safe operative vaginal delivery is to be attempted. Intrapartum translabial ultrasonography (ITU) has recently been applied to measure the fetal head descent objectively. However, it has not been widely used because the reference point of ITU is different from that of digital examination. Whereas digital examination takes the ischiatic spine as a reference point, ITU uses the pubic symphysis because the ischiatic spine is unable to be detected with ultrasonography. In order to compare the finding of ITU with digital examination, we examined the relationship of the pubic symphysis and the ischiatic spine with using pelvic CT data. Methods: Three-dimensional reconstructions from computed tomographic (CT) datasets of 37 normal Japanese female pelvises were used to measure the spatial relationship between pubic symphysis and ischiatic spine. Results:The distance between the interspinous line and the lower end of pubic symphysis ranges from 70-86 mm (79.7 ± 4.5 mm, mean ± SD)and varies greatly between individuals. The angle between midplane of pelvis and the lower end of pubic symphysis is 104-117 • (112.3 ± 3.3 • ). The correlation function with body height is 0.34. Conclusions: It was impossible to make the interspinous plane on the screen of ITU, but the midplane of pelvis can be traced on it. Therefore, ITU can provide the objective information for the assessment of the fetal head descent which has been dependent on the subjective observations of the digital examination, and it will contribute to the safe operative vaginal delivery. Royal Prince Alfred Hospital, Camperdown, NSW, AustraliaObjectives: The purpose of this study was to determine the feasibility of a multicentre randomised control trial to investigate if digital rotation of the fetal head from an occiput posterior (OP) position in the 2 nd stage of labour, prior to the commencement of pushing, reduces the risk of a caesarean section. Methods: We conducted a single centre, double blind, randomised control trial pilot study of 27 women between February 2011 and January 2012. Women were consented antenatally or in the latent phase of labour. Once fully dilated a mobile transabdominal ultrasound scan was performed to confirm position of the fetal head. If an OP position was confirmed, women were eligible to participate, and were randomised to a prolonged vaginal examination (control group) or a digital rotation. The position of the fetal head was confirmed post intervention with transabdominal ultrasound imaging. Ongoing management of labour proceeded as per standard practice for both groups. Maternal demographics, obstetric and neonatal data were collected by chart review, and review of the trial data collection forms. Results: More than 900 women were consented to yield 27 women who proceeded to randomisation. This pilot study is not powered to show statistically significant results or trends. There was no significant difference between the two groups for the incidence of caes...