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pregnancy. Br .I Obstet Gynaecol 1994;101:782-86. Rottem S et al. First trimester tramvaginal diagnosis of fetal anomalies. Lancet 1989,l: 444-445. Sebire et al. Presence of the lemon sign in fetuses with spina bifida at the lo-14 week scan. Ultrasound in Obstetrics and Gynecology 1997, 10: 403-405. Sebire et al. Fetal megacstis at lo-14 weeks of gestation. Ultrasound in Obstetrics and Gynecology 1996, 8:387-390. Snijders RJM, Noble P, Seibre N, So&a A, Nicolaides KH. UK Multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucencky thickness at lo-14 weeks of gestation. The Lancet 1998; 352: 343-346. Souka AP et al. Defects and syndromes in chromosomally normal fetuses with increased nuchal translucency thickness at lo-14 weeks of gestation. Ultrasound in Obstetrics and Gynecology 1998, 11: 391-400. Whitlow BJ et al. The value of sonography in early pregnancy for the detection of fetal abnormalities in an unselected population. British Journal of Obstetrics and Gynecology 1999, 106: 929-936.

Flm.01.03 ULTRASOUND SCREENING FOR FETAL ABNORMALITIES IN THE SECOND TRIMESTER Pave1 Calda, Dept. OB/GYN, Charles University. Prague, Czech Republic

We are witnessing intensive efforts to transfer the basic ultrasound examination to the first trimester. Although these activities have made remarkable progress in the last few years, the second trimester ultrasound remains important and still mandatory in the screening policy for fetal abnormalities. The timing and number of ultrasound examinations during pregnancy differs from region to region. The ultrasound screening has not only scientific, but very important economical and psychological aspect. If the economic circumstances do not permit three routine ultrasound scans, then the first and second trimester scans should be retained. In cases restricted to only one scan, the second trimester scan should be carried out. Together with screening for abnormalities in the second trimester, cervical risk assessment for prematurity and uterine artery Doppler as screening for pre-eclampsia can be performed. The incidence of major fetal anomalies (life threatening defects or major cosmetic defects) ranges between 2-2.5%. The relatively low prevalence of fetal abnormalities in the low-risk population allows us to reassure most expectant parents of their child’s physical and mental integrity. To be effective and economical, screening should cover the entire population and not just the high-risk group. An acceptable quality of ultrasound screening necessitates the expertise of the examiner. Appropriate ultrasound equipment is a prerequisite. It is debatable if the screening should be carried out by personnel (sonologists, trained midwives) in specialized centers or by general obstetricians. Either way, the person performing the screening ought to be trained, have the opportunity to practice screening routinely, and to frequently encounter anomalies. When first trimester screening will become routine, the role of the mid-trimester scan will change (e.g. presence of sonographic soft markers in the second trimester will be of lesser significance). Also, there will be more space in diagnosing the more difficult anomalies (heart, spine, and limbs). However, it seems unrealistic to expect that a single pregnancy scan will detect all fetal malformations. By introducing an early pregnancy scan in addition to the mid-trimester scan, the detection rate is significantly increased.

FM5.02 MULTIPLE PREGNANCY

Flm.02.01 DIAGNOSIS AND MONITORING J. Rosario University, Buenos Aires, Argentina

In recent years, few topics aroused such an intense interest as multiple pregnancy. A large number of multidisciplinary studies established this subject, twin pregnancy, as a new science inside obstetrics. If we take into account that among multiple pregnancies more than 50 % is complicated by preterm labour, accounting for almost 10 % of preterm newborns, we can see the importance of this subject, in terms of clinical practice and public health implications. Multiple pregnancy occurs in one in eighty pregnancies.

FRIDAY, SEPTEMBER 8

Until 1970 women below 30 years of age represent only 30% of all pregnant women. In recent times the proportion of pregnant women over 30 years increased rapidly. The reasons were different for different countries. Some decided to wait in order to establish a professional career or finish a university degree. In consequence the possibility of archiving pregnancy is more difficult Assisted fertilisation is more common for older women, and previous pathologies associated with pregnancy are more common too. For this reason we should be expecting a large proportion of high risk pregnancies among these women, and monitoring these patients with a higher level of care than the general population is granted.

Flm.02.02 CANADIAN CONSENSUS Jon Barrett, Sunnybrook and Women’s College Hospital, University of Toronto, Ontario, Canada

The incidence of twin gestations across Canada has increased by 15% over the years 1993 1997l This increase is the major contributing factor to the rising incidence of pre term birth in Canada.3 Many aspects of the obstetric management of the twin pregnancy cannot be extrapolated from that of a singleton pregnancy. For example the age related karyotypic risk is different for a twin compared to a singleton pregnancy ; during pregnancy the antenatal assessment of fetal growth cannot be adequately assessed without ultrasound and finally, the delivery of the second twin demands special attention. Therefore in December 1997, The SOGC, Universities of Toronto and Western Ontario with support of the Medical Research Council of Canada, and the Pharmaceutical Companies of Serono, Ferring, UpJohn, Adeza, Hewlett Packard and Matria Health Care, coordinated a National Consensus Conference, with representation from across Canada, UK and the USA in order to define, based upon the best evidence available, the standard of care of a twin gestation. Five priority area’s were identified and questions relating to those area’s developed in order to allow participants to concentrate on important guidelines for practice. These area were I) The First 20 weeks - implication for genetic Counselling and

Chorionicity determination. 2) Fetal Growth

3) Pre term labor Prediction and prevention 4) Labor and Delivery -The Second Twin Special Twin Circumstances. This seminar will present some of the important findings of this Consensus Conference by interactive questions and answers and lecture.

0N5.01 RECURRENT DISEASE

0N5.01.01 ROLE OF PALLIATIVE SURGERY IN OVARIAN CANCER W. Memorial Sloan-Kettering Cancer Center, NY, NY, United States

Palliative surgery for ovarian cancer is any surgical procedure to improve the duration of survival or the quality of life in a patient who is unlikely to be cured by further therapy. To be inclusive, this would include most operations for recurrent disease and those operations designed to releive intestinal obstruction. While the occasional patient who undergoes surgery for recurrent disease will be cured, such out comes are infrequent and the usual aim is to combine a surgical reserction with adjunctive therapy so as to optimize the chances of a complete remission and improve the duration of disease free survival. Such surgical procedures are more likely to be successful if there are a limited number of areas of recurrence and if the gross disease can be completely resected. These patients invariably have resisdual microscopic disease and some additional therapy is required to allow a prolonged disease-free interval. Patients who are most likely to benefit from such resections are patients with a long disease-free interval prior to recurrence. Such patients are more likely to respond to adjunctive chemotherapy and when combined with effective secondary cytoreduction may achieve significant palliation. On occasion, patients recur only in the pelvis and following complete surgical resection may benefit from pelvic irradiation. Patients with recurrent disease in the abdomen rarely benefit from adjunctive irradiation because of the limitation in dose that can be delivered. One exception to this latter statement is the patient with recurrence limited to the para-aortic or pelvic and para-aortic lymph nodes where a significant dose of irradiation may be possible. The second type of