Abstract
Two experienced observers performed a review of stored 2D and 3D sonographic examinations of 50 consecutive women with typical sonographic signs of adenomyosis according of the MUSA. 20 patients without any sonographic signs of myometrial pathology were used as control group. Each observer, independently and blinded to each other, evaluated the presence or absence and the severity of adenomyosis using a new score system. The score system evaluated ultrasonographic criteria for focal and diffuse adenomyosis, adenomyoma and for junctional zone (JZ). A score number from 1 to 4 were assigned to the extension and myometrial involvement of each type of adenomyotic lesions and for JZ alterations. Numerical score obtained was classified in three group: mild (ranged between 1 to 7), moderate (8-13) and severe (14)(15)(16)(17)(18)(19)(20). Results: With respect to interpretation of the presence or not of adenomyosis ultrasonographic findings, the agreement was perfect (Cohen kappa, K=1). Multiple rater agreements to classify the different features of adenomyosis (diffuse, focal adenomyoma and focal or diffuse alteration of JZ) ranged from good to almost perfect (Cohen k 0.678 -0.953). According to numerical score the agreement for minimal, moderate and severe adenomyosis ranged from substantial to almost perfect (respectively Cohen k=1, K=0.94, K= 0.79). Conclusions: Our new score system to diagnose adenomyosis severity were reproducible and could be useful in clinical practice. The high percentage of agreement obtained in the JZ evaluation could improve the sensitivity of adenomyosis diagnosis. The ultrasonographic quantification of severity and the extension of adenomyosis in the myometrium could be helpful in correlation to the severity of symptoms but also for an emerging request of surgical treatment.
Abstract
Influence of endometriomas and deep infiltrating endometriosis on pregnancy outcome and first and second trimester markers of impaired placentation
Objectives:
The role of deep endometriosis (DIE) and ovarian endometrioma (E) as a risk factor for adverse perinatal outcomes in women with endometriosis has yet to be established. The aim of this study was to explore if fetal and maternal outcomes, in particular the incidence of small for gestational age (SGA) infants, are different in pregnant women with E versus DIP without endometrioma. Methods: This prospective included 160 pregnant women; 40 patients in each group with endometriosis, and 80 control cases of pregnant women without endometriosis. Women with uterine malformations, chronic hypertension, autoimmune diseases, pregnancy with major fetal structural abnormalities, aneuploidy or multiple gestations were excluded. DIE and E were diagnosed by using standardised ultrasonographic criteria. The study included patients who conceived spontaneously or by assisted reproductive techniques.
Results:
The three groups were similar in demographic characteristics (age, body mass index, mode of conception). No statistically significant difference was found in patients with E and DEP without endometrioma regarding PAPP-A MoM (0.99 vs 1.17 MoM, p=0.211), mean uterine artery pulsatility index (UtA PI) in the 1st (1.70 vs 1.66, p=0.778) and 2nd (0.92 vs 0.94, p=0.779) trimester of pregnancy, and incidence of SGA (5% vs 7.5%, p=0.644; respectively). No statistically significant difference was found in patients with E and DEP without endometrioma when compared to those without endometriosis. Logistic regression analysis demonstrated that neither the presence of E nor the presence of DIP without endometrioma are independent risk factor for SGA. Conclusions: The presence of E and DIP without endometrioma are not risk factor for the delivery of SGA infants. Women with endometriosis should be treated in pregnancy as the general population and do not need a closer monitoring. Objectives: Pouch of Douglas (POD) obliteration can be predicted with a high degree of certainty in women with symptoms suggestive of underlying endometriosis using transvaginal ultrasound (TVS). To evaluate preoperative real-time dynamic TVS in the prediction of pouch of Douglas (POD) obliteration in women undergoing laparoscopy for suspected endometriosis over an eight-year period.
OP31.10

Methods: Prospective study between March 2009 and March 2017. Women who attended the Endogynecology clinic at Nepean
Hospital underwent detailed 'deep endometriosis scan' and follow up laparoscopy. Each woman was assessed for the presence of 'sliding sign' on TVS at the both the retro-cervix(RC) and posterior uterine fundus(PUF). As long as the 'sliding sign' is considered positive in both of these anatomical regions the POD is recorded as 'not obliterated'. If either of these anatomical regions demonstrates that the anterior rectal wall or rectosigmoid does not glide smoothly over the RC or PUF, respectively, then the 'sliding sign' is considered negative, and the POD is recorded as 'obliterated'.
Methods: Prospective study between March 2009 and March 2017. Women who attended the Endogynecology clinic at Nepean
We evaluated the performance of the 'sliding sign' to predict POD obliteration in terms of sensitivity, specificity, PPV & NPV for first 200 cases (March 2009 to January 2013 
Conclusions:
Although the detection rate for POD obliteration was stable between the two cohorts, the false positive rate increased over time. Eliciting the 'sliding sign' is an accurate way to predict POD obliteration in women with suspected endometriosis who are planning laparoscopy.
OP31.11
Follow-up of MRI deep infiltrative endometriotic lesions before and after pregnancy: does it change something?
OP31.11
A. Millischer 1 , L. Marcellin 2 , P. Santulli 3 , C. Chapron 3

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