A. Hamela‐Olkowska

P13.11: Normal range of fetal intracranial translucency (IT) at 11.0 to 13.6 weeks of gestation in a Polish population

Objectives: Size of posterior fossa (PF) is primary feature in the diagnostic algorithm of PF malformations. This study was designed to provide nomograms of the sonographic parameters of PF morphometry in median plane of fetal head. Methods: Three dimensional sonographic volumes of 348 fetal heads in 15–35 gestational weeks were retrospectively studied using multiplanar display in 4D-View application. All patients had low risk, singleton pregnancy, and delivered healthy babies. All examinations were performed by single sonographer (L.Z.). All sonographic volumes were obtained above fetal vertex by sagittal acquisition using transabdominal or transvaginal probe. Borders of PF were defined from clivus to tentorium and from occipital bone to upper tectal plate margin. The measured parameters were: Posterior Fossa Area (PFA), Posterior Fossa Perimeter (PFP). Measurements were performed in the median head plane, by a single observer (P.C.). Based on these measurements we determined the relationship of these parameters to gestational age. Results: From the 348 examinations that were initially included, 282 were selected according to technical visibility. We found a linear growth pattern of PFA and PFP with r = 0.97 for each parameter. Percentiles were calculated for each parameter according to gestational week. The total feasibility rate of our parameters was 81%. The intra-observer variation was 4.5% ± 2.3% for PFA and 2.1% ± 1.2% for PFP. Conclusions: In this study we found a linear growth pattern of the fetal PFA and PFP and created their percentiles along gestational weeks. Our data may be useful in the diagnosis of the anomalies characterized by abnormal posterior fossa size, like Dandy-Walker malformation, Arnold-Chiari malformation and PF arachnoid cyst.

P23.10: Assessment of recipient twin cardiac function in twin pregnancy complicated by twin to twin transfusion syndrome by myocardial performance index

4/5, umbilical arterial hemoglobin 3.2 g/dl and a recipient of 1,356 g with Apgar score 8/8, umbilical arterial hemoglobin 17.7 g/dl. The hemoglobin level of the donor baby was 4.2 g/dl and recovered by red blood cell transfusion. The hemoglobin level of the recipient baby was 22.4 g/dl and this baby manifested mild heart failure and respiratory distress syndrome. Systemic conditions of the babies were recovered almost normal at 67 days of age. The monitering of MCDA pregnancies should include measurement of MCA-PSV in the both fetuses even in the absence of intertwine discordance in amniotic fluid volume. Written informed consent was obtained from the mother and father to report this case.

P12.08: Ductus venosus and umbilical vein flows in fetuses with atrial flutter and atrial fibrillation

women were referred for fetal cardiac screening, the remainder for suspected abnormalities. Fetal Cardiac abnormalities were diagnosed in 16/375 (4.3%) of ‘high risk’ screened women. They included 3/61 (5%) screened women with maternal cardiac disease, 9/166 (5.4%) previous child/sibling? with CHD, 4/34 (11.8%) of screened women with diabetes mellitus. Fetal cardiac abnormalities were identified in 18/375 (4.8%) women who had multiple risk factors. There were no obvious fetal cardiac defects among screened groups with a history of paternal CHD, previous child with CHD, maternal antibodies, and history of drug intake. Conclusions: The rate of antenatally diagnosed cardiac defects is higher than expected among our screened population. However, subgroup analysis revealed that it may vary between groups. Future studies are required to evaluate the implication of implementation of routine fetal cardiac screening policy on the antenatal detection rate of CHD and its management.

P22.04: Premature constriction of the ductus arteriosus in both fetuses of dizygotic twin pregnancy following maternal non‐steroidal anti‐inflammatory drugs application

from January 2006 should include extended cardiac examination (including 4-chamber view, three vessel view and outflow tract views, including colour doppler). However, this should only be performed when possible without extending the standard examination time (30 minutes). All screening procedures were performed by sonographers, specially trained in 2nd trimester ultrasound. All examinations were registered in a fetal medicine database (Astraia), and the proportion of women having a complete extended cardiac examination was monitored quarterly, and reviewed at regular meetings. In Q1 and Q2, 2009, all sonographers at the department completed a two day ‘hands-on course’ in extended cardiac screening. Results: The quarterly proportion of women having an extended cardiac screening is shown on the graph. The time for full implementation was 3 2 year. Conclusions: Implementation of 2nd trimester extended cardiac screening is feasible without extending the examination time of 30 minutes for a complete 2nd trimester examination. The proportion of accomplished extended cardiac screening only exceeded 98% after dedicated ‘hands-on’ training for all sonographers. Monitoring, supervision and early ‘hands-on’ training seem to be of importance in the implementation process.

P31.04: Atrial flutter with atrio‐ventricular block 2 : 1—case report

Fetus with giant hydrothorax and ascites was diagnosed at 25th week of pregnancy. Fetal echocardiography revealed normal heart anatomy with 8 points in Cardiovascular Profile Score (CVPS), (minus one for ascites and hydrothorax). At 26th week of pregnancy pleurocenthesis and amniocenthesis for fetal karyotype were performed. Fetal karyotype was normal however there was re-accumulation of the pleural effusion next week, so at 27th week of pregnancy pleuroamniotic shunt was established. Based on fetal echocardiography CVPS was 8 due to ascites and hydrothorax. Two weeks later there was again re-accumulation of pleural effusion and CVPS was still 8 points. At 29th week of pregnancy second pleuroamniotic shunt was implemented. Four days after second shunting there was no ascites and only rim of hydrothorax. At 31st week of pregnancy the fetus had again fetal echo and hyperoxygenation test which was positive. At 34th week of pregnancy there was still only rim of pleural effusion and no ascites (CVPS was 9). At 35th week there was spontaneous rupture of membrane, however the newborn was delivered by Cesarean section with birth weight 2200g and Apgar scores of 5 and 7. There was only small pleural effusion in left pleural cavity after delivery. The newborn was discharge home at 21 days. Conclusions: Despite dramatic fetal presentation and rapid reaccumulation of hydrothorax, monitoring by fetal echocardiography examinations had shown a safety of repeated fetal needling and double shunting.

OC96: Estimation of the myocardial performance index in fetuses at 11.0–13.6 weeks' gestation

Objectives: To investigate the cardiac defects (CHD) found in association with an increased nuchal translucency (NT). Methods: Patients referred from January 1998 until February 2007 with an NT ≥ 95th percentile at 11–14 weeks and where a cardiac defect was found were included. Chromosome analysis, fetal echocardiography and postnatal echocardiography were performed. After pregnancy termination a postmortem examination was performed when possible. Results: CHD were identified in 63 fetuses (major CHD in 50; 79%). The median NT was 4.8 (range, 2.6−13) mm. Group 1 included 36 fetuses (57%) with a normal karyotype. Median NT was 5.2 (range, 2.8−9) mm. Twenty-four (66.7%) had major CHD. CHD included VSD (10), HLHS (four), TGV (three), AVSD (three), PA + VSD/TOF (two), PS (two), uncertain cardiac diagnosis with hydrops (two), aortic arch abnormalities (two), PDA (two), DORV (one), ASD (one), tricuspid atresia (one), aortic incompetence (one), mitral valve abnormality (one) and persistent right umbilical vein (one). Group 2 included seven fetuses (11%) with a genetic disorder including: 18p deletion (two), 22q11 deletion (two), Coffin–Siris (one) and Holt–Oram (one). CHD found included HLHS, TGV, truncus arteriosus, VSD (two), ASD and DORV. Group 3 included 20 fetuses (32%) with abnormal numeric karyotype including 10 trisomy 21, six trisomy 18, two XO, one trisomy 13 and one trisomy 9. Median NT was 4.7 (range, 2.6−13) mm. Nineteen had major CHD. CHD found with trisomy 21 included AVSD (six), inlet VSD (two) and RV non-compaction (one). In fetuses with trisomy 18, VSD (two), polyvalvular disease (two), HLHS (one) and aortic arch abnormality (one) were found. Both fetuses with XO had HLHS. PA + VSD was found with trisomy 13 and truncus arteriosus in trisomy 9. Conclusions: Various CHD are associated with an increased NT. Conotruncal defects, branchial arch derivative defects, left and right obstructive lesions and shunts were seen. Anomalous pulmonary venous drainage and cor triatriatum were not seen; thus abnormal targeted growth is not the mechanism linking CHD and an increased NT.

OC195: Evaluation of perinatal condition in newborns with elevated concentration of cord cardiac troponin I

Objectives: To evaluate sonographic detection of fetal head rotation during the second stage of labor and to establish a correlation with station. Methods: A group of unselected women in labor underwent serial 2D ultrasound in the second stage. Before each ultrasound examination the station and rotation of the head were clinically assessed by two expert examiners. Rotation of the head was assessed with translabial ultrasound in a transverse view of the maternal pelvis by evaluating the angle between the midline of the fetal brain and the anteroposterior diameter of the pelvis. Results: Sixty women were included in the study group with a total of 168 and a median of three ultrasound and clinical examinations performed for each fetus (range, 1–6). Spontaneous vaginal delivery occurred in 43 (72%), whereas ventouse delivery or Cesarean section were performed in 11 (18%) and six (10%) cases respectively. Rotation was hardly seen on ultrasound with station 0 or + 1 (23/51, 45%), while it was usually well identified with station + 2 and more (117/117, 100%). Rotation of ≥ 45◦ was usually found with station + 2 or less in 70/75 (93%). Rotation of < 45◦ was found with station ≥ +3 or more in 45/65 cases (69%). The 11 ventouses were all applied with rotation of < 45◦ and were all easily performed. Of six Cesarean sections, rotation was undetectable or ≥ 45◦ in one and three cases respectively. Conclusions: Sonographic detection of fetal head rotation in labor is feasible by visualizing the midline of the fetal brain and comparing it with the anteroposterior diameter of the maternal pelvis. Rotation is strongly associated with fetal station and can therefore help the assessment of labor progression in the second stage, as well the choice of operative delivery.

P01.34: Evaluation of complications after the genetic amniocentesis

Objective: To assess the relationship between amniotic fluid sample volume, culture time and culture failure in prenatal diagnosis. Method: We retrospectively evaluated the results of 225 cases of genetic amniocentesis performed between 16 and 20 weeks of gestation. Cases were separated into four groups according to the amount of amniotic fluid obtained: Group A (n = 12, 1 to 5 mL); Group B (n = 23, 6 to 10 mL); Group C (n = 10, 11 to 15 mL); Group D, (n = 180, 16–20 mL). Results: Culture time was significantly longer in Group A than in the other groups. (median 19 days vs. 12.5, 10, 11 days). Even if differences in culture time within Groups B to D were not significant, there was a trend towards an increase in culture time with decreasing amniotic fluid volumes. Moreover, risk of culture failure was also increased with smaller volumes. There were no culture failures in Groups B, C and D but two culture failures in Group A. Conclusion: When necessary, small amniotic fluid volumes (at least 10 mL) may be used for fetal karyotyping with confidence after information of the family. Small volumes of amniotic fluid increase culture time and rate of culture failure.

P04.01: Evaluation of anatomy and function of cardiovascular system in fetuses at 11.0 to 13.6 weeks of gestation

Hydranencephaly is a severe brain condition characterized by complete or almost complete absence of cerebral cortex with preservation of meninges, basal ganglia, pons, falx. Despite the absence of the cerebral hemispheres, The thalami and lower brain centers are typically preserved. This condition is usually preceded by occlusion of the internal carotid arteries, infectious alterations (cytomegalovirus, toxoplasmosis) resulting in massive brain infarction. An 29-year-old woman, gravida 1, presented with fetal death at 18 weeks’ gestation. Initial 2D and 3D ultrasound revealed sloping forehead and abnormal intracerebral architecture which normal cerebral hemispheres could not be identified. Chromosomal study showed normal karyotyping. We report a case of hydranencephaly confirmed by autopsy, which was initially detected by 2D and 3 D ultrasonography at 18 weeks of gestation.

P04.25: Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other ultrasound parameters

Objective: A retrospective analysis of the prognostic significance of the lung-to-head ratio (LHR) and other ultrasound parameters on the outcome of fetuses with left-sided congenital diaphragmatic hernia (CDH). Methods: 25 fetuses with CDH. The LHR was obtained by measuring the right lung at the level of the four chamber view of the heart in the transverse plane. Mean gestational age of diagnosis was 30 ± 5 weeks. Results: 11 (44%) fetuses had isolated CDH, 6 (24%) had heart defects with extracardiac anomalies (meningocele-1, omphalocele1, multicystic kidney-1, hydronephrosis-2, cleft lip and palate-1). 6 (24%) had isolated heart defects, 2 (9%) – only extracardiac anomalies (meningocele-1, hydronephrosis-1). VSD was diagnosed in 5 cases, AVSD – in 2, HLHS – 1, PS – 1, AT – 1, TOF – 2. 3 fetuses had trisomy 18 and were excluded from further analysis, 1 of them died in utero, 1 died after delivery, 1 pregnancy is ongoing. LHR was measured in 18 fetuses. 13 fetuses had LHR < 0.9 – all of them died: 8 after delivery, 5 after operation. 3 had LHR between 0.9 and 1.2–1 pregnancy was terminated, 2 newborns are alive after operation. 2 fetuses had LHR > 1.2–1 child survived after operation, 1 pregnancy is ongoing. Overall, just 3 (13.6%) children out of 22 are alive after the operation, all without heart defects, one had hydronephrosis. Conclusion: LHR proved to be a good predictor for fetal outcome. Co-existence of heart defect and CDH is poor prognostic factor. Outcome of fetuses with CDH is poor, so new methods of prenatal treatment should be considered.