A. Tempesta

Fetal cardiac evaluation at 11–14 weeks by experienced obstetricians in a low‐risk population

The aim of this study was to evaluate the detection rate of congenital heart diseases (CHD) in a low‐risk population by performing cardiac evaluation during the first‐trimester screening for chromosomal abnormalities. In this context, the role of four‐chamber view, tricuspid regurgitation and abnormal ductus venosus flow in the screening for cardiac anomalies in a low‐risk population was also investigated.

Fetal interrupted aortic arch: 2D-4D echocardiography, associations and outcome

To analyze fetal two‐dimensional (2D) echocardiographic characteristics of interrupted aortic arch (IAA) and its different types, to explore whether the use of 4D ultrasound with B‐flow imaging and spatiotemporal image correlation (STIC) can improve prenatal diagnostic accuracy, and to describe associations and outcome.

Aberrant right subclavian artery (ARSA) in unselected population at first and second trimester ultrasonography

To evaluate the feasibility of examining aberrant right subclavian artery (ARSA) at first and second trimester gestation, its prevalence and associations in an unselected population.

Abnormal sonographic appearance of posterior brain at 11–14 weeks and fetal outcome

The aim of this retrospective study was to describe the sonographic appearance of the posterior brain anatomy in normal fetuses at 11 to 14 weeks of pregnancy and to determine the fetal outcome when one of the posterior brain anatomical space is not recognized.

EP08.13: Appearance of the fetal posterior fossa at 11-14 weeks in fetuses with cephalocele

Methods: 34 cases with partial corpus callosum agenesis were diagnosed during detailed level III ultrasonographic examinations. All scans were performed using E8/E10 GE equipment (Zipf, Austria) with a 5-8 MHz 3D abdominal or a 5-9 MHz 3D vaginal transducer. In all cases with abnormal corpus callosum the following variables were checked: absence of rostrum, genu, body or splenium, absence or size of the cavum septi pellucidi, presence of ventriculomegaly and presence of associated malformations. Karyotyping was offered to the parents in all cases and pregnancy outcome was controlled. Results: Gestational age ranged between 21+4 and 33+5 weeks of gestation. Rostrum was missing in 10 cases, genu in 11 cases, body in 12 cases and splenium in 25 cases. Cavum septi pellucidi was absent in 15 cases and too small in the other 19 cases. No cavum vergae was seen in all cases with absence of the posterior part of the corpus callosum. Associated structural malformations were observed in 30 cases, and in 3 cases a chromosomal abnormality was detected. In 22 cases the parents decided for termination of pregnancy. 4 cases had a normal development, in 4 cases a neonatal death occurred and in 4 cases a delayed neonatal development was observed. Conclusions: In partial corpus callosum agenesis the most affected anatomical part of the corpus callosum is the splenium. Prenatal counseling depends on the severity of the defect and the associated malformations. In all cases karyotyping should be offered to the parents.

P27.02: Accuracy of early fetal echocardiography within 16 weeks of gestation in the diagnosis of outflow tracts anomalies in a high-risk population

Objectives: The aim of the study was to evaluate the feasibility of making a correct prenatal diagnosis of the anomalies of the outflow tracts with early fetal echocardiography in an high-risk population. Methods: Early fetal echocardiography was performed in high-risk pregnancies (NT > 99th percentile, NT between 95th and 99th percentile with tricuspid regurgitation (TR) or abnormal flow of the ductus venosus (DV), TR and abnormal DV, previous child affected by congenital heart disease (CHD), suspected CHD or extra-cardiac anomaly during early fetal anomaly scan). In all cases a fetal echocardiographic evaluation was offered at 19-21, 32-34 weeks of gestation and postnatally. Results: On early fetal echocardiography we identified 43 cases of outflow tracts anomalies. Twenty-six cases were excluded from the study because parents opted for termination of pregnancy in the first trimester. In the 17 remaining cases, we diagnosed 5 transposition of great arteries (TGA) (3 TGA and 2 correct TGA), 2 double outlet right ventricle (DORV), 3 Tetralogy of Fallot (TOF), 1 malalignment VSD, 4 pulmonary atresia with VSD (PAVSD), 1 critical stenosis of the aorta e 1 of the pulmonary artery. In 3 cases the diagnosis was slightly modified later in gestation. In addition we had 3 false negative cases (2 TOF, 1 critical stenosis of pulmonary artery). Conclusions: Our study confirmed the feasibility of making a correct prenatal diagnosis of outflow tracts anomalies based on early fetal echocardiography.

OC11.02: Late development of the normal cerebellar vermis: is it really an obstacle to the early diagnosis of Dandy-Walker malformation?

loss occurred in 10.4% and 1.6% of children with 1st and 2nd trimester infection, respectively. One child with deafness treated with cochlear implant and one child diagnosed with mild CP, (attributed to prematurity) both after 1st trimester infection. Three children, after 2ed trimester infection, diagnosed with hypotonia (2) and mild developmental delay (1). Nineteen patients had abnormal sonographic findings (4 with normal MRI, and 10 with subtle MRI findings). Of those, 3 (15.7%) had damage to the auditory system. Two other fetuses had very abnormal US findings (refuse TOP) and they suffered severe neurologic damage. In all cases infection occurred during the 1st trimester. None of the children infected during the third trimester were affected. Conclusions: The outcome of congenital primary CMV infection with normal prenatal US and MRI is favorable. The prognostic value of subtle MRI findings is probably limited and as an isolated finding it probably does not justify termination of pregnancies.

OP12.11: Comparison of the cardiac findings at 11 to 14 weeks' gestation with the second trimester findings

Conclusions: Congenital malformations of the tricuspid valve are known to show a gradation of changes, ranging from Ebstein’s malformation with downward displacement of the valvar leaflets inisolation, through combinations of displacement and dysplasia, to exclusive dysplasia of normally attached leaflets. Several studies have described the prenatal diagnosis of tricuspid valve disease at advanced gestational age, but none addressed the early prenatal diagnosis of tricuspid valve disease. This study addressed for the first time the early prenatal diagnosis of tricuspid valve disease.

OP07.01: First and second trimester assessment of aberrant right subclavian artery (ARSA) assessment in routine population

Objectives: To define the feasibility of assessing the right subcalavian artery (RSA) in 1st and 2nd trimester ultrasonographic assessment of routine population and the association of ARSA with chromosomal, cardiac and extracardiac anomalies. Methods: RSA was prospectively evaluated since July 2009 in all routine patients booked in our fetal medicine Unit. We included 11–14 weeks assessment, pre-invasive US evaluation in patients that declined 1st trimester screening at booking and opted directly for fetal karyotyping due to maternal age ≥35 y and routine anomaly scan. All patients referred for increased NT, amniocentesis, cardiac or extracardiac abnormalities were excluded. Results: We have assessed 4068 routine patients, 3036 in the 1st and 3152 in the 2nd trimester; 2281 patients were assessed in both 1st and 2nd trimesters. RSA assessment was feasible in 2529 1st trimester exams (83%). Feasibility in the first trimester was related to the CRL/BMI ratio. In the 2nd trimester the feasibility was higher reaching 98%. The overall feasibility in our series was 91.1% (3709 feasible cases, considering both 1st and 2nd trimester evaluation). An ARSA was found in 49 fetuses (overall incidence 1.32% of the feasible cases) where 28 were detected in the 1st and 19 in the 2nd trimester. Nine of the 2nd trimester ARSA have been misdiagnosed in the 1st trimester assessment. Fetal echocardiography always confirmed the initial diagnosis, when an ARSA was detected in the screening scan (no false positive cases). Of the 49 ARSA, 39 were euploid with no other findings; the remaining 10 cases included 5 aneuploidies, 1 genetic syndrome, 1 22q11 microdeletion, 1 cardiac and 2 extracardiac abnormalities. Conclusions: The feasibility of RSA assessment in a routine population depends on gestational age and maternal BMI, with more than 80% feasible cases in the first trimester. A high rate of ARSA are associated with genetic or structural, abnormalities.

OC02.05: Fetal echocardiography at 11–14 weeks by experienced obstetricians in a routine population during first trimester US screening for chromosomal abnormalities

C. B. Miltoft1, C. K. Ekelund1, B. M. Hansen2, A. Lando2, O. B. Petersen3, P. Skovbo4, F. S. Jørgensen5, L. Sperling6, H. Zingenberg7, A. Nikkila8, A. C. Shalmi9, I. Stornes10, V. Ersbak11, A. Tabor1 1Fetal Medicine and Ultrasound, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 2Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 3Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby, Aarhus, Denmark; 4Department of Obstetric and Gynaecology, Aalborg University Hospital, Aalborg, Denmark; 5Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark; 6Department of Obstetrics and Gynecology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark; 7Department of Obstetrics and Gynecology, Copenhagen University Hospital, Glostrup, Copenhagen, Denmark; 8Department of Obstetrics and Gynecology, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark; 9Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hillerød, Copenhagen, Denmark; 10Department of Obstetrics and Gynecology, Randers Hospital, Randers, Denmark; 11Department of Obstetrics and Gynecology, Silkeborg Hospital, Silkeborg, Denmark