B Csapo

Procedure-related complications after genetic amniocentesis and chorionic villus sampling.

PURPOSEnAmniocentesis (AC) and chorionic villus sampling (CVS) play an important role in the diagnosis of genetic anomalies. The aim of this study was to evaluate presentable numbers of procedure-related complications of genetic interventions in a tertiary referral hospital.nnnMATERIALS AND METHODSnThe pregnancy outcome of women who underwent genetic AC or CVS during 2003-2010 at the Department of Obstetrics and Gynecology, Medical University of Graz, Austria, was analyzed retrospectively. The primary outcome was miscarriage or membrane rupture after an invasive procedure. Only singleton gestations were included.nnnRESULTSn1,569 AC procedures and 334 CVS procedures (234 transabdominal, 99 transcervical, 1 with undocumented route) were performed. Of these, 57 cases were excluded from further analysis because of severe anomalies. Complete outcome data were available for 93.17% of cases. In 164 (8.89%) cases the pregnancy was terminated due to genetic anomalies or severe malformations. In the remaining collective 10 of 1,342 (0.75%) AC procedures, 3 of 150 (2.00%) transabdominal CVS procedures and 2 of 64 (3.13%) transcervical CVS procedures lead to complications resulting in miscarriage < 24 weeks (n = 13) or rupture of membranes (n = 2) within 2 weeks after procedure. Complication rates were significantly higher after CVS than after AC (OR 3.19).nnnCONCLUSIONnOver an observation period of seven years, the complication rates after AC, transabdominal CVS and transcervical CVS were 0.75%, 2.00% and 3.13%, respectively. These results are comparable to recent international investigations.

Comparison of two-risk assessment algorithms for preeclampsia in first trimester with consecutive intake of low-dose aspirin in the high-risk group – an observational study

Abstract We analyzed outcome of women screened for preeclampsia with two different multifactorial risk algorithms (Predictor®Software by PerkinElmer, PerkinElmer, Waltham, MA; PERK-group: nu2009=u2009214 and Viewpoint® by GE Healthcare, Dornstadt, Germany; VIEW-group: nu2009=u2009209) in first trimester. Women at high risk for developing preeclampsia were advised to take low-dose acetylsalicylic acid (LDA). Screening positive rates for early onset preeclampsia differed significantly between the two groups (7.9% versus 26.3%; pu2009=u20090.000). According the clinical use of screening test criteria, LDA was prescribed in 63 (29.4%) women in the PE-group and 55 (26.3%) in the VP-group (pu2009=u20090.516). There were no differences in onset of preeclampsia [4 (1.9%) versus 6 (2.9%); pu2009=u20090.540]. No early or severe preeclampsia occurred in the whole population.

A Modified Technique for Cord Transection in Monochorionic Monoamniotic Twin Pregnancies

Monochorionic monoamniotic (MA) twins are at increased risk for intrauterine demise (IUD) and discordant anomalies. Selective feticide by cord occlusion may be an option in case of unfavorable discordant problems. In MA pregnancies, however, the surviving co-twin still remains at serious risk for IUD due to progressive cord entanglement. Cord transection has therefore been recommended to protect the survivor. This procedure may turn out to be difficult. We herein describe a modified fetoscopic technique for laser transection using a grasping forceps. We present technical details and clinical outcome in 2 cases of cord transection: one following cord occlusion and the other following spontaneous IUD. Cord transection was performed at 19 and 26 weeks gestation, respectively. A 3 Fr grasping forceps with a working length of 35 cm was used for controlled manipulation of the umbilical cord during transection. There were no procedure-related complications and both surviving co-twins had favorable neonatal outcome. Cord transection using a grasping forceps facilitates easy and precise fetoscopic release of the umbilical cord. To the best of our knowledge, this is the first report on post mortem cord transection after spontaneous single IUD with favorable outcome for the survivor.

P29.01: Maternal hemodynamic changes and complications following intrauterine interventions for monochorionic twin pregnancies

J. Braun3, N. Diemon3, K. Funke4, M. Möllers3, K. Hammer3, J. Steinhard2, C. Sauerland1, V. Müller4, W. Klockenbusch3, R. Schmitz3 1Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, Germany; 2Fetal Cardiology, Heart and Diabetes Centre NRW Ruhr-University Bochum, Bad Oeynhausen, Germany; 3Obstetrics and Gynecology, University Hospital Münster, Münster, Germany; 4Department of Pediatric Surgery, University Hospital Münster, Münster, Germany

Outcome of Bronchopulmonary Sequestration with Massive Pleural Effusion after Intrafetal Vascular Laser Ablation

Objective: To assess the outcome of 12 fetuses with bronchopulmonary sequestration (BPS) and massive pleural effusion after intrafetal vascular laser ablation (VLA). Methods: All fetuses with BPS and massive pleural effusion that were treated with intrafetal VLA during a 5-year period (2012-2016) were reviewed for safety, intrauterine course, and postnatal outcome. Results: In the study period, 12 fetuses with BPS were treated with VLA. In 7 (58.3%) fetuses, complete cessation of blood flow was achieved after the first VLA, while in 5 (41.7%) fetuses, residual perfusion of the feeding vessel was demonstrated at follow-up. A second intervention was successful in 4 of 5 (80%) fetuses. Overall, in 11 of 12 (91.7%) fetuses, complete coagulation of the feeding vessel could be achieved, followed by a reduction in size or complete resolution of the BPS. All 11 fetuses with successful prenatal intervention were live-born at a median gestational age of 39+1 (range, 37+5-41+2) weeks. Postnatally, 2 (18.2%) of the 11 newborns underwent sequestrectomy, as well as the preterm newborn on which a second fetal intervention was not feasible. Conclusion: VLA is an effective and safe treatment of BPS that appears to be of benefit in improving prognosis and decreasing the need for postnatal sequestrectomy.

Severe case of fetal hemolytic disease caused by anti-C(w) requiring serial intrauterine transfusions complicated by pancytopenia and cholestasis.

Anti‐Cw are rarely found as a source for severe fetal and neonatal hemolytic diseases. We report a case with serial intrauterine transfusions complicated by pancytopenia and cholestasis in the neonatal period.

OP34.06: Etiology and perinatal outcome of pregnancies with polyhydramnios

for Down-syndrome. We prospectively measured and compared prenasal soft tissue thickness (PT) and nasal bone length (NBL) in second trimester euploid and trisomy-21 fetuses. Methods: Using 2D abdominal ultrasound the measurement of PT and NBL was taken in mid-sagittal plane of the fetal head identifying diencephalon, tip of the nose, lips, maxilla, mandible, nasal bone in weeks 16–23 in the second trimester. The PT is the shortest distance from the bottom edge of the os frontale to the outer surface of the overlying skin. The nasal bone was measured from this view. The insonation angle was 90◦ (perpendicular) to the nasal bone. NBL/PT ratios of euploid fetuses between 16–23 weeks were analyzed and validated by Shapiro-Wilke test. We used software (SigmaStat 12 & SigmaPlot 12) to create graphs, the regression line and the percentiles curves (5th –25th –75th –95th) have been calculated from the normal values. We used the normal graphs to visualize and compare trisomy 21 cases to euploids (P < 0.0001). Results: Analyzes of 810 euploid and 19 fetuses with trisomy 21 measured between the 16–23 gestational weeks were done. In euploid fetuses the mean PT and NBL increased steadily between 16 and 33 weeks’ gestation. The difference in the median PT values between the two groups was greater than would be expected by chance. There was a statistically significant difference (P = <0.001) Mann-Whitney Rank Sum Test. All of the 19 fetuses with trisomy 21 the NBL/PT values were lower than 5th percentile curve of the euploid group. Conclusions: CIn fetuses with trisomy 21 the NBL/PT ratio was significantly lower compared to euploid ones. The NBL/PT ratio was found to be very sensitive and specific marker for trisomy 2.

P23.01: Monochorionic twin pregnancies: outcome and management

Objectives: To prospectively evaluate the role of ultrasound imaging in counselling patients with adnexal masses. Methods: From September 2011 to February 2012, we evaluated 65 consecutive patients with adnexal masses. The ultrasound features analyzed for the masses were: number, side and dimension, anatomic origin, tenderness and type of tumour (unilocularmultilocular, simple-solid), number of locules, internal cyst wall (regular, irregular, papillary projections), internal septa (completeincomplete), echogenicity, presence of acoustic shadows or ovarian crescent sign, colour Doppler score, presence of ascites or free fluid in the Pouch of Douglas. CA-125 level was measured. Timing, type of intervention and possible referral to an oncological Unit was decided upon imaging characteristics. 62 patients underwent laparoscopy for removal of the mass in our Unit, three patients were sent to referral oncological centre. The surgical specimens were analyzed for histological diagnosis. Results: The mean age of the patients was 44.7 ± 14.6 years, eighteen patients (12%) were post-menopausal. Three patients were pregnant: one with an adnexal mass suspected of borderline ovarian cancer and two with ovarian torsion. The adnexal masses were unilateral in 59 patients and bilateral in six. The dominant mass had a mean largest diameter of 64.2 ± 23.8 mm. The histological diagnosis were: endometryoma (27%), mature teratoma (14%), mucinous/serous cystoadenoma (22%), parasalpyngeal cyst (7%), salpingitis (6%), ovarian torsion (6%), ovarian cancer (1%), others (17%). The subjective assessment of the gynaecologist was benign in 64 cases (90%) and borderline in 7 cases (10%) with a negative predictive value of 100% and specificity of 90%. Conclusions: In a university non-oncological unit, it is feasible to manage the majority of adnexal masses. Our ultrasound based triage avoids work overload of oncological referral centres, were it is mandatory to refer those patients with a high suspicious of malignancy.

OP30.08: Neurodevelopmental long‐term outcome of preterm monochorionic and dichorionic twins

Objectives: Preterm birth is a main contributor for neurodevelopmental impairment in affected infants. The study aimed to evaluate long-term neurodevelopmental outcome of twins following preterm delivery between 2003 and 2008. Methods: Neurodevelopmental outcome of monochorionic (MC) and dichorionic (DC) twins, who were born between 24+0 weeks and 33+6 weeks at the Medical University of Graz, was analyzed retrospectively. Primary outcome was neurodevelopmental impairment at the age of two years. Secondary outcome were pregnancy complications. Results: The population consisted of 264 children (132 twin pregnancies), 94 (71%) were DC and 38 (29%) MC. The most frequent complications (30%) in each group were preterm rupture of membranes and preterm labor. Mean gestational age at delivery was 30+4 and 31+0 weeks for MC and DC twins, respectively. In the MC group 38 (84%) of 66 children had an uneventful outcome, while 7 (16%) had neurodevelopmental impairment [1 (2%) mild, 6 (13%) severe]. 114 (83%) of 138 DC children were healthy, whereas 24 (17%) presented neurologic delay [11 (8%) mild, 4 (3%) moderate, 9 (7%) severe]. Conclusions: The rates for neurodevelopmental impairment of MC and DC twins were comparable. However, severe problems occurred more often in MC twins.