C. Albu

P20.03: Vaginal versus abdominal scan in detection vasa previa in a lot of 364 patients with placenta previa and low lying placenta

Objectives: Uterine myomas are benign disease observed in 2 to 3% of all normal pregnancies. The aim of this study is to assess the influence of large uterine myomas on obstetric outcome. Methods: Sixty nine pregnant women with large uterine myoma (8 cm or greater) identified by second trimester ultrasound scans (Accuvix XQ, Medison Co., Seoul, Korea) who delivered at Yonsei University Health System between January 2005 and March 2011 were enrolled. If more than one myoma was detected, the largest one was considered to be representative. The number, size, position, and location of the uterine myomas and the perinatal complications were analyzed. Results: The women were 33.1 ± 3.9 years of age and delivered infants, weighing 3098 ± 600 g at 36.6 ± 5.6 weeks of gestation. Intrauterine fetal deaths at second trimester were noted in two cases. Three pregnancies terminated between 16 and 20 weeks due to preterm premature rupture of membranes, incompetent cervix, and intrauterine fetal death resulted in postpartum hemorrhage caused by retaind placenta. Acute pain localized at myoma site requiring analgesics occurred in 9 (13%) of the women at 17–22 weeks. The fibroids located at uterine fundus were highly associated with the pain symptom (P < 0.05). Preterm labor showed in 12 (17.4%) cases, 50% of which led to preterm delivery. A Cesarean section was performed in 65% of the pregnancies with vertical uterine incision in 11% thereof. Intraoperative bleeding amount was 726 ± 289 ml. The size of the fibroids remained unchanged during pregnancy in most cases. Conclusions: Large uterine myoma may cause abdominal pain, preterm delivery, high rate of cesarean section, intrauterine fetal death and postpartum hemorrhage. However, the neonatal outcome was not adversely affected by large myoma during pregnancy.

P18.04: Prenatal ultrasound evaluation of the fetus with cheilognathopalatoschisis

To determine whether the cheilognathopalatoschisis is syndromic or non-syndromic. Cheilognathopalatoschisis or complex cleft (involves cleft of the lip, upper jaw, and hard and soft palates) is a severe birth defect. It occurs isolated or associated with other medical conditions. A 29-year-old Caucasian female, pregnant for the first time, was referred at 17 weeks’ gestation for a routine prenatal ultrasound. The couple had normal general health and was not consanguineous. There was no family history of cheilognathopalatoschisis. Routine ultrasonography at 17 weeks of pregnancy, triple test (AFP, uE3, hCG), selective ultrasonography for detection of fetal abnormalities, and amniocentesis were performed. Ultrasound examination revealed a single fetus with an orofacial cleft and no other developmental abnormalities. Triple test was not sensitive to the presence of trisomy 13 but chromosome analysis was recommended because orofacial cleft as a sonographic marker suggested the possibility of a chromosomal anomaly. FISH and QF-PCR detected no aneuploidy in chromosomes X, Y, 13, 18 and 21. Cheilognathopalatoschisis was diagnosed by performing 3D US in the second trimester of pregnancy. Our results suggested a non-syndromic cleft. Prenatal diagnosis was useful in management, prognosis and prevented the negative emotional effects of the parents.

P33.03: Prenatal ultrasound and genetic detection of an unusual presentation of Down syndrome: Case report

Intrauterine growth restriction (IUGR) is an important issue in perinatology. Design: The aim of the study was to assess the bilateral loss of end-diastolic frequencies (NOTCH) in the uterine arterial waveform in predicting risk of brain sparing effect (BSE) in the IUGR fetuses. Material and Methods: Ultrasound (US) scans in 24 fetuses with signs of IUGR between 20 and 24 weeks of pregnancy and before delivery were performed. Uterine arterial waveform and cerebral-placental ratio (the pulsation indices in the middle cerebral artery divided by the pulsation indices in the umbilical artery) were evaluated. All fetuses were singletons and had follow-up to the delivery. Results: 15 fetuses were born at term, whereas another 9 before term. Nevertheless in all cases birth weight was under 10th centile. 21 (87.5%) abnormal flow pattern in uterine arterial waveform in US scans between 20 and 24 weeks of pregnancy were discovered. In US examination performed before delivery BSE in 8 (33.3%) fetuses was observed. In all fetuses with BSE, NOTCH events were observed in uterine arterial waveform. 25%(2/8) fetuses had unilateral, and 75%(6/8) bilateral loss of end-diastolic frequencies in the uterine arterial waveform. Conclusion: The results of the study indicate that bilateral loss of end-diastolic frequencies in the uterine arterial waveform is closely related to the increased risk of BSE at the time of the delivery.

P27.04: Antenatal ultrasound detection of an unusual pattern of anomalies associated with fetal agenesis of the corpus callosum - case report

Agenesis of the corpus callosum (ACC) is an abnormality of brain development characterized by the complete absence of the corpus callosum. It occurs about 9th–16th weeks of gestation and can be detected prenatally. Agenesis of the corpus callosum is hereditary in isolation or as part of a syndrome, but often assumed to be sporadic and sometimes associated with chromosome aberrations. Objectives: To identify and characterize both neural and extra-neural malformations associated with ACC. Patients and methods: A 36-year-old pregnant female was referred at 18 weeks’ gestation for a routine prenatal ultrasound. Fetal monitoring was made by ultrasound scans for fetal growth, congenital malformations, and amniotic fluid volume. We also collected information about family medical history. Amniotic fluid samples were taken to perform prenatal cytogenetic diagnosis. Results: Ultrasound examination revealed a singleton pregnancy with multiple congenital malformations. Image diagnosis showed that the pregnant woman had uterus didelphys. At 20 weeks, repeat ultrasonic examination was performed to confirm dates and search for fetal anomalies. ACC was associated with others CNS anomalies as gyral anomalies, pyramidal tract abnormalities, hypoplastic olfactory tracts and bulbs, and cerebellar hypoplasia. Extra-CNS malformations included craniofacial defects, anomalies of limbs and ribs, gastrointestinal defects and cardiovascular defects. Many of the same malformations are also seen in trisomy 13 or trisomy 18. Karyotype indicated a normal cytogenetic female: 46, XX. The pregnancy was terminated at 23 weeks of gestation. Autopsy findings confirmed the ultrasound diagnosis. The next two pregnancies showed the same pattern of anomalies associated with ACC. Conclusions: An unusual pattern of anomalies associated with fetal ACC was identified and described; recurrent fetal ACC was shown in the next two pregnancies.

P02.69: Genital ambiguity problems discovered through prenatal ultrasound diagnosis

regression of the lesion. As it regards the other 9 cases, 4 cases with cyst diameter less than 5cm were aspirated in utero. Progressive decrease in size and subsequent prenatal or postnatal regression was observed. The remaining 5 cases were submitted to postnatal operative laparoscopy. 1 case among those treated in utero underwent premature rupture of membranes and 1 case showed preterm labor. Conclusion: Many complications associated with fetal and neonatal ovarian cysts have been reported, including gastrointestinal obstruction or perforation, ascites, polyhydramnios, cyst rupture, hemorrhage and torsion. Nevertheless, in utero procedures, make the patients at risk of rupture of membranes, bleeding, intrauterine infection and premature labor. Criteria for management are still debated. A controversial about conservative versus surgical therapy remains. Therapeutic approach should be personalized in order to considered gestational age, size of the cyst, the presence of complications. These considerations will be extensively discussed.

P05.08: Prenatal diagnosis of triplet pregnancy discordant for Edwards syndrome

chorionicity. Only dichorionic twins entered to our study. They were compared with 160 singleton pregnancies. Results: There were 80 dichorionic twin pregnancy during our study period. Increased frequency of intrauterine growth retardation (OR = 6/3; CI = 3/96–15/97). Preterm delivery (OR = 8/6; CI = 4/93–16/23) low birth weight (OR = 10/81; CI = 7/46–21/12). Cesarean delivery (OR = 9/30; CI = 5/82–17/10) PPROM (OR = 5/34; CI = 3/23–9/81) was noted in the twin pregnancies in this study. The frequency of hypertension was 10/8% in mothers with twin compared with a frequency of 7/2% in those with singletons. Conclusion: Twin pregnancies are high risk for mothers & infants. With the appropriate management perinatal outcomes may improve.

P04.11: Trisomy 18 with ambiguous genitalia and congenital heart defect

Introduction: Isomerism of the atrium is the result of a defect in lateralization associated with bilateral morphologically identical atrial appendages. It is commonly associated with gross cardiac and vascular anomalies. Many of the affected individuals die at an early age. Objective: To present our experience in the prenatal diagnosis of anomalies of cardiac isomerism using high-resolution color Doppler ultrasound. Methodology: There were 116,859 low-risk patients scanned in the Antenatal Diagnostic Center as part of their routine screening over a 8-year period from 1998 to 2005. A retrospective review of congenital heart disease (CHD) associated with isomerism was conducted. Results: A total of 36 cases of suspected isomerism were observed among the cases of CHD diagnosed. Isomerism was confirmed by postmortem or postnatal 2D echo in 22 cases. In eighteen out of twenty-two (82%) of these cases, a right-sided isomerism was noted. They typically presented with AVSD (11/18), dextrocardia (8/18), situs inversus (9/18) in antenatal scan. In two of them a large azygous vein was presented. Postmortem showed 3-lobed or 4-lobed lung bilaterally. In four left-sided isomerism cases, only one had azygous drainage of IVC. None of them associated with heart block. Karyotypes were done in 13 of 22 cases and were all normal. Conclusion: There is geographical heterogeneity in the presentation of isomerism. Right isomerism is exceptionally common in our local population. We postulate that there may be a racial predisposition to the presentation of the type of isomerism. There was also a low association with karyotype abnormality.

P04.11: Fetal thanatophoric dysplasia—second trimester ultrasound examination

in two cases. Pregnancy terminated in a case, in which amniotic fluid was positive for AS-AFP and ACE, with a fetus had diastematomyelia associated with open spina bifida. Another case had miscarriage one month after the amniocentesis. None of the cases had chromosomal abnormality. Conclusion: Pregnancy should be managed differently depending on whether the diastematomyelia is isolated, or is in association with more serious neural tube defects. The cases without additional findings and with normal levels of AS-AFP and ACE usually have good outcome, although surgery may be necessary, and there is a risk of neurologic compromise.

P01.10: Prenatal diagnosis of Patau syndrome: ultrasound and maternal serum screening: case report

fetuses. Median values of nasal bone length between 15th and 20th weeks of gestation were 3.4, 3.8, 4.2, 4.5, 4.7 and 5.3, respectively. Median 5th percentiles of nasal bone length between 15th and 20th weeks of gestation were 2.4, 2.8, 2.9, 3.1, 3.4 and 3.4, respectively. A linear line found to be fitted with distribution of nasal bone length in midgestation. Mean MoM values of nasal bone were: 1 in women with normal fetuses and 0.93 in women with Down syndrome fetuses. No statistical significant difference was found between MoM values of two groups. Conclusion: Measurement of nasal bone in midtrimester did not contribute to the screening of Down syndrome in our study.

P01.11: Ultrasound and serum screening at 10–12 weeks of pregnancy with Down syndrome

fetuses. Median values of nasal bone length between 15th and 20th weeks of gestation were 3.4, 3.8, 4.2, 4.5, 4.7 and 5.3, respectively. Median 5th percentiles of nasal bone length between 15th and 20th weeks of gestation were 2.4, 2.8, 2.9, 3.1, 3.4 and 3.4, respectively. A linear line found to be fitted with distribution of nasal bone length in midgestation. Mean MoM values of nasal bone were: 1 in women with normal fetuses and 0.93 in women with Down syndrome fetuses. No statistical significant difference was found between MoM values of two groups. Conclusion: Measurement of nasal bone in midtrimester did not contribute to the screening of Down syndrome in our study.