C. Bravo

Second-trimester fetal aberrant right subclavian artery: original study, systematic review and meta-analysis of performance in detection of Down syndrome

First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second‐trimester ARSA to identify fetuses with Down syndrome.

Perinatal outcome after ultrasound prenatal diagnosis of persistent right umbilical vein

OBJECTIVE Our aim was to describe ultrasound findings and perinatal outcome after prenatal diagnosis of persistent right umbilical vein (PRUV). STUDY DESIGN We performed a retrospective analysis of fetuses with an ultrasound-based prenatal diagnosis of PRUV on record at 2 tertiary centers in Madrid, Spain. We describe clinical, maternal, fetal and perinatal variables for all cases. RESULTS A total of 20,426 fetuses were delivered between the study centers. We detected 22 cases (0.1%) of PRUV. The male-to-female ratio was 1:1. All cases were intrahepatic type and diagnosed during the second and third trimesters (median, 21 weeks; IQR, 20-29 weeks). Doppler ultrasound revealed normal flow in the ductus venosus in all cases. Nine fetuses (40.9%) had additional ultrasound anomalies but no chromosomal abnormalities. Cardiovascular malformations were the most frequently associated congenital anomalies (4/9), followed by neurological malformations (2/9). In 5 of the cases with no concomitant anomalies, the weight of the newborn was below the tenth percentile for gestational age. Gestational development was normal for the remaining newborns. Delivery was unremarkable, and post-natal evolution was favorable. CONCLUSION Our results point to a potential association between PRUV and other fetal malformations and a very low rate of chromosomal abnormalities. Prenatal diagnosis of PRUV should be followed by detailed anatomical evaluation and echocardiography in order to rule out other structural malformations. The indication for a fetal karyotype study must be made on an individual basis considering PRUV type and other ultrasound findings.

Fetal Aortic Arch Anomalies Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol

Aortic arch anomalies are present in 1% to 2% of the general population and are commonly associated with congenital heart disease, chromosomal defects, and tracheaesophageal compression in postnatal life. The sonographically based detection of aortic arch anomalies lies in the 3‐vessel and trachea view. Although highly sensitive, this view alone does not allow identification of the aortic arch branching pattern, which prevents an accurate diagnosis. The systematic addition of a subclavian artery view as part of a standardized procedure may be useful in the differential diagnosis of these conditions. We describe the sonographic assessment of fetal aortic arch anomalies by combining 2 fetal transverse views: the 3‐vessel and trachea view and the subclavian artery view, which are included in the cardiovascular system sonographic evaluation protocol. We also review the sonographic findings and the clinical implications of fetal aortic arch anomalies.

Cardiovascular System Sonographic Evaluation Algorithm A New Sonographic Algorithm for Evaluation of the Fetal Cardiovascular System in the Second Trimester

To evaluate the reproducibility and feasibility of the new cardiovascular system sonographic evaluation algorithm for studying the extended fetal cardiovascular system, including the portal, thymic, and supra‐aortic areas, in the second trimester of pregnancy (19–22 weeks).

The Thy-Box for Sonographic Assessment of the Fetal Thymus Nomogram and Review of the Literature

To assess the feasibility and reproducibility of fetal thy‐box visualization and to set normative data for the fetal thymus using this technique.

Neonatal Magnetic Resonance Imaging as a Complementary Technique After Prenatal Diagnosis of an Aberrant Right Subclavian Artery

Nowadays, although prenatal sonography is the standard technique for the diagnosis of fetal anomalies,1 magnetic resonance imaging (MRI) is increasingly applied as a complementary technique during both the prenatal and neonatal periods. In infants, MRI is used to study structural malformations, whereas fetal MRI is mainly used to study central nervous system defects, diaphragmatic hernias, and placental anomalies.1 However, the application of MRI in the assessment of fetal congenital heart defects remains subject to limitations. A fetal aberrant right subclavian artery is a recently described sonographic marker of aneuploidy, congenital heart defects, or both.2,3 Given the technical limitations of postnatal sonographic evaluation of an aberrant right subclavian artery, MRI could enable us to better characterize this anomaly. To explore this possibility, we report a case of sonographically based prenatal diagnosis of a fetal aberrant right subclavian artery confirmed by postnatal MRI and compare both images in the same view. A 33-year-old woman in her 20th week of gestation was evaluated in our center. Sonographic evaluation of the fetal heart revealed a ventricular septal defect close to the cardiac apex associated with an aberrant right subclavian artery, which was detected in the axial and coronal views of the fetal thorax.3–5 At the level of the 3 vessels and trachea in the axial view, the aberrant right subclavian artery had an anomalous origin and followed a retrotracheal course toward the right arm (Figure 1A). In the coronal view, it was possible to visualize part of the descending aorta at the

Prenatal Diagnosis of Incomplete Bladder Duplication: Sonographic Features and Perinatal Management

Incomplete bladder duplication is a rare abnormality of the lower urinary tract in which the bladder is divided into two parts by a thick muscular septum.1 The term incomplete refers to absent duplication of the urethra, and it is associated with a better prognosis, unlike the complete variant, which is often associated with duplication of the hindgut and the external genitalia.1,2 Both types are not usually linked to an abnormal karyotype, and the prognosis depends on urinary obstruction/infection and possible associated malformations.3,4 Sonography can be useful to identify them prenatally. We report a case of incomplete bladder duplication and describe the prenatal and postnatal (presurgical and postsurgical) sonographic features of this anomaly. A 32-year-old pregnant woman was referred to our fetal medicine unit at 23 weeks’ gestation after megacystis and unilateral pyelic ectasia were found on her morphologic scan. The scan revealed a male fetus with an enlarged bladder of 28 × 34 × 34 mm and a complete sagittal septum

P22.11: Systematic evaluation of the fetal hepatic venous system in mid-trimester scan (CASSEAL protocol in a multicentric study)

Objectives This study aims to explore the antenatal ultrasonic features of isolated left subclavian artery (ILSCA) and isolated left brachiocephalic trunk (ILBCT) malformations, in order to improve the prenatal diagnosis rate. Methods: From March 2015 to March 2017 in our hospital, the ultrasonic features of ILSCA and ILBCT were analysed. At the same time, a literature review was carried out in Pubmed. The ILBCT or ILSCA mentioned in this study refers to the brachiocephalic trunk or left subclavian artery arising from the pulmonary artery. Results: In our study, one case had an ILSCA (figure), and the other had an ILBCT. These two cases both had a right aortic arch with a right arterial duct with normal chromosome without other congenital malformations. The peak velocity of LSCA or both LSCA and left common carotid artery (LCCA) decreased, and acceleration time was prolonged. In Pubmed, a total of twelve cases of ILSCA or ILBCT were reported, nine cases among them were with chromosome anomalies or other congenital cardiac malformations or both. These twelve cases were all diagnosed postnatally, but our two cases are the firstly prenatally diagnosed so far. Conclusions: The ILSCA or ILBCT is commonly observed in the right aortic arch. The change of blood flow spectrum of LSCA or both LSCA and LCCA was helpful for prenatal ultrasonic diagnosis. The prognosis depends on the accompanied severe congenital malformations and chromosome abnormalities.

P06.06: CASSEAL: fetal cardiovascular system sonographic evaluation algorithm - multicentric study on its clinical application for prenatal diagnosis

C. Bravo1,4, F. Gámez1, C. Martı́nez-Payo2, M. Rodriguez3, E. Tello5, J. Pascual6, M. Anaya7, A. Pomares4, M. Ruiz de Azúa Ballesteros2, C. Garrido5, J. De Leon Luis1 1Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 2Obstetricia y Ginecologı́a, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; 3Obstetrics and Gynecology, Hospital General La Mancha Centro, Alcázar de San Juan, Spain; 4Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; 5Obstetrics and Gynecology, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain; 6Obstetrics and Gynecology, Hospital Miguel Servet, Zaragoza, Spain; 7Obstetrics and Gynecology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

OP09.03: CASSEAL: fetal cardiovascular system sonographic evaluation algorithm – multicentric study on its feasibility for prenatal diagnosis

C. Bravo1,3, F. Gámez1, C. Martı́nez-Payo2, M. Rodriguez4, E. Tello7, J. Pascual6, M. Anaya7, A. Pomares3, A. Gomez Manrique2, M. Moreno4, C. Garrido5, J. De Leon Luis1 1Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 2Obstetricia y Ginecologı́a, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; 3Obstetrics and Gynecology, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; 4Obstetrics and Gynecology, Hospital La Mancha Centro, Alcázar de San Juan, Spain; 5Obstetrics and Gynecology, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain; 6Obstetrics and Gynecology, Hospital Miguel Servet, Zaragoza, Spain; 7Obstetrics and Gynecology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain