E. Iglesias

OP21.07: Persistent right umbilical vein: experience in a screening center

Objectives: To evaluate the prognostic value of hematological, biochemical and ultrasound abnormalities in fetuses infected with CMV. Methods: We reviewed 55 cases of fetuses infected with CMV (CMV-PCR positive in amniotic fluid). Fetal blood sampling was performed for evaluation of platelet count, aminotransferases and gammaglutamyltransferase levels, presence of viremia and presence of specific IgM. Ultrasound examinations were performed every fortnight. The primary outcome measure was a combination of histological findings after termination of pregnancy and evidence of cytomegalic inclusion disease at birth when pregnancies were continued. Statistical analysis was conducted to determine the individual value of each parameter by univariate analysis, and the relevant model combining several parameters by multivariate analysis by logistic regression. P < 0.05 was considered significant. Results: Both thrombocytopenia and the presence of any ultrasound abnormality were associated with a poor outcome in a univariate analysis (P = 0.003 and P < 10e3 respectively). None of the other parameters was independently associated with a poor outcome. In the multivariate analysis, both thrombocytopenia and the presence of any ultrasound abnormality remained significant, independent predictors of a poor outcome: OR 17.35 CI (3.8; 79.0); P < 10−4 and OR = 1.08(1.03; 1.20); P < 0.002, for the presence of ultrasound abnormality and for each 10 000/mL decrease in platelet count, respectively. Conclusions: The prognosis of CMV infected fetuses could be assessed by ultrasound examination and fetal blood sampling. The presence of any ultrasound abnormality and/or decreased platelet count are associated with a poor prognosis.

P01.13: Detection of single umbilical artery in first trimester ultrasound: its value as a marker of fetal malformation

Introduction. The value of a single umbilical artery (SUA) in first trimester ultrasound is not well established. The aim of our study was to determinate the relevance of diagnosis of single umbilical artery in first trimester ultrasound as an early marker suggesting the presence of malformations or associated chromosomopathies. Material and Methods. Retrospective study of clinical cases of SUA diagnosed at the University Hospital Puerta de Hierro in Madrid (Spain) during the first trimester ultrasound between September 2008 and September 2012. Results. Prevalence of SUA was 1.1% in single pregnancies and 3.3% in twin pregnancies. Sensitivity, specificity, false positive rate, and false negative rate for the finding in the first trimester were 84.2, 99.8, 0.2, and 15.7%, respectively. 17.6% of cases had associated malformations. With an ultrasound in the 16th week most of the cases with significant fetal malformation were diagnosed. Discussion. SUA is a useful marker in the first trimester for fetal malformation pathology, as it will allow detecting a large number of cases with malformations before 20 weeks of gestation.

P03.08: Omphalopagus twins in a diamniotic pregnancy

accuracy according to the initial, lower and higher angle was calculated. Cases with wrong fetal assignment were individually analyzed. Results: Overall, 95 cases were included in the analysis. Following online genital angle calculation fetal gender assignment was possible in all but one woman (98.9%) in which the angle fell inside the cut-off (28◦). The assigned gender was correct in 90 of the 95 cases (94.7%). Among the 5 cases with wrong fetal gender assignment 2 cases were < 12 weeks and two cases had an angle calculated from the second volume which fell inside the cut-off (undetermined gender). Using the narrower and higher angle the accuracy of fetal gender determination was 93.7% and 96.8% respectively. Conclusions: 3DUS is a highly accurate tool for fetal gender assignment in the first trimester. A second look may have a role in reducing the margin of error in fetal gender determination. In case of discrepancy the wider angle seems to perform better.

P19.13: Prenatal diagnosis of congenital megalourethra with positive outcome

Submission of an uncommon fetal condition, which is not usually diagnosed before birth, with good postnatal development. We report clinical data, most representative ultrasound images and a review of recent literature. 27 year old patient. Previous Cesarean delivery for non-progression of labor. In the current pregnancy 1/111 risk for trisomy 21, in the first trimester combined screening. The result of the amniocentesis was normal 46 XY karyotype. On 16 th week an urethral dilation and penile deformation was observed. On 20th week ultrasound we objective left curved penis with urethral dilation. Bladder wall thickening. Bilateral ureteral dilatation and mild pyelic ectasia. Ultrasound findings remain unchanged for the rest of gestation, mild pyelic ectasia and normal amniotic fluid. We observed corpus cavernosum development (scaphoid megalourethra). There was no hipospadias evidence. Testes in the scrotum. Good postnatal development with normal renal function. Currently awaiting surgical correction of penile deformity. Congenital megalourethra is a rare malformation characterized by dilation of the penile urethra. Its diagnosis is usually postnatal. It is characterized by hypoplasia of the corpus spongiosum and occasionally hypoplasia of the corpus cavernosum (megalourethra fusiform). It could be associated with upper urinary tract defects, VACTERL sequence, oligohydramnios with lung hypoplasia and abdominal wall defects. Prognosis is fairly good if normal renal function.

P26.08: Aberrant right subclavian artery (ARSA): its value in low‐risk population

Methods: This was a retrospective review over a 2 year period (1st June 2008 to 31st May 2010). Cases were identified from local registration, referrals to a tertiary centre, admission to the neonatal unit and the local paediatric cardiology outpatient. 4 chamber view and outflow tracts were evaluated at anomaly scan. Results: There were 17 cases of congenital heart disease out of 7690 deliveries (0.2%). Eleven of the cases were detected antenatally giving a detection rate of 65% (11/16). Six cases went undetected out of which two were transpositions of the great arteries, one pulmonary atresia, one pulmonary stenosis with an atrial-septal defect, one tetraology of fallot and two atrio-ventricular septal defects. One neonate died due to an inoperable defect and the others are all alive and well till date. Five out of the six undetected cases had more than one anomaly scan by sonographers due to ‘inadequate’ cardiac views Conclusions: The overall detection rate in our Hospital NHS Trust meets the required standard of 50% set by the National Screening Committee, UK. There is current inadequate capture of data on a regional level making underreporting likely. In those cases that were missed, repeated anomaly scans by sonographers should prompt specialist review. This is likely to improve the detection rate even further.

P03.04: Right aortic arch: 7 cases

Objectives: To evaluate the diagnostic accuracy of prenatal screening for congenital heart diseases (CHD) based on the combination of the four-chamber view and the three-vessel view in an unselected population. Methods: A prospective study on 8025 scanned fetuses was performed. All singleton pregnancies scheduled for a routine prenatal ultrasound screening at 20–24 weeks’ gestation and subsequently delivered within our unit were included. Data were recorded regarding visualization of the four-chamber view, the outflow tracts and the three-vessel view. Suspected CHD was confirmed by postmortem or postnatal echocardiography. We obtained the followup data of the newborns and calculated the diagnostic accuracy of the test. Results: Major CHD were identified in 32 cases (4.0‰) of which 26 cases (81.3%) were diagnosed antenatally and 6 postnatally. Four cases were false positive. Twenty-one cases were identified by the four-chamber view and five as a result of the abnormal three-vessel view. The sensitive of the four-chamber view alone was 65.6% (17/32), and the specificity was 99.9%. The sensitivity of the combination of the four-chamber view and the three-vessel view was 81.3% (26/32), and the specificity was 99.9%. Conclusions: The three-vessel view is reliable and easy methods to be used in a routine antenatal clinic, along with the four-chamber view. *This project was funded by Beijing Municipal Science and Technology Commission Foundation grant D0906005000091.

P16.11: Absent ductus venosus in the sonography of the 11–14 weeks

Objectives: To evaluate the clinical conditions associated with absent ductus venosus (DV) in the sonography of the 11–14 weeks. Methods: Retrospective review of 5620 sonographies of screening of the first trimester, realized in a tertiary hospital during the last 4 years (2005–2008), in general population. There was valued the measure of the nuchal translucency, the nasal bone (present/absent), as well as the morphology of the wave of the DV, and the foetal morphology. Results: We have found a whole of 3 cases of ductus venosus absent. The following table shows the finds in every case. Conclusions: In our experience, the find of an absent ductus venosus in the sonography of the 11–14 weeks is strongly associated with a foetus affected by Down syndrome.

P11.09: First-trimester Down syndrome screening: clinical results in patients with risk ≥ 1/270

Conclusion: The policy of performing invasive procedures in all women aged ≥ 35yo did not detect any chromosomal abnormality, in our series, that would not be identified after 1st trimester screening. On the contrary, the much higher false positive rate of the age-alone screening adds just increased collateral damage, high cost/benefit ratio to the national health system, precious time consuming investigations for obstetrician/geneticists.

OP07.08: Evaluation of the number of umbilical cord vessels in the sonography of the 12–14 weeks

Objectives: Determination of the expected day of conception is difficult and controversial. However, assessment of the remaining days of pregnancy would be valuable information for growth monitoring and management at term. We aimed to develop a prediction model of the remaining days of pregnancy based on first-trimester measurements. Methods: Data consisted of ultrasound examinations in pregnancies with an estimated gestational age at delivery of at least 37 weeks and with a normal outcome. Predictions of the median interval in days between ultrasound examination and delivery were computed using crown–rump length (CRL), biparietal diameter (BPD), abdominal circumference (AC) and head circumference (HC) measurements. Both a linear quantile regression and a non-linear quantile regression method were tested. The regression cubic spline approach was used to smooth the median and quantile curves. Results were checked through a cross-validation of the random sample estimates. Results: 3649 ultrasound scans were included in the study with ranges of measurements of 24–115, 10–36.3, 31–107.8 and 28–130 mm for CRL, BPD, AC and HC, respectively. The CRL, BPD or HC based prediction models provided similar results with up to 93.6% of the births within ±14 days of the predicted day of delivery from non-linear models, whereas AC provided slightly worse predictions. Cross-validation analysis confirmed these results. Conclusions: We have developed a simple method for predicting accurately the date of delivery based on first-trimester measurements. It allows simple monitoring of growth and term in pregnancies. It also avoids controversies between doctors and patients about the exact date of conception.

Neumotórax catamenial recurrente

Resumen El neumotorax catamenial es una rara entidad caracterizada por la aparicion de aire en el espacio pleural durante la menstruacion. Su presentacion clinica es muy variada, se asocia a endometriosis, y su diagnostico se establece frecuentemente por las manifestaciones clinicas. El tratamiento de esta patologia es controvertido, y se asocia a altas tasas de recurrencia. Presentamos un caso clinico de neumotorax recurrente en una paciente de 24 anos, que presento neumotorax derecho de repeticion que coincidia con la menstruacion, y que requirio tratamiento quirurgico; se realizo el diagnostico clinico de neumotorax catamenial.