H. Figueroa

Fetal evaluation of the modified‐myocardial performance index in pregnancies complicated by diabetes

To evaluate the fetal cardiac function by modified myocardial performance index (Mod‐MPI) in pregnant diabetic patients.

Intrauterine growth restriction modifies the normal gene expression in kidney from rabbit fetuses.

The aim of this work was to study the effect of intrauterine growth restriction (IUGR) on fetal kidneys. The IUGR was induced by uteroplacental vessels ligature in a model of pregnant rabbit. We centralized the study in the gene expression of essential proteins for fetal kidney development and kidney protection against hypoxia, osmotic stress, and kidney injury. The gene expression of HIF-1α, NFAT5, IL-1β, NGAL, and ATM were studied by qRT-PCR and Western blot in kidneys from control and IUGR fetuses. Experimental IUGR fetuses were significantly smaller than the control animals (39 vs. 48 g, p<0.05). The number of glomeruli was decreased in IUGR kidneys, without morphological alterations. IUGR increased the gene expression of HIF-1α, NFAT5, IL-1β, NGAL, and ATM (p<0.05) in kidneys of fetuses undergoing IUGR, suggesting that fetal blood flow restriction produce alterations in gene expression in fetal kidneys.

Nitric oxide synthase and changes in oxidative stress levels in embryonic kidney observed in a rabbit model of intrauterine growth restriction.

This work aimed to study the effect of uteroplacental circulation restriction on endothelial kidney damage in a fetal rabbit model.

EP10.17: Right heart failure in a 36-week fetus with umbilical vein aneurism: a key to pathophysiology: Electronic Poster Abstracts

We report a case of a 26-year-old G1 P0 with an enormous rhabdomyoma arising from the septum and compressing both ventricles. The first trimester NT was normal. A biochemical screening was suggested and refused by the couple. The diagnosis was done at 22 weeks with a hyperechoic mass located at the septum. Morphology scan did not reveal any other associated abnormalities. The mass increased in size during ultrasound follow-up to reach 3.4*2.8 cm. Despite that the mass reached a size big enough to obliterate the ventricular cavities and to limit severely the cardiac output, there was no hydrops. Umbilical and cerebral Doppler were within normal. Biometry was at the 10th percentile. At 36 weeks the patient was admitted for labour and delivered by Caesarean section in our university hospital. The baby had respiratory distress and underwent intubation and ventilation. Hemodynamic stabilisation was not possible, and as the couple had already agreed to this possibility the baby was taken for an immediate salvage surgery. He, unfortunately, deceased briefly following surgery because of cardiac failure. Pathology of the mass confirmed a rhabdomyoma. Parents’ consent was obtained for the scientific report of this case. In conclusion, cardiac rhabdomyoma can have different neonatal outcomes. Size seemed to be an important prognostic factor in this reported case.

OP11.07: Fetoscopic MMC correction in Chile: Short oral presentation abstracts

Objectives: Open surgery has been performed locally, with several maternal complications such as uterine ruptures or severe prematurity. Some series may be unreported. Instead, fetoscopic correction has claimed its place because of lower maternal risks. We report our local experience supported by the Brazilian team. Methods: Cases are selected with strict MOM‘s trial criteria. Surgery was performed with four trocars and biocellulose patch. The first case was operated by the Brazilian team and the second by the local team, with presence of the supporting team. Results: Two cases are operated. The patients: one primigravidae, the second with one previous Caesarean section. Fetuses had L2-5 lesions, with ventriculomegaly (12 and 19mm) and Arnold Chiari II. Both were operated at 27 weeks of GA. The patch could be placed and the skin closed without tension. Both had rupture of the membranes. The first child was born at 33 weeks, with complete skin closure and normal follow-up until 10 months of age. The hindbrain recovered before delivery, no need of valve, and normal development. The second pregnancy is ongoing, without recovery of the hindbrain, and stable ventriculomegaly, at 33 weeks. The surgery has been safe for fetuses and women. Conclusions: Fetoscopic procedure for MMC repair has been feasible with the support of a more experienced team. The procedure is identical in order to lower complications. One case has satisfactory outcome, the second is ongoing.

P15.02: Amniotic band syndrome: literature review of prenatal therapy

Uterine AVM although rare, may be acquired after myometrial damage by instrumentation. Pelvic Transvaginal Ultrasound (TVS), gray-scale with colour Doppler and spectral analysis are excellent diagnostics with AVM appearing as subtle heterogeneous hypoechoic myometrial masses with serpinginous mosaic hypervascularity, with low resistance, turbulent vascular flow on Doppler. PSV seems most accurate with a value below .39 m/sec being considered ‘‘safe area’’ and above 0.83 m/sec ‘‘dangerous area’’. Between 0.40 m/sec and below 0.83 m/sec are ‘‘potentially dangerous’’ according to Timmerman D., Wauters J. et al, Colour Doppler imaging is a valuable tool for the diagnosis and management of UAVM Ultrasound Obstet Gynecol 2003; 21, 570-577. Gold Standard for diagnosis is Angiography, however invasive and reserved for cases needing embolisation, surgery, or both. Presented are 0.14 percent (4/2750 cases) of the total gynecologic cases in 5 years. All presented with profuse vaginal bleeding post curettage. Initial diagnoses were Incomplete Abortion, Endometritis, and Trophoblastic Disease. TVS Indices showed uterine AVM with PSV= 0.55 m/s to 0.7 m/s classified as ‘‘Potentially Dangerous’’. Three warranted blood transfusion with two undergoing Total Abdominal Hysterectomy with Right Salpingoophorectomy and Bilateral Hypogastric Artery Ligation with endometrial mass excision. Two were stable and underwent Uterine Artery Embolisation (UAE). All repeat TVS with Doppler showed homogeneous myometrium. Clinical courses from time of uterine surgery to diagnosis lasted 1.5 to 8 weeks. Total time from prior obstetric procedure to resolution was 2.7 to 12 weeks. The potential danger of Uterine AVM necessitates careful evaluation and treatment. UAE as conservative therapy is recommended for urgent treatment prior to performing another curettage or surgical procedure, to avoid complications. Total clinical time, from prior obstetric surgical procedure to resolution of disease was 8.5 weeks to 12 weeks proving that UAE is a safe and effective option for conservative management.

EP05.02: Difficulties in right CDH survival prediction

Results: The PI of the MCA and UA was successfully measured and CPR calculated in 142/200 (71%) of cases. There was no effect of maternal BMI, fetal CRL or BPD on successful visualisation. The normogram for the CPR in our population was established. The results show no significant relation between CPR and CRL or CPR with BPD, with best fitted linear regression modelling yield: CPR =0.70 +0.004 CRL (R2 =0.003) and CPR =0.31 +0.029 BPD (R2 =0.0194) respectively. Conclusions: It is feasible to measure CPR in 71% of fetuses at the time of NT assessment. This may prove helpful in early assessment of fetuses with growth restriction or congenital heart defects.

OP26.08: 25% of fetal interposition (FI) in the placental equator in TTTS placentas: the fetoscopical approach

Objectives: To compare the perinatal outcome of early laser surgery for Twin–twin transfusion syndrome (TTTS) performed before and after 17 weeks of gestation. Methods: Retrospective study including 53 consecutive cases of monochorionic diamniotic twins with severe stages of TTTS treated before 17w during the last ten years in our centre. Maternal characteristics, surgical data and perinatal outcome were recorded and compared to a control group of 91 patients undergoing fetoscopic laser therapy between 17-26w. Selective fetoscopic laser coagulation of placental anastomoses was performed using a 1.3 or 2.0 mm endoscope depending on GA at surgery. All procedures were performed percutaneously in local anesthesia. Results: Fifty-three patients were treated before 17 weeks of gestation, at a mean GA of 16.1 weeks (15.0-16.6). Early laser was associated with shorter intervention time (17 vs 24 minutes, p<0.001) and higher preterm delivery rate before 28 weeks (20% vs 5 % p=0.016) when compared to controls. There was a non-significant trend to a higher pregnancy loss rate (15 % vs 12 %, p>0.05). Conclusions: Very early laser for severe TTTS is feasible, but seems to be associated with an increased risk of extreme preterm birth, compared to surgery later in pregnancy. However, in early presenting advanced cases, it may be the best management option and parents should be counselled that in the majority of cases, the perinatal outcome is favourable.

Oxidative damage and nitric oxide synthase induction by surgical uteroplacental circulation restriction in the rabbit fetal heart

This study investigated the role of oxidative damage and nitric oxide (NO) synthases in the fetal heart using a model of intrauterine growth restriction induced by uteroplacental circulation restriction (UCR).

P19.05: Longitudinal estimation of fetal growth by ultrasound: a new proposal for the assessment of intrauterine growth restriction

in pregnancy. In publications low PP13 levels have been associated with pre-eclampsia, HELLP syndrome and IUGR. Due to the low PP13 levels in the first trimester, the analytical performance of the PP13 assay is critical. For research study purposes it is important to be able to measure PP13 with a high sample throughput and using low sample volumes to save valuable samples. These properties have been improved in the recently developed AutoDELFIA PP13 Research kitf* compared to the manual PP13 ELISA kit*. Method: The non-clinical performance (precision, linearity and analytical limits [LoB, LoD and LoQ]) of recently developed AutoDELFIA PP13 Research was assessed based on EP15, EP6 and EP-17 guidelines, respectively. The variation was determined in 24 runs with 72 replicates using two AutoDELFIA systems and two kit lots. The assays were run according to the kit insert using 25 μL sample volume. Results: Mean total variation was 6.6%, the within lot variation was 5.4%, and the between lot variation was 3.8% (5 samples, concentration range 3.8–446 pg/mL). For the sample with lowest PP13 concentration of 3.8 pg/mL, the respective variations were 9.5% (total), 8.5% (with-in-lot) and 4.2% (between-lot). The assay was found to be linear in the range from 0 to 660 pg/mL PP13 (maximal observed difference < 2.2%). LoB was found to be 0.15 pg/mL, and LoD and LoQ at least 3.8 pg/mL. Conclusions: The results show that the AutoDELFIA PP13 Research kit is well suited for automated quantitative measurement of PP13. Furthermore, the non-clinical performance characteristics and usability of the evaluated assay were significantly improved.