Hana Belošovičová

P05.01: Presence of intracranial translucency (IT) in a case of large open spina bifida

Objectives: To evaluate the incidence, combined anomaly, and outcome of prenatal diagnosis of single umbilical artery (SUA) in the first trimester ultrasound. Methods: From April 2008 to July 2009, 59 cases of single umbilical artery (SUA) of 3879 unselected pregnancies was observed, during 11–13+6 weeks scan, with Voluson Expert in Puerta de Hierro Hospital from Madrid. Results: The incidence of SUA in our population resulted 1.55%. In 42 cases were isolated SUA diagnosed in the first ultrasound at 11–12 weeks, and was confirmed again at 16 weeks scan. 36 normal pregnancies at birth and 6 cases presented growth retardation at delivery. The other 16 cases had associated ultrasound finds: 8 with congenital heart diseases; 3 skeletal anomalies, 3 central nervous system malformations, 1 kidney anomaly, and 1 cleft palate. Conclusions: During the prenatal period, the fetus with isolated SUA by 11–12 weeks ultrasound examination must be carefully monitored, if no other malformations were found normal pregnancy or growth retardation can be expected.

ABO fetomaternal compatibility poses a risk for massive fetomaternal transplacental hemorrhage

Objective. Severe fetomaternal transplacental hemorrhage increases the risk of fetal anemia. In the third trimester, the syncytiotrophoblast becomes thinner, especially in areas where it comes into intimate contact with villous capillaries, and forms a vasculosyncytial membrane. Our aim was to determine whether ABO compatibility puts the fetus at a greater risk of severe fetomaternal hemorrhage. Design. Case study. Setting. A tertiary care center. Sample and methods. Between 2003 and 2007, we evaluated eight cases of severe fetomaternal transfusion. The Kleihauer‐Betke test was used for diagnosis of fetomaternal hemorrhage. We evaluated blood group compatibility between the mother and fetus and assessed the perinatal outcome. The Fischers factorial test was used for testing a hypothesis. Results. The incidence of adverse outcomes following transplacental hemorrhage was 75% (six of eight). There were two perinatal deaths and four infants were affected by post‐hypoxic damage of varying severity. Fetomaternal ABO compatibility was present in seven of the eight cases. The risk of severe fetomaternal hemorrhage was significantly increased when there was ABO compatibility between the mother and fetus. This was associated with a very poor perinatal outcome. Conclusion. We recommend that resuscitation in utero by intrauterine transfusion should be considered before the 33rd week of gestation in cases of severe fetal anemia. In later gestation, urgent cesarean section is required with adequate resuscitation of the newborn.

P27.15: Inadvertent intra‐arterial administration during intraumbilical transfusion as a cause of severe bradycardia and fetal hypoxia

We performed an arterial embolization at 29 weeks. We observed the disappearing of vascular flow inside the tumor, without any modification on placenta flow. Delivery at 41 weeks gestation: normal newborn (3250 g). We consider that the procedure could be less iatrogenic than others. We could be more selective than laser and less toxic than alcohol. We didn’t observe any bleeding after needle removal. The procedure could be performed after a complete vascular cartography (contribution of the 3D Doppler imaging), a perfect preparation of Histoacryl and be careful not to create a venous embolization. We suggest to do an prospective study, to have an answer about the timing of the procedure, to evaluate the risk and the advantages.