Hye-Sung Won

A Case of Twin Pregnancy with Complete Hydatidiform Mole and Coexisting Fetus Following IVF–ET

Twin pregnancy consisting of complete hydatidiform mole (H-mole) and a coexisting fetus occurs with an estimated incidence of 1 per 22,000–100,000 pregnancies. The incidence of this unusual twin pregnancy with complete H-mole and a coexisting fetus after in vitro fertilization and embryo transfer (IVF–ET) is not thought to be greater than that of general population. We present an unusual twin pregnancy with complete H-mole and a coexisting fetus that occurred following IVF–ET, which was terminated at 21 weeks of gestation and developed into nonmetastatic gestational trophoblastic tumor.

Massive perivillous fibrin deposition in the placenta and uterine metastasis of gastric adenocarcinoma during pregnancy.

The prognosis of gastric cancer during pregnancy is unfavorable because of delayed diagnosis and advanced stage. We present a case of gastric carcinoma metastasized to the placenta and uterus during pregnancy. Pathological examination revealed a poorly differentiated adenocarcinoma of the stomach with lymph node metastasis. After counseling, the patient decided to terminate the pregnancy and begin immediate treatment for gastric cancer. Hysterectomy and subtotal hysterectomy were performed because medical termination of the pregnancy was unsuccessful. Pathological examination of the placenta and uterus revealed metastases of gastric adenocarcinoma. All the uterine vessels were packed with tumor cells and the myometrium showed extensive coagulative necrosis. Moreover, microscopic findings of the placenta were consistent with massive perivillous fibrin deposition. Our case clearly suggests that massive perivillous fibrin deposition in the placenta can be associated with malignancy during pregnancy and that uterine metastasis of maternal malignancy may result in myometrial dysfunction unresponsive to uterotonics.

P28.02: Three-dimensional sonographic measurements of placental volume at early pregnancy

growth discordance. Amniocentesis on the normal twin showed a normal 46,XX karyotype. As pregnancy progressed the fetus with the cystic hygroma developed progressive hydrops with dramatic skin edema. The diagnosis of TRAP was suspected but could not be proven as the direction of flow in the umbilical artery could not be determined with confidence. In addition, there was persistent cardiac activity. At delivery, examination of the fetus and placenta confirmed TRAP sequence. TRAP sequence is a rare complication of twinning, occurring in approximately 1% of monochorionic gestations, or 1/35 000 births. The most common presentation is a grossly anomalous twin with no heart beat and reversed umbilical arterial flow. It is often mistaken for a twin gestation with an early demise. There are case reports of TRAP sequence presenting with initial cardiac activity in both fetuses. This case is unusual in that cardiac activity was present in the TRAP fetus throughout the 26 weeks of gestation. The pregnancy management would have been altered if the diagnosis could have been confirmed earlier. In MCDA pregnancies with an apparent anomalous twin, the direction of flow in the umbilical cord should be established as early as possible in order to diagnose TRAP sequence at the earliest opportunity.

Recommendations on routine mid‐trimester anomaly scan

The purpose of this paper is to discuss the minimal requirements of the routine mid‐trimester anomaly scan in Asian countries after taking into account various factors, including local circumstances, medical practice, guidelines, and availability of experienced sonographers and high‐resolution ultrasound machines, which affect the prenatal detection rate of fetal anomalies. In general, a routine mid‐trimester anomaly scan includes the assessment of the number of fetuses, fetal cardiac activity, size, anatomy, liquor and placental location. The most controversial issue is which fetal structures should at least be examined. We discussed the requirements of a basic routine scan, as well as the optional views, which can be obtained if feasible to improve the detection of fetal, placental or maternal abnormalities. Routine anomaly scan remains a clinical challenge.

Memb-roller: An effective way of making membrane rolls for pathological examination and studies of human placenta

For the pathological evaluation of the chorioamniotic membranes, a membrane roll is made to give an orientation to the sections and to cover more extended planes. We designed a new instrument, Annies memb-roller, for easy preparation of membrane rolls. Annies memb-roller has two non-toothed arms which are 2xa0mm wide, 1xa0mm thick, and 8xa0cm long. To test its effectiveness in making a membrane roll, the placentas obtained from pregnant women (nxa0=xa010) with various obstetrical conditions were used. Preparation of the membrane rolls using Annies memb-roller was easy and successful in all cases tested. The lengths of the membranes measured from fresh placentas and paraffin sections showed a very good correlation (pxa0<xa00.001; rxa0=xa00.941). Application of the memb-roller would be very helpful in the semi-quantitative analysis of the chorioamniotic membranes and the standardization of placental pathology and research practice.

Modified damus-kaye-stansel/dor procedure for a newborn with severe left ventricular aneurysm.

Congenital left ventricular aneurysm (CVA) is a rare cardiac malformation. The prognosis is variable, depending on such factors as the size in comparison to the ventricular cavity, signs of heart failure, arrhythmia and so on. Most infants and young children with large aneurysm showed poor clinical outcomes. Here, we report the case of patient who was prenatally diagnosed with a large CVA, who had severe left ventricular dysfunction at 21 weeks gestation for which she successfully underwent a modified Damus-Kaye-Stansel/Dor procedure.

P32.05: Prenatal echocardiography of total anomalous pulmonary venous connection (TAPVC) : isolated or accompanied by pulmonary venous stenosis

RAA with mirror-image branching. Only one case had deletion of chromosome 22q11. In this case, omphalocele was also found. In two of the cases of RAA with mirror-image branching, the parents chose to terminate the pregnancy. One case of RAA with mirrorimage branching was born alive and received corrective surgery for TOF. In the case of RAA with an aberrant left subclavian artery, no other associated anomalies were recognized despite the vascular ring being formed in the prenatal period. This case was born alive and did well with spontaneous closure of the ductus arteriosus. Conclusion: Prenatal detection of RAA is feasible by 3 VT view. RAA combined with TOF is very common in RAA with mirror-image branching. Meticulous cardiac and extra-cardiac examination with invasive testing seems to be mandatory in prenatal diagnosis of RAA.

P02.11: The outcome of fetal isolated pleural effusion

accuracy of prenatal diagnosis at our center is 73.2% (205/280). The four most accurate systems are abdominal wall (accuracy: 100%), hydrops fetalis (100%), thorax (100%), and gastrointestinal (82.2%) system. The four most inaccurate systems are heart (49%), musculoskeletal (66.7%), face and neck (70.8%), and neural axis (73.5%) system. The differences of accuracy in each system are statistically significant (p < 0.01). Conclusions: Our results show that the accuracy of ultrasound for detecting fetal anomaly differs according to fetal anatomical system. To improve the accuracy system oriented training program for fetal ultrasound is needed.

Preliminary experience with invasive procedure in utero using ‘live‐3D’ ultrasonography

Objective:u2002 Technological advances in ultrasound have revolutionized the prenatal diagnosis and treatment. We recently began to evaluate the clinical applications of three‐dimensional (3D) ultrasonography (USG) to invasive procedures inu2003utero. The purpose of this report is to describe the effectiveness of live‐3D USG on the operative inu2003utero procedures.

P64The newly calculated equations of nuchal skinfold thickness measurement in mid-trimester

Background