Jae-Sung Cho

P24.12: Congenital ichthyosis (Harlequin fetus)

A 24 year old primipara with previous unremarkable antenatal course, presented with an episode of RUQ pain at 30 weeks’ gestation. Investigations showed rapidly rising levels of alkaline phosphatase (ALP) levels, which was of placental origin. Sonography of the hepatobiliary tract was normal. The abdominal pain settled, but the serum levels of ALP activity continued to rise. The woman subsequently had investigations and very close follow-up to exclude liver, kidney, bone, ovarian and autoimmune pathology. The patient had close foetal ultrasound surveillance and biochemical monitoring. By 36 weeks, the ALP had risen to 2700 U/l. In view of concerns about placental function, induction of labour was carried out at 39 weeks. She proceeded to an uneventful vaginal delivery of a healthy female infant weighing 3465 g. The placenta looked normal in appearance and weighed 660 g. Microscopy revealed moderate chronic intervillositis and patchy areas of infarcts and increased perivillous fibrin deposition. After delivery, ALP activity returned to normal reference range within 8 weeks. A literature review found 5 similar cases, all of which also had a normal neonatal and maternal outcome. As long as other causes are excluded, a raised ALP of placental origin does not appear to confer increased risks to the mother or fetus.

P76Early diastolic notch of uterine artery Doppler velocimetry in relation to placental location

Background