L. De Catte

OP15.10: Monochorionic and dichorionic twin pregnancies discordant for fetal anencephaly: a systematic review of prenatal management options

fetal anomalies present postnatally corresponded very closely to those diagnosed prenatally. At 6 hours of life one of the conjoined twins had worsening congestive heart failure and at day 3 of life a successful urgent separation occurred for the pump twin while the anomalous acardiac twin expired. The pump twin continues to do well today but will need further surgical revisions. This is the first case of conjoined twins in which one twin had acardia and the pregnancy was managed with the assistance of Doppler and MRI in addition to ultrasound. To provide optimal treatment for infants with complex anomalies more than one imaging modality may be required and a multidisciplinary team approach is critical. Accurate prenatal diagnosis was critical in our case as urgent intervention was required.

P048: Limb‐Body‐Wall complex (LBWC): prenatal diagnosis of 15 cases

The mother was a 42-year-old G2P1L1 woman who conceived through donor sperm insemination. An ultrasound at 11.5 weeks gestation for nuchal translucency screening showed an abnormal profile. Transvaginal ultrasound confirmed an abnormal profile with retrognathia and suspected cleft lip and palate. She was informed of the findings and wished to continue the pregnancy. Chorionic villus sampling revealed a normal karyotype. A 3-D ultrasound was arranged to better delineate the extent of the facial abnormality. This showed a very extensive craniofacial abnormality including a hypoplastic mandible and a large facial cleft extending from the upper lip to the inner canthus of the right eye. There was severe hypotelorism, low set ears and an abnormal nose. The images were reviewed with the couple and they elected to terminate the pregnancy. The autopsy showed findings consistent with oculoauriculofrontonasal syndrome. The oculoauriculofrontonasal syndrome is a rare developmental field defect which represent an abnormal morphogenesis of the frontonasal eminence. The combination of oculoauriculovertebral spectrum and frontonasal malformation has been described in the literature but to the best of our knowledge our case is the first early diagnosis of this severe condition. In this case, 3D ultrasound provided critical information enabling the couple to make an informed decision with respect to the management of the pregnancy. It also illustrates the ability to evaluation the fetal profile in details at the time of the 11–14 week scan.

OC095: Fetal reduction for social indications in twin pregnancies: obstetrically acceptable?

Introduction: 3D ultrasound technology offers the ability to demonstrate the fetal face in three different display modes: the multiplanar, the surface and the transparent mode. Material and Methods: In 2012 cases the fetal face was assessed with 2D and 3D ultrasound as part of a level III screening evaluation for fetal anomalies. The ultrasound equipment used was a Voluson 530 MT or a Voluson 730 from GE-Kretztechnik, Austria. In every fetus a volume of the face was acquired and stored on a rewritable magneto optical disk (540 MB). Results: The simultaneous display of all three orthogonal sectional planes enables us to define the true facial profile and to review the fetal face in a systematic tomographic survey. The surface view allows a clear demonstration of surface anomalies such as facial dysplasia, cyclopia with proboscis, cleft lip and palate or retrognathia. The translucency mode provides a complete survey of the fetal skull and the facial bones, similar to the appearance of an X-ray film. With the latest 4D ultrasound technology of Voluson 730 the fetus can be visualized three-dimensionally in real time. This gives the examiner a direct access to facial movements such as grimacing, yawning or swallowing. In 67 of the 2012 fetuses facial anomalies were detected. Comparing 2D and 3D ultrasound results, 3D ultrasound provided superior image quality and revealed the anomalies more conclusively in 73% of the fetuses. Summary: 3D ultrasound does not only enable a precise demonstration of subtle malformations of the fetal face, but can also provide more convincing evidence of a normal fetal face than 2D sonograms.

P02.07: Termination of pregnancy for midline cerebral anomalies

Objectives: To compare the accuracy of neurosonography (NSG) and magnetic resonance imaging (MRI) in the assessment of the fetal cortex within a high risk cohort of fetuses diagnosed with central nervous system (CNS) abnormalities. Methods: Single centre prospective study involving an Italian Tertiary Unit. The included cases had antenatal diagnosis or suspicion of CNS abnormality and underwent twoand three-dimensional NSG, which was performed using a 3-5 MHz and a 4-6 MHz endocavitary probe equipped Samsung WS-80 scanner, and MRI. Antenatal findings were compared between the two techniques and differences in terms of CNS anatomy and cortical findings were recorded. Postnatal imaging was also investigated for the study purposes. Results: In all, 31 cases were submitted to NSG at a median gestation of 26+0 weeks (18+3 – 33+2) due to one of the following: abnormal or absent cavum septum pellucidum (5 cases), ventriculomegaly (9 cases), head circumference <3SD (4 cases), posterior fossa abnormalities (3 cases) or other reasons (8 cases), including previous intracranial anomaly or fetal CMV infection. At expert NSG, abnormal cortical findings were diagnosed in 8/31 cases, including lissencephaly (3 cases), microcephaly (1 case) and focal cortical dysplasia in the remaining. All fetuses underwent antenatal MRI, which was performed at a median gestation of 28+4 weeks (20+0 – 34+2). MRI yielded abnormal cortical findings consistent with those reported at NSG in all 8 cases. Additionally, mild asymmetry in the cortical sulci and gyri was noted at MRI in 2 of the remaining 23 cases with normal cortical appearance at NSG. Antenatal findings were confirmed at postnatal imaging or post-mortem examination in all cases. Conclusions: Our results from a cohort at high risk of CNS abnormalities have suggested that antenatal MRI is not superior to expert NSG in the detection of abnormalities of the cortical folding and development.

OP16.09: Termination of pregnancy for central nervous system (CNS) anomalies: Short Oral Presentation (OP) Abstracts

B. Deloison1,2, P. Sonigo3, A. Millischer3, N. Bahi-Buisson4, G. E. Chalouhi1,2, N. E. Russell1, F. Brunelle3, N. Boddaert4, Y. Ville1,2, L. J. Salomon1,2 1Obstetrics and Gynecology, University Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; 2SFAPE Société Francaise pour l’Amélioration des Pratiques Echographiques, Paris, France; 3Pediatric Radiology, University Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; 4Pediatric Neurology, University Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France

OP05.11: Does the way of conception influence pregnancy outcome after fetal reduction?

of both twins occurred in the first 72 hours. Among the remaining 21 cases, two pregnancies are ongoing and beyond 28 weeks. The mean gestational age at delivery of the remaining 19 cases was 31.2 weeks (range, 25–36) and the mean birthweight of the liveborns was 1584 g (range, 460–3800). Overall, both fetuses were born alive in 46% (11/24) of cases, only one fetus was born alive in 33% (8/24), and neither was born alive in the remaining 20% (5/24). 24 of the 30 (80%) nfants born alive survived the perinatal period, yielding an overall perinatal survival rate of 50%. All neonatal deaths were associated with extreme prematurity. Conclusions: Selective laser coagulation appears to be a good treatment option in cases of severe TTTS, but requires technical skills and adequate equipment. Training in identifying the vascular anastomoses is essential before attempting the procedure as this is a critical step in achieving success. Prematurity and its consequences remain major drawbacks. Long-term follow-up, currently underway in our series, is necessary to assess the rate of cardiac and neurological sequelae in the surviving infants.

P04.21: Are 3D sweeps a useful tool to examine the normal fetal heart? A pilot study

Results: Eleven cases of suspected venous anomalies of the cardinal and umbilical veins were evaluated. B-flow provided complete 3D rendition of anomalous anatomy in interrupted IVC with azygos continuation, three cases of agenesis of ductus venosus, one draining into the right atrium, one to the IVC, and one to the right iliac vein; one case of persistent left SVC with drainage to the coronary sinus, one case of PRUV, and one intra-abdominal umbilical vein varix. B-flow was found to have added value as compared to both power Doppler and inversion mode in the evaluation of these lesions, by demonstrating the three dimensional structure of the affected vessels in these complex lesions. The modality was found to improve diagnostic capability as well as communication with professionals and parents. Conclusions: In cases of venous anomalies, B-flow modality can become an important adjunct to complete fetal assessment, and may aid in diagnosis, counseling, and professional consultation.

OC33.01: Multi-slice imaging of the normal fetal heart: a promising new tool?

volume (SV), cardiac output (CO) and total vascular resistance. Simultaneous FBC, electrolyte count, and renin, aldosterone and ANF levels were measured. Laser therapy was performed under local anesthesia and patients were infused with less than 500 ml saline throughout the procedure. Results: Mean gestational age at inclusion was 21 (18–26) weeks. When amnioreduction < 1000 (0–700) ml (n = 12), HR, mean arterial pressure (MAP), TVR, CO and SV did not vary significantly at 6 and 24 hours. When amnioreduction was above 1000 (1000–3700) ml, n = 25: • HR was stable (ANOVA, p = NS) • MAP (mmHg) decreased from 80.6 ± 8 to 70.4 ± 17 and 74.5 ± 9 (ANOVA, p = 0.01) at 6 and 24 hours, respectively. • TVR (dyn* s* cm-5) decreased from 1520 ± 400 to 1170 ± 300 and 1150 ± 300 (ANOVA, p < 0.0001) at 6 and 24 hours, respectively. • CO indexed (ml/minute* m2) increased from 2693 to 3209 and 3231 (ANOVA p < 0.001) at 6 and 24 hours respectively, due to changes in SV. Patients showed significant hemodilution as early as 6 hours after procedure with a reduction in hematocrit (< 0.0001), plasma proteins (< 0.0001). and Hb levels (< 0.0001) with 1.2 g/dl on average. Simultaneously, renine (p < 0.005) and aldosterone (< 0.005) levels decreased, while ANF levels increased (p < 0.05).

OC3.03: Dilemmas in fetal reduction

followed by spina bifida (17%), ventriculomegaly (13%), hydrocephaly (11%), agenesis of corpus callosum (7%), Dandy–Walker malformation (7%), micro-/macrocephaly (5%), anencephaly (3%) and holoprosencephaly (2%). A total of 31% of pregnancies were terminated, and 5% ended in late spontaneous abortion or intrauterine death. A total of 64% of pregnancies (126/198) resulted in live birth. 8 children died postnatally, 118 are alive. Long-term followup (6 months to 9 years) was available in 77 infants. Psychomotor development was normal or slightly disabled for 56% of children, mostly with mild or isolated lesions. Conclusions: The study covers a large study group and describes a long follow-up period. The prognosis for surviving children depends on their specific anomaly. Overcoming the limitations of scant and controversial data leads to a better counselling of the parents about the likely outcome.

P14.74: Achondroplasia: evaluation of the phenotypic expression by 3D ultrasound

Objective: Formation of the external ear can be impacted by any disruption of its complex embryonic development. Recent clinical evidence suggests the hypothesis that idiopathic fetal growth restriction (IUGR) may be a genetic condition, with a dominant pattern of inheritance. However, no phenotypical signs of idiopathic IUGR are recognizable to dat. Here, we tested the hypothesis that an abnormal ear shape is present in patients with idiopathic IUGR. Methods: A total of randomly selected infants with birth weight < 3rd percentile for gestation, M: 10, F: 15 aged 34.2 + −4.2 weeks; birth weight: 1560 + −644, and 25 birth-weight appropriate gestational-matched controls, M: 14, F: 11 aged 34.4 + −5.0 weeks; birth weight: 2305 + −950 g entered the study. High-resolution photographs of the external ears were obtained for all. The maximum width of longest axis (LA) and shortest axis (SA) of the auricle, were measured. The distance of SA from the lowest auricle point (SA-D) ratio and the SA/LA ratio were used as size-independent indicators of the auricle shape. Results: SA-D ratios were significantly lower in IUGR patients (0.5111 + −0.0066 vs. 0.7270 + −0.0561, p < 0.00001), while SA/LA ratios were significantly higher than those of controls (0.578 + −0.083 vs. 0.5320 + −0.070, P = 0.0058). A receiveroperating characteristic curve analysis indicated that SA-D ratio ≤ 0.5567 identified IUGR subjects with 100% sensibility and specificity. Conclusions: These findings indicate a unrecognized, significant change in shape of the external ear in idiopathic IUGR. Given the visualization of the external ear is achieved in > 90% of the fetuses aged 16–28 weeks by 3-4D-volumetric scan, this new sign can be recognized in utero. It is expected that a more accurate evaluation of the external ear biometry and morphology be of help in the early prenatal diagnosis of idiopathic IUGR.