L. Salvador

Conservative treatment for complex neonatal ovarian cysts: A long-term follow-up analysis

OBJECTIVE We aimed to investigate safety and effectiveness of a conservative approach for complex neonatal ovarian cysts and its long term impact on fertility. STUDY DESIGN Neonates with congenital complex ovarian cysts were conservatively managed and followed from the perinatal period to adolescence. Statistical analysis included Students t-test, Mann-Whitney U-test, the Kaplan-Meier method, and the receiver operating characteristic curve. RESULTS The post-natal progressive dimensional reduction of diagnosed ovarian cyst was statistically significant. The Kaplan-Meier survival curves revealed the probability of persistence of the cyst was up to 5% at the age of 25 months. Long term follow-up revealed both ovaries visible at US in 60% of adolescent patients. CONCLUSION Conservative management of asymptomatic complex neonatal ovarian cysts can be safely undertaken. As far as the chances of the ovarian tissue to survive conservative treatment are concerned, the results are not encouraging.

Body stalk anomaly: Management of two dichorionic–diamniotic pregnancies

The anterior wall defects are a heterogeneous group of fetal malformations, essentially represented by omphalocele, gastroschisis, bladder exstrophy, cloacal exstrophy, and body stalk anomaly. Body stalk anomaly is a sporadic, rare and lethal condition, characterized by the presence of a large abdominal wall defect, severe kyphoscoliosis, rudimentary umbilical cord, and limb deformities. The abdominal organs lie outside of the abdominal cavity in the amnio-mesoderm sac, which is limited by the placenta on one side and the amnion on the other (extracelomic space). The umbilical cord is rudimentary or absent, with only one umbilical artery [1]. Associated anomalies are neural tube defects, intestinal atresia, anal atresia, agenesis of the colon, exstrophy of the cloaca, absence of diaphragm, diaphragmatic hernia, genitourinary malformations, craniofacial defects, and anomalies of the pericardium, heart, liver and lungs [1–5]. The prevalence of this syndrome is about 1 per 14 000 births, but the real incidence is 1 per 7500 pregnancies because of spontaneous miscarriage in the first trimester [1,2,4–7]. The pathogenesis of this lethal syndrome has not been completely clarified. There are three main physiopathological hypotheses: early amnion rupture before obliteration of the celomatic cavity with amniotic band syndrome, abnormal embryonic folding when the tri-laminar embryo is transformed into a cylindrical embryo during the first 4 weeks of development, and finally a generalized impairment of embryonic blood flow [1,2,4–7]. We report two consecutive cases of dichorionic–diamniotic pregnancies with one fetus affected by body stalk anomaly. A 26-year-old woman, gravida 2, para 1, with a dichorionic–diamniotic pregnancy, was referred to our department with a diagnosis of exomphalos of one twin at 22 gestational weeks. A detailed ultrasound scan revealed a morphological normal twin with appropriate growth and regular amniotic fluid volume, and an affected fetus with large anterior abdominal wall defect, thoracic hypoplasia, severe kyphoscoliosis, clubfeet, left heart ventricular hypoplasia and right atrium dilatation, and a very short umbilical cord. Because of the presence of a healthy fetus, an expectant management was decided. Serial ultrasound scans were planned. At 27 gestational weeks the patient was admitted because of the presence of hydramnios in the affected fetus and an evacuative amniocentesis (approximately 1000 mL) was effectuated. At 30 gestational weeks the affected fetus died and four days later an emergency cesarean section was performed for abruptio placenta, resulting in the birth of a healthy baby girl weighing 1347 g. Postmortem examination of the affected fetus confirmed the sonographic diagnosis of body stalk anomaly. A 29-year-old woman, gravida 3, para 2, with a dichorionic–diamniotic pregnancy, was referred to our department at 23 gestational weeks with an uncertain diagnosis of myelomeningocele or sacrococcygeal teratoma associated with exomphalos. The ultrasound scan revealed a dichorionic–diamniotic pregnancy with one normal fetus and an intrauterine growth-restricted fetus characterized by the presence of relevant structural anomalies: kyphoscoliosis, abdominal wall defect, thoracic hypoplasia, very short umbilical cord, and limb deformities. Similarly

P51.05: Non‐invasive fetal hemoglobin evaluation near term

Fetal anemia is linked to several conditions, such as red-cell alloimmunization or infections; in all these cases fetal hemoglobin levels determination is necessary for the management and eventually for a fetal transfusion. Until recently fetal hemoglobin levels have been evaluated with the use of cordocentesis. More recently Mari elaborated a new algorithm to calculate the fetal hemoglobin levels using the peak velocity of the middle cerebral artery with Doppler ultrasounds. Furthermore the DIAMOND Study group paper gives evidence that the Doppler ultrasonography can effectively replace cordocentesis to predict fetal anemia. We have recently performed a study to predict fetal anemia at term using the middle cerebral artery peak systolic velocity (MCA-PSV). We included only normal pregnancies (n = 40) in which a Cesarean section has been programmed because of previous Cesarean section or breech presentation. Immediately after birth the neonatal hemoglobin was obtained from the cord. Our data were significantly different from those expected using Mari’s chart. We have calculated a regression curve fitting our data and the result (P < 0.001) is: Hb = 18.86 0.076 MCA-PSV Our work suggests that Mari’s chart has limitations in the third trimester, possibly due to the different viscosity of fetal blood. In conclusion we would like to stress the usefulness of non-invasive method also in late pregnancy. The prediction of fetal anemia, in fact, may modify the management by the obstetricians.

OC110: Arterial and venous Doppler profile changes and perinatal outcome in idiopathic IUGR fetuses

Objective: To characterize the velocity profiles of the uterine and hypogastric vessels before and after ovarian stimulation in the setting of in-vitro fertilization (IVF), using MSDA and GASP software. Methods: The MSDA system consisted of commercial ultrasound machine (Aloka SSD1400), a personal computer and a proprietary electronic board. Interogated vessels consisted of the uterine and hypogastric arteries and veins in a total of 21 women (15 IVF recipients and 6 egg donors) during ovarian stimulation at different time points. Velocity profiles, relative wall distension rate [WDR (%)] and shear rate [WSR (1/s)] were calculated over multiple consecutives cardiac cycles. The designation of arterial laminar flow was applied if one peak occurred in systole, while if > 1 peak in systole was classified as turbulent. Statistical analysis consisted of Spearman correlation. Results: All vessels displayed a laminar flow pattern, except in 4 cases (2 egg donors and 2 IVF patients), where the arterial flow was turbulent. Interestingly, there were qualitative differences in the velocity profiles in circumstances where conventional Doppler waveforms were identical. Hypogastric artery WDR (left, 2.5 ± 0.5; right, 1.9 ± 1) was highly correlated with the ipsilateral uterine WDR (left, 2.6 ± 0.5; right, 1.9 ± 1, rs = 1.00, p < 0.01). The hypogastric artery WSR (left, 455 ± 217; right, 389 ± 212) was highly correlated with the ipsilateral uterine WDR, (rs = 0.883, p < 0.01). Uterine wall shear rate (left, rs = 0.703; right, 0.805, p < 0.01) but not wall distension rate, was highly correlated to the cycle day. Conclusion: Real time velocity profiles are now possible using MSDA and GASP software. We found substantial differences between our new technology and conventional Doppler. These parameters are being evaluated in ongoing studies to determine their relationship to endometrial receptivity, ovarian function and success or failure of IVF attempts.

OP06.17: Non‐invasive diagnosis of fetal anemia due to maternal‐fetal hemorrhage by Doppler assessment of the middle cerebral artery peak systolic velocity waveform

Fetal Hydrops 0/29 6/25 0.003 Hct at diagnosis 26.5 ± 7.0 11.0 ± 3.2 < 0.001 Hct after 1st transfusion 44.8 ± 5.5 45.0 ± 5.3 0.858 No. of IUT/pregnancy 2.4 ± 1.5 3.4 ± 1.5 0.027 IUFD and neonatal death 3/29 4/25 0.399 Induction of labor 23/27 21/21 0.121 CS 19/27 15/21 0.936 Fetal Weight (g) 2335 ± 477 2414 ± 434 0.556 1/5 minutes mean Apgar score 8.1/9.3 8.4/8.5 0.559 1st neonatal Hct 41.0 ± 10.7 39.3 ± 9.1 0.608 Neonatal Blood transfusions 15/27 8/21 0.230 Phototherapy 22/27 17/21 0.963 Hospitalization (days) 17.8 ± 20.2 14.8 ± 9.2 0.570 Respiratory complications 6/27 6/21 0.741 GIT complications 1/27 1/21 0.856 Neurological complications 1/27 0/21 0.378 Neonatal Infections 3/27 1/21 0.621

P10.25: Doppler, NST, and biophysical profile changes in severe IUGR—a longitudinal prospective randomized study

growth and either normal (small for gestational age or SGA) or abnormal (intrauterine growth restricted or IUGR) Doppler studies in the umbilical artery (UA). Pulsatility index (PI) of the AoI was calculated in all groups at the moment of diagnosis. Results: AoI PI was directly related to the severity of the placental insufficiency. Mean UA and AoI PI values, gestational age at delivery and birth weight in both control and study groups are compared in the table. Among the IUGR fetuses the cases showing retrograde net blood flow in the AoI had a 62.5% (5/8) perinatal mortality rate.

P10.26: Temporal sequence of hemodynamic changes in severe IUGR fetuses: a randomised study

growth and either normal (small for gestational age or SGA) or abnormal (intrauterine growth restricted or IUGR) Doppler studies in the umbilical artery (UA). Pulsatility index (PI) of the AoI was calculated in all groups at the moment of diagnosis. Results: AoI PI was directly related to the severity of the placental insufficiency. Mean UA and AoI PI values, gestational age at delivery and birth weight in both control and study groups are compared in the table. Among the IUGR fetuses the cases showing retrograde net blood flow in the AoI had a 62.5% (5/8) perinatal mortality rate.