M. Slodki

Difficulties in prenatal diagnosis of tumour in the fetal sacrococcygeal area

Prenatal ultrasound at the 20th week of gestation revealed a 3-cm tumour in the sacrococcygeal area. Initially, a sacrococcygeal teratoma was suspected on the basis of fetal ultrasonography, which revealed normal heart anatomy and an increasing tumour mass. The diagnosis was then changed to fetus in fetu or teratoma. Prenatal magnetic resonance imaging at the 34th week of pregnancy confirmed the ultrasound diagnosis. No other anomalies were found. Elective caesarean section was performed at term. The care team included a paediatric surgeon, obstetricians, neonatologists, midwives, and an anesthesiologist. A female newborn was delivered in good condition. The tumour was resected in the operating room and mature teratoma was established by histopathological evaluation. Surprisingly, agenesis of the right forearm was revealed which had not been detected prenatally, despite many examinations (both in our hospital and earlier at a primary care obstetrician office).

New method to predict need for Rashkind procedure in fetuses with dextro‐transposition of the great arteries

Prenatal congenital heart disease classification systems distinguish between critical dextro‐transposition of the great arteries (d‐TGA) with restriction of the foramen ovale (FO) (which requires a Rashkind procedure within the first 24 h following delivery) and d‐TGA for which surgery is planned (after prostaglandin perfusion or Rashkind procedure later than 24u2009h after delivery). However, current prenatal diagnostic criteria for postnatal FO restriction in d‐TGA are inadequate, resulting in a high false‐negative rate. We aimed to identify echocardiographic features to predict the urgent need for Rashkind procedure.

Comment on "Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention": a new classification of congenital heart disease.

The recent paper by Pruetz et al. entitled “Outcomes of critical congenital heart disease requiring emergent neonatal cardiac intervention” is exciting and very similar to our approach to critical congenital heart disease that we suggested in our center (the Polish Mother Memorial Hospital Research Institute) few years ago in Poland. We created a new classification of congenital heart defects (for the perinatology team) based originally on four groups of patients:

The significance of a prenatal diagnosis of right aortic arch

To analyze a population of fetuses with prenatally diagnosed right aortic arch (RAA).

P13.08: Prognostic factors of hypoplastic left heart syndrome (HLHS) identified during prenatal and perinatal period: Poster discussion hub abstracts

P13.04 Echo AV interval overestimates MCG PR interval in SSA+ pregnancies: evidence for new criteria for 1◦ AV block B. Cuneo2,1, J.F. Strasburger5, A.M. Kaizer4, S. Bitant3, W. Lutter3, R.T. Wakai3 1Heart Institute, Children’s Hospital Colorado, Denver, CO, USA; 2Colorado Fetal Care Centre, University of Colorado Denver, Aurora, CO, USA; 3Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; 4Biostatistics and Informatics, Colorado School of Public Health, UC Denver, Aurora, CO, USA; 5Pediatric Cardiology, Medical College of Wisconsins, Milwaukee, WI, USA

OP22.10: Neonates with congenital heart defects diagnoses prenatally: comparison of mortality of full-term babies and preterm babies born by Caesarean section: Short oral presentation abstracts

Objectives: Congenital heart defects (CHD) are the most frequent reason for deaths during the neonatal and early infancy periods. The aim of this study was to retrospectively compare outcomes of singleton pregnancy neonates with congenital heart defects born in term and prematurely by Caesarean section (CS). Methods: We retrospectively selected a group (1) of 184 neonates with CHD born in term and second group (2) of 42 preterm babies with CHD born by CS. Exclusion criteria for both group was multiple pregnancy and extra-cardiac malformation. We divided both group using new prenatal CHD classification for: the most severe heart defects, critical heart defects, severe planned defects and planned defects. Results: The total mortality in both group was (1): 18% (33/184) and (2) 64% (27/42) (p>0,0001). In the most severe heart defects group mortality rate was: group (1) 100% (11/11) vs group (2) 100% (2/2), in critical heart defects: group (1) 14% (2/14) vs (2) 100% (8/8) (p=0,05), in severe planned defects: 15% (20/125) vs (2) 78,6% (11/14) (p=0,001) and in planned defects: (1) 0% (0/34) vs (2) 33,4% (6/18) (p=0,003). Conclusions: Preterm neonates with congenital heart defect had generally higher mortality rate than neonates born in term in almost all group of new classification. To improve mortality rate in neonates with CHD we need to improve the management with fetuses with CHD and try to avoid CS before due date.

Retrospective cohort study of prenatally and postnatally diagnosed coarctation of the aorta (CoA): prenatal diagnosis improve neonatal outcome in severe CoA

Abstract Introduction: Prenatal diagnosis of congenital heart disease (CHD) leads to improved outcome but not mortality rate. This may not be the case for coarctation of the aorta (CoA). The objective of this study is to estimate the effect of a prenatal diagnosis of CoA by comparing neonates with CoA by the time of diagnosis. Materials and methods: The study included 38 neonates with CoA diagnosed prenatally and 102 neonates diagnosed postnatally. The postnatal group was divided into two subgroups: (1) severe CoA: symptoms of CoA within the first 7 days (nu2009=u200943) and (2) mild CoA: symptoms within the 8–28th day (nu2009=u200934). The neonates diagnosed more than 28 days after delivery were excluded from the study (nu2009=u200925). Severe CoA was defined as CHD diagnosed postnatally with clinical symptoms that presented in the first week after birth. Mild CoA was defined as CHD that presented clinical symptoms later than 7 days of life. Results: Prostaglandins were initiated at lower doses (pu2009<u2009.001) in the prenatal group. Severe postnatal CoA was associated with more frequent Neonatal Intensive Care Unit (NICU) visits than mild postnatal CoA (pu2009=u2009.005). The length of hospitalization of neonates with severe postnatal CoA was 10 days longer than compared to the prenatal group, but the difference was not statistically significant. The highest mortality rate was in the severe postnatal CoA group (18.6%) which was significantly higher than the mortality rate in the prenatal group (pu2009=u2009.005). Conclusion: 1. Prenatal identification of fetuses at increased risk of developing CoA may reduce mortality and improve outcome only in neonates with severe CoA (symptoms of CoA within the first 7 days after birth); 2. Prenatal diagnosis of severe CoA was associated with lower prostaglandin doses and lower mortality rate.

EP04.14: Does the fetal echosonographic index of infection have an impact on the newborn's condition?

distance between pulmonary trunk and ascending aorta are longer than that of the normal fetus. We set the indices: the longest distance between outside of pulmonary trunk and superior caval vein (dPS), the distance between pulmonary trunk and ascending aorta (dPA), and dPA/dPS. We compared those indices between 4 examinations of 2 RAA fetuses and 67 examinations of normal fetuses. Results: In RAA fetuses, dPA/dPS was significantly higher (23.6±2.9 %) than that of the normal fetuses (13.1±3.7%) (T-test, p<0.001). Conclusions: It would be possible to screen RAA with three vessel view in the second and third ultrasound screening.

P22.02: Polish National Registry for fetal cardiac anomalies in 2016

Results: Low VCI at the entry was found in 19 patients (0.3% of 6024 screenings). Uterine isthmus had already been opened at the entry in 12 patients. Nine cases of VP and one of low VCI without VP were diagnosed at the entry and consistent until the delivery. Two cases were diagnosed as placenta previa with low VCI at the entry. They progressed to low-lying placenta with VP at delivery due to atrophy of the placenta around the internal os. On the other hand, seven patients were diagnosed as low VCI near the closed isthmus at the entry. Five were diagnosed as low VCI without VP at the delivery, however, two cases of velamentous vessels were descending toward the isthmus with the expansion of the amniotic bag after the opening of the isthmus, resulting in VP at the delivery. Conclusions: Not only atrophy of the placenta previa around os develops VP, but also low VCI occasionally migrates in the direction of the uterine cervix with uterine isthmus opening, resulting in VP.

EP04.10: Absent pulmonary valve syndrome: the earlier the operation, the better the results?

(vaginal or abdominal), and in 81,8 % at 16 weeks gestation. The best route for the ultrasound scan at 13-13+6 weeks in patients with a BMI <25 was the abdominal route, while in patients with a BMI> 25 the vaginal route was the best. The 16 weeks scan was the fastest while the slowest was the vaginal route at 13-13+6 weeks. Conclusions: Fetal cardiac examination at 13-14 weeks may be as successful as screening at 16 weeks in patients with low and high BMI. The transvaginal route provides the best image quality, however it is influenced by the fetal position. The transvaginal route could be an alternative to the abdominal route in patients with a poor acoustic window.