M. Vogt

Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound

We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term.

Evidence in a Human Fetus of Micrognathia and Cleft Lip as Potential Effects of Early Cytomegalovirus Infection

Human cytomegalovirus (CMV) infection is one of the most frequent congenital infections, affecting 0.2–2% of all live births. Approximately 30–50% of pregnant women are seronegative at the beginning of pregnancy, and 1% will develop primary infection during pregnancy. Fetal CMV infection is associated with a phenotype that has been described to include central nervous system anomalies, hydrops fetalis and oligohydramnios. Impaired first branchial arch development as well as orofacial clefts after CMV infection have been shown in animal models. We present a case in which ultrasound examination at 29 weeks of gestation revealed marked micrognathia and slight cleft lip as well as multiple signs of fetal infection. We focus on the detection of fetal face and skull anomalies.

[Case Report: Recurrent postpartum haemorrhage after emergency caesarean section - Clipping, embolization and haemostaseological therapy].

Immediately after emergency caesarean section a 37 yr old patient suffered severe atonic bleeding requiring different operating procedures (Clipping of the uterine arteries) in combination with an uterotonic and haemostaseological medication as well as massive transfusion of blood components and recombinant factor VIIa. After a period of 17 days without any bleeding the patient presented to the emergency room with recurrent massive uterine bleeding. Transarterial embolization of the anterior bundles of the iliac arteries in combination with a second uterotonic and haemostaseological medication stopped the haemorrhage. Reasons and risk factors of a recurrent postpartum bleeding are discussed and a multidisciplinary algorithm for treatment is proposed.

P10.03: Magnetic resonance imaging as an alternative to amnioinfusion in suspected fetal renal agenesis

Primary renal agenesis is not a diagnostical challenge as oligohydramnios is almost always present at the time of the anomaly scan. In contrast secondary (or progressive) renal agenesis (e.g. in multicystic dysplastic kidney) is frequently missed as kidneys are present but smaller in size and they tend to vanish with advancing gestational age. We present a case of a 24-year-old woman, gravida 1 para 0, referred to our center at 24+3 weeks’ gestation for suspicion of IUGR and oligohydramnios. Ultrasound showed a small multicystic left kidney. The right kidney could not be visualized. In view of the challenging scan conditions and the fact that normal kidneys were documented on previous exams a fetal MRI was requested. This case stresses the possibility of MCDK and other forms of cystic renal dysplasia in fetuses with oligohydramnios – even if a normal urinary tract was visualized on earlier exams. From our experience MRI as an alternative to amnioninfusion was decisive in confirming the diagnosis.

OP16.01: Volume slice ‐ a new diagnostic imaging tool in prenatal ultrasound

Objectives: The purpose of this presentation is to describe the use of 3D volume-slice in prenatal diagnosis. Conventional 3D multislice allows simultaneous display of multiple sequential parallel planes while in 3D volume slice it is multiple sequential 3D or 4D rendered volumes that are simultaneous displayed on the screen. The render line offset distance between sequential images can be set from a minimum of 1 mm to a maximum of 5 mm and each volume displayed on the monitor can be rendered separately. In other words up to 7 volumes can be rendered using different algorithms and visualized side by side at the same time. Methods: Volume data were acquired prospectively from the mid-sagittal plane of the fetal spine and face in 15 fetuses at the second and third trimester. All volumes were acquired with Accuvix V20 (Medison) using 4–8 MHz transabdominal curved array mechanically driven probe. Results: The following information was able to be obtained from all volumes obtained (Number of ribs, anterior vertebral bodies, both nasal bones, the metopic suture) Conclusion: 3D volume-slice is a promising new tool in the visualization and analysis of fetal bony structures.

OP16.04: An investigation of the relationship between MRI and ultrasound derived measurements of fetal head descent

Objectives: The purpose of this presentation is to describe the use of 3D volume-slice in prenatal diagnosis. Conventional 3D multislice allows simultaneous display of multiple sequential parallel planes while in 3D volume slice it is multiple sequential 3D or 4D rendered volumes that are simultaneous displayed on the screen. The render line offset distance between sequential images can be set from a minimum of 1 mm to a maximum of 5 mm and each volume displayed on the monitor can be rendered separately. In other words up to 7 volumes can be rendered using different algorithms and visualized side by side at the same time. Methods: Volume data were acquired prospectively from the mid-sagittal plane of the fetal spine and face in 15 fetuses at the second and third trimester. All volumes were acquired with Accuvix V20 (Medison) using 4–8 MHz transabdominal curved array mechanically driven probe. Results: The following information was able to be obtained from all volumes obtained (Number of ribs, anterior vertebral bodies, both nasal bones, the metopic suture) Conclusion: 3D volume-slice is a promising new tool in the visualization and analysis of fetal bony structures.

P17.12: Whirlpool sign associated with abnormal fetal heart rate pattern in prenatal volvulus

Introduction: Fetal subdural hematoma (SDH) is a rare event. With advances in obstetric ultrasound however it has been recognized that SDH may occur in utero before the onset of labor. We present a unique case of atraumatic SDH diagnosed in the second trimester. Case Report: A 31-year-old woman was referred to our institution for the investigation of a brain anomaly detected in an anomaly scan, at 22 weeks and 4 days of gestation. The woman had an uneventful pregnancy so far. A rounded hyperechogenic mass was detected in the posterior fossa, measuring about 2 cm, between the skull and the brain producing only a mild midline shift to the right. A strong suspicion of a fetal subdural hematoma was brought to mind among others. We suggested fetal brain MRI and this confirmed our suspicion of atraumatic spontaneous subdural hematoma of the posterior fossa. Medical consultation was given to the parents stating the scarcity of the condition and the poor prognosis that is referred to the literature. The parents chose the termination of the pregnancy, which took place with misoprostol leading to the delivery of a dead female fetus weighing 596 gr. The pathology report, confirmed the ultrasonographic and MRI diagnosis. Conclusion: Spontaneous fetal subdural hematoma is an extremely rare condition with a poor prognosis and it has never been reported before in literature to occur and be diagnosed at the time of the midtrimester scan. Ultrasound and other imaging techniques such as CT and MRI, and use of Doppler techniques for detecting cerebral hemodynamic abnormalities, might help in earlier diagnosis and perhaps lead to more accurate management and prognosis.