Mona Massoud

Dilatation of the supra‐pineal recess on prenatal imaging: early clue for obstructive ventriculomegaly downstream of the third ventricle

The objective of this article is to describe the diagnostic significance of prenatal identification of dilated supra‐pineal recess (SPR) in cases of ventriculomegaly.

Prenatal diagnosis of osteopathia striata with cranial sclerosis

Allcases were diagnosed postnatally. The etiology of this disorderis related to a mutation in the gene Wilms tumor on the Xchromosome (WTX) also known as FAM123B, an inhibitor ofWNT signaling, associated with increased skeletal ossificationin mice and humans and other sclerosing bone dysplasias. Ageat diagnosis and clinical presentation are variable, ranging fromasymptomatic to neonatal lethal cases. The prenatal diagnosisof OS-CS is challenging because fetal clinical presentation ishighly variable and mothers with OS-CS can be misdiagnosed.WereportherethefirstprenatalcaseofOS-CSwithsonographicand autopsy findings and discuss the possibility of a prenataldiagnosis when the WTX mutation is identified in the mother.

How deviations from STAN guidelines contribute to operative delivery for suspected fetal distress

OBJECTIVE To evaluate how deviations from STAN guidelines contribute to operative delivery for suspected fetal distress in a high-risk population. STUDY DESIGN This retrospective cohort study was conducted in a tertiary referral center with about 3000 deliveries a year. During the study period, STAN usage rate was 15.2%. All consecutive patients monitored with STAN who had an operative delivery for suspected fetal distress were included in the index group. Patients who delivered spontaneously or had an operative delivery for any reason other than suspected fetal distress were included as controls. Case review was performed by three referent obstetricians for STAN technology blinded to neonatal outcomes. Main outcome was agreement between decision made and decision recommended by STAN clinical guidelines. Secondary outcomes were reasons explaining guideline deviation and ST event to birth interval in cases with a significant ST event. RESULTS Eighty-three patients were included in each group. Decision made was consistent with STAN clinical guidelines in 124 patients (74.7%): 50 patients (60.2%) in the index group and 74 patients (89.2%) in the control group (p<0.05). Among these patients, no fetal metabolic acidosis was reported. Decision made was not consistent with STAN labor management guidelines in 42 patients (24.3%): 33 patients (39.8%) in the index group and 9 (10.8%) in the control group (p<0.05). Including ST event to birth interval, interventions were outwith STAN clinical guidelines in 51.4% of patients with suspected fetal distress. CTG misclassification was involved in over 75% of cases. CONCLUSION STAN guideline deviations contribute to an increased operative delivery rate in patients with suspected fetal distress and normal neonatal outcomes. Guideline deviations are more frequent in patients with suspected fetal distress than in controls. CTG misclassification was the leading cause of guideline deviation. STAN guideline deviations may contribute to alter STAN specificity.

Prenatal diagnosis of pericallosal curvilinear lipoma: specific imaging pattern and diagnostic pitfalls

We report the first series of cases of pericallosal curvilinear lipoma (CL) diagnosed prenatally and highlight the limitations in identifying a specific prenatal imaging pattern using ultrasound and magnetic resonance imaging (MRI). In all five of our cases, on ultrasound, the main feature leading to referral was a short corpus callosum. This subtle callosal dysgenesis was associated with a band of hyperechogenicity surrounding the corpus callosum, mimicking the pericallosal sulcus, which increased in size during the third trimester in three of the four cases in which sonographic follow‐up was performed. On T2‐weighted MRI, this band showed typical hypointensity in all cases; in contrast, on T1‐weighted imaging, in only one case was there hyperintensity, suggestive of fat, as seen typically in the postnatal period. For appropriate prenatal counseling regarding outcome, it is important to identify or rule out CL when mild corpus callosal dysgenesis is observed. One should be aware of subtle diagnostic findings, such as a thin band of echogenicity surrounding the corpus callosum that is seen as a band of hypointensity on T2‐weighted fetal MRI, and which may increase in size during gestation. Copyright

Expanding Porencephalic Cysts: Prenatal Imaging and Differential Diagnosis

Objectives: The aim of this study was to report the prenatal imaging findings of expanding porencephalic cyst, which have not been previously described in the prenatal period, and to underline that these lesions can involve the cerebellum and not exclusively the supratentorial structures. Materials and Methods: This is a retrospective observational study of five cases with a prenatal diagnosis of expanding porencephalic cyst. Results: The cystic lesion was located in the supra- and infratentorial space in 2 cases, respectively, or in both in one case. The lesion expanded into the pericerebral space or communicated with the ventricular system in 4 and 1 cases, respectively. Differential diagnosis included tumoural lesion in 2 cases because of internal echogenic components related to haemorrhagic changes, which were identified using foetal MRI, and arachnoid cyst in 2 cases because of expansion into the pericerebral space. In the last case, communication within the ventricular system mimicked a unilateral ventriculomegaly. Conclusion: Differential diagnosis of any cystic lesion with extra-axial component should include expanding porencephalic cyst. Foetal MRI is helpful to differentiate this entity from extra-axial lesions such as arachnoid cysts but also from rare tumours.

Antenatal manifestations of inborn errors of metabolism: prenatal imaging findings.

Prenatal manifestations of inborn errors of metabolism (IEM) are related to severe disorders involving metabolic pathways active in the fetal period and not compensated by maternal or placental metabolism. Some prenatal imaging findings can be suggestive of such conditions—especially in cases of consanguinity and/or recurrence of symptoms—after exclusion of the most frequent nonmetabolic etiologies. Most of these prenatal imaging findings are nonspecific. They include mainly ascites and hydrops fetalis, intrauterine growth restriction (IUGR), central nervous system (CNS) anomalies, echogenic kidneys, epiphyseal stippling, craniosynostosis, and a wide spectrum of dysostoses. These anomalies can be isolated, but in most cases, an IEM is suggested by an association of features. It must be stressed that the diagnosis of an IEM in the prenatal period is based on a close collaboration between specialists in fetal imaging, medicine, genetics, biology, and pathology.

Prenatal Caffey disease (prenatal cortical hyperostosis): severe forms with favorable outcome.

Service obstétrique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France Centre Pluridisciplinaire de Diagnostic Prénatal, Hôpital Femme Mère Enfant, Bron, France Département d’imagerie Pédiatrique et Fœtale, Hôpital Femme Mère Enfant, Université Claude Bernard Lyon I, Lyon, France Service de génétique, Hôpital Femme Mère Enfants, Hospices Civils de Lyon, Lyon, France *Correspondence to: M. Massoud. E-mail: mona.massoud@chu-lyon.fr

OP14.07: Outcomes of fetuses with small cerebellum on second and third trimester ultrasonography

G. Kasprian2, G.M. Gruber1, G. Dovjak2, D. Bettelheim3, C. Haberler4, D. Prayer2 1Department for Anatomy, Centre of Anatomy and Cell Biology, Vienna, Austria; 2Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; 3Department of Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria; 4Institute of Neurology/Neuropathology, Medical University of Vienna, Vienna, Austria

What about the Misgav-Ladach surgical technique in patients with previous cesarean sections?

OBJECTIVE The Misgav-Ladach technique is recommended worldwide to perform cesarean sections but there is no consensus about the appropriate technique to use in patients with previous cesarean sections. This study evaluated the feasibility of the Misgav-Ladach technique in patients with previous cesarean sections. STUDY DESIGN This prospective cohort study included all women undergoing cesarean section after 36 weeks of gestation over a 5-month period, with the Misgav-Ladach technique as first choice, whatever the previous number of cesarean sections. RESULTS Among the 204 patients included, the Misgav-Ladach technique was successful in 100%, 80%, and 65.6% of patients with no, one, and multiple previous cesarean sections, respectively. When successful, the Misgav-Ladach technique was associated with a shorter incision to birth interval in patients with no previous cesarean section compared with patients with one or multiple previous cesarean sections. Anterior rectus aponeurosis fibrosis and severe peritoneal adherences were the two main reasons explaining the Misgav-Ladach technique failure. CONCLUSION The Misgav-Ladach technique is possible in over three-fourths of patients with previous cesarean sections with a slight increase in incision to birth interval compared with patients without previous cesarean section. Further studies comparing the Misgav-Ladach and the Pfannenstiel techniques in women with previous cesarean should be done.

The many faces of prenatal imaging diagnosis of primitive aqueduct obstruction

OBJECTIVE To describe the different prenatal imaging patterns related to primary aqueduct obstruction throughout pregnancy and their impact on prenatal counseling. METHOD Retrospective review of consecutive prenatal cases of isolated aqueduct obstruction diagnosed over a seven-year period (2010-2016). Prenatal imaging findings, postnatal imaging, pathological data and postnatal outcome, were analyzed. RESULTS Twelve cases were included. In four cases, termination of pregnancy was performed, due to early severe ventriculomegaly in three cases suggestive of complete aqueduct obstruction. In eight cases in which pregnancy was continued, three different evolving imaging patterns were demonstrated. In three cases the ventriculomegaly evolved rapidly during third trimester and were subsequently associated with abnormal white matter changes on fetal MRI. Theses cases led to premature delivery in two cases and early surgical care in all, with focal cystic parenchymal damage shown on follow-up MRI in two cases. Slowly evolving ventriculomegaly in three cases diagnosed in the second and the third trimester which required delayed surgery during the first year of life. Stable ventriculomegaly in two cases which did not require any surgical procedure. CONCLUSION The diagnosis of primary aqueduct obstruction may be based on different prenatal imaging patterns that include either severe early ventriculomegaly, stable, slowly or rapidly evolving ventriculomegaly.