Myoung Jin Moon

The Distribution of Fetal Nuchal Translucency Thickness in Normal Korean Fetuses

The aim of present study was to establish normative data for the distribution of nuchal translucency (NT) thickness in normal Korean fetuses. The data were collected from pregnant women with singleton pregnancies in whom fetal ultrasound was performed and the fetal NT thickness was measured between 11 and 14 weeks of gestation. Among them, a total of 2,577 fetuses with a known normal outcome were included in this study. The distribution of multiple of median (MoM) values of the NT thickness with crown-rump length (CRL) in 10-mm intervals and the 95th percentile of MoM were calculated with the linear regression method. The present study showed that NT measurements increase with increasing CRL and a false positive rate increases with increasing gestational age. Therefore, a fixed cut-off point through the first trimester was not appropriate and each NT measurement should be examined according to the gestational age. The present study offers normative data of the fetal NT thickness in a Korean population, which can be used as reference for screening chromosomal aberrations or other congenital abnormalities in the first trimester.

Procedural and obstetrical outcomes after embryo reduction or fetal reduction in multifetal pregnancies: a retrospective study

To compare the obstetric outcome and incidence of procedure‐related adverse events after embryo reduction (ER) vs fetal reduction (FR), in multifetal pregnancies undergoing reduction to twins or singletons.

Association study of five functional polymorphisms in matrix metalloproteinase-2, -3, and -9 genes with risk of primary ovarian insufficiency in Korean women

OBJECTIVE Primary ovarian insufficiency (POI) is diagnosed clinically by increased follicle-stimulating hormone (FSH) levels and estradiol (E2) deficiency. A previous report suggests a possible association matrix metalloproteinase (MMP) and estrogen signaling pathway; however, there are no reports of MMP genetic associations with POI. STUDY DESIGN Blood samples were collected from 374 karyotypically normal study participants consisting of 138 patients with POI (46, XX; mean age ± standard deviation [SD], 31.7 ± 3.51 years) and 236 control subjects (46, XX; 32.2 ± 3.50 years). Five functional polymorphisms in MMP-2 (-1575G>A [rs243866] and -1306C>T [rs243865]), MMP-3 (-1612 5A/6A [rs3025058]), and MMP-9 (-1562C>T [rs3918242] and 2678G>A [rs17576]) genes were genotyped using polymerase chain reaction-restriction fragment length polymorphism assays in a cohort of 236 controls and 138 POIs. RESULTS MMP-2 -1306CT+TT was associated with POI occurrence. Moreover, relatively lower serum estradiol levels were detected in healthy women with the MMP-2 -1575GA+AA/MMP-2 -1306CT+TT and MMP-2 -1306CT+TT/MMP-9 2678GG combination genotypes. CONCLUSIONS MMP-2 -1306C>T polymorphism may contribute to an increased POI prevalence in Korean women. Further studies are needed to confirm the genetic associations in other ethnic populations.

P19.02: Procedural and obstetrical outcomes of amniocentesis or chorionic villus sampling in dichorionic twin pregnancies: Poster discussion hub abstracts

diagnosis of two diseases were searched and the diagnostic value was evaluated. Results: Quantile (Q) value of the internal diameter of the aorta (AO Q-score), the ratio of the diameter of the pulmonary artery to the internal diameter of the aorta (PA/AO), and Q value of the ratio of the diameter of the pulmonary artery to the internal diameter of the aorta (PA/AO Q-score) were the key parameters for the differential diagnosis of fetal large VSD and TOF. PA/AO is the primary parameter, which area under the curve (AUC) of PA/AO is 0.951. The mean value of PA/AO in normal fetuses was 1.22, in fetuses with large VSD was 1.21, and in TOF fetuses was 0.49. If we set the threshold of two differential diagnosis of PA/AO to 0.89, then the diagnostic sensitivity can be guaranteed more than 90% in range of false positive rate of 10%. Conclusions: The accuracy of ultrasonic diagnostic parameters of large VSD and TOF is high by medical data statistics and big data analysis. It provides a new way for prenatal diagnosis of large VSD and TOF.

OP16.02: Comparison of the clinical outcomes of non-surgical and surgical treatment of cornual pregnancies: Short oral presentation abstracts

Introduction To compare the clinical efficacy and safety of ultrasound (US) guided intragestational sac injection of methotrexate (MTX) and cornual resection in the management of cornual pregnancies. Method Between January 2007 and December 2017, retrospective review of diagnosed with cornual pregnancy at a single center, CHA Bundang Medical Center. we treated 19 cases in which there was implantation at the cornual area with embryo heart beat activity at the time of diagnosis by cornual resection. However, 12 cases were treated with local injection of MTX under ultrasound guidance and sixteen with cornual resection. The two groups were compared with respect to the procedurerelated and subsequent obstetrical outcomes. Results Compared to the cornual resection group, the local MTX treatment group had a much shorter mean procedure time (21.64±7.18 minutes versus 60.53±5.16 minutes p<0.01) and the length of hospital stay (2.40±0.54 days versus 3.43±0.37 days, p=0.018). Conclusion Non-surgical treatment is a more effective method than cornual resection for the management of cornual pregnancies and is associated with better clinical outcomes. Table. Results of the 2 subgroups according to treatment method

Ultrasound-guided local injection of methotrexate and systemic intramuscular methotrexate in the treatment of cesarean scar pregnancy

Objective To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies. Methods This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX. After the procedure, serial follow-up sonographic examination and serum beta-human chorionic gonadotropin (β-hCG) measurement were performed. Results The mean initial β-hCG level was 20,610.73 mIU/mL and ranged from 263.00–71,316.50 mIU/mL. Mean gestational age was 6.3 weeks and ranged from 4.8 to 8.5 weeks. The majority of ectopic cases were treated successfully and follow-up β-hCG level declined abruptly following the first dose of MTX. The rate of success of local MTX treatment was significantly higher than that of systemic MTX treatment. It was 93.75% vs. 73.33%, respectively (P<0.05). Conclusion Ultrasound-guided intragestational injection of MTX is an effective method for the management of cesarean scar pregnancies and is associated with minimal side effects and high treatment success.

OP23.05: Procedure outcomes of embryo reduction and selective feticide with multifetal pregnancy to twin or singleton pregnancy: a retrospective study

the use of intracardiac potassium chloride and fetal reduction must be performed using cord occlusion techniques such as bipolar cord coagulation, interstitial laser or by radiofrequency ablation. We present our series of selective reduction in complex triplet pregnancy with an MC pair using radiofrequency ablation (RFA). Methods: This was a retrospective study of the procedures in our unit for the period between 2010 and 2016. We had 25 cases of complex triplets (19 Dichorionic and 6 Monochorionic triplets). The indications for fetal reduction include 14 of multifetal pregnancy reduction, 9 cases of TTTs in the Monochorionic pair, 1 of fetal anomaly in co twin and 1 of discordant growth in the MC pair. Results: Outcome data was available in 24 cases. Median GA at procedure was 15.4 weeks (range 12.1-21.7) and at delivery was 32.9 weeks (range 17.4-41). We had 3 miscarriages; 2 cases occurred within 2 weeks of procedure. IUD of the co-twin occurred in 3 cases (2 in DCTA and 1 in MCTA). The median GA at delivery following MFPR in complex triplets was 34.6 weeks and in the TTTS group was 32.3 weeks. Complications included complex thermal injury to the co twin in 1 case resulting in the subsequent termination of the co twin. There were no cases of neurological impairment in the survivors post procedure. Conclusions: This is the largest case series of fetal reduction in complex triplets by RFA. Selective reduction by RFA in complex triplet pregnancies resulted in a total pregnancy loss in 12.5% of the cases with an 87.5% favourable outcome, in other words two live babies at discharge from hospital. The gestational age was higher at delivery in the MFPR group compared to other indications for selective fetal reduction. This data is useful in appropriate counselling of complex triplex pregnancies.

Prenatal diagnosis of double aneuploidy, 48, XXY, +21 (Down-Klinefelter syndrome)

한 개체에서 중복홀배수체 염색체 이상의 발생은 상대적으로 매우 드문 형태로 그 발생률은 문헌에 따라 다양하다. 본 사례는 클라인펠터 성염색체 이상과 여기에 보통염색체 21번이 추가된 중복 홀배수체가 진단된 경우이다. 산전검사를 위해 임신 1분기에 시행한 초음파 검사에서 태아 목덜미투명대가 3.8 mm로 증가되었으며 이에 염색체검사를 위해 융모막융모생검을 시행하였다. 그 결과 48, XXY, +21인 중복홀배수체로 진단되었으며 태아는 임신 13주에 자연유산 되었다. 이에 본 저자들은 다운-클라인펠터 중복홀배수체 염색체 이상을 문헌고찰과 함께 보고하고자 한다.

P38.10: A case of Meckel—Gruber syndrome diagnosed by ultrasonography at 14 weeks' gestation

ultrasound and MRI defined further enlargment of ventricular width (14 mm) and the absence of parieto-occipital fissure, calcarine fissure and cingulate sulcus. The couple after extensive counseling opted for continuing pregnancy. At the moment the pregnancy is ongoing. Unilateral borderline ventriculomegaly, as an isolated finding, is a common sign during ultrasound scan in midgestation, and reports describe it is as minimally effective on developmental outcome. The control of malformations of cortical development with different sulcal and gyral patterns may be associated with specific diagnoses, and provide accurate parental counseling.