P. Lee

P28.02: Three-dimensional sonographic measurements of placental volume at early pregnancy

growth discordance. Amniocentesis on the normal twin showed a normal 46,XX karyotype. As pregnancy progressed the fetus with the cystic hygroma developed progressive hydrops with dramatic skin edema. The diagnosis of TRAP was suspected but could not be proven as the direction of flow in the umbilical artery could not be determined with confidence. In addition, there was persistent cardiac activity. At delivery, examination of the fetus and placenta confirmed TRAP sequence. TRAP sequence is a rare complication of twinning, occurring in approximately 1% of monochorionic gestations, or 1/35 000 births. The most common presentation is a grossly anomalous twin with no heart beat and reversed umbilical arterial flow. It is often mistaken for a twin gestation with an early demise. There are case reports of TRAP sequence presenting with initial cardiac activity in both fetuses. This case is unusual in that cardiac activity was present in the TRAP fetus throughout the 26 weeks of gestation. The pregnancy management would have been altered if the diagnosis could have been confirmed earlier. In MCDA pregnancies with an apparent anomalous twin, the direction of flow in the umbilical cord should be established as early as possible in order to diagnose TRAP sequence at the earliest opportunity.

Memb-roller: An effective way of making membrane rolls for pathological examination and studies of human placenta

For the pathological evaluation of the chorioamniotic membranes, a membrane roll is made to give an orientation to the sections and to cover more extended planes. We designed a new instrument, Annies memb-roller, for easy preparation of membrane rolls. Annies memb-roller has two non-toothed arms which are 2xa0mm wide, 1xa0mm thick, and 8xa0cm long. To test its effectiveness in making a membrane roll, the placentas obtained from pregnant women (nxa0=xa010) with various obstetrical conditions were used. Preparation of the membrane rolls using Annies memb-roller was easy and successful in all cases tested. The lengths of the membranes measured from fresh placentas and paraffin sections showed a very good correlation (pxa0<xa00.001; rxa0=xa00.941). Application of the memb-roller would be very helpful in the semi-quantitative analysis of the chorioamniotic membranes and the standardization of placental pathology and research practice.

OC11.05: Comparison of clinical manifestation in fetuses with Ebstein's anomaly and pulmonary atresia with intact ventricular septum

cases. With no previously affected child, about half use echo and fetal heart rate monitoring and about one quarter use echo alone. Most respondents (∼ 2/3) would start monitoring at 16-20weeks. Frequency of monitoring varied, being every 2 weeks in ∼40%, and weekly in about one quarter of responses. From replies, there was no consensus on how long to monitor the pregnancy for. If 1st degree atrioventricular (AV) block or myocardial abnormalities were found, most (50-60%) would increase frequency of scans and ∼40% would start steroids. Most use left ventricular inflow-outflow Doppler to measure the AV interval, but there is no consensus on how to define 1st degree AV block. With a previously affected child, most would monitor the pregnancy differently but ∼20% would not. Conclusions: Although there were some trends, there was no clear consensus on how to monitor these pregnancies. Evidence-based guidelines are likely to optimise fetal surveillance.

P18.07: Prenatal diagnosis of aortopulmonary window and its perinatal outcomes: a single-centre experience: Poster discussion hub abstracts

Objectives: The aim of this study is to constructing fetal CHD database system, to improve training effectiveness of prenatal diagnosis of CHD. Methods: From Jan 2011 to Dec 2017, we established the ultrasonic database of fetal CHD by continuous transverse scanning or STIC technology which included the transverse section of the abdominal cavity, four chamber, left ventricular outflow tract, right ventricular outflow tract and three vessels trachea section. For the fetuses with conus arteriosus or great vascular malformations, the STIC flow imaging is stored. The anatomical database was established when the fetus was terminated pregnancy. Every anatomical database contains 500 to 800 cross-section images. The above ultrasonic and anatomy database constructed the CHD database system. Results: Total 90 cases database system were established which involve more than 95% different types CHD. The anatomical databases could be displayed continuously and rotated arbitrarily which can be used to displaying the sectional and spatial anatomical structures of different types CHDs. Combining ultrasonic databases and STIC blood flow imaging (figure), students can easily understand and grasp the ultrasonic characteristics of different types of CHDs. Conclusions: The fetal CHD database system includes anatomy and ultrasonic databases of different types of fetal CHD. We can improve the quality and efficiency of training by contrastive learning.

P10.04: Clinical outcome of prenatally diagnosed isolated pericardial effusion

Objectives: The aim of this study was to analyze the antenatal characteristics of HLHS, its association with increased nuchal translucency, extracardiac anomalies and other obstetric outcomes. Methods: The medical records of antenatally diagnosed HLHS cases managed at Seoul National University Hospital between January 2007 and April 2012 were reviewed. The main policy of fetuses with HLHS in our institution is to maintain pregnancy and intention to treat with staged surgical palliation. Results: Twenty two fetuses (n = 22) were diagnosed antenatally during this period. Two cases had increased NT (9.09%). Only minor extracardiac anomalies were found in 2 cases (megacisterna magna, unilateral multicystic dysplastic kidney). Most fetuses (90.9%) had an isolated HLHS. Eleven cases performed karyotyping antenatally and all fetuses had normal karyotype. The 4 cases resulted in termination of pregnancy at other hospitals as parents wanted. In 18 cases who maintained pregnancy, there was no intrauterine fetal death and 2 cases (11.1%) developed cardiomegaly at near term. Seventeen cases attempted vaginal delivery, in 3 cases (17.6%), emergent cesarean section occurred due to intrapartum fetal distress. In 14 (82%) cases, labor progressed without any fetal distress. All cases had normal cord ABGA (Cord pH >7.1). Postnatally three cases had diagnosed as Cornelia de lange syndrome, 2q duplication, unilateral MCDK. Conclusions: Most fetuses with HLHS in our institution in Korea were isolated HLHS. And the incidence of increased NT, extracardiac anomalies and abnormal karyotype in HLHS were much less than previous reports in western country. There could be racial difference in characteristics of HLHS fetuses in Asian people.

P34.04: Congenital hypophosphatasia associated with poorly ossified facial bone as the first ultrasound sign

hospital for oligohydramnios at 24 weeks. The examination showed oligohydramnios and kidneys seemed normal shape and location in ultrasound. C-section was performed at 37 weeks. The baby was admitted to the neonatal intensive care unit instantly but despite all intensive care treatment, the respiratory distress from hypoplastic lung, hypotension and anuria worsened and the baby died on the 2 day of life. Endocrinological and Histopathological studies showed same as case 1. Conclusion: Severe oligohydraminios with normal shape kidneys since second trimester, we should add RTD in differential diagnosis.

OP27.04: Impact of a successful pleuro‐amniotic shunt on cardiac function in fetuses with pleural effusion

Objectives: To evaluate the potential use of the lung-head ratio (LHR) for the prediction of neonatal outcome in severe left congenital diaphragmatic hernia (CDH) after fetal tracheal occlusion (FETO). Methods: Between January 2006 and December 2009, 20 fetuses with severe, isolated left CDH (LHR < 1.0 and liver-up) were submitted to FETO between 26–30 weeks of gestation. The LHR was evaluated before (26–28 ws) and after (32 ws) FETO procedure and then correlated with neonatal outcome (deaths). Results: Neonatal deaths occurred in 9/20 (45.0%) cases. Significantly lower values of LHR were observed in those cases that died before (0.6 ± 0.3) and after (0.9 ± 0.4) FETO procedures in comparison to those that survived (0.8 ± 0.3 and 1.6 ± 0.4; respectively, P < 0.05). Conclusions: The LHR may be useful to predict neonatal outcome in fetuses with severe left CDH submitted to FETO procedures.

OP33.06: Ultrasonography as a prenatal screening method of fetal choledochal cyst

Amniocentesis was performed, and we confirmed the presence of meconium in 3 of them. The fetus with the amniotic fluid clear amniocentesis showed intestinal obstruction with reflux of stomach contents due to the narrow opening of the abdominal wall defect. There was no rupture of the bowel. There were no cases of bowel perforation in the other 24 fetuses. Conclusions: The presence of debris in the amniotic fluid and in the gastric contents, associated with the classic signs of bowel distress, may be an important tool to detect the presence of bowel perforation.

OP03.11: Normal fetal lung volume using three-dimensional eXtended Imaging Virtual Organ Computer aided AnaLysis (XIVOCAL) method in Korean population

the left lung, and R2 = 0,937 to the total lung volume). The lung volume also proved to be highly related to fetal weight (R2 = 0,905 to the right lung, R2= 0,84to the left lung, and R2 = 0,908 to the total lung volume). The intra-observer variability study was of 0,990 for the right lung, 0,986 for the left lung, and 0,995 for the total lung volume. The value of Cronbach Alfa Coefficient to evaluate the inter-observer variability was 0,975 for the right lung, and 0,962 for the left lung. Conclusion: the fetal lung volume measurement by VOCAL method of 3-dimensional unltrasonography shows good reproducibility and can be utilized to evaluate fetal lung growth.

P05.12: Developmental outcome of prenatally diagnosed agenesis of the corpus callosum

septum pellucidum (SP), hypoplasia of the optic chiasma and nerves, and various types of pituitary dysfunction. The etiology of SOD is unknown. Most cases are sporadic, but a familial occurrence has been noted which raises the possibility of autosomal recessive inheritance. Sonographic demonstration in utero of isolated absence of the SP with central fusion of the frontal horns is a clue to the diagnosis of DSO, which is confirmed after birth with findings of the magnetic resonance imaging (MRI), direct ophthalmoscopy and pituitary hormonal deficiency. Case report: A healthy 28 year-old woman, gravida 2 para 1, was referred at 33 weeks’ gestation to the UNIFESP Fetal Medicine Service on suspicion of fetal ventriculomegaly. Sonographic examination revealed absence of the SP and mild ventriculomegaly. A Fetal MRI confirmed the sonographic findings and showed a probable hypoplasia of the optic nerves. The possibility of DSO was raised. A full-term 3240g male infant was delivered by Cesarean. Postnatal investigation confirmed the diagnosis of SOD with the following findings: RMI showed absence of the SP and mild ventriculomegaly, hypoplasia of the optic nerves by direct ophthamoscopy, and pituitary dysfunction. Currently the child has been followed at the UNIFESP endocrinology and neurology service. Discussion: Absence of the SP is a rare congenital brain malformation and occurs in 2-3 : 100.000 individuals in the general population. It may occur without other brain anomalies, or may be associated with holoprosencephaly, schizencephaly, agenesis of the corpus callosum and DSO. Sonographic demonstration in utero of isolated absence of the SP with central fusion of the frontal horns is a clue to the diagnosis of DSO. However, the diagnosis of SOD is only confirmed with postnatal investigation, with findings of the MRI, direct ophthamoscopy and pituitary hormonal deficiency.