P. Valentini

P26.03: Persistent fetal tachycardia and decelerations after abrupt stomach extrusion in gastroschisis

F. Fuchs1, O. Picone1, M. Mabille2, A. L. Delezoide3, R. Frydman1, M. V. Senat1 1Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France, 2Service de Radiologie. Assistance Publique Hôpitaux de Paris, Université Paris Sud., France, 3Service d’Anatomopathologie, Assistance Publique Hôpitaux de Paris, Université Paris Sud., France

P31.01: Postnatal follow-up of a case with proximal focal femur deficiency

Objectives: To determine the characteristics of fetal bladder filling and emptying in the 2nd and 3rd trimester. Methods: Fetal bladder’s volume was measured by 3D volume acquisition at intervals during routine 2nd (T2) and 3rd (T3) trimester ultrasounds in 129 patients. Measurements were obtained by using the 3D mode on Voluson E730 with a rotation angle of 15 degrees. The midline plane was that with the bladder and 2 umbilical arteries visible, with a rapid sweep of 70 degrees. We assessed the speed of bladder filling (Vf) and emptying (Ve), the maximal (Vmax) and minimal (Vmin) bladder volume as well as the time of filling (Tf) and emptying (Te) corresponding to the time necessary to obtain a maximal and minimal volume respectively. Multiple pregnancies, fetal structural or chromosomal anomalies were excluded. Results: Out of 129 patients, only 75 with good quality acquisitions, were recruited. 39 were 2nd trimester (24 male and 15 female) and 36 were 3rd trimester (22 male and 14 female). The mean Vf was 0.052 cm3/min (SD = 0.046) in T2 and 0.611 cm3/min (SD = 0.693) in T3. The mean Ve was 0.095 cm3/min (SD = 0.113) in T2 and 1.231 cm3/min (SD = 1.71) in T3. The mean Vmax was 1.10 cm3 (SD = 2.2) in T2 and 16.11 cm3 (SD = 4.31) in T3. The mean Vmin was 0.24 cm3 (SD = 0.16) in T2 and 4.65 cm3 (SD = 3.05) in T3. The mean Tf was 12.5 min (SD = 6.51) in T2 and 20.57 min (SD = 15.39) in T3. Conclusions: Dynamic fetal bladder assessment in the 2nd and 3rd trimester is still unexplored. Our study allowed us to establish a profile of normal fetal bladder filling and voiding, in male and female fetuses. This profile will help explore lower urinary tract obstructive pathologies and bladder dysfunction in other extraurinary pathologies. . . Further number is needed to confirm these results.

P09.14: Report of first two cases of TRAP treated with US guided bipolar forceps cord coagulation in Chile

Bronchogenic cysts develop from abnormal budding of the ventricular diverticulum of the foregut resulting in focal cystic duplication of the tracheobronchal tree.They may present single or, rarely, as multiple lesions. Dimension of bronchogenic cysts vary from a few milimeters to greater 5 cm. Wall of the cysts contain fibrous tissue and small amounts of cartilage and the content of the cysts may be watery or viscid. Pneumocystis jiroveci (old P. carinii) is now considered a fungus based on nucelic acid and biochemical analysis; nevertheless, on the basis of morphologic and biologic characteristics it’s included in the atlas of medical parasitology. P.j. is one of the most common infections in immunosuppressed patients with AIDS. Other impairments of cellular immunity such as primary immunodeficiency, steroid treatment, organ transplantation and cancers predispose to P.j. infection which usually infiltrates diffuse but also atypical presentations can occur: nodules, cavitation, consolidation, pneumatocoele and pneumothorax. Clusters of P.j. are demonstrated in the alveolar space of lung biopsy tissue. We met 20 w. fetus of 19 y.o. healthy pregnant patient with unremarkable history with a single cyst 2.5 cm. This cyst was located in middle part of the left lung. Aspiration was done under ultrasound control, 9 ml of pure limpid liquor was aspirated. When we drew a needle out empted cyst’s cavity a little of fetal blood was admixed. Aspirated liquor contaminated by fetal blood was sent to cytological examination. Cytological expert conclusions were surprised – in sediment a lot of pneumocites were found. Of course, we can’t be sure about exact source of P.j., cystic liquor or fetal blood because contamination. Unfortunately we have no another additional data so far as the family decided to terminate pregnancy and forbad any further investigations. Nevertheless we publish these incomplete data because it’s very unusual and first prenatal P.j. findings from fetal lung tissue

P13.16: Can we trust in 3D brain volumes? Internal validation of DBP, FOD, cisterna magna and TCD measurements

B. van der Knoop1, J. I. de Vries1, F. Slaghekke2, S. J. Steggerda3, J. I. Verbeke4, L. S. de Vries5, L. R. Pistorius6 1Obstetrics and Gynaecology, VU University Medical Center Amsterdam, Amsterdam, Netherlands; 2Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands; 3Neonatology, Leiden University Medical Center, Leiden, Netherlands; 4Radiology, VU University Medical Center, Leiden, Netherlands; 5Neonatology and Child Neurology, University Medical Center Utrecht, Utrecht, Netherlands; 6Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands

OP18.07: Characteristic discordance of umbilical vein flow (UVF) in twin-twin transfusion syndrome (TTTS) is absent in normal twins

Methods: This was an observational study of 75 consecutive monochorionic twin pregnancies complicated with amniotic fluid discordance (AFD) which did not meet the criteria for TTTS (polyhydramnios and oligohydramnios) at initial presentation. AFD was defined as mniotic fluid volume of both fetus did not meet oligohydramnios and polyhydramnios (2cm < MVP ≤ 3cm, 7cm ≤ MVP < 8cm). Fetoscopic surgery was applied for TTTS progressing before 26 weeks’ gestation. The population was subdivided into two groups (normal Doppler: ND, abnormal Doppler: AD) by presence of abnormal Doppler studies of umbilical artery or ductus venosus in either twins. Results: Forty six of 75 cases (61%) showed presence of abnormal Doppler blood flow. Twenty seven of 46 cases (59%) progressed to severe TTTS and 8 cases of those (30%) progressed to TTTS after 26 weeks’ gestational age. Survival rate without neurological problem of cases progressed to TTTS after 26 wks 63% (ND) was 24% (AD). And survival rate without neurological problem in cases without progression to TTTS was 88% (ND) and 47% (AD). Cases with abnormal Doppler study in either twins showed poor prognosis. Conclusions: Our data suggest that amniotic fluid discordance in monochorionic diamniotic twin pregnancies in combination with abnormal Doppler study represents an extremely high-risk constellation for adverse pregnancy outcome. Fetoscopic laser coagulation of vascular anastomoses can be considered as a therapeutic option for this group.

OP22.09: Excess of Cesarean sections because of ultrasound overestimation of fetal weight

of 37 consecutive, singleton, term pregnancies. General Electric Voluson 730 Expert Ultrasound equipment was used to capture 3D volumes from each uterine quadrant after color Doppler application. Four volumes (one from each quadrant) were stored for each woman. The sum of the four volumes was compared to the cord length after birth. Results: Mean umbilical cord length at autopsy was 55.8 cm (SD 7.6 cm). Mean sonographically estimated umbilical cord volume was 95.5 cm3 (SD 80.6 cm3). Measurement of umbilical cord volume by 3D ultrasound (VOCAL) appears to correlate in a negative way with the umbilical cord length (Pearson Correlation: −0.351 (P = 0.033), Spearman’s rho: −0.370 (P = 0.024). Conclusions: Estimated cord volume apparently has no significance in the calculation of umbilical cord length. In the light of these results, 3D ultrasound estimation of cord volume cannot be used as an admission test for delivery. Further investigation is needed with a larger number of patients.

P35.03: Hydrocolposonography in the diagnosis of a transverse vaginal septum in a 37 weeks' pregnant woman

macroscopic and microscopic appearance of the placenta confirmed the diagnosis: it weighed 1100g; there were multiple dilated vessels on this surface, each of about 2 cm diameter. The second case : A 31year-old primigravida with normal screening ultrasound at 9 weeks and 11 weeks. The 22 weeks screening ultrasound exam discovered a thickened placenta, with hyperechogenic and hypoechogenic areas and an isoechogenic area of about 2 cm diameter. Fetal morphology, biometry and velocimetry were normal. At present the patient is 32 weeks of gestation. We are presenting these cases to show the importance of a careful ultrasound exam of the placenta and the correlation with the histopathologic findings to discriminate a distinct group of high risk pregnancies.