R. Poppiti

P27.12: Identifying fetuses at risk of pulmonary hypoplasia with three dimensional ultrasonography and role of amnioinfusion in the management

Objectives: Oligohydramnios occurring early during the second trimester has to be considered a severe sign of poor prognosis. Amnioinfusion has been reported improving the prognosis in case of reduction of amniotic fluid volume due to premature rupture of membranes (PROM). We present our experience with amnioinfusion for oligohydramnios with or without preterm PROM. Methods: We prospectively enrolled pregnant women presenting oligohydramnios from January 2009 to December 2009. Second level scan was performed after each amnioinfusion. Further analysis such as magnetic resonance or genetic tests were performed after counselling. Results: Twenty-six cases were included in our study. Ten cases presented PROM and eight out of ten performed more than one amnioinfusion. One case of PROM revealed sonographic sign of fetal aneuploidy confirmed at karyotype. Sixteen cases were enrolled without any anamnestic or clinical sign of PROM. Ten cases presented sign of renal dysplasia before amnioinfusion confirmed after the procedure, and in two cases the second level scan revealed further anomalies. The five remaining fetuses did not presented either PROM of renal anomalies. One case out of six demonstrate intrauterine growth retardation (IUGR) and congenital heart disease, two cases presented IUGR associated to altered uterine artery Doppler. The three remaining cases remained unexplained. Conclusions: Amnioinfusion might provide benefits such as confirmation of rupture of membranes and detailed sonography examination. This procedure has to be considered in cases with oligohydramnios due to further counselling during pregnancy.

P25.12: Spontaneous resolution of cystic hygroma colli and intrabdominal cyst in a fetus with normal karyotype

The OEIS complex (omphalocele, bladder exstrophy, imperforate anus, spine defect) is an extremely rare condition. The spectrum of defects is variable. The etiology is probably heterogeneous. The complexity of this malformation challenges the identification by ultrasound in early gestation. Most of the reported cases were diagnosed postmortem or postnatally. To our knowledge, we report the earliest diagnosed case of OEIS complex. A 30 year old primigravid woman was referred at 11 weeks and 2 days of gestation for nuchal translucency screening. The nuchal translucency was 1 mm. We detected a large umbilical cord cyst. The ultrasound examination was repeated at 12 weeks 2 days. Skin covered lumbosacral neural tube defect and ventral wall defect were suspected and bladder was not observed. The patient was reexaminated at 14 weeks 2 days. Three umbilical cord cysts, single umbilical artery, scoliosis and club foot were determined. The prognosis was explained and the family decided to terminate the pregnancy. Postabortal examination demonstrated absent external genitalia, exstrophy of bladder, imperforate anus, large omphalocele resulting from a median ventral wall defect at the caudal end of the body that resulted with the herniation of two lobes of liver, small intestine and one gonad. The defect was covered by a membrane composed of peritoneum and amnion. The histology of the gonads revealed a normally developed testis. Karyotype was 46, XY. X ray examination of the fetus demonstrated vertebral defects and autopsy findings were consistent with OEIS complex. Differential diagnosis includes cloacal extrophy, body stalk anomaly, amniotic band syndrome, isolated omphalocele and isolated neural tube defect. Probably early ultrasound diagnosis of OEIS complex with heterogeneous presentations will be possible with further accumulation of data in the literature. Although the risk of recurrence is very low, autopsy and fetal chromosome analysis should be offered in these cases.

P40.05: Prenatal diagnosis of dacrocystocele: case report

one of the most important parts of the examnination. Threedimensional ultrasonography may improve the evaluation of the fetal face phenotype and give some clues for the diagnosis of rare conditions. We report prenatal fetal features of a Prader-Willy syndrome suspected at 27 weeks of pregnancy. The ultrasound examination showed polyhydramions, criptorquidia, absence of fetal movements and suspected 3D images of fetal face, ears and hands. The confirmation of the fetal syndrome was made at birth. The baby presented transitory respiratory distress, delay of breast feeding, no crying at birth, hypomobility, criptorquidia, low setting ears, and face features of the syndrome. In this article, we show some 3D ultrasound signs and features not described so far on prenatal diagnosis of Prader-Willy syndrome.

P40.16: Cystic adenomatoid malformation volume ratio to predict fetal outcome: bidimensional versus three-dimensional ultrasound

Results: Thirteen cases with fetal lung mass were examined. Expert ultrasound and fetal MRI identified: cystic adenomatoid malformation (CAM) (nine), lung sequestration (three), larynx atresia (one). Ultrasound was accurate in 12/13 cases. One fetus with lung sequestration had CAM type I also. Of the cases with CAM, 55% was type III, one of them had an extra – lung malformation. Polyhydramnios was present in three patients and one case had fetal hydrops. 44% of the CAM cases born at term and three of the all cases with CAM required surgical treatment. Conclusion: A wide range of lung malformations can be recognized in the fetus. Antenatal categorization of the abnormal findings is difficult and not always precise. The knowledge of the prognosis allows for parental counseling.

OP09.04: Lip and clef palate: a comparision between ultrasonographic three-dimensional multiplanar technique and multislice technique

(six) compared to heart (one), and spine (two) in the controls. The average BMI for those recalled was 35. Only 10/26 recalled in index BMI cases had anterior placentas compared with 2/5 in the control group. Conclusions: Pregnant patients with BMI ≥ 30 require a greater number of scans to complete the anatomy survey. The commonest indication for recall was poor cardiac views. Placental location did not appear to be the main limiting factor.

P02.66: Management of fetal ovarian cysts: our experience

ultrasounds and renal scan with TC-99m labeled MAG3 revealed normal functioning kidneys. In addition, the infant demonstrates normal growth and neurological development. This case represents a challenging dilemma in counseling patients with heyperechoic kidneys and normal amniotic fluid volume. Based on this case and on previous reports, we conclude that in these cases, when normal renal size and shape is seen and in the absence of familial history and abnormal parental renal findings a cautionary but favorable prognosis can be given to the patients.

P06.08: Twin–twin transfusion syndrome: amnioreduction vs septostomy

Objective: Fetal megacystis in the first and second trimesters of pregnancy is an indication for diagnostic vesicocentesis. Our goal is to assess the effectiveness of early vesicocentesis as a treatment option of megacystis. Materials and Methods: From 1995 to 2005, 18 pregnancies were identified with early fetal megacystis. Fetal biometry, morphology, amniotic fluid, bladder size and volume were evaluated. Karyotype was available in 6 cases (6/18 = 33%). Vesicocentesis was performed in 8 fetuses (8/18 = 44%). Fetal urine biochemical markers were determined after each vesicocentesis. Results: Megacystis was never isolated: 6 cases (6/18 = 33%) demonstrated oligohydramnios or anhydramnios, 5 fetuses (5/18 = 28%) presented renal dysplasia, 4 had renal hyperechogenicity (4/18 = 22%), 3 had mild pyelectasis (3/18 = 17%), 1 ureteral dilatation (1/18 = 5.5%) and 1 a polymalformative syndrome with sacrococcigeal mielomeningocele (1/18 = 5.5%). Any case had chromosomal abnormalities. In 3 fetuses (3/8 = 37.5%) biochemical markers indicated a good fetal kidney function, in the remaining 5 fetuses (5/8 = 62.5%) a poor renal prognosis was suggested. In 2 cases (2/8 = 25%) pregnancy proceeded with normal amniotic fluid volume and a normal-sized urinary bladder with normal dynamics. In 3 cases (3/8 = 37.5%) megacystis recurred and a second vesicocentesis was performed. In the remaining 3 cases (3/8 = 37.5%): 2 terminations of pregnancy were performed and 1 spontaneous abortion occurred. Conclusions: Fetal vesicocentesis in the first trimester of gestation is a useful treatment option in case of megacystis. Fetal vesicocentesis is a minimally invasive procedure that can be life-saving if performed in early pregnancy.

P10.37: Unusual appearance of placental haematoma in a patient affected with deficit of factor XIII and venous thrombosis

Introduction: The aim of the presence case-report study was to evaluate the nature of the depicted round subchorionic ‘‘tumor’’ of 81 mm at 12 week of gestation age versus a possible myoma of haematoma and possible affection of fetal growth. Background: We studied serially using color-Doppler technique all the parameters of fetal growth and the tumor was still depicted at 34th week of gestation age ultrasound with the same dimensions and peripheral vascularisation but the fetal measurements started at that time to stay 1 week of gestational age and 3 days behind. Results: From that time a close study of the previous pregnancy started and after the caesarean section at 37th week of gestational age a healthy boy of 2.200 grams was delivered. The neonate admitted in NICU for 7 days for medical care. Discussion: The nature of the removed ‘‘tumor’’ was an haematoma which remained so long time and affected at the end the fetal growth marginally. Three months after delivery the mother examined for endovaginal color-Doppler ultrasound in which increased vascularisation depicted at the site of the described ‘‘tumurous’’ haematoma. Conclusion: The persistence of the haematoma might to be due to specific uterine vascularisation conditions of the posterior uterine wall which permitted its extremely enlongated presence.

P05.01: Regional responses in middle cerebral artery in severely growth restricted fetuses: preliminary reports of postnatal follow up

in the assessment of uterine malformations and its contribution to operative management. Methods: Forty-four pre-menopausal patients with suspected uterine anomalies on 2D TVS were evaluated by 3D TVS, hysteroscopy, and if necessary by laparoscopy or MRI. Ultrasound volume of the uterus was obtained by free hand rotation of the probe on the longitudinal axis of the uterus. Three perpendicular planes were simultaneously shown on the screen and classification of the type of anomalies was effected on the coronal view of the uterus based on the outer shape and the angle of the fundal identation. This 3D TVS diagnosis was compared with the hysteroscopic and/or laparoscopic classification. Results: We correctly classified by 3D TVS 20 arcuate, 12 septate and 6 bicornuate uteri (concordance rate 86%). Using 3D ultrasound 4 septate uteri were classified by hysteroscopy as arcuate and 2 arcuate uteri as septate. Sensitivity for bicornuate uteri was 100%. Conclusions: 3D TVS allows accurate differentiation between uterine anomalies and is useful for a preoperative surgical planing.

P04.24: Power Doppler evaluation of uterine malformation: the gamma sign

Objective: To investigate the role of power Doppler in differentiating septate and bicornuate uterus prior to perform office operative hysteroscopy. Methods: Ten patients with previous hystory of infertility were referred to our US Dept. At the admission, transvaginal US axial scan of the uterus showed that the endometrium was as divided in two parts separated by hypoechoic tissue. B scan alone was unable to differentiate bicornuate from septate uterus. No shows difference could be found in uterine fundal contour. Power Doppler evaluation of uterine vascularization was performed in all patients. All patients were submitted to diagnostic laparoscopy. Results: In six patients the main branches of uterine arteries appeared to converge, at the uterine midline, in a single median arterial vessel flowing between the two emiuteruses, mimicking the greak letter gamma. Irregular vascular spots, at the uterine midline, have been found in the remaining four patients. Laparoscopy revealed that the a (gamma) sign was peculiar in case of bicornuate uterus. Median irregular vascular spots had been found in case of septate uterus. Conclusions: Power Doppler study of uterine malformations and the presence of the gamma sign seem to be able to differentiate bicornuate uterus from septate uterus.