R. Sugibayashi

P28.05: The prenatal diagnosis and outcomes of fetal lung cystic lesions: 100 cases at a single centre

Objectives: To investigate the relationship between the prenatal diagnosis and outcomes of fetal lung cystic lesions. Methods: We retrospectively reviewed the medical records of all patients prenatally diagnosed with congenital lung cystic lesions between 2002 and 2016 at our centre. Prenatal diagnoses were made by ultrasound. Fetal lung cystic lesions were diagnosed as bronchopulmonary sequestration (BPS) when the aberrant artery derived from the systemic circulation and as congenital pulmonary airway malformation (CPAM) when the blood supply was from normal pulmonary circulation. Macrocystic CPAMs were those with a maximum diameter of the cyst of ≥5 mm and microcystic CPAMs were those with a maximum diameter of the cyst of <5 mm. Postnatal diagnoses were made by a pathological examination after lung resection during operations, contrast-enhanced chest computed tomography or bronchoscopy. Results: Of 100 cases with prenatal diagnoses, 49 were macrocystic CPAMs, 27 were microcystic CPAMs and 24 had BPS. All prenatally diagnosed BPS cases were confirmed as BPS postnatally. The 49 prenatally diagnosed macrocystic CPAMs included 27 with CPAMs, 15 with bronchial atresia (BA), 4 with BPS and 3 others. The 27 prenatally diagnosed microcystic CPAMs included 19 with BA, 4 with CPAMs, 1 with BPS and 3 others. The maximum CPAM volume ratio at the prenatal diagnosis was significantly higher in CPAMs than in cases of BA or BPS (mean±standard deviation: 2.58±1.55 vs 1.49±1.00, 1.13±0.68). Fetal treatments was performed more often for CPAMs than in BA or BPS cases (65% vs. 18%, 17%). Postnatal surgery was performed more often and at an earlier age for CPAMs than in BA or BPS cases (94% vs. 76%, 66%, median (interquartile range): day0 (0,186) vs day366 (287,436), day293 (45,440)). Conclusions: The prenatal diagnosis of BPS was correct. Only 55% of macrocystic CPAMs were diagnosed as CPAMs after birth, and 70% of microcystic CPAMs were diagnosed as BA postnatally. CPAMs needed surgery after birth. A more precise prenatal diagnosis of fetal lung cystic lesions is required.

P15.07: Fetoscopic tracheal occlusion for congenital diaphragmatic hernia in Japan: the feasibility and preliminary results of lung volume analyses

Canada. Singleton pregnancies with red blood cell isoimmunisation resulting in fetal anemia that required IUT therapy were eligible. Adverse pregnancy outcomes included intrauterine fetal demise, stillbirth, termination of pregnancy, neonatal death, and preterm birth (<34weeks). We analysed interval IUT time and GA length using repeated measures survival analysis with cox proportional hazard models. To identify risk factors for APO, we fitted multivariable logistic regression models. Results: A total of 246 cases were identified. Mean GA at first IUT was 27.3 weeks (s.d. 5.04), and mean GA at delivery was 35.9 weeks (s.d. 3.96). The frequency of APO was 11.5%. The majority of pregnancies were affected primarily by anti-D (80.9%), followed by anti-Kell (13.8%) and other antibodies (5.3%). On average, pregnancies underwent 3.3 IUTs (s.d. 1.58). Mean interval IUT time was 2.5 weeks (s.d. 1.40). Later GA at first IUT (β= -0.03; p=0.003), higher postprocedure hemoglobin (Hb, β= -0.15; p<0.001) and higher transfused volume (β= -0.08; p<0.001) were associated with lower risk of subsequent IUT and longer IUT intervals. Fetal hydrops (β= 0.26; p=0.011) was associated with higher risk and shorter interval to subsequent IUT. Antibody type was not associated with IUT interval length. Conclusions: Red blood cell antibody type does not predict time-to-transfusion interval or adverse pregnancy outcome in isoimmunised pregnancies, whereas fetal hydrops does. Transfusion-related protective factors against adverse pregnancy outcomes include higher postprocedure hemoglobin, and larger transfusion blood volume.

P30.16: Stomach herniation predicts non‐reassuring fetal status in fetal gastroschisis

Conclusions: Arhinencephaly and semicircular agenesis are the most specific and frequent features of CHARGE, although congenital heart disease and posterior fossa anomalies are also frequent. Therefore, brain MRI should be systematically performed in second trimester fetuses with CHD and/or CLP and in the third trimester when posterior fossa anomalies are detected with either CHD, microphtalmia or hydramnios in a eutrophic foetus.