S. Millard

Prenatal diagnosis of a paraurethral cyst.

Paraurethral cysts arising from Skenes gland are a rare cause of urogenital masses in the neonate. We report the case of a pelvic mass noted at the vaginal introitus on prenatal ultrasound that following delivery was found to be a paraurethral cyst. On prenatal ultrasound, there was no evidence of involvement of the urinary, gastrointestinal, or upper genital tract. Serial ultrasounds demonstrated slight enlargement of the cyst without other changes. The patient delivered at 33 weeks and postnatal evaluation demonstrated a paraurethral cyst. The cyst was managed expectantly and drained spontaneously on the second day of life with complete resolution.

Discordant anomalies and karyotype in a monochorionic twin pregnancy: a call for comprehensive genetic evaluation

Monochorionic twins are generally considered to be genetically identical, thus presenting a difficult counseling scenario when they have discordant anomalies. A 28-year-old primigravida with a monochorionic diamniotic twin pregnancy was referred at 13 weeks’ gestation for first-trimester screening. Twin A had a crown–rump length (CRL) of 73.5 mm, a nuchal translucency (NT) measurement of 1.9 mm, normal anatomy and normal amniotic fluid volume. Twin B (the anomalous twin) had a CRL of 51.0 mm (< 10th percentile), NT measurement of 0.6 mm, a midline brain defect consistent with alobar holoprosencephaly, a flattened profile and normal amniotic fluid volume. Transcervical chorionic villus sampling (CVS) was performed and the karyotype was normal 46,XX. On follow-up ultrasound, a congenital heart defect was suspected in Twin B, and at 14 weeks the patient had developed Stage III twin-to-twin transfusion syndrome (TTTS). As treatment for TTTS, the patient elected selective reduction of the anomalous twin by cord occlusion at 16 weeks. To evaluate selectively the genetics of this fetus, an amniotic fluid sample was obtained for chromosomal microarray at the time of the procedure. A 19.4-megabase terminal deletion of chromosome 7 (7q34→qter) was detected. This region includes the Sonic Hedgehog gene (SHH) which, when found in the haploinsufficient state, is associated with holoprosencephaly1. To evaluate for Twin A

Prenatal ultrasound and Doppler findings of progressing portal hypertension in a fetus with congenital cystic hepatobiliary disease

A 37-year-old woman, gravida 3 para 0, was referred at 24 + 5 weeks’ gestation for suspected fetal ascites. On examination, ascites and hepatomegaly with multiple subcapsular hepatic cysts were noted (Figure 1). The brain, kidneys and lungs, and the hepatic vasculature, umbilical artery (UA), middle cerebral artery (MCA), umbilical vein (UV) and ductus venosus flow velocity waveforms were all normal. Fetal magnetic resonance imaging confirmed the findings and raised concern for hepatic cystic dysplasia with cirrhosis. A diagnostic amniocentesis and fetal paracentesis revealed the predominance of lymphocytes and monocytes in the ascites, normal karyotype, normal microarray analysis and negative viral polymerase chain reaction studies. On follow-up, hepatomegaly and cyst numbers had increased; at 30 weeks’ gestation, maternal

The Relationship between the Fetal Volume-Corrected Renal Artery Pulsatility Index and Amniotic Fluid Volume

Introduction: To evaluate if the volume-corrected renal artery pulsatility index (vcRA-PI) is more closely related to the amniotic fluid level than the uncorrected or the gestational age (GA)-adjusted RA-PI. Methods: RA-PI and kidney volume were measured in low- and high-risk pregnancies at 17–38 weeks. Fetal anomalies associated with nonrenal causes of abnormal amniotic fluid volume were excluded. The vcRA-PI was calculated by dividing the RA-PI by the renal volume. The RA-PI was adjusted for GA, to obtain the GA-adjusted RA-PI. The uncorrected, GA-adjusted, and the vcRA-PI were related to the amniotic fluid level using nonparametric tests and receiver operating characteristic (ROC) curve analyses. Results: 146 examinations from 59 pregnancies were reviewed. Of these, 16 had oligo- and 15 had polyhydramnios. A higher vcRA-PI was associated with oligohydramnios (OR 2.54, 95% CI 1.67–3.86, p < 0.001), while the uncorrected RA-PI and GA-adjusted RA-PI were not able to predict oligohydramnios. ROC curve analysis showed a high predictive accuracy of the vcRA-PI for oligohydramnios (AUC 0.84, 95% CI 0.72–0.94). On the other hand, the uncorrected RA-PI and GA-adjusted RA-PI significantly predicted polyhydramnios (p = 0.04 and 0.02, respectively), while the vcRA-PI did not. Conclusion: The vcRA-PI is superior to the uncorrected and the GA-adjusted RA-PI in predicting oligohydramnios.

P15.09: The impact of operative fetoscopy on the cervical length

ablation for TRAP sequence, fetal cord blood sampling, fetal blood transfusion, fetal ascites aspiration, thoraco-centesis for severe fetal pleural effusion, amnioinfusion and fetal intramuscular injection for anesthesia. We descriptively analysed the feasibility and efficacy of real-time two-dimensional B-mode bi-plane image using eM6C probe. Results: In all cases, we found the safety because of the real-time two-dimensional images would provide other organ positions such as liver, lung, and heart that we could not see in using 1 dimensional image. In centesis into small cavity such as umbilical cord or thoracic cavity, 3D information supported us the successful centesis by leading tip position. The technical limit is that the well-trained assistant must chase the needle tip by tracking ball just online the guided needle after operator. We needed ‘‘momentary stop ’’ just before final insertion from the edge of the organ surface. Conclusions: A biplane mode of real-time 4D imaging may be a promising tool for applying fetal interventions.

OP04.06: Variation of fetal lung size in congenital diaphragmatic hernia (CDH): biology or measurement error?

Objectives: To find prognostic factors of antenatally diagnosed congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS) by analysing the pregnancy outcomes. Methods: Retrospective analyses were carried out for antenatally diagnosed fetal CCAM (77 cases) and fetal BPS (21 cases) at our institution from July 2005 to May 2015. Demographic characteristics, sonographic findings, postnatal diagnoses and pregnancy outcomes were collected from medical records and analysed. Diagnoses were confirmed postnatally by imaging studies and pathologic findings. Results: A total of 98 cases were prenatally diagnosed as CCAM (77 cases) and BPS (21 cases) during the study period. In 44 cases (44.9%) who followed up and delivered in our institution, one fetal intrauterine death (2.3%) occurred in a dichorionic diamniotic twin due to progression of fetal hydrops. Among 43 live births, 20 cases of CCAM and 5 cases of BPS were diagnosed postnatally and the others showed spontaneous regression of thoracic mass. The concordance rate between antenatal and postnatal diagnosis was 80%. From 21 cases who showed spontaneous regression of CCAM (17 cases) or BPS (4 cases) on antenatal sonography, three cases were diagnosed as CCAM postnatally. Postnatal surgery was done in eight cases (18.6%) including one case of catheterisation. Location of mass, mediastinal shift, hydrops, polyhydramnios and associate anomaly were not associated with size decrease of mass, spontaneous regression of mass and postnatal operation. Conclusions: Prenatally diagnosed CCAM and BPS showed excellent survival and prognosis irrespective of sonographic findings including the location and size of mass. One case of intrauterine fetal death was observed due to progression of fetal hydrops in a dichorionic diamniotic twin. Postnatal surgery was necessary in less than 20% of cases.

OP04.03: Prenatal prediction of extracorporeal membrane oxygenation requirement in patients with congenital diaphragmatic hernia

N. Abbasi1, R. Ruano2, A. Johnson3, S. Haleh4, A. Benachi5, J. Saada5, G. Ryan1, FETO Consortium 1Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; 2Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA; 3Obstetrics and Gynecology, UTHSC, Houston, TX, USA; 4Obstetrics and Gynecology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA; 5Hôpital Antoine-Béclère, Hôpitaux Universitaires Paris-Sud, Paris, France

P15.06: The relationship between perioperative cervical dynamics and the interval to delivery after fetoscopy

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.

Aortic isthmus shunt dynamics in normal and complicated monochorionic pregnancies

To study fetal aortic isthmus (AoI) shunt dynamics in monochorionic (MC) twins.