S. Wavrant

Prediction of neonatal outcome of TTTS by fetal heart and Doppler ultrasound parameters before and after laser treatment

To determine the prognostic value of fetal Doppler and echocardiographic parameters for neonatal survival up to 30 days after laser coagulation in monochorionic pregnancies complicated by twin–twin transfusion syndrome (TTTS).

Impact of amniotic fluid “sludge” on the risk of preterm delivery

Abstract Objective: To evaluate the impact of amniotic fluid “sludge” (AFS) on the risk of preterm delivery and to describe the effect of antibiotic treatment in that situation. Methods: Case–control study including singleton pregnancies with or without AFS, between 15–32 weeks of gestation. Factors associated with preterm delivery before 32 weeks, 34 weeks and 37 weeks were evaluated with univariate and multivariate logistic regression. Since all women with AFS in this study were treated with antibiotics, a historical comparison was performed with similar patients with AFS found before 2007 and not treated with antibiotics. Results: AFS was observed in 90/1220 patients (7.4%). AFS was associated with shorter cervical length, greater body mass index, cervical cerclage and preterm birth before 28 weeks. However, after adjustment, AFS did not remain associated with preterm delivery before 32 or 34 weeks. The historical comparison suggested that azithromycin could significantly reduce the risk of preterm delivery before 34 weeks (odds ratio: 0.2; 95% CI: 0.04–0.92). Conclusions: AFS, treated with azithromycin, was associated with a higher risk of prematurity, but not independently after adjustment for cervical length and second trimester vaginal bleeding. Further studies need to evaluate the effect of antibiotics in pregnancies with AFS.

Aortic Isthmus Flow Recording Predicts the Outcome of the Recipient Twin after Laser Coagulation in Twin-Twin Transfusion Syndrome

Introduction: The objective was to assess the prognostic value of the systolic flow through the aortic isthmus in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS) treated by placental laser ablation. Material and Methods: Fetal echocardiography and outcome data of 105 cases of TTTS treated by laser photocoagulation of placental anastomoses were reviewed. Hemodynamic parameters were collected before and after treatment. The isthmic systolic index (ISI) was calculated as the peak systolic velocity/systolic nadir ratio. Results: A total of 105 laser coagulations were studied. Fetal echocardiography pre- and post-laser were available in 68 cases, including 55 with data on aortic isthmic Doppler. Survival rates were 17, 22, and 61% for 0, 1, or 2 twins, respectively. At least 1 twin was delivered alive in 83% of the pregnancies. The mean gestational age at surgery was 21 weeks (range 16-26). Median ISI values were similar for donor and recipient twins, before and after laser ablation (all p > 0.05). A lower recipient ISI before laser was related to early recipient demise within 24 h (p = 0.04). Discussion: A lower ISI before placental laser ablation for TTTS is associated with postoperative demise of the recipient twin.

Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and Doppler ultrasound

To determine the prognostic value of fetal Doppler and echocardiographic parameters for intrauterine fetal demise (IUFD) within 24 hours and within 1 week after laser coagulation in monochorionic pregnancies complicated by twin‐twin transfusion syndrome.

Outcomes of extremely premature infants with twin–twin transfusion syndrome treated by laser therapy

ObjectiveTo compare short-term and long-term outcomes of preterm infants born at <29 weeks of gestational age (GA) with twin–twin transfusion syndrome (TTTS) treated with laser therapy to preterm twin infants without TTTS.DesignRetrospective case–control study comparing 33 preterm TTTS twins to 101 preterm diamniotic–dichorionic (di–di) twins born at our institution between 2006 and 2015.ResultsGA at birth were 26.4 ± 1.4 weeks (TTTS) and 26.9 ± 1.6 weeks (di–di) (p = 0.07). TTTS premature newborns were less exposed to antenatal steroids (p = 0.01), more frequently born by C-section (p = 0.005), received more surfactant therapy (p = 0.004, and were smaller for GA (p < 0.001). When adjusted for antenatal steroids and birth weight, TTTS status was not associated with increased mortality (HR 1.66, 95% CI 0.77–3.56, p = 0.20). No differences were found on neurodevelopmental outcomes at 18 months of corrected GA.ConclusionPremature TTTS newborns treated with fetal laser therapy had similar survival and neurodevelopmental outcomes compared to preterm di–di twins without TTTS.

P24.03: Prenatal diagnosis of recto-uterine fistula: a case report

phenotypic female sex. Histological examination of the placenta confirmed a monochorionic, diamniotic twin placenta. Karyotyping was performed on different tissues (see table). Genetic analysis was performed in both twins to proof chimerism. Chimerism was verified by Microsatellite analysis in blood lymphocytes. We presented a rare case of chimerism after IVF/ICSI and assisted hatching. The prevalence of a discordant karyotype in monochorionic twins is low and might be elevated after reproductive treatment. Therefore, we recommend karyotyping in both fetuses of monochorionic twin pregnancies at risk for chromosomal anomalies.

P17.04: Prenatal diagnosis of hydromylia: a case report

corpus callosum hypoplasia and cortical malformation with inferiory olive complexes heterotopia reminiscent of classical lissencephaly (type I) linked to LIS1 gene deficit. The Miller-Dieker lissencephaly was confirmed by FISH that showed a 17p13.3 deletion at LIS locus. Karyotype and 17p13.3 FISH analysis of both parents were normal, allowing reassuring genetic counseling. To our knowledge, this is the first report of Miller-Dieker syndrome revealed as early as 20.4 weeks gestation by corpus callosum hypoplasia with a diagnosis based on fetal and neuropathological screenings. This report highlights the good impact of neuropathological examination on cause identification after pregnancy terminations for brain malformations.

P27.03: Validity of first trimester 3D fetal anatomy assessment

Objectives: Highlighting the alveolar ridge on three-dimensional volumes obtained when performing the screening for the end of the first trimester. Methods: A prospective study of group of 121 pregnant patients, each pregnancy with a single fetus. Each fetus had a 3D volume acquired between 11+0 and 13+6 weeks. Using multiplane and multislice technique we obtained a cranial axial section, highlighting the alveolar ridge and measuring its area. Three fetuses spontaneously aborted at 11, 12, 13 weeks, were studied, to compare the images obtained by ultrasound with the one from the miscarriage. The volume acquisitions were done by a different operator from the one responsible for choosing and processing the sections. The alveolar ridge area measurement was performed by two different operators and the results were compared. Results: Out of 120 volumes, at 100 fetus volumes, we obtained, using multiplane processing, sections similar to the one from the miscarriage (82.64%). The hyperechoic bowshaped area from the anterior region of the maxilla which represents the alveolar ridge was observed in these 100 volumes. Measurement of alveolar ridge area was possible in cross section obtained in all 100 volumes, without any significant differences between the two operators (mean 0.1900 cm2, 95% CI: 0.1754–0.2046, 0.1908 versus mean, 95% CI: 0.1762–0.2054, p: 0.9389). Conclusions: Analysis of volumes, stored when performing the end of the first trimester ultrasound screening, obtains sections which contain the alveolar ridge, part of the palate. This paper is partially supported by the Sectoral Operational Programme Human Resources Development, financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/89/1.5/S/64153.

OC07.08: Prognostic value of the isthmic systolic index (ISI) in fetuses with congenital diaphragmatic hernia

Gestational age at scan (weeks) 33.4 ± 4.3 36.6 ± 3.1* 35.8 ± 3.2* 28.9 ± 2.5* < 0.001 Umbilical artery pulsatility index 0.07 ± 0.58 0.01 ± 0.63 0.62 ± 1.12 4.08 ± 3.61* < 0.001 Middle cerebral artery pulsatility index 0.49 ± 1.02 0.13 ± 0.70 −0.19 ± 1.28* −1.64 ± 0.84* < 0.001 Cerebroplacental ratio 0.06 ± 1.24 −0.09 ± 1.15 −0.87 ± 1.61* −2.90 ± 1.15* < 0.001 Ductus venosus pulsatility index 0.01 ± 1.09 0.18 ± 1.18 0.06 ± 0.94 2.29 ± 3.37* < 0.001 Left myocardial performance index 0.01 ± 0.58 0.93 ± 1.01* 1.04 ± 1.11* 1.59 ± 1.05* < 0.001 Cardiothoracic ratio 0.28 ± 0.05 0.32 ± 0.05* 0.33 ± 0.05* 0.34 ± 0.06* < 0.001 Right sphericity index 1.92 ± 0.38 1.52 ± 0.29* 1.54 ± 0.29* 1.66 ± 0.23* < 0.001 Right ventricular free wall thickness 0.16 ± 0.05 0.15 ± 0.04 0.18 ± 0.05 0.42 ± 0.13* 0.003

P03.03: Early diagnosis of Greig cephalopolysyndactyly syndrome

A 24 year-old woman was referred for suspicion of craniosynostosis. She had no past medical history and the ultrasound performed during first trimester screen for trisomy revealed a slightly flattened forehead, which alerted the treating physician. In our center, fetal cardiac and morphological ultrasounds were done and revealed significant craniofacial dysmorphism with prominent temporal bones, large thumbs and upward displacement of the right hemidiaphragm. Amniocentesis was normal. Follow-up ultrasound at 26 weeks showed progression of the craniofacial deformity, polyhydramnios and macrosomia. Greig cephalopolysyndactyly syndrome (GCPS) was then suspected. The patient opted for termination of pregnancy. On macroscopic evaluation, the fetus was a male weighing 1510 g (normal for 28–29 weeks). Craniosynostosis was confirmed from the prominent forehead and absence of fontanelles. Hypertelorism, polysyndactyly, brachydactyly and bilateral palmar creases were also noted. GCPS consists of a triad of hypertelorism, macrocephaly and polysyndactyly. Its incidence is estimated to be 1-9/1,000,000. Other anomalies seen in GCPS include craniosynostosis, diaphragmatic hernia, mental retardation and agenesis of the corpus callosum. It is caused by mutations in GLI3 and is inherited in an autosomal dominant pattern. Careful observation of the forehead during first trimester screening could potentially allow early detection of Greig syndrome, especially in families at high risk.