V. Donadono

P03.11: Ultrasonographic features of trisomy 13

as being normal (n = 22) or abnormal (n = 26) and whether the diagnosis was made correctly. Results: For the discernment between normal and abnormal the sensitivity is higher for VE (86.2% vs. 81.5% P = 0.24) and the specificity is higher for 2D/3D US (83.6% vs. 73.6% P = 0.05). VE has a higher sensitivity (63.3% vs. 53.1% P = 0.07) when analyzing the correctness of a diagnosis, whereas specificity is comparable. Malformations of the face, skeleton and extremities are more often correctly diagnosed with VE. The reviewers preferred VE above 2D/3D US. More time was required for evaluation with VE as compared to 2D/3D. Conclusions: The detection rate for first trimester abnormalities is higher for VE and more diagnostic information became available with VE. VE has additional value in first trimester diagnosis of malformations of the face and limbs/skeleton.

W179 MANAGEMENT OF A WOMAN HOMOZYGOUS FOR FII20210A WITH IUGR COMPLICATED BY HELLP SYNDROME

Objectives: Thrombophilia is a multifactorial predisposition for thromboembolism affecting about 15–25% of Caucasian population; this medical condition is associated with recurrent pregnancy loss, placental abruption, preeclampsia, IUGR. In 2011 a 32-years-old woman III gravida was referred to our High Risk pregnancy Unit. The patient was affected by homozigosis for prothombin G20210A mutation and homozigosis for MTFHR C677T mutation and she developed Preeclampsia in the two previous pregnancies. Materials: The patient started the prophylaxis with low molecular weight heparin (LMWH) at 7 weeks of gestation immediately after the diagnosis of pregnancy. She was strictly monitored; the ultrasonographic biometry and anatomy were normal during pregnancy; but the Doppler showed a bilateral alteration in pulsatility of both uterine arteries. At 29 weeks of pregnancy the fetus developed mild IUGR and mild flow restriction that induced hospitalization at 31 weeks of pregnancy. Methods: The fetus wellness was daily monitored by cardiotocography and by ultrasonographic evaluation. IUGR and reduction of diastolic flow in Umbilical Artery persisted; Doppler of Middle Cerebral Artery and Ductus Venous were normal. The cardiotocography revealed no sign of fetal suffering; the blood pressure and the proteinuria were both normal. The patient continued prophylaxis with LMWH and she underwent to prophylaxis with corticosteroids for fetal lung maturity. At 35 weeks of gestation the patient developed an HELLP syndrome (blood pressure elevation, right upper quadrant pain; platelets 72000/ml, AST 469, ALT 262, LDH 1636 U.I./l), so emergency delivery by caesarean section was performed. Results: A newborn with a birth weight of 1500g was delivered and recovered to NICU; he had an Apgar score of 8/9 and was discharged by NICU after twenty days of recovery. Platelets and liver enzyme normalized and the patient was discharged four days after c-section. Conclusions: Prothrombin 20210A mutation is associated with IUGR, low birth weight, late fetal loss early onset of severe preeclampsia. The relation between the PT mutation and HELLP syndrome is controversial. The patient came to our attention for isolated IUGR with no other sign of preeclampsia; this clinical condition persisted and only in late pregnancy the patient developed an HELLP syndrome. IUGR is a condition that has to be strictly monitored because it can underlie severe forms of preeclampsia especially in patients with other risk factors as thrombophilia.