Oct 7, 2007 - Fetal Medicine Unit, St George's Hospital, United Kingdom. Objectives: To ... In 46 (35.7%) cases short FL was associated with other structural abnormalities. ... gallbladder abnormalities detected on antenatal sonography. Methods: ... and parents' decisions are dependent on a complete diagnosis. OC106.
7–11 October 2007, Florence, Italy
OC103 Outcome of antenatally diagnosed short femur N. Fratelli, K. Leslie, A. Bhide, B. Thilaganathan, A. T. Papageorghiou Fetal Medicine Unit, St George’s Hospital, United Kingdom Objectives: To examine the outcome of fetuses with short femur length (FL) at the time of the routine anomaly scan. Methods: This was a retrospective review of antenatal, pediatric and genetics records of pregnancies where ultrasound measurement of FL at 18–24 weeks of gestation was found to be below the 5th centile. All pregnancies had an ultrasound at 11–13 + 6 weeks to confirm pregnancy dating and also had nuchal translucency (NT) risk assessment. Results: There were 129 fetuses over a 6-year period. In 46 (35.7%) cases short FL was associated with other structural abnormalities. In this group skeletal dysplasias (n = 16), chromosomal abnormalities (n = 10) and genetic syndromes (n = 4) were the most common associations. Short FL was classified as isolated in the remaining 83 (64.3%) cases. There were no cases of chromosomal abnormalities in this group. Eleven (13%) were false positives with FL at subsequent scans within the normal range; all of these had a normal outcome. In the remaining 72 (87%) FL measurements were consistently below the fifth centile. Early severe fetal growth restriction (FGR) with abnormal umbilical artery Doppler requiring delivery before 37 weeks of gestation occurred in 33/83 (40%); 90% of these had abnormal uterine artery Doppler at the time of presentation. This cohort was complicated by pre-eclampsia in 12/33 (36%) cases, intauterine fetal death in 11/33 (30%), while a further two suffered a neonatal death. In 39/83 cases umbilical artery Doppler remained normal; five of these patients delivered before 37 weeks owing to pre-eclampsia or placental abruption (n = 3) or spontaneous preterm labour (n = 2), while in 34 delivery occurred after 37 weeks of gestation. Conclusions: In a population previously screened by NT, isolated short FL at the time of the routine anomaly scan is not associated with chromosomal abnormalities. Severe FGR associated with high mortality occurs in 40%, making uterine artery Doppler evaluation more useful than amniocentesis in these pregnancies.
OC104 Isolated gallbladder abnormality in utero: clinical significance as a screen for fetal anomaly M. H. Moon1 , J. Y. Cho2 , Y. H. Lee1 , M. J. Song1 , M. S. Lee1 , H. J. Cho1 1 Cheil General Hospital and Womens Healthcare Center, Kwandong University College of Medicine, Republic of Korea, 2 Seoul National University College of Medicine, and the Institute of Radiation Medicine, Republic of Korea
Objectives: To evaluate the clinical significance of isolated gallbladder abnormalities detected on antenatal sonography. Methods: We prospectively evaluated the fetal gallbladder in 2170 low-risk pregnant women from February 2005 to April 2006. Our institutional review board approved the study, and verbal informed consent was obtained from each woman. The fetal gallbladder was evaluated for the presence, size, location and shape. When the fetus had a gallbladder abnormality as an isolated finding on antenatal sonography, postnatal outcomes were determined from obstetric and neonatal records. Results: The gallbladder was not seen in 584 fetuses (26.9%) throughout gestation and in 5.7% (80/1396), even at 16 and 34 weeks’ gestation when the gallbladder was most frequently seen. Cholecystomegaly, defined as above 95% in length or width, was seen in 85 of 1442 fetuses (5.9%). The shape of the fetal gallbladder was abnormal in 5.4% (78/1442), and the location abnormal in 0.8% (12/1586). Most of the fetuses with a gallbladder abnormality as an isolated finding were normal in neonatal outcome.
Ultrasound in Obstetrics & Gynecology 2007; 30: 367–455
Oral communication abstracts
Furthermore, the detected abnormalities on postnatal evaluations deemed to be minor problems irrelevant to a biliary tract abnormality or chromosomal aneuploidy. Conclusions: Isolated gallbladder abnormality detected on antenatal sonography has little clinical significance as a screen for fetal anomaly.
OC105 Congenital heart defects and associated extracardiac anomalies in a non-selected population of 42 381 fetuses E. Tegnander, S. H. Eik-Nes National Center for Fetal Medicine, Norwegian University of Science and Technology, Trondheim, Norway Objectives: To evaluate the incidence and impact of extracardiac anomalies in fetuses with major or minor congenital heart defects (CHDs) in a non-selected population. Methods: From 1986 to 2001, all pregnant women who delivered at our hospital were registered prospectively. The classification of CHDs was done retrospectively either by postnatal echocardiogram or autopsy, with further classification into isolated CHDs, CHDs with abnormal karyotype or CHDs with associated anomalies but normal karyotype. The children were followed for a minimum of 2 years and a maximum of 13 years. Results: Of the 139 major CHDs, 32% had an abnormal karyotype and 17% associated anomalies. Trisomy 21 (20/45) and trisomy 18 (13/45) were the most common abnormal karyotypes, while common CHDs such as AVSD, TOF, HLHS and TGA had 77%, 29%, 9% and 5% associated anomalies, respectively, with situs inversus and syndromes as the most common. Significant differences in survival after 2 years were found between children with isolated CHDs and those with abnormal karyotype (P < 0.001) and isolated CHDs and associated malformations (P = 0.005). Of the 443 minor CHDs, 7% had an abnormal karyotype and 10% associated anomalies. Trisomy 21 (17/33) and trisomy 18 (10/33) were the most common abnormal karyotypes, while common CHDs such as perimembranous and muscular VSDs and secundum ASDs had 20%, 1% and 14% association, respectively. Syndromes, serious CNS malformations and foot deformities were the most commonly associated anomalies. Significant differences in survival after 2 years were found between children with isolated CHDs and those with abnormal karyotype, and isolated CHDs and associated malformations (P < 0.001). Conclusions: When a major CHD is diagnosed there is a 50% chance of extracardiac anomalies. When an extracardiac anomaly is found there is a 35% chance of reaching the age of 2 years. The counseling and parents’ decisions are dependent on a complete diagnosis.
OC106 The clinical significance of isolated muscular ventricular septal defect (VSD) M. O. Bahtiyar1 , B. Stevens1 , B. Weeks2 , A. Friedman2 , J. A. Copel1 1 Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT, United States, 2 Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
Objectives: Congenital heart defects affect 0.5%–1% of all pregnancies. Isolated VSDs, in all parts of the septum, are the most common cardiac defects, accounting for nearly 30% of all pediatric cardiac defects. However, those that are in the muscular septum may be less easily appreciated prenatally. Counseling patients with isolated VSD is an important clinical challenge, because more small muscular VSDs are now being diagnosed with high-resolution ultrasound equipment. The incidence of these lesions is not yet
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17th World Congress on Ultrasound in Obstetrics and Gynecology
Oral communication abstracts
described and the frequency with which muscular VSDs resolve in utero has also not been extensively reported. Methods: We investigated the perinatal course of isolated muscular VSDs diagnosed and followed between 1 January 2005 and 31 December 2006. Results: We performed a total of 2583 fetal echocardiograms on 2410 fetuses during 2328 pregnanies. The study group included 78 twin gestations (3.4%) and seven triplet gestations (0.3%). There were 16 diagnoses of isolated muscular VSD (6.6/1000). Mean ± SD gestational age at diagnosis was 24.5 ± 4.9 weeks. Two of the isolated muscular VSDs (12.5%) spontaneously resolved prenatally. One fetus had trisomy 21. Conclusions: Isolated VSD is a common congenital heart defect. Resolution of prenatally diagnosed isolated muscular VSDs is less frequent than reported in the past. Trisomy 21 risk may be increased in isolated muscular VSDs even in the absence of other ultrasound markers. A larger cohort is needed to provide a better risk estimate for aneuploidy in the presence of an isolated VSD.
normal USG is a benign lesion and other investigations are not necessary. Prognosis of fetal isolated VSD is different from that diagnosed postnatally due to chromosomal aberrations and other organ anomalies. There are numerous extracardiac malformations in fetuses with isolated VSD.
OC107 Coexistence of extracardiac malformations and abnormal karyotype among fetuses with prenatally diagnosed isolated ventricular septal defect (VSD) P. Wlasienko1 , A. Kaplanska1 , J. Kuran1 , E. Sliwka2 , J. Papierz1 , A. Kraska1 , J. Dangel1 1
Medical University of Warsaw, Poland, 2 Center of Medical Postgraduate Education, Warsaw, Poland
Objectives: The aim of this study was to evaluate the prevalence of isolated VSD in fetuses. Type of VSD in relation to chromosomal aberrations, other fetal abnormalities and perinatal follow-up was assessed. Methods: This was a retrospective analysis of the computer database of the reference Perinatal Cardiology Centre between 2004 and 2006. Of 295 fetuses with CHD, 75 (25%) had an isolated VSD. Median gestational age at diagnosis was 27 weeks; in 29 VSD was diagnosed before 24 weeks. Forty women were from low- and 35 from high-risk groups. Ten (25%) in the low-risk group and eight (23%) in the high-risk group had an abnormal karyotype. Results: There were 27 (36%) perimembranous, 27 muscular (36%), 17 (22%) inlet, two (3%) multiVSD and one (1%) subaortic defects. Some 34 (45%) fetuses were karyotyped. The karotype was normal in 16, 11 had Edward syndrome, six had Down syndrome and one had 46,XX,del5p15.1. Of 17 fetuses with trisomies, 11 (65%) had large-inlet VSD and six (35%) perimembranous VSD. Ten (91%) with Edward syndrome had large-inlet VSD and five (83%) with Down syndrome had perimembranous VSD. The fetus with del5p had perimembranous and multiVSD. Extracardiac malformations were as follows:
OC108 Ventricular performance in the fetus with hypoplastic left heart syndrome A. Szwast, Z. Tian, M. McCann, D. D. Donaghue, J. Rychik The Fetal Heart Program at The Children’s Hospital of Philadelphia, United States Objectives: In the fetus with hypoplastic left heart syndrome (HLHS), the right ventricle (RV) alone performs the task of perfusion to the body and placenta. Our understanding of the physiology of the single right ventricle prior to birth is limited. We used Doppler-derived measures to investigate the differences in ventricular performance between the fetus with HLHS and normal fetuses. Methods: Measures of (1) myocardial performance index (MPI) of Tei, (2) ejection force (Ef) as described by Isaaz, and (3) cardiac output (CO) were analyzed in 44 fetuses with HLHS and 76 age-matched normal controls. There was no left ventricle (LV) ejection of significance, no tricuspid regurgitation of significance, and no evidence of hydrops in the fetuses with HLHS. RV systolic performance appeared qualitatively normal in all. Results: RV-MPI and RV-Ef was greater, but CO was significantly lower in the fetuses with HLHS than in the normal fetuses.
GA (weeks) Fetal weight (kg) RV-MPI LV-MPI RV-Ef (mNewtons) LV-Ef (mNewtons) RV-CO or combined CO (mL/min/kg)
HLHS (n = 44)
Normal (n = 76)
P
26.7 ± 5.1 0.89 (0.28–3.17) 0.47 ± 0.09 – 9.39 (1.56–84.9) – 385 ± 84
25.9 ± 5.2 0.82 (0.20–3.84) 0.43 ± 0.05 0.40 ± 0.05 6.62 (0.97–28.5) 5.82 (0.73–24.2) 477 ± 79
0.38 0.61 0.005 – < 0.001 – < 0.001
Conclusions: The fetal RV in HLHS generates greater force than the normal RV as it must support the entire circulation; however ventricular performance is impaired as the RV-MPI is elevated. Despite the increased ejection force, overall CO and perfusion in the fetus with HLHS is diminished in comparison to normal. Increased cardiac work, but relatively decreased perfusion, may possibly explain the poor somatic growth seen during fetal life and may offer an explanation for the frequency of central nervous system abnormalities seen at birth in HLHS. Further investigation of the relationship between these cardiac parameters during fetal life and outcome is warranted.
Abnormal karyotype Type of additional defect CNS Facial Diaphragmatic hernia Gastrointestinal Urogenital tract Skeletal
47,XX/ XY +18
47,XX/ XY +21
9 2 0 4 3 2
1 0 0 1 2 0
46,XX del Normal Unidentified 5p15.1 karyotype karyotype 0 0 0 0 0 0
5 4 3 1 4 5
4 0 0 1 2 0
All fetuses with a normal karyotype, Down or Cri-du-chat syndrome were born alive. Two pregnancies were terminated, one with Edward syndrome and one with a muscular VSD and extracardiac malformations. Conclusions: Fetal inlet and perimembranous VSDs are strong markers of chromosomal abnormalities so are an indication for fetal karyotyping. Fetal muscular isolated VSD with otherwise
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OC109 Prominence of the coronary circulation in the fetus: a prognostic indicator of poor outcome? J. Rychik1 , M. Bebbington2 , M. McCann1 , A. Szwast1 , Z. Tian1 1 The Fetal Heart Program at The Children’s Hospital of Philadelphia, United States, 2 The Center for Fetal Diagnosis and Treatment at The Children’s Hospital of Philadelphia, United States
Objectives: Fetal echocardiography (FE) with color Doppler (CD) imaging allows detailed visualization of features of the developing heart. As the coronary arteries (CA) are normally very small, they are rarely easy to see. Conditions in which there is a mismatch between myocardial oxygen demand and coronary circulatory supply may
Ultrasound in Obstetrics & Gynecology 2007; 30: 367–455
