16th World Congress on Ultrasound in Obstetrics and Gynecology
and early second trimester were not suggestive of the seriousness
of the lesion, which was progressive and manifested in later second
trimester.
P03.11
Fetal hydrocephalus prenatal diagnosis and postnatal
management
J. L. Hernandez, X. Santamaria, A. Cordon, C. Rueda,
M. Folch, M. Prat, M. Lopez-Yarto, R. Rubio, R. Carreras
Hospital del Mar, Spain
Advances in realtime ultrasound imaging and a greater availability
of high-quality ultrasound equipment have resulted in an increased
number of congenital abnormalities being diagnosed prenatally
in the last 10 years. Among them central nervious system
disorders outstand for their importance. Severe Ventriculomegaly
or Hydrocephalus is a severe pathology of the central nervious
system, whose neonatal development has decreased significantly
due to ecographic prenatal diagnosis. It is defined as an increase
in the atrial diameter higher than 15 mm and it is linked to an
abnormal cerebrospinalfluid circulation. We described the case of
a women in her first pregnancy whose fetus was diagnosed in
week 18 of gestation of a big ventricular enlargement. Careful
prenatal evaluation was made including a detailed anatomic survey
and genetic amniocentesis. The cariotype study excluded any
abnormality and a concomitant pathology of the central nervious
system or fetal infection was also discarded. The mother was
properly advised but decided for personal reasons to continue
gestation. In the follow-up, the horn of lateral ventricles reached
a size of 40 mm with an obvious compression but conservation
of the cerebral parenquima, however other pathological findings
such as dilatation of the subarachnoid cistern were excluded. We
show the evolution and the case management with prenatal 2
and 3D Ecographies. We include prenatal and postnatal Magnetic
Resonance imaging, postnatal Ecographies and pediatric follow-up
of the newborn. We also have included an extense review of the
diagnosis, management, prognosis and possible treatments which
has been described in recent literature.
P03.12
Large fetal encephalocele prenatal diagnosis and neonatal
management
A. Reitter, S. Dittrich, V. Boda, M. Kieslich, R. Schlosser,
F. Louwen
University Hospital of Frankfurt, Department of Obstetrics
and Gynecology, Germany
Encephalocele belong to neural tube defects, diagnosis is usually in
early pregnancy. They are often part of complex brain anomalies.
Diagnosis in early pregnancy is usually followed by termination of
pregnancy. There are only few casereports from encephalocele in
term pregnancies. Mortality rates up to 30100% are descriped.
Two cases with late diagnosis are presented.
Case 1: 24 year old obese (102 kg, 164 cm) 2G 0P referred at
40 + 6 weeks of gestation with suspected fetal cerebral anomaly.
Sonographic finding large occipital encephalocele (57.3 47.4
55.3 mm). She had regular antenatal visits and scans. Delivery by
Cesarean section. Postpartum period was difficult due to adequate
covering. A cranioplastic was successfully done with five month of
age. Genetic testing was normal. Development of hydrocephalus and
paraplegia, but the child communicates adequately.
Case 2: 36 year old 3G 1 P referred for second opinion at
34 + 1 weeks of gestation with fetal hydrocephalus. Past obstetric
history fetal death due to hydrocephalus. No genetic testing.
A prenatal MRI confirmed the hydrocephalus. On ultrasound
examination no midline was identified, only in the occipital region
rest brainlike structure. Frontal midline defect, suspected frontal
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Poster abstracts
encephalocele and/or nasopharyngealtumor. Delivery by Cesarean
section. Postpartum diagnosis of a large frontal encephalocele and
a complex brain anomaly. The herniated tissue was excised and the
defect was covered. Postnatal development of paraplegia. Genetic
testing normal. Beside some mental retardation contact to the parents
is possible.
The prognosis of fetale encepehalocele is better than descriped
in literature. These two cases will help to counsel parents with
suspected fetal encephalocele especially if they wish to continue
with the pregnancy. In cases of complex fetal brain anomalies
a multidiciplinary approach and an individual treatment plan is
necessary.
P03.13
Intrauterine diagnosis of diastematomyelia: 2 case reports
Y. Baytur, B. Cetinkaya, H. Caglar, Y. Uyar
Celal Bayar University, Turkey
The aim is to present 2 intrauterine diagnosed diastematomyelia
cases.
Case 1: Ultrasonography performed at the 17th week of pregnancy
revealed diastematomyelia in the lower thoracic vertebrae. The case
was suggested to be evaluated by intrauterine MRI at the 3rd
trimester of the pregnancy and taken to an operation in the first
week following the delivery. MRI performed at the 32nd week of the
pregnancy showed diastematomyelia at thoracolumbar junction and
a low conus. The case was handed over to the surgery department
after the delivery.
Case 2: The pregnant woman having Type I diabetes mellitus was
examined at the 29th week of the pregnancy. Ultrasonography
revealed a defect at 23 lumbar vertebra level and the case was
diagnosed with diastematomyelia. The patient was suggested to
undergo an MRI evaluation. She was hospitalized for the regulation
of her diabetes mellitus; however, upon her request, she was
discharged without full regulation. MRI was not performed due
to lack of her approval. The case was handed over to the surgery
department after the delivery.
This rarely seen abnormality can be diagnosed with ultrasonography
during the early weeks of the pregnancy. It is characterized with a
sagitalle cleft at the isolated diastematomyelia, spinal cord, conus
medullaris and filum terminale. Early surgical intervention may yield
good outcomes at those diagnosed with diastematomyelia.
P03.14
Fetal hydrocephalus in a pregnancy complicated by idiopathic
thrombocytopenic purpura
M. W. Kim, H. M. Choi
Inje University Ilsan Paik Hospital, Republic of Korea
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune
disorder in which the platelets of patient are destroyed by
autoantibody. It commonly affects young women and the
obstetricians frequently come across the disordered patients. But,
the incidence of intracranial hemorrhage in the neonates born
to the mother with ITP has been reported to be less than 1%.
Moreover, intrauterine intracranial hemorrhage regardless of the
mechanical stress at delivery seems to be very rare. We report a
pregnancy complicated by ITP, in which intrauterine intracranial
hemorrhage diagnosed prenatally in third trimester. A 34-year-
old woman, gravida 3, para 1, was referred at the gestational
age of 33 weeks. She was diagnosed to have ITP in 1999.
Her laboratory data showed a platelet count of 2 109 /L with
normal coagulation status. On targeted ultrasonography, there was
intracerebral hypoechogenic lesion adjacent to the lateral ventricle
suggesting intracerebral hemorrhage. On follow up examination
at 37+2 weeks of gestational age, fetal hydrocephalus was newly
developed. After immunoglobulin therapy and transfusion of 12
Ultrasound in Obstetrics & Gynecology 2006; 28: 512614
37 September 2006, London, UK
units of platelet concentrate, the pregnancy was terminated by
Cesarean section. Laboratory data of the baby showed a platelet
count of 1 109 /L with prolonged prothrombin time. Immunologic
examination was negative for anti-platelet antibody and platelet-
associated immunoglobulin G. The hydrocephalus was confirmed
by brain ultrasonography and computed tomography.
P03.15
Prenatal diagnosis of hydranencephaly using 2D and 3D
ultrasound
S. J. Kim, G. S. R. Lee, I. Y. Park, J. C. Shin, H. Y. Ahn,
S. P. Kim, I. Y. Park, H. Y. Ahn, M. J. Kim
Holy Family Hospital Catholic University, Republic of Korea
Hydranencephaly is a severe brain condition characterized by
complete or almost complete absence of cerebral cortex with
preservation of meninges, basal ganglia, pons, falx. Despite the
absence of the cerebral hemispheres, The thalami and lower
brain centers are typically preserved. This condition is usually
preceded by occlusion of the internal carotid arteries, infectious
alterations (cytomegalovirus, toxoplasmosis) resulting in massive
brain infarction. An 29-year-old woman, gravida 1, presented
with fetal death at 18 weeks gestation. Initial 2D and 3D
ultrasound revealed sloping forehead and abnormal intracerebral
architecture which normal cerebral hemispheres could not be
identified. Chromosomal study showed normal karyotyping. We
report a case of hydranencephaly confirmed by autopsy, which was
initially detected by 2D and 3 D ultrasonography at 18 weeks of
gestation.
P03.16
Antenatal diagnosis from six cases of ventriculomegaly
S. Marta, A. S. Cerdeira, H. Ferreira, R. Z. Macedo,
A. Ferreira
Hospital Geral de Santo Antonio, Portugal
Ventriculomegaly is a central nervous system disorder defined
as dilation of lateral ventricles, measuring 10 mm or more on
ultrasound (US). This condition may result from chromosomal
disorders, genetic syndromes, congenital infections, vascular and
central nervous system anomalies. Research into its cause is
clinically important since prognosis is mainly dependent on
etiology and associated anomalies. Therefore, pre-natal detection of
ventriculomegaly entails exhaustive fetal ultrasonography, cerebral
magnetic resonance imaging (MRI), cerebral Doppler, karyotyping,
and unravelling fetal infection. The authors present six clinical cases
from Prenatal Diagnostic Center of Santo Antonio Hospital-Porto.
These different fetal pathologies were diagnosed on clinical study
following detection of ventriculomegaly, 1st case: 17 weeks fetus
US: single dilated midline ventricle; karyotype: 46XY; MRI: alobar
holoprosencephaly, confirmed by anatomopathology examination
(AE). 2nd case: 21 weeks fetus US: ventriculomegaly, hydramnios;
karyotype: 47XX+18 confirmed by EA. 3rd case: 22 weeks fetus
US: midline cyst with turbulent flow on Doppler; MRI: aneurysm
of the vein of Galen. 4th case: 21 weeks fetus US: ventriculomegaly,
lemon and banana signs, myelomeningocele, karyotipe: 46 XX;
EA confirmed Arnold Chiari syndrome type II. 5th case: 34 weeks
fetus US: dilatation of posterior fossa; MRI: interhemispheric cyst
and agenesis of the corpus callosum. 6th case: 33 weeks fetus
US: severe ventriculomegaly, hyperechoic images; MRI: intracranial
hemorrhage. Termination of pregnancy was performed in the first
four cases. In three cases (trissomy 18, aneurysm of the vein of Galen
and Arnold Chiari syndrome), ventriculomegaly was associated with
other ultrasonographic anomalies. The development of imaging
techniques improved diagnostic accuracy, facilitating important
clinical diagnosis and management in ventriculomegaly.
Ultrasound in Obstetrics & Gynecology 2006; 28: 512614
Poster abstracts
P03.17
Prenatal diagnosis of schizencephalia a case report
A. S. Cerdeira, S. Marta, H. B. Ferreira, C. Dias, L. Ferreira,
R. Z. Macedo
Hospital Geral de Santo Antonio, Portugal
Schizencephaly is a neuronal migration disorder, resulting in clefts
that extend from the ventricle to the cortical surface of the cerebral
parenchyma. Depending on fusion of cleft lips this disorder is
classified as type I, closed type and type II, open type. Usually
this disorder is initially suspected on fetal ultrasonogram (US) by
focal ventricular dilatation associated with cerebral parenchyma
abnormalities. However magnetic resonance imaging (MRI) is the
most sensitive imaging method to establish diagnosis.
Notwithstanding being related to multiple genetic and acquired
factors such as vascular, infectious, toxic and metabolic, the
precise ethiology of schizencephaly remains unknown. There are
multiple associated intracranial malformations including absent
septum pellucidum, polimicrogyria, gray matter heterotopias,
agenesis of the corpus callosum and optic nerve hypoplasia. These,
in association with localization and amount of brain involved,
condition a variable prognosis. Patients can die at early age or
live until adulthood, however motor abnormalities, development
delay, microcephaly, mental retardation or epilepsy are almost
invariable. One case of antenatal open schizencephaly diagnosed
at Santo Antonio Hospital, is reported. A 34-year-old woman, G2
P1 was referred to our institution at 22 weeks gestation according
to last menstrual period and fetus ultrasonometry. She was a healthy
woman with normal first-trimester routine lab tests, not on any
medication besides vitamin and ferrum supplements. Routine US
performed at 13 week was negative for any findings characteristic
of the disease. Ultrassonography at 22 weeks gestation revealed
a ventricular dilatation with a hiperecoic image surrounding the
ventricle. Amniocentesis revealed 46,XY fetal karyotype. Prenatal
MRI allowed diagnosis of type II unilateral schizencephaly. Medical
termination of pregnancy was performed according to parents
request, approved by the ethics committee.
P04: FETAL HEART
P04.01
Evaluation of anatomy and function of cardiovascular system
in fetuses at 11.0 to 13.6 weeks of gestation
J. Dangel, A. Hamela-Olkowska, K. Jalinik
2nd Department of Obstetrics and Gynecology, Warsaw,
Poland
Objective: To evaluate anatomy and function of cardio-
vascular system in fetuses at 11.0 to 13.6 weeks gesta-
tion.
Methods: Results of ultrasound examination of 215 singleton
fetuses at 11.0 to 13.6 weeks gestation were analyzed. Exams
were performed using Sequoia 512, with transabdominal 6C2
probe. 43 (20%) women were over 35 years old, 101 (47%)
were from high risk group (positive family history of congenital
heart defects, diabetes mellitus and other). The exams comply
with the policy of the ISUOG Journal Ultrasound in Obstetrics
& Gynecology.
Results: Anatomy of both ventricles was successfully seen in 180
(84%) cases and outflow tracks in 161 (75%) cases. In 9 cases
heart defects were diagnosed: ectopia cordis 3, VSD 2, complete
heart block with left isomerism 2, hypoplastic RV 1, DORV 1,
pulmonary atresia with VSD 1; 5 of them had increased NT.
1 fetus had premature atrial contractions. 2 fetuses had NIHF
with hygroma colli, one of them had Turner syndrome. 10 fetuses
had reversed A-wave in DV: 8 with heart defect, 1 with NIHF
and 1 with normal heart anatomy (NHA) and trisomy 21. TI
was observed in 6 fetuses: 2 with CHD, 2 with NHA and 2
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