Electronic poster abstracts previa in a dichorionic twin gestation with two early separated placental masses. After delivery, macroscopic examination of the placentas confirmed this event of separate placentas without the evidence of presence of velamentous cord insertion or succenturiate lobe until fluorescent in situ hybridisation (FISH) was used to clarify the findings. An accessory lobe from the placenta of Twin A was completely fused into the placenta of Twin B.Supporting information can be found in the online version of this abstract EP20.14 Natural history of a monochorionic triamniotic triplet pregnancy complicated with TRAP sequence: prenatal ultrasonographic and postnatal placental findings -''a pump, an indirect pump and an acardiac triplets' destiny'' K. LeeObstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Republic of Korea A monochorionic triplet pregnancy with TRAP sequence is an extremely rare event, accounting for approximately 1 in 4.5 million pregnancies. Here we report a prenatally diagnosed case of TRAP sequence in a monochorionic-triamniotic triplet pregnancy without intervention. Caesarean delivery was performed at 34+1 weeks of gestation: a 1,300 g pump triplet complicated with ventricular septal defect, a 1,600 g healthy indirect pump triplet and a 2,200 g acardiac triplet complicated with multiple anomalies, including craniofacial malformations, scoliosis, limbs' defects, omphalocele. Postnatal detailed examinations of the placenta and three-dimensional CT findings of the acardiac triplet were consistent with the prenatal ultrasonographic findings. In some cases of monochorionic pregnancy with Twin-twin transfusions, there are observed some unexpected differences in the chronology of US changes, which complicate the prediction of development and outcome. The recent modified TTTS and TAPS classifications offer to evaluate the cardiovascular twin's systems in addition to the standard classification parameters of R. Quintero.We present the case of atypical Twin-twin transfusion in 36 years old patient with monochorionic twin, P6. It was a TAPS type of Twin-twin transfusions, however with additional symptoms of twin's significant polyhydramnion and oligohydramnion. At 27-28 GW the next US features were found: 20% discordance of the calculated fetal weight, twin's polyhydramnion and oligohydramnion with the deepest pockets of 120 mm and 30 mm respectively. The donor's bladder was visualised during the entire period of observation. There were critical cardiovascular disorders of the recipient: hypertrophy of the myocardium, reduction of the ejection fraction to 25%, pulsation of the umbilical vein and ductus venosus reversed flow. The donor had an absent end-diastolic UA blood flow. The discordance of the MCA PSV of twins was of 20 cm/s and 76 cm/s. The recipient's liver resembled the image of "starry sky" due to polycythemia. CS was performed due to cardiovascular disorders of the recipient fetus. At birth, there was a significant polyhydramnion. Donor's and recipient...
Objectives:The embryology and pathophysiology of nuchal translucency (NT) are still not entirely known. Current guidelines recommend measuring NT in fetuses with a Crown-rump length (CRL) of 45-84 mm. The aim of this study was to assess the significance and the evolution of enlarged NT if detected before the CRL of 45 mm. Methods: Retrospective observational study. Information about NT measurements performed at our centre in 2005-2016 was retrieved from the database. We searched for cases of singleton pregnancies with viable fetuses and with NT above the 95th centile observed before the CRL of 45 mm, and for which a second NT measurement was performed in the recommended CRL of 45-84 mm. The information about a fetal karyotype, a result of first-trimester combined test, ultrasound scan at 20 weeks and pregnancy outcome was recorded. Results: In total, 44067 women had the NT scans during the period. Of these, 17 cases with paired measurements were eligible for the analysis. The average CRL of the first NT measurement was 38 mm (range 31-44 mm), the average of the second measurement was 57 mm (range 45-73 mm). In 8 (47%) fetuses the NT measurement was found to be below the 95th centile at the second measurement. The risks from combined test were low (range 1/440-1/25000), CVS was performed in one case with normal karyotype and in all these cases ultrasound scans at 20 weeks were normal and healthy neonate were born. However, NT remained enlarged at the second measurement in 9 (53%) cases. Of these, an abnormal karyotype was found in 4 (44%) cases, one (12%) fetus had a complex cardiac anomaly, and in 4 (44%) cases the karyotype was normal and a healthy neonate was born. Conclusions:The results of our study suggest that the significance of enlarged NT detected before the CRL of 45 mm is questionable. The second evaluation with the recommended CRL of 45-84 mm is warranted and the NT thickness falls below the 95th centile in 47% of cases. If the enlargement disappears and the risk from combined test is low, the pregnancy outcome is excellent. EP24.02 Association of embryonic bradycardia with gestational outcomes using first trimester transvaginal ultrasound (TVS)A.J. Sigue, P. Maquiran Obstetrics and Gynecology, Cardinal Santos Medical Centre, San Juan, Metro Manila, PhilippinesObjectives: To know the association of embryonic bradycardia, mean sac diameter (MSD), Crown-rump length (CRL), yolk sac (YS) diameter, subchorionic hemorrhage and maternal factors with gestational outcome. Methods: A retrospective cross-sectional, observational analytical and correlational study among 215 patients who had TVS on the 1st trimester. Maternal factors include age, obstetric score, signs and symptoms of threatened miscarriage. Ultrasound parameters include MSD, YS diameter, CRL, cardiac rate, and presence or absence of subchorionic hemorrhage. Results of initial and follow-up TVS after 1-2 weeks were studied. Results: Among the 215 embryos with bradycardia, 185 (86%) were alive on follow-up scan. For embryos which survived, mean ca...
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