Fetal pleural effusion, a nonspecific accumulation of fluid in the pleural space, is an uncommon anomaly which can be associated with aneuploidy and a range of other structural malformations or genetic syndromes. Spontaneous resolution is not rare and confers a good prognosis. Perinatal outcome is better for those fetuses without hydrops than those presenting with hydrops. A detailed review of the literature indicates that, for fetuses with persistent effusions, in utero intervention (repeated thoracocentesis, intrauterine shunting and pleurodesis) may improve the chances of survival.

An excess of structural anomalies is observed in twins compared to singletons. Approximately 1-2% of twin pregnancies may face the dilemma of expectant management versus selective termination following diagnosis of an anomaly affecting only one fetus. If the option of selective fetocide is considered, the main variable determining the technique to achieve this aim is chorionicity. In a dichorionic pregnancy, passage of substances from one twin into the circulation of the co-twin is unlikely due to the lack of placental anastomoses, hence KCl can be injected safely into the circulation of the affected twin to produce fetal asystole. In monochorionic twin pregnancies, selective termination needs to be performed by ensuring complete and permanent occlusion of both the arterial and venous flows in the umbilical cord of the affected twin, in order to avoid acute haemorrhage from the co-twin into the dying fetus, which may lead to death or organ damage. Bipolar cord coagulation under ultrasound guidance is associated with approximately 70-80% survival rates.

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Urinary electrolytes, urinary beta2-microglobulin and pre-shunt serum beta2-microglobulin, whether increased or normal, failed to be predictive of potential response to prenatal intervention. Serial samples of fetal blood may provide distinction between patients who do and do not respond to prenatal treatment of lower urinary tract obstruction.

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Poster abstracts monochorionic co-twin. Fetal neurosonography is a valuable tool for the prediction of the neurologic outcome in such cases. P12.04Laser coagulation of placental anastomoses in severe mid-trimester twin-to-twin transfusion syndrome and anterior placenta with a 30 • fetoscope A. Huber, K. Hecher Klinik für Geburtshilfe und Pränatalmedizin, GermanyObjective: to investigate perinatal outcome after endoscopic laser coagulation of the placental vascular anastomoses with the 30 • fetoscope in severe mid-trimester twin-to-twin transfusion syndrome (TTS) with anterior placenta. Methods: In a prospective study in 20 consecutive cases with severe mid-trimester TTS and extensive anterior placenta laser coagulation of placental anastomoses was performed by means of the new 30 • fetoscope. Results: The overall survival rate was 72.5% (29/40). In 65% of the pregnancies (13/20) two fetuses survived, in 80% (16/20) at least one fetus survived. The median gestational age at laser coagulation was 20.8 weeks, the median gestational age at delivery of liveborn babies 34.6 weeks with a median interval between the intervention and the delivery of liveborn babies of 14.1 weeks. The median duration of the fetoscopy was 30.5 minutes. Recipient twins had a median birth weight of 2245 g and donor twins of 1755 g. Conclusions:Even in technically challenging situations as extensive anterior placenta laser coagulation with the new 30 • fetoscope offers a treatment option in severe TTS with outcomes similar to the overall survival rates for laser coagulation in severe mid-trimester TTS with technically more favourable placental locations.