SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.

No abstract

Electronic poster abstractspediatric and surgical care of the newborn the aim of this study was to describe the outcome of patients prenatally diagnosed with congenital kidney and urinary tract anomalies. Methods: A prospective observational study included a sample of 19 cases prenatally diagnosed with CAKUT in a one-year period. This study took place in the Maternity and Neonatology Center of Tunis. Results: The average age of pregnant women was 31 years old and 48% of them were multiparous. Kidney and urinary tract anomalies were diagnosed in the second trimester ultrasound in 65% of the cases. Termination of pregnancy was proposed in 7 cases of kidney and urinary tract anomalies associated with oligohydroamnios: bilateral renal agenesis, multicystic dysplastic kidney, hydronephrosis and megacystis. The clinical course of 12 patients prenatally diagnosed with CAKUT was heterogeneous. The diagnosis was confirmed in 7 cases. Urinary tract infection occurred in one case of non-obstructive megaureter. Surgery was performed in one case of pelviureteric junction obstruction with a favourable outcome. Conclusions: Prenatal diagnosis of kidney and urinary tract anomalies allows a better management of this fetal abnormality and an appropriate counselling for the mothers to be. The prognosis depends on whether these anomalies were associated with other anomalies or chromosomal aneuploidy or not and oligohydramnios. EP24.16Profile of fetuses diagnosed with gastroschisis in a reference fetal medicine centre in the South of Brazil

Virtual poster abstractsneonatal centre in Tunis Ultrasounds: T1 and T2 were without abnormalities and related to the corresponding terms. The patient was admitted to our department on 01/21/2008, i.e. on a term of 37 weeks + 1 day for premature rupture of the membrane for more than 12 hours. On examination: BDC positive, TV: cervix dilated to 4cm full seat high, sac of ruptured waters with clear amniotic fluid. Ultrasound: complete breech presentation, deflected head, BIP: 96, bones of both femurs appear Discontinuous. Caesarean birth of a newborn male PN 3100g, in apparent death Apgar 02/02 and cardiopulmonary failure. Failed resuscitation and neonatal death at H1 of life. Examination of the newborn finds a large fontanel and deformed limbs. On the x-ray: the bones of the upper and lower limbs were curved and site of fractures, as well as the presence of fractures at the level of certain ribs.The disease, in the vast majority of cases, is of dominant transmission. There is relative intra-family homogeneity; which means that all people with the family have a form of the same severity. Osteogenesis imperfecta falls within a broad framework of very different aspects in severity. The recent pathophysiological bases, the modes of transmission currently accepted and the classification of any disease observed in parents or children already born, are all elements which should henceforth intervene in the indication and carrying out of the prenatal diagnosis of the disease. VP10.21Congenital kyphosis associated with lumbosacral myelomeningocele

Introdução: a histiocitose engloba um grupo raro de distúrbios proliferativos caracterizados pelo acúmulo e infiltração de monócitos, macrófagos e células dendríticas. Objetivo: relatar uma paciente com histiocitose de células de Langerhans, chamando atenção para os seus achados clínicos e laboratoriais. Material e métodos: realizou-se a descrição do caso junto com uma revisão da literatura. A obtenção dos achados clínicos e resultados de exames complementares foi feita através de revisão do prontuário da paciente. Na revisão da literatura, foram utilizados descritores Mesh, junto à base de dados PubMed/MEDLINE. Foram incluídos apenas trabalhos em português/inglês, publicados após 2007. O tempo de duração para a montagem do relato foi de cerca de 1 mês. Resultados: a paciente era a filha única de um casal sem história de casos semelhantes na família. Aos 20 dias de vida, ela foi hospitalizada por edema facial e exoftalmia. No seu exame físico, observavam-se macrocrania, afastamento das suturas cranianas e dismorfias de face secundárias à infiltração de tecidos moles. Os seus exames laboratoriais mostravam anemia e neutropenia. A tomografia computadorizada do crânio revelou reação periosteal, tipo raios de sol, comprometendo os côndilos mandibulares, asas do esfenoide, maxilas e porções escamosas dos ossos temporais. A ressonância magnética de encéfalo revelou formações expansivas bilaterais e simétricas, que comprometiam os ossos da base do crânio, especialmente as escamas temporais, as asas esfenoidais, as paredes laterais das órbitas, as estruturas maxilares e os ramos da mandíbula, as quais apresentavam aspecto tumescente, com realce irregular ao contraste. A avaliação oftalmológica diagnosticou proptose ocular e lagoftalmo. As radiografias de corpo inteiro evidenciaram expansão difusa das vértebras, com importante alargamento da superfície da metáfise dos ossos longos. Os achados foram compatíveis com hiperproliferação osteoblástica e/ou lesão infiltrativa. Na imunofluorescência foram encontradas células monocíticas com fenótipo aberrante, e no mielograma, displasia e hiperplasia relativa eritroide, além de monocitose. Conclusão: a histiocitose de células de Langerhans é uma condição típica da infância, cuja causa exata ainda não é conhecida. A sua apresentação clínica pode variar muito, indo desde casos leves a fatais. Esta depende dos órgãos e sistemas envolvidos.