PF.76 Pregnancy Outcome and Management of Fetal Hypertrophic Cardiomyopathy: A Case Report and Literature Review

Abstract

Abstractsdue to polyhydramnios and preterm labour. Live female infants were born at 28+1/40 gestation, but died at 90 minutes of age. Case 2 (2006) 32 year old G2P1 presented with craniothoracopagus CT at 12+4 gestation, proceeding to emergency Classical CS due to preterm labour at 33 weeks. Liveborn female infants died at 30 minutes of age. Case 3 (2009) 31 year old G3P2 presented with parapagus CT at 11/40 gestation, proceeding to elective classical CS at 35 weeks out of state. Live male infants were successfully separated at 4 months of age in GOSH, London. Case 4 (2011) 33 year old G2P1 presented with thoracopagus CT at 13+4 gestation, proceeding to elective Classical CS at 34 weeks. Liveborn female infants died at 91 minutes of age.In the management of CT, we recommend frequent antenatal review including serial ultrasound, MRI and echocardiography, and multidisciplinary assessment, with neonatology, paediatric surgery, cardiology and bereavement care involved.Interestingly, all four case parents reside within 20 km of each other. The estimated incidence of CT in this population is 6.3 per 100000. The rate of stillbirths for this District General Hospital was 3.5 per 1000. Equal amounts were considered low risk, receiving MLC, to high risk. 56% had had at least one previous delivery with the mode being a parity of one. The ranges for maternal age and BMI were wide, with the mean 30 and 27 respectively. Majority of stillbirths occurred less than 37 weeks (58%), nearly a third below 28 weeks. Twin pregnancies accounted for 6% of the stillbirths. A Review of Ten95% of stillbirths were in the antenatal period, 4 of the 5 intrapartum stillbirths occurred after 39 weeks. A third of the stillbirths were found to be growth restricted. Karyotype analysis was accepted in 97% of cases and was found to be abnormal in 6%. 60% of patients declined post mortem examination adding pressure for answers to be found from the remaining investigations. Thrombophilia results were abnormal in 10% of cases while TORCH screen picked up only 2 infections. Of the 93 placentas sent for histology 89% showed an abnormality. Commonly occurring placental abnormalities included: Maternal vascular under perfusion syndrome, chorioamnionitis, reteroplacental haemorrhage and distal villous immaturity or hypoplasia. Conclusion Review of stillbirth data is essential to maintaining high standards in all maternity units. Investigations such as TORCH should be used selectively. Placental histology provides the most information for cause and planning in future pregnancies. We report an interesting case of a diabetic pregnancy with fetal hypertrophic cardiomyopathy. The diagnosis was made following an emergency caesarean delivery at 37 weeks for fetal distress and was associated with severe metabolic acidosis and poor apgar scores. We acquired some outcomes for 56 pregnancies. Outcomes were located for 42 fetuses. 7 pregnancies were terminated. Most (n = 31, 55.4%) babies were born vaginally unassisted. Most (n = 30, 73.2%) fetuses had no known none-ge...