P22.05: Report of a prenatal diagnosis of Scimitar syndrome: a case report

19th World Congress on Ultrasound in Obstetrics and Gynecology

Poster abstracts

an uneventful spontaneous delivery of a female infant. After birth the neonate had slightly distended abdomen and yellowish watery diarrhoea without meconium passage. An infantogram after birth showed mild bowel gas distension without evidence of intestinal obstruction, small bowel series showed no small bowel transit time delay and diffuse gas distended colon without obstruction. She had hyponatremic metabolic alkalosis and hypochloridemia. The stool chloride concentration was high, 101 mmol/L (reference value < 90 mmol/L), confirming the diagnosis of CCD. She was discharged with sodium chloride for electrolyte correction.

and appropriate management. Not all patients have the typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be considered.

P22.09 Sonographic imaging of the fetal hard palate during 2nd trimester pregnancy scan: setting the standard for three-dimensional sonography G. Centini1 , L. Rosignoli1 , G. Tonni2 , A. Ventura2

Supporting information can be found in the online version of this abstract.

P22.07 Umbilical vein varix – successful fetal outcome by delivery at 34 weeks H. Samarage1 , R. Wimalasundera2 , A. Seale2 1

Obstetrics & Gynaecology, Northwick Park Hospital, Harrow, United Kingdom; 2 Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital, London, United Kingdom Case Report: We are reporting 2 cases of isolated umbilical vein varix diagnosed antenatally by ultrasound. Gestational ages of diagnosis were at 30 and 32 weeks. Targeted organ screenings to rule out other structural malformations were negative. The central venous system, including the hepatic vein, ductus venosus and inferior vena cava were normal. Fetal cardiac scanning was normal and ventricular function was assessed and was normal. Both patients delivered live-born infants at 34 weeks after antenatal steroids. No neonatal complications were noted. Post delivery neonatal scans confirmed umbilical scan varix in first 48 hours. Conclusion: incidental finding of umbilical vein varix has reported to have a different fetal outcome in the literature. Delivery at 34 weeks may avoid adverse neonatal outcome.

P22.08 Meconium peritonitis: prenatal diagnosis and postnatal outcome B. Kang Obstetrics and Gynecology, Chungnam National University Hospital, Daejeon, South Korea Objectives: Meconium peritonitis is a rare condition with high mortality in the neonatal period. Hence, it is important to detect meconium peritonitis during the fetal period. This study evaluated the prenatal ultrasound findings for diagnosing meconium peritonitis and predicting patient outcomes. Methods: The prenatal and postnatal medical records of all patients with confirmed meconium peritonitis in our institutions were reviewed, with emphasis on the prenatal ultrasound findings, results of postnatal investigations, operative findings, outcomes, and possible causes of meconium peritonitis. Results: Over an 8-year period, six neonates were confirmed as having meconium peritonitis at birth. Three cases were diagnosed correctly because the prenatal ultrasound showed ascites and calcified/dilated or hyperechoic bowel loops. In the other three cases, the prenatal ultrasound showed ascites only. Four patients underwent surgery during their first day of life. In five of the six cases, the intra-operative findings were ileal atresia and perforation; the intra-operative finding in the remaining case was malrotation of the small bowel, volvulus with strangulation, jejunal atresia, and perforation. All patients survived and prospered. Conclusion: Prenatal ultrasound allows babies with suspected meconium peritonitis to be transferred to a tertiary center for delivery

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AOUS, Prenatal Diagnosis Unit, Siena, Italy; 2 Prenatal Diagnostic Unit, Ospedali Riuniti Guastalla, Reggio Emilia, Italy

1

Cleft lip and cleft palate are among the more common congenital abnormalities representing the fourth most common birth defect in the United States with an incidence of 1 in 700 live births. The study of fetal secondary palate has reached new potentials due to new three-dimensional applications namely tomographic sonography imaging (TUI) and volume contrast imaging (VCI). The aim of the study is to release the three-dimensional sonographic setting for a systematic study of the fetal secondary palate during 2nd trimester pregnancy. We believe that sonographers can easily achieve appropriate training in 3D scanning of the fetal face under expert tutoring and furthermore we are also convinced that the sonographic study of the fetal secondary palate should become an integral part of the 2nd trimester scan. Technically, the axial and coronal sections are those that better displayed the 3D reconstruction especially when the fetus is facing the transducer (profile section). The use of static VCI may enhance the tomographic sonography imaging of the fetal secondary palate and should therefore be integrated in this target examination.

P22.10 Bladder exstrophy – pitfalls for a false diagnosis, case report A. M. Alves, P. Veca, G. Borges, C. Monteiro, L. Gra¸ca Ultrasound Unit of the Obstetrics, Gynaecology and Reproduction Medicine Department and Unit of Pediatric Surgery, Hospital de Santa Maria, Lisbon, Portugal A 30 year-old secondigravida was referred to our unit at 24 weeks of gestation because of an ambiguous genitalia. The pregnancy occurred after failure of oral contraception (etinilestradiol + clomiphen acetate). The US examination of the fetus was difficult because of the breech presentation and little motility, but we could confirm the ambiguous genitalia, a low insertion of the umbilical cord and a median cystic structure with both the umbilical arteries alongside it (which we interpreted to be the bladder) and yet another cystic structure just beside it. We could also confirm the presence of the anus. After we learned the karyotype was normal (46XX) we looked for adrenal hyperplasia (to justify the enlarged clitoris) through an hydroxylase test of the amniotic fluid which was negative; finally we requested an MRI that reported a normal insertion of the umbilical cord, a double bladder or urachal cyst and a normal female genitalia. Throughout the rest of the pregnancy, we continued to observe a strange genitalia with the two labia very far apart and between them the enlarged clitoris and the double bladder. After birth, which occurred spontaneously at 38 weeks we were surprised by the postnatal diagnosis: bladder exstrophy (which was previously taken to be the enlarged clitoris); a very low insertion of the umbilical cord with a small omphalocelo (what we had previously thought to be the bladder); ectopic ureters that drained in a double vagina, one of which was very large, (the second cystic structure); marked diastases of pubic bones, documented by X-ray, that justified the diastases of the labia. After 24 hours the baby was submitted to a first surgical correction of the bladder exstrophy and later began the orthopaedic correction. Nowadays, this child is 3 years old, has

Ultrasound in Obstetrics & Gynecology 2009; 34 (Suppl. 1): 177–284