The aim of this study was to analyze the antenatal characteristics of HLHS, its association with increased nuchal translucency, extracardiac anomalies and other obstetric outcomes. The medical records of antenatally diagnosed HLHS cases managed at Seoul National University Hospital between January 2007 and April 2012 were reviewed. The main policy of fetuses with HLHS in our institution is to maintain pregnancy and intention to treat with staged surgical palliation. Twenty two fetuses (n = 22) were diagnosed antenatally during this period. Two cases had increased NT (9.09%). Only minor extracardiac anomalies were found in 2 cases (megacisterna magna, unilateral multicystic dysplastic kidney). Most fetuses (90.9%) had an isolated HLHS. Eleven cases performed karyotyping antenatally and all fetuses had normal karyotype. The 4 cases resulted in termination of pregnancy at other hospitals as parents wanted. In 18 cases who maintained pregnancy, there was no intrauterine fetal death and 2 cases (11.1%) developed cardiomegaly at near term. Seventeen cases attempted vaginal delivery, in 3 cases (17.6%), emergent cesarean section occurred due to intrapartum fetal distress. In 14 (82%) cases, labor progressed without any fetal distress. All cases had normal cord ABGA (Cord pH > 7.1). Postnatally three cases had diagnosed as Cornelia de lange syndrome, 2q duplication, unilateral MCDK. Most fetuses with HLHS in our institution in Korea were isolated HLHS. And the incidence of increased NT, extracardiac anomalies and abnormal karyotype in HLHS were much less than previous reports in western country. There could be racial difference in characteristics of HLHS fetuses in Asian people.

Although screening ultrasound for detection of major fetal anomaly is usually done in mid-trimester, fetal anomalous structure can be also found in the third trimester during subsequent routine ultrasound. To objective of this study is to evaluate the frequency and spectrum of fetal anomalies diagnosed in the third trimester. Cases with fetal anomalies in singleton pregnancy which were confirmed by postnatal diagnosis was evaluated between Jan 2008 and Dec 2009 in Seoul National University Hospital. The gestational age of detection of fetal anomaly was classified as 1st/2nd trimester and 3rd trimester. We excluded cases in which routine screening ultrasound for detection of major fetal anomaly in mid-trimester was not done. There were a total of 162 cases of fetal major anomalies during the study period. Twenty-nine cases (18%) of fetal anomalies were diagnosed subsequently in the third trimester, and 14 cases (48%) had CNS (central nervous system) or heart anomalies. In 6 cases with CNS anomalies, 4 cases were those with intracranial hemorrhage or destructive lesion and 2 cases were Dandy-Walker variant. Among 11 cases with heart anomalies, 4 cases were those with arrhythmia, 2 cases with coarctation of aorta/hypoplastic left heart syndrome, and 1 case with pulmonary stenosis. Three cases has both CNS and heart anomalies. Even though the result of routine ultrasound in mid-trimester is normal, fetal anomalies can be additionally detected in about 20% of cases during the third trimester. About half of these anomalies diagnosed in third trimester are CNS or heart anomalies, and spectrum of anomalies might be different from that diagnosed in the first/second trimester. P30.19: Table

To determine if there is a difference in pregnancy outcomes among triplet pregnancies which were reduced to twin pregnancies, ongoing triplet pregnancies, and primary twin pregnancies. This retrospective cohort study was conducted in consecutive multi-fetal pregnancies who were delivered after 20 weeks of gestation in Seoul National University Hospital between January 2007 and June 2011. Study population was divided into three groups: 1) ongoing triplet pregnancies (primary triplet pregnancies), 2) triplet pregnancies which were reduced to twin pregnancies after selective fetal reduction during the first trimester (reduced twin pregnancies), and 3) primary twin pregnancies. Pregnancy outcomes included gestational age at delivery and the rate of preterm delivery (< 34 weeks). Data analysis was performed using SPSS version 19.0. During the study period, we identified 65 primary triplet pregnancies, 44 reduced to twin pregnancies, and 795 primary twin pregnancies. Gestational age at delivery (GAD) in reduced twin pregnancies (median [range]: 37.4 weeks [24.4–39.7]) was significantly higher than in primary triplet pregnancies (median [SD]: 34.4 weeks [24.1–39.0) (P < 0.001). However, there was no difference in GAD between reduced twin pregnancies and primary twin pregnancies (median [range]: 37.3 weeks [20.4–40.6]). The rate of preterm delivery (< 34 weeks) in reduced twin pregnancies was not different from that in primary triplet pregnancies (22.7% vs. 32.3%, P > 0.2), but tended to be higher than in primary twin pregnancies (22.7% vs. 13.6%, P = 0.09). The rate of preterm delivery (< 34 weeks of gestation) of ongoing triplet pregnancies was comparable to that of triplet pregnancies reduced to twin pregnancies after selective fetal reduction. Women with triplet pregnancies should be informed of complete pregnancy outcomes when they make a decision about selective fetal reduction.