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.

Maternal hypertension is an important medical complication associated with fetal growth restriction. The purpose of this study is to show whether there is a difference of catch-up growth potential in growth restricted fetuses according to the presence of absence of maternal hypertension. Singleton fetuses on suspicion of growth restriction by antenatal ultrasound and whose birth weight was less than 10th percentile for their gestational age (more than 34 weeks) were included. Postnatal body weights were monitored at around 1, 3, 6 and 12 months. Newborns with aneuploidy or multiple and/or severe structural anomalies were excluded. Maternal hypertensive disease was defined as chronic or gestational hypertension, preeclampsia or superimposed preeclampsia. The degree of growth restriction was measured by a z-score for each age and gender of the infant using the Korean growth standards. The gap between z-score at specific month and z-score at birth was interpreted as a degree of catch-up growth. The women with hypertensive disease were delivered at lower gestational age than those without hypertension (median [range]: 36.1 [34.3–40.9] vs. 38.5 [34.7–41.9], P < 0.05), but there were no differences of maternal height, follow-up duration or gender ratio of newborns between the two groups. The gap between z-score at 3, 6, and 12 months and z-score at birth was significantly higher in newborn born to mothers with hypertensive disease than those without hypertension for each. The difference of the gap of z-score at 12 months between the two groups was still significant after adjusting for gestational age at birth (median [range]: 4.41 [2.69–6.87] vs. 2.08 [1.79–6.26], P < 0.05). Secondary growth restriction caused by maternal hypertension may be transient in utero and can be overcome postnatally. However, constitutionally small babies lag behind normal growth.

To describe maternal and neonatal outcomes in patients who underwent delayed delivery of twin or triplet pregnancy. A retrospective study was performed of all the mothers and infants who were born at Seoul National University Hospital by delayed delivery from January 2004 to December 2010. Maternal outcomes included obstetric outcomes and maternal sepsis. Neonatal outcomes were compared in the initial and subsequent delivery groups, and outcomes included mortality and severe morbidity: bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing entrocolitis, intracranial hemorrhage grade III or IV, etc. There were 10 twin and 4 triplet pregnancies. They all managed antibiotics, tocolytis (except for 2 cases with no uterine contraction) and if cervix was dilated, cerclage was done (5 twin and 2 triplet). First fetuses was delivered at 18 + 0 to 27 + 5 weeks of gestational age (median 23 + 1 weeks) and later fetuses was delivered at 24 + 6 to 35 + 5 weeks (median 27 + 4 weeks). The median latency interval was 33 days, with a range of 3 to 105 days. The percentage of survival rate of firstborn was 35.7% (5/14) compared with 88.9% (16/18) among later-bone infants, severe morbidity was 60%(3/5) vs. 62.5% (10/16). But mainly morbidity of later infants were broncho- pulmonary dysplasia due to prematurity. Maternal complication were clinical chorioamnitis (1 case), and abruption (1 case). Patients with long latency intervals (58.5 days vs. 16.2 days) had earlier birth (< 23 + 4 weeks) of the firstborn. Although there is a limitation of number in this study, delayed delivery is associated with an improvement of neonatal survival rate when retained fetuses are compared with first fetuses, especially when the first was delivered early.

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is rare, sometimes referred to as Herlyn-Werner-Wunderlich syndrome (HWW). It usually diagnosed after menarche with pelvic pain or abdominal mass. We report 2 cases of Herlyn-Werner-Wunderlich syndrome in fetus. One of that the dilated vagina and uterus mimicking dilated ureter was identified by prenatal sonography, prior to symptoms development. And the other was diagnosed by postnatal MRI due to highly suspicion of mullerian anomaly with renal agenesis in female fetus. It would be advisable to look for mullerian anomaly, whenever unilateral renal agenesis or dysplastic kidney in a fetus for early and accurate diagnosis.

Respiratory distress syndrome (RDS) is a major cause of neonatal morbidity and mortality. This study investigates whether fetal pulmonary artery Doppler waveforms predict the subsequent development of clinical RDS. Prospective cohort study was performed in women with impending preterm birth. Flow velocimetry measurements, including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D), peak systolic velocity (PSV), and acceleration time/ejection time ratio (At/Et), were measured in the main pulmonary artery of the fetus just before delivery. RDS was diagnosed by clinicians blinded to the Doppler results. Logistic regression analysis with adjustment for confounding variables was used. As expected, newborns that developed RDS (n = 9) had significantly lower gestational age at birth and lower birthweight than those without RDS (n = 30): 28.7 (24.7–31.1) vs. 33.2 (26.1–36.0) weeks and 1060 (410–1490) vs. 1760 (920–2770) g (median [range]; P < 0.01 for each, Mann-Whitney U test); there was no difference in antenatal corticosteroid administration. Pulmonary artery At/Et ratio was significantly higher in fetuses that developed RDS compared with those that did not (median [range]: 0.361 [0.26–0.41] vs. 0.297 [0.21–0.44]; P < 0.05). This relationship was maintained after controlling for potential confounders, including gestational age at birth. An elevated At/Et ratio in the fetal pulmonary artery is associated with the subsequent development of RDS in preterm infants. These data suggest that fetal pulmonary artery Doppler velocimetry may provide a noninvasive technique to evaluate fetal lung maturity. Similar to the way in which MCA Doppler has replaced amniocentesis and OD450 for the assessment of fetal anemia, we propose that pulmonary artery Doppler velocimetry may replace amniocentesis and fetal lung maturity measurements to assist in the optimal timing of delivery.

To investigate the prevalence of intrauterine death (IUD) after 20 weeks in monochorionic twins and to evaluate the perinatal outcome of the surviving co-twins compared to dichorionic twins. We retrospectively reviewed medical records for 869 twin pairs born from 2000 to June 2009 in the Seoul National University Hospital. Nineteen twin pregnancies (11 monochorionic diamniotic and 8 dichorionic) were complicated by IUD after 20 weeks of gestation. Cranial ultrasound scans were performed most of surviving co-twins complicated IUD. A 195 monochorionic diamniotic (MCDA) and 674 dichorionic diamniotic (DCDA) twin pairs were included in the study. Single fetal demise occurs in 5.6% (11/195) of MCDA twins, and 1.2% (8/674) of DCDA twins. 92.3% (180/195) MCDA twin pairs resulted in 2 survivors, 2.1% (4/195) in no survivor, while 98.7% (665/674) DCDA twin pairs resulted in 2 survivors, 0.1% (1/674) in no survivor. Gestational age (GA) at delivery and GA at IUD was not statistically different between MCDA and DCDA twins (35.0 (range, 30.1–40.7) vs. 32.1 (range, 30.1–41.3) weeks) (P = 0.55) and (29.0 (range, 20.3–38.6) vs. 29.9 (range, 22.4–33.1) weeks) (P = 0.60), respectively. The incidence of cerebral injury and cardiac complication was 18.2% (2/11) (intraventricular hemorrhage, encephlaomalacia), 9.1% (1/11) (cardiomyopathy) in MCDA twin pregnancies compared to DCDA ones 0%. Our study confirmed the higher risk of perinatal morbidity for the co-twins in case of single fetal demise after 20 weeks in MCDA twin pregnancies. MCDA twin pregnancies have a much higher risk ischemic lesion in vital organs such as brain and heart compared to DCDA ones, limited by small number of cases.

To evaluate usefulness of sagittal CDUS images for the differential diagnosis of fetal cleft lip (CL) and cleft palate (CP). We got coronal and axial images of upper lip and maxillary alveolar in 25 fetuses with CL and CP. Existence of defect and malalignment of alveolar was assessed. We assessed existence of hard palate defect on the mid-sagittal image and flow through the defect on CUDS during fetal swallowing. We compared the US findings with postnatal features. We assessed the accuracy of axial and sagittal images in the differential diagnosis of CL and CP. 19 cases had CL and CP. 6 cases had CL without CP. 3 of 6 CL cases had cleft alveolar. Alveolar defect on axial image was detected in 18 of 19 cases with CP and 3 of 6 with CL. Alveolar malalignment was detected in 11 of 19 cases with CP, but in no case with CL. Hard palate defect on the sagittal image was detected in 15 of 19 cases with CP, but in no case with CL. CDUS evaluation of fetal swallowing was possible in 20 of 25 cases. Communicating flow through the palate defect was detected in 14 of 15 cases with CP, but in no case with CL. The accuracy of alveolar defect and malalignment on axial image were 84% and 68%, respectively. Accuracy of hard palate defect and flow on mid-sagittal image were 84% and 95%, respectively. Combined axial and sagittal images correctly diagnosed in all 6 cases with CL and 18 of 19 cases with CP. The accuracy was 96%. Sagittal US evaluation of the fetal hard palate may have additional value in the differential diagnosis of fetal CL and CP. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Previous study suggested different cutoff value of pelvis antero-posterior diameter (APD) of kidney for pyelectasia for each trimester; 4 mm for 2nd and 7 mm for 3rd trimester, and 10 mm as pathologic. The objective of this study was to examine the cutoff value of pelvis APD for prediction of surgical management in renal units with antenatally diagnosed pyelectasia. Pelvis APD was serially measured in 91 renal units of 74 patients with pyelectasia from 2nd trimester. Pyelectasia was defined as pelvis APD of more than 4 mm in 2nd trimester and that of more than 7 mm in 3rd trimester. ROC curves were constructed to select the cutoff value for prediction of surgical management, and 10 mm was selected as the cutoff value for both 2nd and 3rd trimester. Renal units were divided into 4 groups according to change of pelvis APD during 2nd and 3rd trimester: group 1, normalized APD (4 < APD < 10 mm in 2nd trimester and APD⩽7 mm in 3rd trimester, n = 33); group 2, persistent but without progressive change (4 < APD < 10 mm in 2nd trimester and 7 < APD < 10 mm in 3rd trimester, n = 21); group 3, progressive change (4 < APD < 10 mm in 2nd trimester and pelvis APD ≥ 10 mm in 3rd trimester, n = 21); group 4, APD ≥ 10 mm in 2nd trimester (n = 16). Renal units were divided into 2 groups according to the postnatal outcome; surgical and conservative management. In total, 11% (10/91) of renal units underwent surgical management: 0% of renal units in group 1 (0/33); 0% of renal units in group 2 (0/21); 5% of renal units in group 3 (1/21); and 56% of renal units in group 4 (9/16) (P < 0.001). Renal units in group 4 had higher rate of surgical management than those in group 3 (P < 0.005). Renal units with pelvis APD ≥ 10 mm in 2nd trimester had worse outcome than those with progressive change. Ten or more (mm) of pelvis APD at 2nd trimester may be a powerful predictor for surgical treatment.

Nuchal translucency (NT) is the most powerful screening tool for Down syndrome and cardiac anomaly. Because of its clinical impact, strict guidelines were established to get accepted NT measurement. However, to stick to the guidelines in most pregnant women is time-consuming and superfluous. We undertook this study whether the simplified protocol enables to select low risk group and skip the recommended NT measurement in them. A prospective study was conducted. The measurements of NT and crown–rump length (CRL) were performed by one author in 315 fetuses between 11 + 0 and 13 + 6 weeks of gestation. First, CRL was measured in the ordinary view that was mid-sagittal section of fetus in neutral position, and NT was measured at the same frozen screen (1st measured value, 1MV). Then, NT was measured again according to the Fetal Medicine Foundation (FMF) guidelines (2nd measured value, 2MV). Data were analyzed using ROC curve (95% CI, P < 0.05). There was good correlation between 1MV and 2MV in each case (r = 0.89). ROC curve was conducted to examine the relationship between 1MV and over the 95th percentile (p) 2MV (AUC: 0.98, P < 0.001). NT value of 2 mm in 1MV could be used as a cut-off to obtain over the 95p 2MV (sensitivity of 100%, specificity of 80.5%, PPV 22.7%, NPV 100%). All the 95p or more 2MV could be detected with this simplified protocol. NT ≥ 2 mm in 1MV was 22.2% of all cases, in other words, we had only to measure 2MV in 22.2% patients. If NT is less than 2 mm at ordinary CRL view, we may skip the recommended NT measurement. Supporting information can be found in the online version of this abstract. ROC curve for identification of over the 95p 2MV by 1MV. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Congenital chloride diarrhoea (CCD) is a rare autosomal recessive disorder in which the transport of chloride in the distal ileum is disrupted. This is medically treatable condition but is easy to be misdiagnosed as a surgically treatable condition such as small-bowel atresia. A 28-year-old primigravida woman was referred at 34 weeks 2 days for evaluation of fetal dilated bowel loops and polyhydramnios. Her familial and medical histories were unremarkable. A sonographic examination showed a single fetus with generalized dilatation of the bowel in right side of the abdomen and polyhydramnios (amniotic fluid index, 30.48). Serial follow-up scans showed no notable change. Fetal growth was appropriate for the gestational age. We suspected distal small bowel obstruction or ileal atresia and consulted to pediatric surgery for postnatal surgery. At 37 weeks 2 day, she was admitted for premature rupture of membrane. The next day she had 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. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Heterotaxy syndrome, including right and left isomerism, is frequently associated with complex cardiac anomalies can be detected by antenatal sonography. The purpose of this study was to assess postnatal outcomes of live births with heterotaxy syndrome for antenatal counseling. Retrospective chart review was done between 1999 and 2009. Eighteen fetuses were confirmed by postnatal imaging and autopsy. The ratio of right (n = 12) and left isomerism (n = 6) was 2 to 1. Five cases were terminated and 13 fetuses were delivered at term. Of them, three postnatal deaths was found only in cases with right isomerism. The causes of deaths were complications related to cardiac operation and sepsis associated with asplenia. The survival rate of live births was 76.9% with median follow-up of 24 months (range 1–81). Cardiac disease is the main problem of right isomerism survivors and all of them need to undergo operation. However in cases of left isomerism, extracardiac problems such as biliary atresia determined the main outcome. Interestingly, right isomerism was more common than left isomerism which was different from data from western world. Postnatal outcomes of live births with heterotaxy syndrome were not grave. Obstetrician who counsel the parents conceiving such fetuses should consider these points before decision of maintenance or termination of pregnancy. P25.04: Table