16th World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts

and early second trimester were not suggestive of the seriousness encephalocele and/or nasopharyngealtumor. Delivery by Cesarean
of the lesion, which was progressive and manifested in later second section. Postpartum diagnosis of a large frontal encephalocele and
trimester. a complex brain anomaly. The herniated tissue was excised and the
defect was covered. Postnatal development of paraplegia. Genetic
testing normal. Beside some mental retardation contact to the parents
P03.11 is possible.
Fetal hydrocephalus prenatal diagnosis and postnatal The prognosis of fetale encepehalocele is better than descriped
management in literature. These two cases will help to counsel parents with
suspected fetal encephalocele especially if they wish to continue
J. L. Hernandez, X. Santamaria, A. Cordon, C. Rueda,
with the pregnancy. In cases of complex fetal brain anomalies
M. Folch, M. Prat, M. Lopez-Yarto, R. Rubio, R. Carreras a multidiciplinary approach and an individual treatment plan is
Hospital del Mar, Spain necessary.

Advances in realtime ultrasound imaging and a greater availability

of high-quality ultrasound equipment have resulted in an increased P03.13
number of congenital abnormalities being diagnosed prenatally Intrauterine diagnosis of diastematomyelia: 2 case reports
in the last 10 years. Among them central nervious system
Y. Baytur, B. Cetinkaya, H. Caglar, Y. Uyar
disorders outstand for their importance. Severe Ventriculomegaly
or Hydrocephalus is a severe pathology of the central nervious Celal Bayar University, Turkey
system, whose neonatal development has decreased significantly
due to ecographic prenatal diagnosis. It is defined as an increase The aim is to present 2 intrauterine diagnosed diastematomyelia
in the atrial diameter higher than 15 mm and it is linked to an cases.
abnormal cerebrospinalfluid circulation. We described the case of Case 1: Ultrasonography performed at the 17th week of pregnancy
a women in her first pregnancy whose fetus was diagnosed in revealed diastematomyelia in the lower thoracic vertebrae. The case
week 18 of gestation of a big ventricular enlargement. Careful was suggested to be evaluated by intrauterine MRI at the 3rd
prenatal evaluation was made including a detailed anatomic survey trimester of the pregnancy and taken to an operation in the first
and genetic amniocentesis. The cariotype study excluded any week following the delivery. MRI performed at the 32nd week of the
abnormality and a concomitant pathology of the central nervious pregnancy showed diastematomyelia at thoracolumbar junction and
system or fetal infection was also discarded. The mother was a low conus. The case was handed over to the surgery department
properly advised but decided for personal reasons to continue after the delivery.
gestation. In the follow-up, the horn of lateral ventricles reached Case 2: The pregnant woman having Type I diabetes mellitus was
a size of 40 mm with an obvious compression but conservation examined at the 29th week of the pregnancy. Ultrasonography
of the cerebral parenquima, however other pathological findings revealed a defect at 23 lumbar vertebra level and the case was
such as dilatation of the subarachnoid cistern were excluded. We diagnosed with diastematomyelia. The patient was suggested to
show the evolution and the case management with prenatal 2 undergo an MRI evaluation. She was hospitalized for the regulation
and 3D Ecographies. We include prenatal and postnatal Magnetic of her diabetes mellitus; however, upon her request, she was
Resonance imaging, postnatal Ecographies and pediatric follow-up discharged without full regulation. MRI was not performed due
of the newborn. We also have included an extense review of the to lack of her approval. The case was handed over to the surgery
diagnosis, management, prognosis and possible treatments which department after the delivery.
has been described in recent literature. This rarely seen abnormality can be diagnosed with ultrasonography
during the early weeks of the pregnancy. It is characterized with a
sagitalle cleft at the isolated diastematomyelia, spinal cord, conus
P03.12 medullaris and filum terminale. Early surgical intervention may yield
Large fetal encephalocele prenatal diagnosis and neonatal good outcomes at those diagnosed with diastematomyelia.
management
A. Reitter, S. Dittrich, V. Boda, M. Kieslich, R. Schlosser,
F. Louwen P03.14
Fetal hydrocephalus in a pregnancy complicated by idiopathic
University Hospital of Frankfurt, Department of Obstetrics thrombocytopenic purpura
and Gynecology, Germany
M. W. Kim, H. M. Choi
Encephalocele belong to neural tube defects, diagnosis is usually in Inje University Ilsan Paik Hospital, Republic of Korea
early pregnancy. They are often part of complex brain anomalies.
Diagnosis in early pregnancy is usually followed by termination of Idiopathic thrombocytopenic purpura (ITP) is an autoimmune
pregnancy. There are only few casereports from encephalocele in disorder in which the platelets of patient are destroyed by
term pregnancies. Mortality rates up to 30100% are descriped. autoantibody. It commonly affects young women and the
Two cases with late diagnosis are presented. obstetricians frequently come across the disordered patients. But,
Case 1: 24 year old obese (102 kg, 164 cm) 2G 0P referred at the incidence of intracranial hemorrhage in the neonates born
40 + 6 weeks of gestation with suspected fetal cerebral anomaly. to the mother with ITP has been reported to be less than 1%.
Sonographic finding large occipital encephalocele (57.3 47.4 Moreover, intrauterine intracranial hemorrhage regardless of the
55.3 mm). She had regular antenatal visits and scans. Delivery by mechanical stress at delivery seems to be very rare. We report a
Cesarean section. Postpartum period was difficult due to adequate pregnancy complicated by ITP, in which intrauterine intracranial
covering. A cranioplastic was successfully done with five month of hemorrhage diagnosed prenatally in third trimester. A 34-year-
age. Genetic testing was normal. Development of hydrocephalus and old woman, gravida 3, para 1, was referred at the gestational
paraplegia, but the child communicates adequately. age of 33 weeks. She was diagnosed to have ITP in 1999.
Case 2: 36 year old 3G 1 P referred for second opinion at Her laboratory data showed a platelet count of 2 109 /L with
34 + 1 weeks of gestation with fetal hydrocephalus. Past obstetric normal coagulation status. On targeted ultrasonography, there was
history fetal death due to hydrocephalus. No genetic testing. intracerebral hypoechogenic lesion adjacent to the lateral ventricle
A prenatal MRI confirmed the hydrocephalus. On ultrasound suggesting intracerebral hemorrhage. On follow up examination
examination no midline was identified, only in the occipital region at 37+2 weeks of gestational age, fetal hydrocephalus was newly
rest brainlike structure. Frontal midline defect, suspected frontal developed. After immunoglobulin therapy and transfusion of 12

550 Ultrasound in Obstetrics & Gynecology 2006; 28: 512614

37 September 2006, London, UK Poster abstracts

units of platelet concentrate, the pregnancy was terminated by P03.17

Cesarean section. Laboratory data of the baby showed a platelet Prenatal diagnosis of schizencephalia a case report
count of 1 109 /L with prolonged prothrombin time. Immunologic A. S. Cerdeira, S. Marta, H. B. Ferreira, C. Dias, L. Ferreira,
examination was negative for anti-platelet antibody and platelet- R. Z. Macedo
associated immunoglobulin G. The hydrocephalus was confirmed
by brain ultrasonography and computed tomography. Hospital Geral de Santo Antonio, Portugal

Schizencephaly is a neuronal migration disorder, resulting in clefts

that extend from the ventricle to the cortical surface of the cerebral
P03.15 parenchyma. Depending on fusion of cleft lips this disorder is
Prenatal diagnosis of hydranencephaly using 2D and 3D classified as type I, closed type and type II, open type. Usually
ultrasound this disorder is initially suspected on fetal ultrasonogram (US) by
S. J. Kim, G. S. R. Lee, I. Y. Park, J. C. Shin, H. Y. Ahn, focal ventricular dilatation associated with cerebral parenchyma
S. P. Kim, I. Y. Park, H. Y. Ahn, M. J. Kim abnormalities. However magnetic resonance imaging (MRI) is the
most sensitive imaging method to establish diagnosis.
Holy Family Hospital Catholic University, Republic of Korea Notwithstanding being related to multiple genetic and acquired
factors such as vascular, infectious, toxic and metabolic, the
Hydranencephaly is a severe brain condition characterized by precise ethiology of schizencephaly remains unknown. There are
complete or almost complete absence of cerebral cortex with multiple associated intracranial malformations including absent
preservation of meninges, basal ganglia, pons, falx. Despite the septum pellucidum, polimicrogyria, gray matter heterotopias,
absence of the cerebral hemispheres, The thalami and lower agenesis of the corpus callosum and optic nerve hypoplasia. These,
brain centers are typically preserved. This condition is usually in association with localization and amount of brain involved,
preceded by occlusion of the internal carotid arteries, infectious condition a variable prognosis. Patients can die at early age or
alterations (cytomegalovirus, toxoplasmosis) resulting in massive live until adulthood, however motor abnormalities, development
brain infarction. An 29-year-old woman, gravida 1, presented delay, microcephaly, mental retardation or epilepsy are almost
with fetal death at 18 weeks gestation. Initial 2D and 3D invariable. One case of antenatal open schizencephaly diagnosed
ultrasound revealed sloping forehead and abnormal intracerebral at Santo Antonio Hospital, is reported. A 34-year-old woman, G2
architecture which normal cerebral hemispheres could not be P1 was referred to our institution at 22 weeks gestation according
identified. Chromosomal study showed normal karyotyping. We to last menstrual period and fetus ultrasonometry. She was a healthy
report a case of hydranencephaly confirmed by autopsy, which was woman with normal first-trimester routine lab tests, not on any
initially detected by 2D and 3 D ultrasonography at 18 weeks of medication besides vitamin and ferrum supplements. Routine US
gestation. performed at 13 week was negative for any findings characteristic
of the disease. Ultrassonography at 22 weeks gestation revealed
a ventricular dilatation with a hiperecoic image surrounding the
P03.16 ventricle. Amniocentesis revealed 46,XY fetal karyotype. Prenatal
Antenatal diagnosis from six cases of ventriculomegaly MRI allowed diagnosis of type II unilateral schizencephaly. Medical
termination of pregnancy was performed according to parents
S. Marta, A. S. Cerdeira, H. Ferreira, R. Z. Macedo, request, approved by the ethics committee.
A. Ferreira
Hospital Geral de Santo Antonio, Portugal
P04: FETAL HEART
Ventriculomegaly is a central nervous system disorder defined
as dilation of lateral ventricles, measuring 10 mm or more on P04.01
ultrasound (US). This condition may result from chromosomal Evaluation of anatomy and function of cardiovascular system
disorders, genetic syndromes, congenital infections, vascular and in fetuses at 11.0 to 13.6 weeks of gestation
central nervous system anomalies. Research into its cause is
clinically important since prognosis is mainly dependent on
J. Dangel, A. Hamela-Olkowska, K. Jalinik
etiology and associated anomalies. Therefore, pre-natal detection of 2nd Department of Obstetrics and Gynecology, Warsaw,
ventriculomegaly entails exhaustive fetal ultrasonography, cerebral Poland
magnetic resonance imaging (MRI), cerebral Doppler, karyotyping,
and unravelling fetal infection. The authors present six clinical cases Objective: To evaluate anatomy and function of cardio-
from Prenatal Diagnostic Center of Santo Antonio Hospital-Porto. vascular system in fetuses at 11.0 to 13.6 weeks gesta-
These different fetal pathologies were diagnosed on clinical study tion.
following detection of ventriculomegaly, 1st case: 17 weeks fetus Methods: Results of ultrasound examination of 215 singleton
US: single dilated midline ventricle; karyotype: 46XY; MRI: alobar fetuses at 11.0 to 13.6 weeks gestation were analyzed. Exams
holoprosencephaly, confirmed by anatomopathology examination were performed using Sequoia 512, with transabdominal 6C2
(AE). 2nd case: 21 weeks fetus US: ventriculomegaly, hydramnios; probe. 43 (20%) women were over 35 years old, 101 (47%)
karyotype: 47XX+18 confirmed by EA. 3rd case: 22 weeks fetus were from high risk group (positive family history of congenital
US: midline cyst with turbulent flow on Doppler; MRI: aneurysm heart defects, diabetes mellitus and other). The exams comply
of the vein of Galen. 4th case: 21 weeks fetus US: ventriculomegaly, with the policy of the ISUOG Journal Ultrasound in Obstetrics
lemon and banana signs, myelomeningocele, karyotipe: 46 XX; & Gynecology.
EA confirmed Arnold Chiari syndrome type II. 5th case: 34 weeks Results: Anatomy of both ventricles was successfully seen in 180
fetus US: dilatation of posterior fossa; MRI: interhemispheric cyst (84%) cases and outflow tracks in 161 (75%) cases. In 9 cases
and agenesis of the corpus callosum. 6th case: 33 weeks fetus heart defects were diagnosed: ectopia cordis 3, VSD 2, complete
US: severe ventriculomegaly, hyperechoic images; MRI: intracranial heart block with left isomerism 2, hypoplastic RV 1, DORV 1,
hemorrhage. Termination of pregnancy was performed in the first pulmonary atresia with VSD 1; 5 of them had increased NT.
four cases. In three cases (trissomy 18, aneurysm of the vein of Galen 1 fetus had premature atrial contractions. 2 fetuses had NIHF
and Arnold Chiari syndrome), ventriculomegaly was associated with with hygroma colli, one of them had Turner syndrome. 10 fetuses
other ultrasonographic anomalies. The development of imaging had reversed A-wave in DV: 8 with heart defect, 1 with NIHF
techniques improved diagnostic accuracy, facilitating important and 1 with normal heart anatomy (NHA) and trisomy 21. TI
clinical diagnosis and management in ventriculomegaly. was observed in 6 fetuses: 2 with CHD, 2 with NHA and 2

Ultrasound in Obstetrics & Gynecology 2006; 28: 512614 551