A 34-year-old multiparous woman presented with anti-Rh-D antibodies (1: 512) and fetal hydrops at the 21st week of gestation. Ultrasound revealed massive fetal skin edema, ascites, hepatomegaly, placentomegaly, and anhydramnios. No fetal movements were observed. Fetal heart was enlarged, with reportedly decreased contractibility. The Doppler parameters were abnormal: the peak systolic velocity in median cerebral artery (MCA PSV) was increased (84 cm/s, 3 MoM), and absent end diastolic flow (AEDF) was reported in the umbilical artery. Ultrasound examination indicated severe fetal anemia and heart failure. Umbilical vein puncture was performed and the fetal blood count was determined (RBC 0.01 × 106/µl, Ht 0.1%, PLT 67 × 103/µl, WBC 2.1 × 103/µl, indeterminable hemoglobin level). Packed red blood cells (0 Rh-, 30 ml) were immediately transfused to the fetus. Altogether, seven intrauterine transfusions were performed. Fetal hydrops disappeared gradually during the next few weeks. The male neonate (1860 g, 45 cm, Apgar score 3–4) was delivered after the last transfusion at 34th week of gestation due of intrauterine asphyxia. The infant was discharged after 21 days, in good condition, on breastfeeding. There was one 10 mm focus of periventricular leukomalacia in the brain, diagnosed based on trans-fontanel ultrasound, without any signs of damage to other organs. At the age of 5 years, the child is healthy, with no abnormalities in his neurodevelopmental parameters.

Conclusions: Prenatal ultrasound findings (hydrops, macrocystic or microcystic type, aberrant artery from aorta) were useful for the clinical and pathologic assessment of fetal CPAMs. P30.22The head progression distance measured by trans-perineal ultrasound in prolonged 2 nd stage of labor: its role in predicting mode of delivery Y. Gilboa, Z. Kivilevitch, M. Spira, A. Kedem, O. Moran, R. Achiron OBGYN, Sheba Medical Center, Hod Hasharon, IsraelObjectives: To evaluate, the clinical significance of the head progression distance (HPD), measured by trans-perineal ultrasound, during prolonged second stage of labor. Methods: A prospective study of women, above 37 weeks of gestation, with failure to progress in the second stage of labor was conducted. A TPU approach in a sagital plane, was performed in order to assess the HPD. It's correlation with feto-maternal characteristics, mode of delivery, and perinatal outcome were evaluated. Results: Sixty six women in prolonged second stage were enrolled in the study. Sixteen (25.8%), delivered by spontaneous vaginal delivery (SVD), twelve (19.4%) delivered by Cesarean delivery, thirty (48.4%) by vacuum extraction, and four (6.5%), by forceps. The mean HPD in cm measured in SVD, vacuum extraction, forceps and Cesarean delivery was 6.6 ± 0.9, 6.5 ± 1.2, 7.7 ± 1.1 and 5.8 ± 1.5 respectively, did not differ between modes of delivery. The only parameter that correlated with HPD was fetal head circumference measured after delivery R = 0.381 P < 0.04 Conclusions: Our study indicate that head progression distance do not predict the mode of delivery at prolonged 2 nd stage. Objectives: To describe the ultrasonographic findings, maternal and perinatal variables in cases with prenatal diagnosis of intraabdominal umbilical vein varix (IUVV). Methods: A retrospective study was carried out on the cases with prenatal diagnosis of IUVV that were attending our Fetal Medicine Unit in the period between March 2010 and May 2011. The prenatal detection of IUVV was achieved at the level of the abdominal circumference when the intraabdominal portion of the umbilical vein showed a diameter over 9 mm or 1.5 times the expected diameter for the gestational age (Figure 1). Doppler color application on the area usually shows turbulent flow inside the varix. We describe the maternal-fetal variables at the time of the diagnosis and the perinatal outcome of the affected cases. Results: A total of 6 cases of IUVV were diagnosed in our Unit (0.7/1000 prevalence) in three (50%) of them it was not an isolated finding but non-mayor congenital anomalies were associated. No chromosomal abnormalities were detected in our series. For all IUVV cases the mean of gestational age at diagnosis was 30 weeks. Perinatal outcomes were normal in all the cases. P30.23 Conclusions:The prenatal diagnosis of IUVV should prompt a detailed evaluation of the fetus to rule out any other associated anomalies. Previous series have associated IUVV with poor prognosis including intrauterine demise and structural and chromosomal defects...

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