Lower urinary tract obstruction consists of a heterogeneous group of conditions in which the normal urethral egress of urine from the fetal bladder is impaired. The most frequent diagnoses are posterior urethral valves, urethral atresia, and less common obstructive ureterocele. We report a case of a fetus with prenatal diagnosis of obstructive ureterocele who presented progressive bilateral hydronephrosis. A fetal cystoscopy with laser ablation was performed.

Objectives: Echogenic and/or dilated bowel is often encountered on prenatal ultrasound and may represent a feature of gastrointestinal pathology, chromosomal abnormality or sign of prenatal infection. Prenatal differentiation between transient, physiological versus pathological manifestation is often difficult and remain uncertain. As a consequence, patients' counselling and timely involvement of pediatric surgeons is challenging. We aimed to review prenatal cases with echogenic or/and dilated bowel and analyse their neonatal outcomes. Methods: This is a retrospective observational study. All ultrasound scans demonstrating fetal echogenic and/or dilated bowel were retrieved from the viewpoint and grouped into three categories: 1. echogenic; 2. dilated and 3. combined cases. Bowel echogenicity has been defined as grade 1 to 3, in relation to the surrounding liver or bone echogenicity. Bowel dilatation is defined as the largest diameter measuring >7mm during second and third trimester. Results: Out of 26,353 screened prenatal ultrasound scans: 30, 3 and 8 cases were identified with bowel echogenicity (grade 2 or 3), dilatation and their combination respectively. 9/41 (21%) neonates had confirmed gastrointestinal related pathologies; 5 with echogenic and 2 from each, dilated and combined bowel abnormalities group. 3/30 (10%) cases with echogenic and 1/8 (13%) case with dilated bowel required postnatal intestinal surgery. None among neonates with combined echogenic and dilated bowel exhibited structural intestinal abnormality that needed surgical correction. Conclusions: Prenatal diagnosis of isolated echogenic and/or dilated bowel carries overall favourable neonatal outcomes. However, still minority of cases with fetal echogenic or dilated bowel may elucidate of possible gastrointestinal abnormalities that require thorough parents' counselling, prenatal work up and multidisciplinary team involvement. Further research is needed to more precisely define prenatal ultrasound features of severe gastrointestinal abnormalities that require neonatal interventions. VP09.08 Cystic biliary atresia or choledochal cysts: is it possible to be accurately differentiated prenatally?

The role of ultrasound (US) during pregnancy is well established. However many diseases and syndromes have manifestations throughout pregnancy and life, but are not always clarified by the US which generate difficulties in counselling. Case report: 27-year-old, 2G0P (1 spontaneous abortion). Normal 1st trimester US, low-risk combined screening but low PAPP-A (0,23MoM). At 20 weeks' US showed female genitalia, an inlet perimembranous ventricular septal defect (VSD), right cardiac cavities disproportion, hyperechogenic foci on the left ventricle, persistence of the right umbilical vein, femur on the 5th centile and umbilical cord with 2 vessels. Uterine mean pulsatility index >95th centile. Fetus with both normal karyotype and array-cGH. Infectious screening was negative. Fetal echocardiogram confirmed previous cardiac findings. At 24 weeks' US, beside cardiac anomalies, long bones were below 5th centile. After genetic counselling (GC) it was decided to do a whole-exome sequence (WES) that was normal. At 28 weeks' US, type 1 fetal growth restriction (FGR) was diagnosed (2,7th centile). Currently she is 32 weeks pregnant, fetus with type 1 FGR (0,3th centile), hypoplasia of long bones, normal fetal flowmetry and abnormal placental flowmetry with cardiopathy (VSD with 4.7mm and disproportion of great vessels with a suspicion of aorta coartation). Antenatal counselling is difficult and the prognosis is uncertain, which must be shared with couple. In conclusion, this case highlights the difficulty in GC. Genetic tests were promptly performed. As the pregnancy was evolving, we came across different malformations-cardiac malformation, placental dysfunction and short long bones. At this point, WES would be important to exclude not only skeletal dysplasia, but also more complex syndromes that could help to explain the various sonographic findings. However, even with adequate GC, it is not always possible to find the explanation to US findings and predict neonatal outcome.

Cellular angiofibroma of the vulva is a rare benign mesenchymal tumor in middle-aged women, first reported in 1997 by Nucci et al. It is important to differentiate cellular angiofibroma from other tumors as these may be more aggressive and recurring. Cellular angiofibroma has a limited potential for local recurrence and is usually treated with complete local excision. A 45-year-old woman was referred to the gynecology appointment with a complaint of a discomfort mass in the right labium minus 1 year before, which has been progressively increasing in size for the past three months up to 6 cm. No change in vulvar skin color, local itching, or bilateral inguinal adenopathy. The tumor was excised, and the histopathological exam revealed a cellular angiofibroma. The patient recovered well and a good aesthetic result was achieved. This is the first case described of the cellular angiofibroma which arises from one of the labia minora. It is bigger in size and growing more rapidly than usual within three months. A simple excision was carried out and until now (12 months after) no recurrence signals.

In pregnant women, low molecular weight heparin is recommended as the preferred agent for venous thromboembolism prophylaxis and treatment. Despite their widespread application, heparin-induced skin lesions are probably under-reported and under-estimated. We present a case report of a primigravida treated with low molecular weight heparin for deep vein thrombosis, who developed a delayed-type hypersensitivity reaction to enoxaparin, tinzaparin and dalteparin. As the patient was pregnant, treatment options were restricted. Tolerance was achieved with dalteparin with adjuvant administration of prednisolone. An attempt to decrease prednisolone dose triggered delayed-type hypersensitivity reaction recurrence that was solved by keeping the initial prednisolone prescription. To the best of our knowledge, there are no described cases using this approach. In cases of delayed-type hypersensitivity reaction to low molecular weight heparin during pregnancy our case suggests that switching low molecular weight heparin and adjuvant administration of prednisolone can be an option.