A 34-year-old patient had her first trimester Down syndrome scan followed by serial ultrasound scans which showed a single intrauterine pregnancy with multiple cystic areas in the anterior placenta. She presented in preterm labour with a breech presentation at 32 weeks and underwent an emergency caesarean section. She delivered a male infant weighing 1750 g. The placental histopathology showed a complete hyatidiform mole. At 4 weeks postpartum, beta-human chorionic gonadotrophin (Bhcg) levels rose from 460 to 836 mIU/mL over 1 week. Metastatic workup revealed prominent pelvic nodes and pulmonary nodules in both lungs. This was discussed at the Multi-Disciplinary Tumour Board and single-agent intramuscular methotrexate was recommended. After chemotherapy, she achieved Bhcg normalisation after three cycles. This case highlights the importance of clinical vigilance even in low-risk patients. Unexpected findings on ultrasound should involve multidisciplinary input with radiology colleagues. A high index of suspicion for gestational trophoblastic disease and close follow-up is imperative.

Endometrial hyperplasia (EH) is a precursor of endometrial cancer. It arises in an environment of unopposed oestrogen. Treatment is based on a combination of weight management, diet and exercise, and the use of progestogens either via a levonogestrel-intrauterine system (LNG-IUS) or orally. The LNG-IUS is the first-line recommendation for EH without atypia. Recurrences are rare, and any recurrences despite prolonged treatment and control of risk factors necessitate a thorough consideration of other oestrogenic sources. This case report presents a rare case of a coexisting ovarian Brenner tumour and ovarian stromal hyperplasia in a menopausal patient in her 50s with recurrent EH despite earlier regression. The above histology may have provided the additional oestrogenic influence. This patient subsequently underwent a definitive hysterectomy and bilateral salpingo-oophorectomy (BSO). It is important to maintain a high index of suspicion for potential oestrogenic influences in cases of refractory EH that are not identifiable on imaging. BSO should be considered at the time of hysterectomy in such cases of unidentified oestrogenic foci.

Objectives: To assess the accuracy of antenatal diagnosis of oral clefts (isolated or associated clefts) and pregnancy outcomes in a tertiary referral centre, so as to provide a basis for prenatal counselling and prenatal invasive diagnostics. Methods: This was a retrospective review of cases with postnatal diagnosis of oral cleft from our hospital's database. Cases with estimated date of delivery between 1 January 2011 and 31 December 2015 were included. Results: During the study period, 78 cases of oral cleft were identified. 58 cases underwent screening at 18 to 23 weeks and detection rate was 93.1% (54/58). Prevalence in our local population is 13.6 per 10,000 (78/57,528) live births with a male to female ratio of 1.3 (41/32).Detection rate for isolated oral clefts was significantly higher compared to clefts associated with congenital anomalies (associated cleft) [100.0% (47/47) vs 63.6% (7/11); p=0.0003)]. While studies have demonstrated that chromosomal abnormalities were most frequently seen in associated clefts, we were unable to demonstrate a significant difference in our study (isolated cleft -95.8% (23/24) vs associated cleft -88.9% (8/9), p=1).Our results showed that fetuses with median clefts were more likely to have associated congenital anomalies compared to unilateral and bilateral clefts [50% (2/4), 27.4% (17/62),16.7% (2/12)].While the live-birth rates for fetuses with isolated or associated clefts was not statistically significant [66.7% (38/57) vs 90.5% (19/21), p=0.0695)], neonates with isolated cleft had a higher survival rate [isolated -100% (38/38), associated cleft -19.0% (4/19), p<0.0001]. Conclusions: Our study demonstrated prenatal detection and prevalence rates comparable to literature. We were unable to demonstrate a significant difference in detection of chromosomal abnormalities between the different types of oral clefts due to the small number of patients who underwent genetic analysis. Fetuses with median cleft were more likely to be associated with congenital anomalies. Neonates with isolated cleft had a higher survival rate. OP23.07Parental serum alkaline phosphatase activity as an auxiliary tool for prenatal diagnosis of hypophosphatasia

Introduction: At KK Women's and Children's Hospital's (KKWCH) Department of Obstetrics and Gynaecology (O&G), a junior doctor's handbook exists to guide safe practice. A challenge remains in ensuring relevant, current, and readily accessible content. The onus of re-editing is left to senior clinicians with heavy clinical and supervisory roles, leading to a lack of sustainability. Mobile applications (apps) can be a sustainable 'just-in-time' learning resource for junior doctors as they balance new responsibilities with relative inexperience. Methods: The app was developed in-house with the Residency's EduTech Office. A focus group comprising junior doctors identified content deemed useful. The alpha version was launched in August 2017 and trialled amongst the wider junior doctor population. Data on usefulness were collected through serial focus groups and analysed using grounded theory. Results: An online survey disseminated to all 100 junior doctors showed that 100% owned a smartphone. 97.1% supported this new resource. Consultative discussions recommended inclusion of (i) Procedural and consent information; (ii) Risk calculators; and (iii) Clinical pathways and management algorithms. Mobile learning apps entreat the user to immediately reflect and conceptualise their concrete experiences, and actively experiment with the content to build on his/her current knowledge. Learners become stakeholders in creating their own learning material. Qualitative feedback indicated a continued interest to contribute, underscoring the app's sustainability potential. Conclusions: Apps can be a sustainable on the go resource developed by junior doctors, for junior doctors. Learners become stakeholders in creating their own learning material through continued reflection, conceptualisation and active experimentation. This can be scaled for wider clinical use.