doi:10.1111/jog.13386
S1: 3–19, June 2017
FETAL MEDICINE
0001
A case report on the successful antenatal management
of the Philippines’ first living non-immune hydrops
fetalis due to hemoglobin bart’s disease
Maria Jane Ellise Javier1,2, Maria Rosario Castillo Cheng1,2
1
Department of Obstetrics and Gynecology, The Medical City,
Ortigas, Pasig, The Philippines, 2Department of Obstetrics
and Gynecology, Section of Perinatology, The Medical City,
Ortigas, Pasig, The Philippines
Hemoglobin Bart’s hydrops fetalis, characterized by a
deletion of all four α-globin genes is the most severe
and lethal form of Thalassemia disease. Given the poor
overall prognosis, most countries resort to pregnancy
termination or expectant management as the only
options to offer affected pregnancies. This paper presents
a case of a primigravid, diagnosed with hydrops fetalis
at 29 4/7 weeks age of gestation. Congenital anomaly
scan revealed normal cardiac structures, cardiomegaly,
and findings signifying heart failure. Doppler
ultrasound showed normal fetal Doppler indices, with
peak systolic velocity of the middle cerebral artery
showing absence of fetal anaemia. Her TORCH panel,
and RPR all revealed negative results. She eventually
delivered to a live, preterm, via cesarean section. On
further work up, the expanded new born screening
revealed elevated levels for hemoglobinopathies.
Fetalhemoglobin electrophoresis revealed presence of
hemoglobin Bart’s (42.6%), hemoglobin H (11.4%), and
decreased hemoglobin F (1.2%). Gene testing of both
parents confirmed heterozygous α -thalassemia
SEA 0
SEA
mutation, and the offspring having homozygous
mutation on both chromosomes confirming the
diagnosis of HemoglobinBarts disease. After a turbulent
neonatal ICU stay, there was noted reversal of the heart
failure and fetal hydrops. The baby continues to survive
past eleven months of age, with no definite neurological
deficits noted. Blood transfusion is being done to
maintain hemoglobin level > 100 mg/dL. This report
aims to improve the clinicians’ knowledge regarding
the work up and management of patients diagnosed
with hydrops fetalis, and provide evidence-based
guidance for managing this condition in future cases.
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
J. Obstet. Gynaecol. Res. Vol. 43, No.
0007
Fetal akinesia syndrome. A rare fetal condition with
very poor prognosis for the fetus. Case report
Christos Spyroulis, Peter Yeh
London North West NHS Healthcare Trust, Harrow, Greater
London, UK
Introduction: Fetal akinesia syndrome is a very rare,
autosomal recessive inherited disease which has a very
poor prognosis for the fetus. Sometimes, is possible to
be the result of a mutation in the RAPSN or DOK7
genes.
Case report: We present a case of 42 year old, Somalian
woman, who had 9 previous normal deliveries, history
of essential hypertension, mild asthma (non-medicated)
and with a BMI:35. She had gestational diabetes which
was managed with diet. The 20 week scan shown
polyhydramnios, flexed wrists and feet. Also, the AC
was significantly reduced, but the rest measurements
were in normal range. The fetal movements were
significantly slow from the 20 week scan. She had FMU
scans every 4 weeks from 24 weeks and consecutive
assessments in DAU for CTG, since she refused to
terminate the pregnancy, as was advised by the Fetal
Medicine Consultant. In each antenatal visit was advised
to terminate the pregnancy since the outcome was
significantly poor, according to literature. Patient was
very reluctant to that. Variability was much reduced in
all CTG and was unresponsive to any fluid challenge.
She delivered at 35 weeks by emergency caesarean
section. Apgars were 1, 5 and 8, in 1, 5 and 10 minutes,
and baby transferred to NNU of our hospital. Baby
was intubated from the beginning and is supported
mechanically, since the X-ray shows that there is a
significant pulmonary hypoplasia and in any attempt
to remove the intubation, baby is grunting. Recently, in
the FMU meeting of the department, it was decided to
stop the support of the new-born child based on 2
previous similar cases at Queen’s Charlotte hospital
Conclusion: In such cases, we need to advise the parents
to terminate the pregnancy, since there is no single
reported case in bibliography with long life term
expectancy
3
Fetal Medicine
0035
Prenatal diagnosis of cardiac anamolies – using fetal
echocardiography as a screening tool
Medarametla Vijayasree
Mamata Medical College, Khammam, Telangana State, India
Introduction: Cardiac defects are the most common
structural abnormalities seen at birth with prevalence
of 8 per 1000 live births. It has been shown that
prenatal detection of congenital heart disease may
reduce perinatal mortality. Fetal echocardiography has
evolved over the past three decades as a vibrant tool
in obstetrical medicine that makes prenatal diagnosis,
counselling, prenatal therapies and perinatal and
neonatal management planning for various fetal
cardiovascular abnormalities feasible as early as
possible.
Aims and objectives: To find out the effectiveness of
fetal echocardiography in the diagnosis of fetal cardiac
lesions in antenatal women.
Materials and methods: This was a prospective study
done on 100 antenatal women at 24 weeks of gestation.
Sixty high-risk and forty low-risk women were
evaluated. High-risk factors were hypothyroidism,
diabetes, heart disease, Rh negative pregnancies, pre-
eclampsia, Systemic lupus erythematosis, sickle cell
anemia and thalessemia. All women had detailed fetal
echocardiographic examination. Accuracy of fetal
echocardiography was evaluated from neonatal
outcome at birth.
Observation & results: Two percent of antenatal
women had echocardiographic findings suggestive of
fetal heart disease (1.7% in low-risk and 2% in
high-risk group). Major congenital heart disease on
echocardiography were VSD(1), TOF(2) and Sinus
bradycardia(1), was suspected in four women of
high-risk group, which was further confirmed in the
neonatal period. Six fetuses were suspected with minor
cardiac abnormalities like VSD (5), Echogenic foci in
the left ventricle(1) in the low risk group. However,
after birth two of them were found to be normal and
four neonates needed to be kept under follow-up for
confirmation and spontaneous resolution. The
high risk factors were Diabetes in two women,
Hypothyroidism in one women and Anemia in
another women.
Conclusion: Fetal echocardiography is suggested in
high-risk pregnancy for exclusion of congenital heart
disease. It should be offered to low risk antenatal women
also.
4 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
0040
A case of single intrauterine fetal demise in
dichorionic diamniotic twin pregnancy
Jacqueline Bueno-Uy
Victor R. Potenciano Medical Center, Quezon City, The
Philippines
This is a case of a 32 year old, G1P0 Diamnionic,
Dichorionic Twin Pregnancy Uterine 40 2/7 weeks
AOG, with Twin demise at 18 weeks AOG, cephalic, in
labor, who had regular prenatal check-ups and periodic
antenatal evaluation by ultrasonography to closely
monitor and prevent morbidity and mortality to both
the surviving twin and mother. Patient was healthily
carried to term and at 40 2/7 weeks AOG, patient
delivered to Twin A: term birth living female via Normal
Spontaneous Delivery BW 3742 g, BL 48 cm, MI 41 AGA,
and Twin B: dead female fetus (FetusPapyraceus) under
Epidural Anesthesia with unremarkable post-operative
and hospital stay.
This case report shows how a twin pregnancy with
diamnionic, dichorionic placentation was conservatively
managed with only judicious and prudent serial
assessment and ultrasound documentation throughout
the duration of her pregnancy.
0045
A study on the association between eye movement and
regular mouthing movement
Kana Maehara, Seiichi Morokuma, HikoHiro Okawa,
Yasuyuki Fujita, Kiyoko Kato
Kyushu University Hospital, Fukuoka, Japan
Introduction: In term infants, regular mouthing
movements (RMMs) are known to occur in clusters
during non-rapid eye movement sleep. We have
observed that RMMs occur in fetuses. Moreover,
previous studies have also indicated that RMMs occur
during non-eye movement (NEM) period after 35 weeks
of gestation. However, those studies did not reveal when
RMMs occur and synchronize with NEM period.
Objectives: The aim was to clarify the existence of an
association between eye movement and RMMs at 24–
39 weeks of gestation.
Methodology: Normally developing fetuses were
examined from 24-39 weeks of gestation. Fetal eye and
mouth movements were observed using real-time
ultrasonography, and they were stored on a HDD.
The standard plane was determined to be a nearly
frontal section of the fetal face from the lips to the lens
margin, with the fetal lens being detected as a ring-like,
round echo. EM period and NEM period was defined
when the lens moved and when it did not move for a
Copyright of individual abstracts remains with the authors.

minute, respectively. RMMs were defined as a sequence
of mouth movements for a second.
Results: The median values (range) of RMM clusters (/
min) for each group at 24-25, 26-27, 28-29, 30-31, 32-33,
34-35, 36-37, and 38-39 weeks of gestation were 0.283
(0.1-0.661), 0.81 (0.262-1.102), 0.561 (0.233-0.833), 0.695
(0.383-1.717), 0.617 (0.237-1.593), 0.797 (0.383-0.966),
0.517 (0.161-1.655), and 0.695 (0.102-1.458), respectively.
There were no inflectional points. The median values
(range) of RMMs (%) during the NEM period for each
group at 24-25, 26-27, 28-29, 30-31, 32-33, 34-35, 36-37,
and 38-39 week gestation were 60 (0-94), 50 (0-92), 52
(0-88), 42 (7-87), 42 (0-92), 54 (5-92), 64 (0-99), and 74
(33-85), respectively. There was an inflectional point at
34-35 week of gestation.
Conclusion: This study revealed that RMM cluster rate
increased after 34-35 weeks of gestation.
0051
Proteomic analysis of cord blood of neonates with
maternal schizophrenia
Yoshinori Moriyama, Tomomi Kotani, Hiroyuki Tsuda, Asuka
Tachi, Masataka Nomoto, Yukako Iitani, Yumiko Ito, Tomoko
Nakano, Fumitaka Kikkawa
Nagoya University, Nagoya, Aichi, Japan
Introduction: Pregnancy complicated with
schizophrenia is attracting more attention these days,
not only because of difficulty in managing it, but also
because of its possible influence on the fetus, which
remains to be clarified.
Objective: To identify changes in cord blood proteome
of neonates born to mothers with schizophrenia.
Methodology: Three pregnant schizophrenia patients
and as many pregnant controls were included. Cord
blood was sampled at delivery, and centrifuged for
serum isolation. Proteome of the serum was measured
by LC/MS, and then analyzed by gene ontology and
pathway analysis. This study was conducted with the
approval of the ethics committee at Nagoya University.
Results: A total of 282 proteins were observed in
neonatal cord blood by LC/MS. Of them, 103 proteins
showed more than 2-fold difference in any case-control
pair. Eighteen proteins were increased in all the cases.
In gene ontology analysis for biological process, acute-
phase response was listed at the top, which has been
reported to be involved in schizophrenia patients. In
pathway analysis, the complement pathways and acute
inflammatory response were considered involved.
Conclusion: We identified proteomic change in cord
blood of neonates born to mothers with schizophrenia.
It was mainly associated with acute-phase response,
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
which could be resulted from change in that response
in mothers. It was also related to inflammatory system,
which is very important in terms of the
neuroinflammatory hypothesis of the disease.
Additional data accumulation and then search for
prognostic biomarker candidates are needed.
0078
A case series on fetal pleural effusion with positive
neonatal outcomes
Emiciel Alta Gigante, Emerson Tan
St. Luke’s Medical Center, Quezon City, The Philippines
Fetal pleural effusion is rarely an isolated finding. It is
commonly seen in association with hydrops fetalis.
Limited data is available regarding the incidence, but it
was noted to be 1 in 10 000 to 1 in 150 000 pregnancies.
It is usually detected incidentally upon routine prenatal
ultrasound during the second trimester, as evident in
the two cases of isolated unilateral fetal pleural effusion
presented in this series, wherein their congenital
anomaly scan done at 19 and 22 weeks AOG,
respectively, showed fetal hydrothorax. The first case
was a low risk mother, while the second one had
gestational diabetes mellitus insulin-requiring. The third
case as well was incidentally diagnosed during the third
trimester, but with concomitant findings of fetal ascites
and subcutaneous edema consistent with hydrops fetalis
and a small ventricular septal defect. All three cases were
managed appropriately in a multidisciplinary approach
resulting to good perineonatal outcomes. Despite the
increased death rate from fetal pleural effusion, all three
newborns were delivered alive and discharged
improved and stable after approximately one month
admission at the nursery.
Fetal pleural effusion has a high mortality rate. Hence, if
diagnosed antenatally, knowing its etiology is of utmost
importance in the prognostication of the neonate’s
survival as well as in the holistic decision-making
regarding the individualized management of each case.
0080
Double bubble sign in fetal midgut malrotation: a case
report
Emiciel Alta Gigante, Sol Pangan
St. Luke’s Medical Center, Quezon City, The Philippines
Double bubble sign seen on antenatal ultrasound is
commonly related to duodenal atresia. However, there
are several other rare fetal disorders which can also
manifest as double bubble as evident in this case. A
19 year old G1P0, known to have gestational diabetes
mellitus, was admitted at 33 weeks age of gestation
5
Fetal Medicine
due to preterm labor. Pelvic ultrasound at this time
showed polyhydramnios and an evolution of sonologic
findings from a previously normal stomach bubble at
31 weeks age of gestation to appearance of two bubbles
in the fetal abdomen. Due to uncontrolled uterine
contractions, she eventually delivered by spontaneous
vaginal to a live preterm boy, with good Apgar score
(9,9) and birthweight of 2330 grams. Few hours after
delivery, x-ray baby gram showed distended gastric
cavity with a double bubble configuration which was
compatible with the antenatal ultrasound. On day 2 of
life, the baby underwent exploratory laparotomy with
intraoperative findings of a dilated stomach and
proximal duodenum, as well as malrotated midgut,
Meckel’s diverticulum and multiple adhesive bands in
the intestines. Baby was discharged on the 25th day of
life, stable and improved.
Diagnosis of fetal disorders during the antenatal period
allows the health care team and the family as well to
prepare for the best care of the mother and the baby
upon delivery. There are a handful of fetal
malformations which can result to a double bubble sign.
Therefore, clinical correlation based on maternal history
and antenatal sonologic features of each case should be
of utmost consideration so as to arrive at a conclusive
diagnosis. This will guide the physicians in counselling
and managing their patients before any contemplated
major procedure.
0084
Establishment of a useful prenatal marker for
predicting lung morbidity at 1 year of age in infants
with congenital diaphragmatic hernia
Hiroyuki Tsuda, Tomoko Nakano, Yumiko Ito, Asuka Tachi,
Yukako Iitani, Yoshinori Moriyama, Masataka Nomoto,
Fumitaka Kikkawa
Nagoya University Graduate School of Medicine, Nagoya,
Japan
Introduction: Congenital diaphragmatic hernia (CDH)
causes pulmonary hypoplasia and pulmonary
hypertension, which are often fatal. Some prenatal
parameters have been reported as useful to predict
mortality in infants with CDH, but little has been
reported regarding the predictors of long-term lung
morbidity.
Objective: The aim of this study was to establish a
marker for predicting lung function at 1 year of age in
infants with CDH.
Materials and methods: Infants with isolated CDH who
were delivered after 35 weeks of gestation from April
2008 to June 2016 at Nagoya University Hospital were
6 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
registered. Regarding alive infants with CDH, only those
who underwent follow-up for at least 1 year
were registered. Finally, 48 infants were analyzed in this
study.
Results: Gestational age at diagnosis, observed-to-
expected MRI fetal lung volume (percent FLV), liver
herniation, amniotic lamellar body count at birth, and
polyhydramnios were significant parameters for
predicting mortality in infants with CDH. However,
regarding alive infants with CDH (n = 41), percent FLV
was the only significant parameter to predict need for
oxygen therapy at 1 year of age (p < 0.05). Using ROC
curve, a percent FLV cutoff value of 25.1% resulted in
88.6% sensitivity, 40.0% specificity, 42.9% positive
predictive value, and 97.1% negative predictive value
for predicting need for oxygen therapy at 1 year of age.
There was a significant negative correlation between
percent FLV and duration of oxygen therapy in infants
with CDH (r = 0.516, p < 0.001).
Conclusions: Percent FLV can be a useful predictor of
long-term lung morbidity in infants with CDH and
would be beneficial for prenatal counselling.
0087
Survey on knowledge, attitude and related factors
among pregnant women in developing country as
Thailand regarding antenatal thalassemia screening
Tharangrut Hanprasertpong1, Kasem Raungrongmorakot1,
Alan Geater2, Pawin Puapornpong1, Wipada Laosooksathit1,
Aurasa Hemachandra1, Maysita Suksamarnwong1
1
Srinakharinwirot University, Nakhon Nayok, Thailand,
2
Prince of Songkla University, Hat Yai, Thailand
Objective: To examine the patient’s knowledge and
attitude on antenatal thalassemia screening and to
evaluate the factors which influence the patient’s
knowledge and attitude on antenatal thalassemia
screening
Study design: This prospective study was conducted
among pregnant women who attended antenatal care
at MahaChakriSirindhorn Medical Center, Faculty of
Medicine, Srinakharinwirot University, Thailand,
between September 2015 and June 2016by using a
questionnaire based interview. Baseline demographic
and clinical characteristics of participant, and scores of
knowledge and attitude were calculated and the factors
influencing knowledge and attitude score were
identified.
Results: 1006 participants were enrolled. The percentage
of incorrect and do not know answer were more than
60% in 7/10 items of knowledge questions. Maternal
age, level of education, primigravidity, family history
Copyright of individual abstracts remains with the authors.

of thalassemia and level of patient’s attitude were found
to be statistically significant predictors of patient’s
knowledge score. Level of education, primigravidity
and the patient’s level of knowledge were found to be
statistically significant prediction of patient’s attitude
score. Most participants (82%) agreed to undergo the
screening process. Adjunctive Down syndrome risk
assessment and fetal sex determination were the
encouraging reasons for acceptance of antenatal
thalassemia screening. Most participants wished for total
cost support from the government.
Conclusion: Pregnant women’s knowledge on antenatal
thalassemia screening was low. Maternal age more than
or equal to 35 years had higher level of knowledge.
Higher level of education and multigravidity, presence
of family history of thalassemia and positive level of
attitude were more likely to have received the higher
scores for knowledge. Higher level of education and
level of knowledge score were also more likely to have
received the positive attitude score but multigravida
negatively affected attitude score. Down syndrome
screening or fetal sex determination can be used as
encouraging.
0091
Sirenomelia: the mermaid syndrome - a rare case
report
Sehereen Farhad Siddiqua, Sharmin Abbasi
Anwer Khan Modern Medical College Hospital, Dhaka,
Bangladesh
Case Report: A 30 years old primiwt 115 kg,non
diabetic, normotensive,euthyroid at 38 weeks of
gestation admitted with labour pain.It was her
spontaneous pregnancy and she was in regular antenatal
check-up. At 13 weeks her down’s screening was
normal.In 20 weeks anomaly scan done AFI was almost
nil and the lower limbs did not visualized properly.
Every 2-3 weeks interval we did USG but she remained
anhydramnios throughout the pregnancy. Patient party
was counseled about the fate of the baby and advised
for termination.
She delivered a term baby with 2.6 kg with fused
lower limbs. The baby cried immediately after birth.
The apgar score was 4 at 1 min and 1 at 5 min. On
physical examination the infant showed narrow chest,
bilateral hypoplastic thumb, fused lower limbs with
single foot and 10 toes, absent external genitalia,
imperforate anus and umbilical cord with single
umbilical artery. There were also prominent epicanthal
folds, hyper telorism, downward curved nose, receding
chin, low set soft dysplasticears and small slit like
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
mouth suggestive of potters facies. X-ray of lower
limbs of the baby showed –completely fused lower
limb and one femur and one tibia, incomplete
development of pelvis with absent acetabulum,
ischium and pubic bones. USG of whole abdomen
showed-bilateral agenesis of kidney and urinary
bladder. The baby died 6 hours after delivery.
Sirenomelia is fatal congenital anomaly and has a strong
association with maternal diabetes and obesity. Early
diagnosis and termination should be in mind. But 9
mermaid cases survived after reconstructive surgery
have been reported. However prevention is possible
and should be goal. Regular antenatal check-up
with optimum maternal blood glucose level in
preconceptional period and in first trimester should be
maintained to prevent this anomaly.
0094
Rapid biophysical profile for assessment of fetal well-
being in high-risk pregnancies
Cherry Khaing, Saw Kler Ku, Kyi Kyi Nyunt
University of Medicine, Mandalay, Mandalay, Myanmar
Introduction: Antepartum fetal testing is essential for
determining optimal time and mode of intervention.
The rapid biophysical profile (rBPP) was developed to
overcome the problems of long procedure time and need
of well-trained ultra-sonographers for currently using
fetal wellbeing tests. This test consists of sound
provoked fetal movement (SPFM) and amniotic fluid
index (AFI). Total scores are score 4, 2 and 0.
Objective: To study the accuracy of rapid biophysical
profile for assessment of fetal well-being in high-risk
pregnancies.
Methods: This is a hospital based prospective study
including 160 cases of high risk pregnancies admitted
to Central Women’s Hospital, Mandalay from 8th March
2014 to 31st December 2014. AFI and SPFM were
performed within 24 hours before delivery. The
associations with adverse fetal outcomes, test accuracy
and the correlation to Apgar scores at five minute and
umbilical arterial pH were evaluated.
Results: Among 160 cases, 14% of cases (n = 23) had
score 2 and 86% of cases (n = 137) had score 4. The(rBPP)
test had sensitivity of 78.7%, specificity of 94.1%, positive
predictive value of 57.3%, negative predictive value of
97.9% and efficiency of 91.2% (p < 0.001). Forty eight
percent of score 2 and 97.1% of score 4 were found to
be Apgar score ≥ 7; 34.8% of score 2 and 5.1% of score
4 were found to be pH < 7.2; 47.8% of score 2 and 2.9%
of score 4 were admitted to SCBU; 73.9% of score 2 and
6.6% of score 4 encountered the adverse fetal outcomes.
7
Fetal Medicine
It had statistically significant correlation to Apgar score
at five minute (r = 0.5).
Conclusion: Rapid biophysical profile is an accurate test
for assessment of antenatal fetal well-being in high-risk
pregnancies. It can be used as a confirmatory test for
suspicious fetal well-being state.
0095
A novel system to capture circulating fetal cells from
maternal blood using nano-structural microfluidic
chip
Hei-Jen Jou1, Hsin-Cheng Ho3, Sheng-Wen Chen3, Pei-
Hsuan Lo1, Pei-Ying Ling1, Chung-Er Huang2,3
1
Departments of Obstetrics and Gynecology, Taiwan
Adventist Hospital, Taipei, Taiwan, 2International College of
Semiconductor Technology, National Chiao-Tung University,
Hsinchu, Taiwan, 3Cytoaurora Biotechnologies, Inc. Hsinchu
Science Park, Hsinchu, Taiwan
Introduction: Isolating and analyzingfetal cells from
maternal blood provides a non-invasive and fetal-cell
based prenatal diagnostic tool for chromosomal or
genetic abnormalities. It is important to develop a
technique that can effectively isolate fetal cells from
maternal blood because the number of those cells is very
scarce.
Objectives: We are developing a system (CytoAurora
Cell Reveal System) to capture and isolate fetal cells in
maternal blood. The goal of present study is to evaluate
the efficiency of this system.
Methodology/process: We collected blood from 50
mothers during first trimester at a community
hospital in Taipei, Taiwan. We enumerated the
number of fetal cells in the maternal blood following
the process below:
1. Incubating blood sample with fetal cell specific
antibody
2. Capturing fetal nucleated red cells and trophoblasts
utilizing nanostructural microfluidic chip (CytoAurora
Adhesion-Cavity Chip)
3. Identifying the target cells via CytoAurora Cell
Analysis Tool (CAT)
4. Isolating intact fetal cells using CytoAurora pick-it-up
system
5. Verifying the fetal cells by molecular analysis, FISH,
STR or NGS
Result: The preliminary results showed that the
CytoAurora Cell Reveal System can effectively catch
and isolate fetal cells from maternal blood during the
first trimester.
8 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Conclusion: We can envision that this system may
facilitate the advent of a revolutionary non-invasive
prenatal diagnosis.
0125
Characteristic of IUGR cases at Dr. Soetomo Hospital
2014-2016, and cerebroplacental ratio (CPR) as a
screening for detecting IUGR
Muhammad Ilham Aldika Akbar, Yoan Alexandria, Aditia
Warman, Manggala Pasca Wardhana, Khanizyah Erza
Gumilar, Budi Wicaksono, Ernawati Dharmawan, Agus
Sulistyono, Hermanto Tri Joewono, Erry Gumilar Dachlan
Dept Obgyn Dr. Soetomo Hospital, Faculty of Medicine
UniversitasAirlangga, Surabaya, East Java, Indonesia
Introduction: Intrauterine Growth Restricted was a
common problem in developing country and the main
cause of perinatal morbidity and mortality.
Objective: To present the characteristics and outcome of
IUGR at Dr. Soetomo Hospital, Surabaya, Indonesia
from 2014-2016, evaluate maternal diseases that cause
IUGR, and calculating the cerebro placental ratio [CPR]
(ratio between middle cerebral artery to umbilical artery
pulsatility index) as a predictor of IUGR. We analyse the
efficacy of CPRs and FL/AC for screening and detection
of IUGR.
Methods: A retrospective cohort study of IUGR cases
from 2014-2016, data was collected from medical record.
Pearson’s correlation test was used to calculate the
correlation between maternal diseases and IUGR.
Ultrasound was done on all cases then we calculate
FL/AC. From the Doppler velocimetry result, we
measure the CPR.
Results: 117 cases were detected to be IUGR from 3327
live births at Dr. Soetomo Hospital from 2014-2016.
The perinatal outcome was perinatal death, Apgar
Score, ventilator or CPAP used. 53% babies born with
IUGR had Apgar score 4-6, 74 babies used CPAP,
and 8 babies used ventilator for breathing assisted. 55
out of 117 (47%) were died (17 cases were AEDV (+)
and 15 cases were REDV (+)). We performed C-Section
on 100 cases, included all cases with REDV (+). There
was a strong correlation between severe preeclampsia,
eclampsia, HELLP syndrome, and SLE with IUGR
(p < 0,01 and p < 0,001). The sensitivity-specificity of
CPR for detecting IUGR was 98,7% and 75% with LR
3,94 higher than FL/AC 64,3% and 33.3% (with CI
95%).
Conclusion: Preeclampsia, eclampsia, HELPP
syndrome, SLE were correlate to IUGR. CPR was proved
to be sensitive for detecting IUGR.
Copyright of individual abstracts remains with the authors.

0165
History-indicated cerclage: Association between
previpus preterm history and cerclage outcome
Kyong-No Lee, Eun-Jee Whang, Kylie Hae-Jin Chang,
Ga-Hyun Son, Keun-Young Lee
Kangnam Sacred Heart Hospital of Hallym University, Seoul,
Republic of Korea
Recently ACOG guideline regarding indication for
History-indicated cerclage (HIC) have changed from
three or more to one or more prior second-trimester
pregnancy loss. However, there are no appropriate
references or evidence to support this guideline. Our
hospital has been performing HIC in patients with one
or more prior second-trimester pregnancy loss history
according to our hospital protocol. We sought to
compare outcome of HIC based on number of prior
preterm history: 1 vs 2 or more in women at risk of
preterm birth. The aim of this study to provide
supportive evidence-based data result regarding
changed guideline.
We conducted a retrospective observational study of
HIC (n = 1270) performed between January 2007 and
June 2016, based on number of prior second-trimester
pregnancy losses related to painless cervical dilation
and in the absence of labor or placenta abruption. The
final population included 420 patients who delivered
at our institute, with 21 patients delivered due to
preeclampsia were also excluded. We evaluated and
compared the perioperative complications and
outcome who delivered in our hospitals between two
groups.
The incidence of delivery before <32 weeks was
statistically lower in in group with one prior second-
trimester pregnancy loss compared to group with
two or more pregnancy losses (15/194 (8%) vs 28/
205 (14%), p = 0.04), but preterm delivery before
<34 weeks and < 37 weeks showed no difference
between two groups (p = 0.06 and p = 0.129,
respectively). PPROM rate was 7% vs 8%, and PPROM
before <32 weeks rate was 2.1% vs 3.4% (p = 0.416 and
p = 0.305, respectively), neonatal NICU admission rate
was 10% vs 17% (p = 0.044), in group with one prior
second-trimester pregnancy loss vs group with 2
or more prior second-trimester pregnancy loss,
respectively.
Our data show that HIC is beneficial and improve
outcome in patients if they have experienced even one
prior preterm delivery, supporting the changed ACOG
guideline of HIC indication.
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
0167
Diagnosis of fetalanemia due to Rh alloimmunization
by MCA Doppler and pregnancy out come
R. Vijetha, Makam Adinarayana
People Tree Hospital, Bangalore, Karnataka, India
Introduction: Maternal alloimmunization occurs when
an Rh negative mother has an immunologic response
to a paternally derived red-cell antigen that is foreign
to the mother and inherited by the fetus. The antibodies
may cross the placenta, bind to antigens present on the
fetal erythrocytes, and cause hemolysis, fetal anaemia,
hydrops fetalis, and fetal death. Despite the availability
of prophylactic rhesus immune globulin, haemolytic
disease of the new-born and fetal death(hydrops fetalis)
due to rhesus alloimmunization, is still a major
contributor to perinatal morbidity and mortality in
India.
Objectives: A study of fetal middle cerebral artery
peak systolic velocity to diagnose fetalanemia and
outcome of the pregnancy in INDIAN obstetric
population.
Methodology: Fetal MCA-PSV was measured in 46
pregnant women referred for ultrasound due to clinical
suspicion of fetomaternal abnormality. Middle cerebral
artery peak systolic velocity was measured by a single
experienced fetal medicine expert on color Doppler
ultrasound machine.
Results: All these patients were followed till delivery
irrespective of intra uterine transfusion or not. Of 17
patients with severe fetal anaemia 5 received intrauterine
transfusion about 40 ml- 50 ml each and 4 patients
delivered a healthy neonate with no requirement of
transfusion in post-natal period and 1 baby received
post-natal transfusion and underwent extended period
of NICU care. And 4 patients without transfusion had
a good pregnancy outcome rest had poor neonatal
outcome.
Conclusion: MCA-PSV is a good predictor of fetal
anaemia and In our experience, intrauterine fetal blood
transfusion was found to be lifesaving, and very
effective in the management of Rh isoimmunized
pregnancies. Early diagnosis of fetal anaemia and
intrauterine transfusion are most important for optimal
perinatal outcome.
9
Fetal Medicine
0191
Cord blood 25-hydroxyvitamin D as a novel marker of
neonatal respiratory disorders
Yumiko Ito, Hiroyuki Tsuda, Tomoko Nakano, Asuka Tachi,
Yukako Iitani, Yoshinori Moriyama, Masataka Nomoto,
Fumitaka Kikkawa
Nagoya University Graduate School of Medicine, Nagoya,
Aichi, Japan
Introduction: Maternal vitamin D deficiency is
associated with lung dysfunction in infants and
neonates, such as wheezing, asthma, and respiratory
distress syndrome (RDS). To determine whether fetal
vitamin D is related with respiratory disorders, we
investigated the association between umbilical 25-
hydroxyvitamin D (25(OH)D) levels and (1) the outcome
of neonatal respiratory function, including RDS and
transient tachypnea of the new-born (TTN). (2) amniotic
lamellar body concentrations (LBCs) which can be a
useful marker to predict fetal lung maturity.
Materials and methods: We registered 49 cases at 31-
41 weeks of gestation treated in Nagoya University
Hospital between August 2011 to May 2015. The 25
(OH)D levels in umbilical vein blood were measured
using ELISA. Amniotic LBCs were measured using a
platelet channel. This study was approved by the Ethics
Committee of Nagoya University Hospital.
Results: RDS/TTN was present in 13 neonates (26.5%).
The mean 25(OH)D levels were statistical significantly
lower in cases of RDS/TTN than those in controls
(12.34 vs 21.81 ng/ml; p < 0.05). Significant positive
correlation was observed between amniotic LBCs and
cord 25(OH)D levels (r = 0.423, p < 0.01) .
Conclusions: Low 25(OH)D levels in cord blood were
associated with complication of neonatal respiratory
dysfunction. Vitamin D deficiency is well known to be
the common problem all age group worldwide, as well
in the pregnant women. Thus, it is suggested that
vitamin D supplementation during pregnancy would
be a protective factor against neonatal respiratory
disorders.
0200
The study of 67 cases diagnosed as trisomy 13 at a
single perinatal center
Hiromi Nagase, Mai Shimura, Megumi Uehara, Shinya
Kondo, Toshiyuki Itai, Akihiko Mochizuki, Hiroshi Ishikawa,
Katsuaki Toyoshima, Yasufumi Itani, Kenji Kurosawa
Kanagawa Children’s Medical Center, Yokohama, Kanagawa,
Japan
To investigate the pregnancy outcome of the fetuses with
trisomy13 and the prognosis of the infants with trisomy
10 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
13, we studied 67cases of trisomy 13 diagnosed
perinatally at our hospital from 1992 to 2016.
Among them, 44 cases were born at our hospital and 23
cases were transferred after birth from other hospitals or
clinics. The median gestational age at delivery was
36w + 7d. Premature delivery occurred in 52% of them.
The male were 33 cases (49%) and the female were
34cases (51%).The median birth weight of them was
2212 g. Intrauterine fetal death (IUFD) occurred in 5
cases of 44 in-born cases. IUFD before the onset of labor
was one case. There were 62case of infants of trisomy 13.
The median survival period was 5.5 days (9 minutes-
400 days). The male infants survived longer than the
female infants. (18 days vs 5 days p = 0.024) Among the
live born infants 9 cases could go home. They could stay
home for 45 days (5-102 days). Among the 67 cases, 31
cases (46%) were diagnosed as trisomy 13 prenatally.
There were no significant difference about the sex,
gestational age at delivery, the mode of delivery, the rate
of the congenital cardiac defect and the rate of anomaly
of central nervous system between the prenatal
diagnosed group and the non-prenatal diagnosed group.
The birth weight of the cases with prenatal diagnoses
were heavier than that of the cases without prenatal
diagnoses. (p = 0.004) And in the non-prenatal diagnosed
group 23% could go home though in the prenatal
diagnosed group only 3% could go home. (p = 0.031)
And the survival period of the non-prenatal diagnosed
group was significantly longer than that of the prenatal
diagnosed group.
These findings constitute critical information for the
couples whose fetuses or infants have been found to
have trisomy 13.
0213
Raising confidence threshold increases the positive
predictive value of a SNP-based NIPT for the 22q11.2
microdeletion
Allison Ryan, Rae Lee, Sushma Iyengar, Zachary Demko
Natera Inc., California, USA
Introduction: In addition to aneuploidies, non-invasive
prenatal testing (NIPT) using cell-free DNA in maternal
plasma can also detect subchromosomal anomalies such
as the 22q11.2 microdeletion. We previously reported a
high sensitivity (97.8%) and specificity (99.2%) of the
SNP-based NIPT for 22q11.2 screening.
Objectives: To examine whether raising the confidence
threshold at which the algorithm for a SNP-based NIPT
for the 22q11.2 microdeletion makes a positive call
would increase the positive predictive value (PPV)
without affecting test sensitivity.
Copyright of individual abstracts remains with the authors.

Methodology: 20 776 NIPT samples received between
Feb–Aug, 2014 were previously evaluated for the
22q11.2 deletion using primers targeting 672 SNPs in a
2.9 Mb segment of 22q11.2, and analyzed using a high-
risk confidence threshold of 0.90. Follow-up
information, including ultrasound findings, were
collected for high-risk cases. Here, the algorithm’s
confidence threshold was raised to 0.95, and PPV
recalculated for the entire cohort and for the subset of
cases with prior-known directly-associated ultrasound
anomalies (high a priori risk) and with no prior-known
anomalies (low a priori risk).
Results: At the original confidence cut-off, the test had a
PPV of 18%, which increased to 42.3% upon reflex-
sequencing of high-risk samples at a higher read depth
(HDOR).Raising the algorithm’s confidence level further
increased the PPV to 52.4% and reduced the false
positive rate from 0.12% to 0.07%, with no loss in test
sensitivity. The PPV was 100% for high a priori risk cases,
and 20% for low a priori risk cases.
Conclusion: The updated methodology (raised
confidence level + reflexing) eliminated 80% of the FP
cases originally reported, yielding an improved PPV
for this SNP-based NIPT (52.4% vs. 18%). Given the
higher than previously-reported incidence of the
22q11.2 microdeletion and benefits of early intervention,
we expect this improved test to be highly beneficial in
prenatal testing.
0222
“THE POUCH” A case of esophageal atresia: prenatal
diagnosis, pregnancy and neonatal management
Fritzie Aurea Sales, Marie Catheleen Santiago
Manila Central University, Caloocan City, The Philippines
Objectives: To present a case of a 27 year old G2P0
(0010) at 32 weeks age of gestation with fetal esophageal
atresia. This case shows the essential role of prenatal
ultrasound in diagnosing a congenital anomaly.
Methods: A systematic approach in the ultrasound
diagnosis of esophageal atresia was done. Prenatal
suspicion of esophageal atresia is usually based on
association of polyhydramnios with an absent stomach
bubble and esophageal pouch. Prenatal diagnosis
allowed the multidisciplinary teams and the family to
be prepared for the birth and planned prompt treatment
of the affected neonate. Close antenatal surveillance is of
utmost importance, being careful to watch out for
preterm labor and preterm premature rupture of
membranes.
Results: Routine ultrasound study revealed
polyhydramnios, absent gastric bubble and dilated
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
esophageal pouch which led to the diagnosis of fetal
esophageal atresia. Amnioreduction was done to
alleviate maternal symptoms and prolong pregnancy.
She delivered to a preterm baby boy weighing
2450 grams. Work up done confirmed esophageal
atresia, isolated type. Baby underwent cervical
esophagostomy and gastrostomy on the second day of
life and eventually discharge improved on the 31st day
of life.
Conclusions: Prenatal diagnosis of esophageal atresia
improves the outcome of affected neonates by allowing
optimization of both prenatal and postnatal care. It
helped a lot in preparing the family as well as the
physicians for a thorough management, planned
delivery and prompt surgical correction thereby
allowing an excellent neonatal outcome.
0233
A case report of prenatal diagnosis of sirenomelia
using 2D/3D USG
Wai-Lam Lau, Ah-Lai Liu, Wai-Kuen Yung, Wai-Chu Wong
Kwong Wah Hospital, Hong Kong
Case summary: This was 30-years old, G3P0 + 2
women. Nuchal scan at 12 + 5wk revealed normal
nuchal translucency. The right leg appeared to be
normal but the left leg could not be well identified.
There were similar findings on rescan at 13 + 1wk.
Subsequently, 2D/3D USG at 16 + 1 weeks revealed
the presence of right femur, single deformed right calf
bone and right foot. The left leg could not be
identified. In addition, there were single umbilical
artery and oligohydramnios. Medical termination of
pregnancy was performed at 16 + 3 weeks. Gross
examination of the abortus revealed single right leg
with femur and calf bone present, absent external
genitalia and imperforated anus. Babygram confirmed
the prenatal findings. The placental biopsy revealed
normal karyotype, 46XY. The clinical picture was
compatible with sirenomelia type VI with single femur
and single tibia.
Discussion: Sirenomelia is a rare and lethal congenital
anomaly characterized by fusion, rotation, hypotrophy
or atrophy of the lower limb. Prenatal diagnosis during
first trimester by either 2D or 3D has been reported.1
The exact cause of sirenomelia is not known. It has
been postulated as damage to the caudal mesoderm
of the embryo between days 13 to day 22. There have
been reports on the association between sirenomelia
and drug exposure. For this patient, she had taken
clarithromycin 500 mg BD from day 11 to day 17
which overlapped the vulnerable period. However,
11
Fetal Medicine
no association could be demonstrated between the use
of clarithromycin in the first trimester of pregnancy
and major malformations according to a recent
nationwide cohort study. 2
References:
1. Singh C et al. Diagnosis of Sirenomelia in the First Trimester. J
Clin Ultrasound 2014; 42:355–359.
2. Anderson JT et al. Clarithromycin in Early Pregnancy and the
Risk of Miscarriage and Malformation: A Register Based
Nationwide Cohort Study. PLoS One 2013; 8(1): e53327.
0251
Two cases of Twin Reversed Arterial Perfusion (TRAP)
sequence
Kim Suk Young, Choi Min Jung, Lee You Jung, Jung Sun
Young
Gachon University Gil Medical Center, Incheon, Republic of
Korea
Twin Reversed Arterial Perfusion (TRAP) sequence is a
unique complication of monozygotic twin pregnancy.
The severity of this syndrome depends on the type of
anastomosis, volume of acardiac twin, and the timing
of detection. Acardiac recipient twins are failed to
develop cardiac anatomy and function during
embryogenesis because of insufficient oxygen supply
from arterial-to-arterial anastomoses, but they grow in
volume by blood perfusion from the pump twin. On
the other hand, the pump donor fetuses usually have
normal anatomy but due to prematurity and the
anomalous perfusion circuit, they have an increase in
risk of perinatal morbidity and mortality. Treatment is
focused on the prevention of intrauterine fetal death
of the pump twin. There are many treatment options
such as observation, medications (indomethacin,
digitalis, tocolysis), and surgical interventions (ligation
of the acardiac twin’s umbilical cord, embolization of
the acardiac twin’s umbilical artery with absolute
alcohol).
Two different cases of TRAP sequence were reviewed
at our institute. There are few report of surviving
pump twins and embryo-pathology of amorphous
fetus. In the review of pump twin in both cases,
unfortunately, there could not be thrive as well.
Therefore, we reviewed the proper treatment of
TRAP sequence, providing concepts for further
studies and the morphological abnormalities of
acardiac twins.
12 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
0253
Perinatal management of the Cantu syndrome: A case
report
Akihiko Mochizuki, Hiroshi Ishikawa, Megumi Uehara,
Masaya Kondo, Naho Koshimizu, Toshiyuki Itai, Hiromi
Nagase, Katsuaki Toyoshima, Yasushi Itani
Kanagawa Children’s Medical Center, Yokohama, Japan
Background: Cantu syndrome is a rare disorder
characterized by congenital hypertrichosis, neonatal
macrosomia, a distinct osteochondrodysplasia, and
cardiomegaly. Cantu syndrome is caused by mutations
in the ABCC9 gene, and it has been newly added to the
list of KATP channelopathies.
Case presentation: We report a case of a 22-year-old
primiparous woman who had recurrent
polyhydramnios. She needed drainage of amniotic fluid
five times until 34 weeks of gestation. Fetal heart showed
myocardial hypertrophy and cardiomegaly at 34 weeks
of gestation. She had a Caesarean section due to
preeclampsia at 38 weeks of gestation. Her baby boy
weighting 4349 g had congenital hypertrichosis,
characteristic face, persistent ductus arteriosus (PDA),
cardiomegaly, and skeletal abnormalities. He underwent
PDA ligation on day 6, and was treated for cardiac
failure. Genetic analysis revealed mutations in the
ABCC9 gene.
Conclusions: To the best of our knowledge, this is the
first case of fetal Cantu syndrome in Japan; only few
studies have reported prenatal findings of Cantu
syndrome. There is a possibility that undiagnosed cases
of Cantu syndrome may exist in cases of unexplained
polyhydramnios and macrosomia.
0263
Fetal stroke - Intrauterine Intracranial Hemorrhage
Olubunmi Oniya1, Abdullah Ibrahim2, Huda Saleh2, Aya
Aly2, Ramy Wahba2, Amina Sayed2, Ashley Robinson1,
Karim Kalache1
1
Sidra Medical and Research Centre, Doha, Qatar, 2Hamad
Medical Coporation, Doha, Qatar
Introduction: We present an unusual case of Fetal
intracranial hemorrhage (FICH) at 33 weeks. A 34 year
old gravida 5 had presented with persistently reduced
fetal movement for 5 days and increased head
circumference on ultrasound scan. She was admitted to
the labor ward with suboptimal CTG tracing.
Background: Antenatal period was uneventful with
normal serial ultrasound. She was Rhesus positive. She
had previously presented to the emergency room at
28 weeks (6 weeks prior to the diagnosis of FICH) with
a history of fall at home which did not involve her

abdomen. She was discharged after a normal scan and
CTG.
Investigation: USS revealed a HC equal to 40 weeks
with a significant FICH and a large retracting clot. Fetal
brain was displaced with a midline shift. The lateral
ventricles were dilated at 17 mm. There was significant
cerebral edema and dilated arterial-venous plexuses.
MCA Doppler was normal.
Management: CTG and fetal movement improved.
Fetal MRI was carried out and plans made for delivery
if CTG deteriorated. Maternal Antiplatelet antibody
and Viral screen was negative. MRI showed extensive
episodic and ongoing haemorrhage covering both the
parietal, frontal lobes as well as the posterior fossa.
Fetus was in “windswept” posture. Decision was
made to deliver by Caesarean section in view of
ongoing bleeding. A female infant was delivered
weighing 2.6 kg, Apgars 6 & 9. Hemoglobin was
4.8 g/dl, Platelets and coagulation profile was normal.
A Neurosurgical procedure was done to place a sub-
dura drain. The baby did well and was discharged
on day 24. No other abnormality/vascular
malformation were noted on brain imaging.
Conclusion: Cases of fetal intracranial hemorrhage are
well documented and most are thought to be associated
with trauma. It is however unusual for hemorrhage to
persist after this length of time. Other causes of FICH
include Neonatal alloimmune thrombocytopenia,
Infection, Clotting disorders, Thrombosis and Artero-
venous malformations.
0264
A case series on methamphetamine abuse in
pregnancy
Anna Therese Abiog, Vaneza Valentina Penolio
Quirino Memorial Medical Center, Quezon City/NCR, The
Philippines
Introduction: Globally, one out of three drug users is a
woman. In the Philippines, it is estimated that there are
1.3 million drug users. Perinatal drug abuse from 7
perinatal centers in Manila showed 22.6% prevalence
among pregnant women with 21.4% positive for
methamphetamine.
Methods: Case series
Cases
Patient 1 is a 26 year old G6P5 (5004) Pregnancy
Uterine 33 5/7 weeks age of gestation by last menstrual
period in Preterm Labor who is a methamphetamine
user for 12 years. She was diagnosed with concomitant
Iron Deficiency Anaemia corrected with blood
transfusion. Patient delivered a live term male
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
appropriate for gestational age and underwent bilateral
tubal ligation.
Patient 2 is a 31 year old G6P4 (4014) Pregnancy Uterine
38 weeks’ age of gestation by last menstrual period. She
is a methamphetamine user for 12 years. She presented
with anaemia and gestational hypertension. Patient
underwent low transverse caesarean section due to
prolonged fetal bradycardia and delivered a live term
female small for gestational age. Baby was treated for
Neonatal Pneumonia.
Patient 3 is a 25 year old G5P3 (3013) unknown weeks
age of gestation. She is a methamphetamine user
for 2 years. Urine drug test was positive for
methamphetamine. Patient delivered a live term female
appropriate for gestational age.
There were no observed signs and symptoms of opioid
withdrawal for all new-borns.
Summary: A case series of three young multigravid
patients with history of methamphetamine abuse is
discussed. Management was directed towards
determining whether methamphetamine use posed
adverse effects on maternal and neonatal health.
Anaemia was corrected, fetal well-being ensured,
sexually-transmitted infections screened, counselling
and rehabilitation was made, contraception was offered
and neonatal screening for opioid withdrawal was done.
Methamphetamine abuse leads to a downward cycle of
habits preventing the woman from seeking proper
health care for herself and her baby.
0265
Can we avoid failed non-invasive prenatal testing
(NIPT): case series in a tertiary hospital
Wei Ching Tan, Vivian W.L. Ang
Singapore General Hospital, Singapore
Non-invasive prenatal testing (NIPT) for aneuploidies is
based on cell-free fetal DNA (cfDNA) analysis in the
maternal blood. Non-invasive prenatal testing (NIPT) is
a useful clinical test for the detection of common fetal
aneuploidies. While the accuracy of aneuploidy
detection outperforms existing screening tests, failed
results from NIPT have been reported. Maternal
characteristics that affects fetal fraction include high
maternal BMI, maternal weight, maternal age and an
early gestational age. Autoimmune diseases affect fetal
fraction levels and cause increased variance in cfDNA
counts. In this series of 4 cases, we discuss the various
reasons for failed NIPT.
Mdm A had 3 previous miscarriages and first two NIPT
samples failed due to failure to meet threshold for
quality control. A third sample showed low risk for the
13
Fetal Medicine
3 trisomies. NIPT results could not be obtained for the
Mdm B as 2 samples failed for the same reason. Mdm
C was of advanced maternal age who conceived via in-
vitro fertilisation. The first NIPT failed due to low fetal
fraction and the 2nd sample confirmed low risk result.
Mdm D had a significant history of Immune
Thrombocytopenic Purpura (ITP), Antiphospholipid
Syndrome (APS) and 3 previous miscarriages. All 3
samples failed due to high variance in cfDNA counts.
A late termination was performed at pre-viable gestation
for severe eclampsia and severe fetal growth restriction.
The main reasons for a failed NIPT result were largely
due to insufficient fetal fraction and failure to meet
thresholds for quality control.
Healthcare workers should be sufficiently
knowledgeable to counsel expectant couples when
offering NIPT as a screening test. Conditions for a
successful NIPT should also be maximised. NIPT can
be integrated into clinical practice contingent on the
results of FTS such that risk assessment from FTS is
available in event of failed NIPT
0292
Multidrug maternal therapy for fetal supraventricular
tachycardia - a case report
Fathima Minisha1, Melissa Archangela Deniz1, Sawsan
AlObaidly1, Reema Kamal2
1
Department of Obstetrics and Gynecology, Hamad Medical
Corporation, Doha, Qatar, 2Department of Pediatrics, Hamad
Medical Corporation, Doha, Qatar
Background: Fetal tachycardia occurs in 0.5% of all
pregnancies, out of which the most common is supra
ventricular tachycardia. If left untreated, this leads to
cardiac failure, hydrops and ultimately fetal death.
Modern imaging allows accurate diagnosis and
maternal administration of anti-arrhythmic drugs is an
established practice. We present a case of fetal supra-
ventricular tachycardia (SVT) diagnosed in utero and
successfully managed by multi drug therapy by a
multidisciplinary team including pediatric cardiologist,
adult cardiologist and obstetrician.
Case report: A healthy 31 years old, gravida 3 para 1,
presented at our tertiary care hospital at 32+ weeks
gestation, and was diagnosed with fetal SVT with
evidence of cardiac failure on her first ultrasound scan.
The fetal heart rate was found to be 229/min and there
was evidence of mild pericardial effusion with ascites.
After administering steroids for lung maturity, therapy
was started with i/v digoxin followed by oral.
Flecainide was added when there was no response
with digoxin monotherapy. Flecainide was replaced
14 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
with sotalol for the next four days and on the fifth
day amiodarone was added, and this helped achieve
cardio-version on day 14 of admission. The mother
tolerated the medications well. She labored
spontaneously and delivered a 2.6 kg baby boy at
35 weeks gestation. The baby was discharged home
on day 7 on once daily dose of amiodarone with
outpatient follow up.
Conclusion: The most commonly used first line
medication, digoxin, failed as a mono-therapy in our
case as there was already evidence of hydrops. A
multi-drug therapy of digoxin, sotalol and amiodarone
successfully achieved cardio-version. This report
suggests that the therapy needs to be titrated according
to the response and the maternal tolerance.
0309
Changing pattern of prenatal testing for down
syndrome: women’s choice
Chung Fan Poon, Suk Ling Kwok, Annisa Shui Lam Mak,
Helena Hui Ling Lee, Teresa Wei Ling Ma, Kwok Yin Leung
Department of Obstetrics and Gynaecology, Queen Elizabeth
Hospital, Hong Kong
Introduction: Universal prenatal screening for Down
syndrome (DS) was started in public hospitals from July
2010 while self-financed non-invasive prenatal testing
(NIPT) (cell –free DNA) have been available since
August 2011 in Hong Kong.
Objectives: We investigated (a) women’s uptake of
invasive prenatal diagnosis (IPD) and (b) prenatal
detection rate of DS after introduction of NIPT.
Methodology: All pregnant women screened positive
(with a risk > = 1 in 250) by conventional DS screening
in our center, mostly first-trimester screening, 1 year
before (pre- NIPT) and 1, 2 and 3 years after the
introduction of NIPT (post-NIPT) were studied
retrospectively. NIPT was not publicly funded.
Descriptive analysis and Chi-square test were used.
Patients who had NIPT were given counseling and
mid-trimester anomaly scans. All pregnancies outcomes
were traced.
Results Of 4288, 5726, 5618, and 6544 women screened in
pre-NIPT and in years 1, 2 and 3 (post-NIPT), 306 (7.0%),
362 (6.3%), 401 (7.1%), 458 (7.0%) were screened positive
respectively. In year 1, 2 and 3, 49 (13.5%), 107 (26.7%)
and 169 (36.9%) of them had NIPT while IPD rate
(chorionic villus sampling and amniocentesis) decreased
by 16.1%, 25.6% and 32.6% respectively (p < 0.001). Rate
of no further testing decreased in year 3 (p < 0.001).
There was no increase in IPD rate for scan abnormalities
before and after NIPT introduction (p = 0.7771). Prenatal
Copyright of individual abstracts remains with the authors.

detection rate of DS remained similar in pre-NIPT and in
years 1, 2 and 3 (100%, 86.4%, 95.7%, 94.4% respectively;
p = 0.4219). There were no false negative cases for NIPT.
Conclusions: IPD rate had decreased significantly for 3
consecutive years, without reduction in prenatal
detection rate of DS or increase of IPD for scan
abnormalities, attributed to more women choosing NIPT
after a positive conventional DS screening test. More
counseling and anomaly scan are required to support
those choosing NIPT.
0312
Outcomes of monochorionic twin pregnancies
managed in multiple pregnancy clinic
Annisa Shui Lam Mak, Helena Hui Ling Lee, Chung Fan
Poon, Suk Ling Kwok, Teresa Wei Ling Ma, Kwok Yin
Leung
Department of Obstetrics and Gynaecology, Queen Elizabeth
Hospital, Hong Kong
Introduction: In July 2010, we set up the multiple
pregnancy clinic (MPC) to provide a one-stop service
that offers both antenatal follow up and ultrasound
examinations by our maternal and fetal medicine
(MFM) team using a standardized protocol.
Objective: We aim at reviewing the complications and
neonatal outcomes of monochorionic (MC) twin
pregnancies managed in MPC.
Methodology: We retrospectively reviewed the
outcomes of all MC twins managed in our MPC in
2010 to 2014. Complications including selective
intrauterine growth restriction (sIUGR), twin-twin
transfusion syndrome (TTTS), short cervix, fetal
anomalies and twin anemia polycythaemia sequence
(TAPS) were diagnosed and managed according to
international guidelines. Chi-square and t-test were used
for statistical analysis.
Results: For the 152 MC twins with known outcomes,
out of 160 MC twins in total, at least one survival
(ALOS) rate was 88.8%. Miscarriage (<24 weeks), with
rate being 6.6%, was the main cause of fetal loss.
There were three cases with severe anomalies, two of
them were terminated and one miscarried. sIUGR
was more common (30.9% vs 13.2%, p = 0.001) than
TTTS, and associated with a lower preterm delivery
before 32 weeks (13.3% vs 45.0%; P = 0.002), and a
higher ALOS rate (97.9% vs 70.0%, p < 0.001). Of 47
sIUGR, three required bipolar coagulation of cord
before 24 weeks. Of 20 TTTS, nine were subsequently
treated by endoscopic laser photocoagulation of
placental anastomoses, one by amnioreduction, and
one by radiofrequency ablation of umbilical cord.
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
TAPS was identified in four cases (2.6%), and all of
them survived after preterm delivery. Without any
complications, ALOS rate was 100% after 24 weeks
and there was no intrauterine fetal death after
34 weeks.
Conclusions: Among MC twins, majority of fetal loss
occurred before 24 weeks. Specialized care is required
for frequent monitoring and timely management when
evidence of complications is detected.
0313
A fetus with lethal chromosomal abnormality lead to a
spontaneous abortion in the first trimester
Yu Wakimoto1, Hideaki Sawai1, Maiko Misaki2, Kyoko
Minagawa2, Goh Wakimoto1, Mako Ueda1, Hiroyuki
Tanaka1, Shinichiro Kobayashi3, Naoko Ohama4, Minoru
Shigeta4, Yasuhiro Takeshima2, Hiroaki Shibahara1
1
Department of Obstetrics and Gynecology, Hyogo College of
Medicine, Nishinomiya, Hyogo, Japan, 2Department of
Pediatrics, Hyogo College of Medicine, Nishinomiya, Hyogo,
Japan, 3Koba Ladies Clinic, Himeji, Hyogo, Japan, 4Fuchu
Nozomi Clinic, Izumi, Osaka, Japan
Background: It has been considered that the difference
in infertility, recurrent pregnancy loss (RPL), and
congenital disorders is a degree of mutation if the cause
is a chromosomal abnormality. Some of infertility may
occur due to large chromosomal mutations, which
prevents pregnancy, owing to natural selection at the
embryo stage. Some of RPL may also be due to moderate
chromosomal mutations that lead to a spontaneous
abortion. Small chromosomal mutations result in
children delivered with an aberrant chromosome. In this
study, we compared karyotype analysis of the products
of conception in first-trimester miscarriage, second-
trimester fetal chromosomal abnormalities with
amniotic fluid, and peripheral blood in the neonatal
period.
Methods: Informed consent was obtained from all
patients. In total, 161 patients in 3 facilities who had
spontaneous abortions during the first trimester were
included in this study; Karyotype analysis was possible
in 148 cases. 2057 patients who had prenatal diagnosis
of fetal chromosomal abnormalities by amniocentesis
during the second trimester and 117 cases who had
karyotype analysis of peripheral blood in the neonatal
period were included in this study.
Results: The cases of chromosomal abnormality in the
products of conception, amniotic fluid, and the new born
are 107(71.8%), 153(7.43%), 45(38.5%), respectively. The
classification and composition of abnormal karyotypes
are trisomy 66(61.7%), 95(62.1%), 36(80%). Other
15
Fetal Medicine
abnormal karyotypes are 41, 58, 9. The cases of 21-
trisomy are 4(3.7%), 59(38.6%), 45(62.2%) (products of
conception vs amniotic fluid:P<0.01) (products of
conception vs newborn:P<0.01) .
Discussion: If a baby is born with an aberrant
chromosome, there would be several cases of 21-trisomy.
In other abnormal karyotypes, a fetus may lead to a
spontaneous abortion in the first trimester rather than
second trimester.
0315
Sequence of ultrasonographic findings in prenatal
fetal ovarian cyst complicated with spontaneous
intracystic hemorrhage
Kasem Raungrongmorakot, Tharangrut Hanprasertpong,
Maysita Suksamarnwong, Wipada Laosooksathit
Department of Obstetrics and Gynaecologist, Faculty of
Medicine, Srinakharinwirot University, Nakhon Nayok,
Thailand
Fetal ovarian cyst commonly presents as anechoic, thin
wall and unilateral cyst. Intracystic bleeding is rare and
mostly suspected by ultrasonographic presentation. All
previous reported case occurred at late third trimester of
pregnancy and all infants were delivered normally with
fetal ovarian tumour with hemorrhage as the diagnosis.
Thus, a sequence of ultrasonographic appearance for fetal
ovarian cyst complicated with spontaneous intracystic
bleeding has never been reported. Herein, the
ultrasonographic appearance for fetal ovarian cyst
complicated with spontaneous intracystic bleeding
sequencing in a 3-weeks period was revealed.
0329
Evaluation of oligohydramnios and pregnancy
outcome at term
Apurba Bhattacharya1, Ashish Bhattacharjee2, Jupirika
Pyrbot3
1
Jorhat Medical College, Jorhat, Assam, India, 2Gauhati
Medical College, Guwahati, Assam, India, 3NEIGHRIMS,
Shillong, Meghalaya, India
Amniotic fluid which surrounds developing fetus in
amniotic sac provides several benefits to the fetus.
Estimation of amniotic fluid volume is generally done
ultrasonographically. The causes and fetal outcome of
early onset oligohydramnios are different from late onset
oligohydramnios. This study was conducted during the
period from July 2011 to June 2012 in the Department
of O&G, Gauhati Medical College, Guwahati, India for
assessment of maternal factors associated with
oligohydramnios to evaluate pregnancy outcome and
perinatal outcome in cases with oligohydramnios at
16 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
term pregnancy. Women at term (> 37 weeks), who
had singleton pregnancy in cephalic presentation, were
subjected to USG and the AFI was calculated and were
divided in to three groups; Group A with AFI < 5,
Group B with AFI 5–8 and Group C with AFI > 8. A total
of 200 cases were studied- they were categorized as
Group A (AFI < 5), Group B (AFI 5–8) and Group C
(AFI > 8). Most of them were primigravida in the age
group 21–30 years, with mean gestational age
39.52 + 1.45 weeks(Group A),40% of the study group
did not have any antenatal complications. The rate of
LSCS in Group A was 69.09%, Group B 49.23% and
Group C 22.5%. Perinatal morbidity in Group A, B and
C were respectively 10.9%, 6.15% and 6.25% respectively
and no perinatal mortality seen in all the groups. The
result of the study was similar to that of international
data in terms of perinatal morbidity and mortality. High
Caesarean rate was seen due to more elective cases and
difference in the mode of termination. No perinatal
mortality seen due to early detection of fetal distress,
early intervention and good NICU facilities.
0331
Placental growth factor and pregnancy associated
plasma protein-a in Mongolian pregnant women
Enkhtaivan Tserendulam1, Tserensambuu Urjindelger2,
Erkhembaatar Lkhagva-Ochir3
1
Maternity Hospital "Khuree", Ulaanbaatar, Mongolia,
2
National Center for Maternal and Child Health, Ulaanbaatar,
Mongolia, 3Maternity Hospital "Urguu", Ulaanbaatar,
Mongolia
Introduction: In recent years, many biochemical markers
have been widely used in screening of pregnancy
disorders and chromosomal abnormality. The
biochemical markers vary depending on the nationality,
women age and gestational period. A study on identifying
Mongolian women’s level has not been yet carried out.
Objectives: To evaluate PIGF and PAPP-A in first
trimester pregnancy
Methodology: The study was conducted for 200
pregnant women with 11-13 + 6 weeks by using the cross
sectional method. The level of PAPP-A and PIGF in their
blood was measured on the Victor D machine of Perkin
Elmer Company.
Results: The study covered 18-45 aged pregnant
women. The average level of PAPP-A in the blood of
11-14 weeks pregnant women was 626,51 mU/L (95%
CI 550.22-702.79), (11-11 weeks - 482,94, 12 weeks -
602,32, 13 weeks - 815,70), whereas the average level of
PlGF was 49,34 pg/mL (95% CI 41.34-57.35) (11 weeks
- 34,23, 12 weeks - 49,62, 13 weeks - 64,55).
Copyright of individual abstracts remains with the authors.

Conclusion: The level of PlGF and PAPP-A in blood
increases depending on the pregnancy age.
0334
Applying a fetal-fraction based risk score (FFBR) to SNP-
based NIPT with ‘no results’ due to low fetal fraction
Allison Ryan, Trudy McKanna, Shifra Krinshpun, Rae Lee,
Kimberly Martin
Natera, Inc., San Carlos, CA, USA
Background: Fetal fraction (FF), a critical metric in non-
invasive prenatal testing (NIPT), is influenced by several
factors-gestational age, maternal weight, and other
placental and biological factors (including chromosome
abnormalities, such as trisomies 13 and 18, and
digynictriploidy). Some professional society guidelines
recommend that women who receive a ‘no result’ due
to low FF on NIPT are directly offered invasive
diagnostic testing. However, not all women with low
FF are truly at risk of aneuploidy or other adverse
outcomes.
Objective: To determine the relative risk for certain
chromosome abnormalities for cases that received a
“no result” due to low FF using a fetal-fraction based risk
(FFBR) model that adjusts for maternal weight and
gestational age.
Methods: Clinical follow-up was collected on 1352
patients who received ‘no results’ due to low FF on
NIPT. The FFBR score, computed by comparing the
observed FF with three models (‘normal’, ‘trisomy 13
or 18’, ‘digynictriploidy’), identifies cases with lower-
than-expected FF, corrected for gestational age and
maternal weight. When FFBR is <1%, the total
aneuploidy rate is consistent with prior risk. High FFBR
scores indicate a > 1% risk of FF-related aneuploidy.
Results: Women with high FFBR scores had a greater
than 10-fold increased risk of a FF-related aneuploidy
than women with low FFBR scores (4.8% vs. 0.4%). For
cases with a high FFBR score, the incidence of pregnancy
loss or aneuploidy was 17.4%, versus 2.9% for cases with
a low FFBR score. The rate of trisomy 21 in both FFBR
groups (high and low) was consistent with a priori risk.
Conclusions: We have validated the FFBR model for
women who received no results on NIPT due to low
FF. The FFBR score may provide clinicians with
additional information on patients’ relative risk for
aneuploidy.
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
0337
The effect of antenatal steroid treatment on the fetal
pulmonary Doppler wave form in women at a risk of
preterm delivery
Geum-Joon Cho, Hai-Joong Kim, Min-Jeong Oh, Soon-Cheol
Hong, Ki-Hoon Ahn, Hyo-Soon Hwang, Yoo-Jin Lee, Jae-
Young Sim
Korea University College of Medicine, Seoul, Republic of
Korea
Objective: The aim of this study was to evaluate the
effect of steroid treatment on the fetal pulmonary
Doppler wave form, acceleration time (At)/ejection time
(Et) ratio in women at a risk of preterm delivery.
Materials and Methods: Pregnant women at 24-
34 weeks who admitted due to the risk of impending
preterm delivery and received steroids for fetal
pulmonary benefit were enrolled. Fetal pulmonary
artery Doppler velocity waveforms were measured at
the level of the main pulmonary artery before, and
1 day and 7 days after treatment. The changes of At/Et
ratio by steroid treatment were calculated between the
measurement point.
Results: A total of 47 pregnant women were enrolled.
At/Et ratios were not different between before and
1 day after treatment. However, At/Et ratio increased
7 days after treatment compared with before and 1 day
after treatment. Similar patterns were found in At
between three measurement points. However, there was
no difference in Et between three measurement points.
Conclusion: In this study, we found that steroid
treatment increased At/Et ratio 7 days after treatment
by increase of At. This suggests that ultrasound
evaluation of fetal pulmonary artery Doppler wave form
may be a promising new noninvasive technique to
monitor the effect of steroid treatment.
0368
The utility of umbilical venous flow volume in
predicting birth weight in the human foetus
Afrooz Najafzadeh1,2,3, Jan Dickinson2
1
Global Diagnostics Australia, Mandurah, WA, Australia,
2
School of Women’s and Infants’ Health, The University of
Western Australia, Perth, WA, Australia, 3School of Health
Professions, Murdoch University, Mandurah, WA, Australia
Background: The umbilical venous flow volume is a
direct physiological representation of the amount of
nutrients and oxygen reaching the foetus from the
placenta. Although the umbilical venous flow volume
is reported to be reduced in growth restricted foetuses,
its association with neonatal birth weight has never been
examined in normal human pregnancies.
17
Fetal Medicine
Methods: In a prospective, longitudinal ultrasound
study of 136 low risk singleton pregnancies in Western
Australia, the umbilical venous blood flow volume was
calculated three times in pregnancy (18, 26 and 34 weeks
gestation) using Doppler ultrasound. The mean internal
diameter of the umbilical vein and its mean flow velocity
were used to calculate the flow volume using a validated
formula. A series of general linear regression models
were derived with neonatal birth weight as the
dependant variable and umbilical venous flow volume
at each gestation as the main predictor variable.
Maternal BMI and gestation at birth were entered in
the models as confounder variables.
Results: Median maternal age was 30. The mean birth
weight was 3475 grams (SD 490) with the mean gestation
at birth of 38.9 weeks (SD 1.22). The umbilical venous
blood flow volume was 28.7 ml/min (SD 10.3) at
18 weeks which increased to 131.5 ml/min (SD 38.1) at
26 weeks and 268.9 ml/min (SD 82.4) at 34 weeks
gestations respectively. The umbilical venous flow
volumes at 26 weeks (B-Coefficient 2.94, p-value 0.001)
and at 34 weeks (B-Coefficient 1.69, p-value 0.000) were
significant predictors of birth weight after controlling
for maternal BMI and gestation at birth.
Conclusion: The umbilical venous flow volume from
26 week gestation can act as a useful adjunctive tool in
predicting foetal growth, as it is significantly associated
with neonatal birth weight.
0375
Obstetric outcome of pregnancies complicated by
anencephaly beyond the age of viability: A 25 year
single tertiary maternity hospital experience
Jis Thomas1,2, Sawsan Al Obaidly1, Mahmoud Abujubara1
1
Women’s Hospital, Hamad Medical Corporation, Doha,
Qatar, 2Royal College Of Obstetricians and Gynecologists,
London, UK
Background: Anencephaly is a lethal type neural tube
defect. Early prenatal diagnosis is essential to provide
parents with the option of pregnancy termination. This
wouldn’t be applicable in cases of late diagnosis or if
parents opt to continue with pregnancy. We aimed in
our study to review the obstetric impact and natural
history of anencephaly managed beyond the age of
viability.
Methods: A retrospective chart review of cases with
prenatal diagnosis of anencephaly, who had antenatal
follow-up and gave birth after 24weeks gestation in the
period of 1990 till 2014 in Women’s Hospital, Qatar.
Results: A total of 37cases were studied. The average
maternal age was 28 years (range 20-42). Qatari women
18 ©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
were 35%(13/37) and non-Qatari were 65%(24/37).
Primigravidas were 24%(9/37). Maternal overt diabetes
in 13%(5/37)
The average gestational age at diagnosis was 21 weeks
(range 12-41). Induction of labor in 54%(20/37). The
average gestational age at birth was 34 weeks (range
25-44 weeks)
Intrauterine fetal demise was documented in 57%(21/
37) and livebirth was in 43%(16/37). The average birth
weight was 1505 grams +/- 740 grams.
The rate of successful vaginal birth was 70% (26/37) The
rate of primary Caesarean section for failed induction or
abnormal lie was 8% (3/37) and the rate of repeat
Caesarean section was 22% (8/37). There were no
differences in achieving vaginal birth in the group who
had induction of labor compared to spontaneous labor
with a rate of caesarean section of 10% (2/20) compared
to 11% (1/9) respectively.
One case of shoulder dystocia. No reported cases of
APH, PPH, complicated caesarean sections or uterine
rupture.
Conclusion: Our study includes the largest case series of
anencephaly managed beyond the age of viability. Apart
from the tendency for post-term pregnancies, diagnosis
of anencephaly doesnot pose significant increased
maternal risk. Our study provides a valuable tool for
obstetricians with evidence-based counselling for
parents of anencephalic fetuses who opt to continue the
pregnancy.
0392
Risk of intra-amniotic infection/inflammation and
respiratory distress syndrome according to the birth
order in twin preterm neonates
Seung-Mi Lee1, Jeong-Won Oh1, Sun-Min Kim2, Byoung-Jae
Kim2, Chan-Wook Park1, Jong-Kwan Jun1, Joong-Shin Park1
1
Department of Obstetrics and Gynecology, Seoul National
University College of Medicine, Seoul, Republic of Korea,
2
Department of Obstetrics and Gynecology, Seoul
Metropolitan Government Seoul National University
Boramae Medical Center, Seoul, Republic of Korea
Objective: In epidemiologic studies, it has been
suggested that non-presenting twins are more likely to
develop respiratory distress syndrome (RDS) than
presenting twins. The underlying mechanism of this risk
is not well determined, although it is well known that
exposure to intrauterine inflammation reduces the risk
of respiratory morbidity in singleton gestation. In the
current study, we have compared the risk of intra-
amniotic infection/inflammation (IAI) and RDS
according to the birth order in twin preterm neonates.
Copyright of individual abstracts remains with the authors.

Methods: The study population consisted of twin
neonates who delivered preterm (≤35 weeks of
gestation) and underwent amniocentesis within 7 days
of delivery. The frequency of IAI and RDS was
compared between presenting and non-presenting
twin pairs. Amniotic fluid (AF) was cultured for
aerobic/anaerobic bacteria and genital mycoplasma
and intra-amniotic inflammation was defined as AF
WBC ≥19/mm3. The frequency between twin pairs
were compared with McNemar test, and a
generalized estimating equation was used in
multivariate analysis.
©Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology.
Copyright of individual abstracts remains with the authors.
Fetal Medicine
Results: A total of 104 twin pairs were enrolled. The risk
of IAI was lower in non-presenting twin than presenting
twin (23.1% vs 34.6%, p < 0.05), and non-presenting
twins had higher frequency of RDS than presenting twin
(26.9% vs 18.3%, p < 0.05). In multivariate analysis, the
relationship between IAI and RDS remained significant
after adjustment for birth order and gestational age.
Conclusions: In preterm twin neonates, non-presenting
twin had lower risk of IAI and was more likely develop
RDS. The relationship between IAI and RDS can be the
underlying mechanism in the higher risk of RDS in
non-presenting twin.
19