We report prenatal diagnosis of torcula herophili thrombosis (THT), in three cases.

Chronic villitis/intervillositis of unknown etiology: Clinical features and perinatal outcome. Munoz H1, Solari C2, Campanella C3, Perez A4, Vial MT1, Munoz G1, Germain A1.

1. Obstetrics and Gynecology, Hospital Clinico Universidad de Chile/Clinica las Condes, Santiago de Chile, Chile. 2. Obstetrics and Gynecology, Hospital Clinico Universidad Catolica , Santiago, Chile.

3. Obstetrics and Gynecology, Hospital Base Curico, Santiago, Chile. 4. Imagenologia, Clinica Las Condes, Santiago, Chile.

Objectives:

The aim of this study is to describe the clinical behavior of pregnancies with placental placental histologic diagnosis of Chronic villitis/intervillositis of unknown etiology (CVUE).

Methods:

Retrospective descriptive study of all CVUE cases occurring during a 13-year period in a tertiary care hospital. All cases of CVUE were diagnosed by placental histology by a single pathologist. We reviewed patient data of all CVUE cases, characterizing their clinical and ultrasound features, pregnancy associated diseases and perinatal outcomes. Continuous variables with abnormal distribution data are shown as mean and ranges. Categorical variables are shown as absolute value and proportion.

Eighteen pregnancies had FGR (50%). The median gestational age at diagnosis was 31 weeks. Besides from four patients with thrombophilia and one with Hypothyroidism, none of the remaining patients from FGR group had maternal associated pathologies. Only three FGR pregnancies had increased uterine artery pulsatility index (PI) (3/18), four had increased umbilical artery PI (4/18), nine had cerebral vasodilatation (9/18) and one had ductus venosus reversed a-wave (1/18). As for maternal characteristics, 24,3% had history of recurrent miscarriage and 10,8% had history of FGR or stillbirth.

Conslusions:

CVUE is a rare placental disorder characterized by a chronic cellular inflammation of villous stroma and intervillous space. , discovered in patients with poor obstetric outcomes. FGR, fetal demise and preterm delivery are highly prevalent among these patients. High recurrence rate of CVUE in next pregnancy has been reported. Novel prevention strategies are urgently needed.

FGR (<10)

FGR (<3) Preterm Stillbirth Abortion Normal Total

Focal 7 3 6 1 2 1 13

Multifocal 12 4 11 2 2 4 24

Total 19 7 17 3 4 5 37Results: We analyzed 37 cases of CVUE. Mean maternal age was 34,5 years (range 28-46 years). Among all placenta specimens, 64.9% were classified as moderate/severe (multifocal) and 35.1% as mild (focal). Thirty-two (86,4%) of patients exhibited a poor perinatal outcomes including fetal growth restriction (FGR), early or late spontaneous abortion, stillbirth, preterm birth and neonatal death; only five (13.9%) were born without any complication. Collectively 92% of the focal and 83% of the multifocal CVUE had adverse perinatal outcomes.

Table 1. Perinatal outcomes

Case 3. Patient referred at 32+3 weeks pregnancy, ultrasound and MRI examination showed a 51 x 39 x 54 mm heterogeneous image located on the mid line posterior fossa, over tentorium. Cerebral hem isphe re was d i sp laced and seve re ventriculomegaly was observed. THT and secondary severe ventriculomegaly diagnosis was sugges ted . Dur ing p regnancy THT and ventriculomegaly size progressively reduced. Cesarean section was performed at term pregnancy. New born physical examination, cerebral Ultrasound and MRI were normal.

EP08.12 Prenatal diagnosis of torcula herophili thrombosis: A report of three cases Hernan Muñoz1, Gianna Munoz2, Yazmin Copado Mendoza3, Ximena Ortega4, Sandra Acevedo3, Juan Manuel Gallardo3,

Caterina Solari5, Alejandro Cerda2, Ana Luisa Perez 2 1. Obstetricia y Ginecologia, Hospital Clnico Universidad de Chile/Clinica las Condes, Santiago de Chile, Chile. 2. Obstetricia y Ginecologia, Hospital Clnico Universidad de Chile, Santiago, Chile.

3. Instituto Nacional de Perinatología Isidro Espinosa de los Reyes , Ciudad De Mexico, Mexico. 4. Imagenologia, Clinica Las Condes, Santiago, Chile.5. Obstetricia y Ginecologia, Hospital Clinico Universidad Catolica , Santiago, Chile.

Case 1. Patient was referred at 23+3 weeks of pregnancy, ultrasound examination revealed a 23 x 21 x 23 mm heterogeneous image located on the mid line posterior fossa, over tentorium. No vessels objectivized. Cerebral hemisphere was displaced without ventriculomegaly. Images suggested THT diagnosis. T1 and T2 MRI confirmed these findings.D u r i n g p r e g n a n c y, T H T s i z e progressively got reduced. Cesarean section was performed at term pregnancy. New born cerebral Ultrasound and MRI were normal.

THT is an uncommon diagnosis, at this time no more that 60 cases have been published. Etiology is unknown, and

prognosis go from spontaneous regression until cerebral atrophy and fetal death. In our cases THT was not associated with others CNS malformations and all cases had a favorable

evolution with spontaneous regression at birth.

Abstractobjective:We describe a series of pregnancies diagnosed with Ballantyne Syndrome, in which the fetal etiology thatconditionedthediseasewasidentified,aswellfetalandmaternalclinicalcondition.Abstractmethods:Informationwascollectedfromtheclinicalrecords.Biodemographicdatawasobtained,aswellastheetiologyofthesyndrome,clinicalpicture,maternalbiochemicalandimagingresultsandperinataloutcome.

BallantyneSyndrome:CaseseriesSilvaMC,CopadoDY,ViverosG,Parra-CorderoM,AcevedoS, MuñozG,MuñozHUniversidaddeChile,Clinica lasCondes, InstitutoNacionaldePerinatología, IsidroEspinosadelosReyes.

AbstractconclusionThe Ballantyne syndrome is a severe maternal complicationassociatedwithsomefetalconditionthatproducesheartfailurewithor without hydrops, with a high rate of neonatal mortality andmaternalmorbidity.

AbstractresultsFourcaseswerediagnosedduringthestudyperiod).Thepatientswere33yearsold(22.5-40.0),twomultiparousand two primiparous. Two corresponded to monochorionic double twin gestations and the other two, singlegestations.Theetiologyinmonochorionicpregnancieswererelatedtomonochorionicspecificcomplications,fetalfetal transfusion syndrome (TTTS) and selective intrauterine growth restriction (sIUGR) type II associated withpolyhydroamnios on a twin with Beckith Weideman syndrome. One fetus had hypertrophic cardiomyopathy,polyhydramniosandsubsequentnon-immune fetalhydrops in thecontextofNoonansyndrome (Fig,1)., and theotherhadalimblymphangiohemangiomacompatiblewithKlipplelTrenaunayWebersyndrome(Fig.2).TheTTTScasewasmanagedwithamnioreductionat21weeks,butevolvedwithapremature ruptureofmembranesandsecond-trimester abortion 24 hours later amnioreduction. Selective restriction pregnancywas interrupted at 34weeksandBallantynesyndromewasdiagnosedpostpartum.Thefetuscarryingthecardiomyopathyat29weeks,developedfetalhydropsandthepregnancywasimmediatelyinterrupted,buttwohourslaterthenewborndied.Inourfourthcase,thefetuswithKlipplerTrenaunayWeberSyndromeandfetalhydrops,wassuccessfullymanagedwithtransplacentaldigoxin,whichrevertedhydrops,andpregnancywasinterruptedat39weeks.Intheimmediatepostpartum, themother developedhypertension, oliguria, hyperkalemia anddilutional anemia, compatiblewithBallantynesyndrome.Inourseries,thematernalclinicalconditionwiththemostconsistentoutcomewasthepresenceofnormochromicanemia induced by hemodilution, generalized edema in all 4 cases, followed by hypertension in three cases,increaseofPro-BNPintwocasesandpulmonaryedemainonecase.

Figure1

Figure2

Case 2. Patient was referred at 25+4 weeks of pregnancy, ultrasound and MRI e x a m i n a t i o n s h o w e d a 2 1 m m heterogeneous image located in the mid line posterior fossa, over tentorium. No vessels and no mass effect were observed. THT diagnosis was suggested. At 30 weeks of pregnancy THT reduced to 17 mm diameter. Patient is still pregnant.

PENTALOGY OF CANTRELL. A EIGHTEEN CASES SERIES.

Muñoz H, Copado DY, Aguilera S, Campanella C, Perez A, De La Fuente S, Muñoz G, Solari C, Acevedo S.

1. Obstetrics and Gynecology, Hospital Clinico Universidad de Chile/Clinica las Condes, Santiago, Chile. 2. Obstetrics and Gynecology, Hospital Clinico Universidad Catolica , Santiago, Chile.

3. Obstetrics and Gynecology, Hospital Base Curico, Santiago, Chile. 4. Department of Pathology, Clinica las Condes, Santiago, Chile

5. Obstetrics and Gynecology Clinica Las Condes, Santiago, Chile