22nd World Congress on Ultrasound in Obstetrics and Gynecology Poster abstracts

babies out of the 88 (15.90%) MCDA twins were admitted to

neonatal unit and had mean gestational age of 35.76 (1.29) weeks.
Conclusions: There is no statistically signicant (P > 0.05) difference
between vaginal delivery rates of uncomplicated MCDA and
uncomplicated DCDA twin pregnancies delivering after 34 weeks.
The rate of admission of babies to neonatal unit was similar in both
these groups. Vaginal delivery should be considered as an option
in uncomplicated MCDA twins without a signicant increase in
neonatal morbidity.
P14.06
Report on a case of combined intrauterine and abdominal
pregnancy neglected on ultrasonographic examination in the
rst-trimester
L. Wang
Ultrasound Department, Chinese PLA General Hospital,
Beijing, China
A patient at the age of 30 years was found to have amenorrhea for
40+ days and a positive urinary pregnancy test. Ultrasonographic
examination on the 7
th
week of amenorrhea revealed an intrauterine
pregnancy with a CRL of the embryo in 0.3 cm. Free uid was seen in
the pelvic cavity in a depth of about 1.3 cm. No other abnormality
was found. Follow-up examination at the 12
th
menstrual week
showed that the CRL of the fetus has grown to 5.8 cm and the
NT was not thickened. Repeated ultrasound scanning in the 21
th
week of amenorrhea revealed 2 fetuses, of whom one was at an
estimated gestational age of 20 weeks plus 6 days while the other
was 2 weeks plus 2 days smaller and in much lower position.
Dichorionic twin pregnancy was considered. Another ultrasound
examination at 26 menstrual weeks and 2 days showed that this was
a combined intrauterine and abdominal pregnancy of 25 weeks plus
1 day, another abdominal fetus had one umbilical artery and was
located left laterally behind the uterus. MRI examination conrmed
the diagnosis. The patient was hospitalized and received ultrasound
examination once every 2 to 3 weeks. With the growing gestational
weeks, the severer growth restriction occurred in the abdominal
fetus. Ultrasound examination at 33 menstrual weeks and 6 days
showed very weak heartbeats with irregular low heart rate of
74100 beats/min in the abdominal fetus. The diastolic blood ow
of the umbilical artery disappeared. The estimated gestational age
of the abdominal fetus was 27 weeks plus 2 days and the EBW was
1164 g. The fetus was dying. Surgical sectioning was done to take
out the two fetuses on the following day. The nal diagnosis was
a combined intrauterine- abdominal pregnancy with death of the
abdominal fetus. The birth weight of the survived intrauterine fetus
was 1990 g.
P14.07
Complete hydatidiform mole and co-existing live fetus
(CHCF): ultrasound diagnosis is possible by 6 weeks gestation
C. Cranston
1
, T. Dinolfo
1
, K. Odunse
2,3
, P. Frederick
2,3
,
S. Mann
1,3
1
Ob/Gyn, Rochester General Hospital, Rochester, NY, USA;
2
Gynecologic Oncoloy, Roswell Park, Buffalo, NY, USA;
3
Ob/Gyn, University at Buffalo, Buffalo, NY, USA
CHCF is a rare form of twin pregnancy that is challenging
to diagnose but crucial to identify because of the potential for
complications (fetal loss, pre-eclampsia, hemorrhage, persistent
gestational trophoblastic disease). A 17 year old G1P0 initially
presented to the emergency room with nausea and vomiting and
previously undiagnosed pregnancy. Quantitative BHCG was 40,866
and an ultrasound (see picture) demonstrated two intrauterine
gestational sacs. In one gestational sac there was a viable fetus
consistent with a 6 week 2 day gestation. The other sac was notable
for no evidence of a fetal pole or yolk sac and contained a
heterogenous echogenic mass. The patient had an aminocentesis
at 18 weeks and 1 day showing a normal 46 XX karyotype. The
patient wanted to continue with the pregnancy understanding the
risks associated with CHCF. The patient ultimately presented at
19 weeks with vaginal bleeding and pre-eclampsia. bHCG was
94,513. A dilation and extraction was performed and pathology
conrmed a diagnosis of complete hydatidiform mole and co-
existing live fetus. 10 weeks after the TOP her quantitative bHCG
was 30. This interesting case represents the earliest diagnosis of
CHCF reported in the literature. Early identication of this rare
twin complication is important to allow for adequate counseling
and management of this potentially life threatening condition.
Supporting information can be found in the online version of
this abstract.
P14.08
Prediction of the risk of Cesarean delivery after induction of
labor based on clinical and ultrasound parameters in twin
gestations
K. Park, S. Lee, A. Ryu, S. Kim, K. Oh, A. Kim
Department of Obstetrics and Gynecology, Seoul National
University College of Medicine, Seoul National University
Bundang Hospital, Seongnam, Republic of Korea
Objectives: To develop a model based on clinical and ultrasound
parameters to predict the risk of Cesarean delivery after induction
of labor in twin gestations.
Methods: The study population consisted of 141 consecutive
women with twin gestations at >36.0 weeks of gestation who
were scheduled for induction of labor. Seventy-four patients were
prospectively recruited from October 2008 to October 2011 and
67 patients entered into a previous prospective investigation of
induction success (dened as the achievement of the active phase
of labor) were retrospectively collected from March 2004 to
September 2008. Ultrasound measurement of the cervical length
and determination of the Bishop score were performed. The data
collected at enrolment included maternal age, height, weight, parity,
length of pregnancy, Bishop score and cervical length. Receiver-
operating characteristics curve and logistic regression analysis were
used for statistical analysis.
Results: Thirty-nine (27.6%) of these 141 women had Cesarean
delivery. Logistic regression analysis identied maternal height,
parity, and cervical length, but not maternal age, weight or Bishop
score, as the best predictors of cesarean delivery. A risk score based
on a model including these 3 parameters was calculated for each
patient. The model was shown to have an adequate goodness of
t (P = 0.253), and the area under the curve was 0.744, indicating
reasonably good discrimination.
Conclusions: Maternal height, parity, and cervical length are the
most important parameters in predicting the risk of Cesarean
delivery after labor induction in twin gestations. A predictive model
using these parameters at the initiation of labor induction provides
useful information in the decision-making process regarding the
mode of delivery.
P14.09
Fetal reex movement in twin pregnancies late in the rst
trimester: 4D sonographic study
K. Kanenishi, M. Ito, N. Mori, E. Uketa, U. Hanaoka,
H. Tanaka, A. Shiota, T. Hata
Perinatology and Gynecology, Kagawa University School of
Medicine, Kagawa, Japan
Objectives: The objective of this study was to evaluate reactions to
touch in utero between twin fetuses using 4D sonography late in the
rst trimester of pregnancy.
226 Ultrasound in Obstetrics & Gynecology 2012; 40 (Suppl. 1): 171310