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Poster Session II: Perinatal Diagnosis and Therapy a Case of HELLP Syndrome in Primigravida Carrying Twins *Sande Zlateski (1)

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Poster Session II: Perinatal Diagnosis and Therapy a Case of HELLP Syndrome in Primigravida Carrying Twins *Sande Zlateski (1) Poster session II: Perinatal diagnosis and therapy A case of HELLP Syndrome in primigravida carrying twins *Sande Zlateski (1), Snezana Zlateska (2), Sofija Zlateska (1), Snezana Gorgonoska (1), Zaharija Partaloska (1), Ylber Kokale (3) (1) General Hospital, Ginecology and Obstetrics, Struga, R. Macedonia; (2) General Hospital, Neonatology, Ohrid, R. Macedonia; (3) Public Health Organization, Debar, R. Macedonia Introduction: HELLP Sy is a form of severe preeclampsia, found in 4-12% of pregnant women suffering from this clinical condition. The syndrome consists of the following triad: Haemolysis, Elevated liver enzymes and Low platelets. The HELLP syndrome can be found isolated or accompanied with all symptoms of the EPH complex. Aim: The aim of this study is to present a case of appropriately and in due time diagnosed and treated HELLP syndrome in primigravida carrying twins. Case study: A twenty-nine year old primigravida carrying twins was examined. She was in the 25th week of gestation and was admitted to hospital due to pain in the epigastrium and right subcostal area, accompanied with nausea and vomiting. The patients BP was 140/100mmHg, and the laboratory test Results proved anaemia (Hb=86g/L, RBC=3.13x1012/L, Hct=0.27); thrombocytopenia (PLT=80 000/mm³); elevated liver enzymes (ALT=144 IU/L, AST=215 IU/ L). The patient was transmitted to the Clinic for Gynecology and Obstetrics where the pregnancy was terminated. The decision was made upon the severe clinical condition and the fact that twin pregnancy in early week of gestation was in question.. Conclusion: Symptoms found in HELLP syndrome are non-specific, thus it can often be misdiagnosed with hepatitis, atrophia flava hepatis, purpura thrombocytopenica and syndroma haemorhagicum. Therefore it is important to recognize the symptoms of the HELLP syndrome as soon as possible, and if needed to terminate the pregnancy in due time. All these measures help prevent hepatic coma development and patient’s exitus Corresponding author: Sande Zlateski [email protected] Phone: ++389 70 509797 722 Poster session II: Perinatal diagnosis and therapy Antenatal invasive treatments in monochorionic gestations *Mariana Veiga (1), Alexandra Sofia (1), Telma Almeida (1), Dulcina Ramada (1), Carla Barbedo (2) (1) Hospital S Sebastiao, Obstetrics and Gynecology, Santa Maria Feira, Portugal; (2) Centro Patologia do Desenvolvimento, Porto, Portugal Monochorionic pregnancy occurs in 20-30% of multiple gestations. In 10-15% of these twin-to-twin transfusion sydrome may occur. Ultrasonography is of primordial importance for diagnosing chorionicity, major abnormalities, evaluation of chromossomophaties markers and for the therapy of this syndrome. The authors present two patients with twin-to-twin transfusion sydrome beginning on early second trimester (weeks 14 and 16). Both were treated by laser fethoscopy at King`s College Hospital. In both only the receptor fetus survived. We conclude that the outcome for the giving fetus is very reserved (antenatal mortality rate is higher - 18 to 35%). Laser therapy can improve mortality rate on the receptor fetus and potentially reduces neurologic morbidity. Corresponding author: Dulcina Ramada [email protected] Phone: ++351 91 9221874 723 Poster session II: Perinatal diagnosis and therapy Congenital cystic adenomatoid malformation (CCAM) associated to fetal hydrops in a diamniotic-dichorionic pregnancy *Mª Dolores Gómez Roig, Edurne Mazarico, Elisabet Miró, José Mª Lailla San Joan de Déu University Hospital, Obstetrics and Gynecologist, Barcelona, Spain; Introduction: CCAM represents 25% of congenital lung malformations, but 75% of those with prenatal diagnosis. CCAM Results from an abnormality of branching morphogenesis of the lung, due to a mistake in the maduration of bronchiolar structures. The survival rate is usually good (70-85%). Case report: 21 years-old patient, without pathological antecedents. Blood group O Rh positive with negative serologies and indirect Coombs test. Diamniotic-dichorionic spontaneous pregnancy, with correct gestational controls. At 23rd weeks of gestation a left thoracic hiperecogenic mass of 40x60mm that moved completely the heart was found in one of the fetuses, suggesting CCAM type III, associated to skin edema, pleural effusion, ascites and polyhydramnios. No abnormalities were found in the other fetus. Postnatal confirmation of the diagnosis of CCAM was made, doing at 40 days of life, a left upper pulmonary lobectomy, with a good course afterwards. Discussion: CCAM and shift of the mediastinum may lead to obstruction of the inferior vena cava and cardiac compression, Resulting in the development of hydrops from increased central venous pressure. Hydrops is associated with a minority of fetus with CCAM (8-10%), and usually occurs in big malformations. The size of the lesion and the presence of hydrops are the determinant neonatal prognostic factors. The survival rate of non-hydropic fetuses is almost 100%, while with hydrops is less than 10%. It is important to point out the infrequent association of CCAM and hydrops, and the good postnatal course of the newborn. Corresponding author: Edurne Mazarico [email protected] Phone: ++34 93 626360935 724 Poster session II: Perinatal diagnosis and therapy Obstetrical and perinatal outcome in twin-to-twin transfusion syndrome *Costin Berceanu (1), Sabina Berceanu (1), Elena Coleta (2), Oana Sorina Tica (3), Andrei Adrian Tica (3), Sidonia Vrabie (1) (1) University of Medicine and Pharmacy, Obstetrics and Gynecology, Craiova, Romania; (2) University of Medicine and Pharmacy, Neonatology, Craiova, Romania; (3) University of Medicine and Pharmacy, Pharmacology, Craiova, Romania Objective – Twin-to-twin transfusion syndrome (TTTS) is the Result of an intrauterine blood transfusion from one twin to another twin. TTTS represents a condition that develops in about 10- 25% of monochorionic twin pregnancies. Our paper is targeting to evaluate the obstetrical and perinatal outcome in TTTS pregnancies. Methods – our research has been developed on a lot of 29 patients diagnosed with twin pregnancies, between 1/2006 and 1/2009. There have been identified 7 twin pregnancies presenting TTTS (24.13%). The diagnostic pattern included: same sex of the fetuses, thin membranary septum, stuck twin aspect, lack of the lambda sign, Doppler anomalies, one hydramnios sack and one olygoamnios one, weight discordance, urinary bladder identification, nuchal translucency or small CRL. Results – there have been diagnosed 6 monochorionic and 1 bichorionc twin pregnancies with TTTS. Pregnancy outcome for the 7 cases with TTTS consisted in 2 vaginal deliveries and 5 caesarian sections. Significant birth weight discordances occurred in all of the cases with TTTS. One case of severe TTTS in a bichorionic twin pregnancy with in utero fetal death and mummification of the dead fetuses. Placental vascular anastomoses were detected in 100% of the cases. In 6 cases with medium or low grade of TTTS, perinatal outcome was satisfactory. Conclusions – TTTS is a serious fetal condition which can lead to unfavorable maternal and fetal prognosis when unidentified or untreated. Death of one fetus in TTTS can lead to neurological lesions or intravascular disseminated coagulation with a somber prognosis for the living fetus. Corresponding author: Costin Berceanu [email protected] Phone: ++40 722 728180 725 Poster session II: Perinatal diagnosis and therapy Use of modified ultra-thin fetoscope for laser coagulation of placental anastomoses in twin-to- twin transfusion syndrome significantly improves neonatal outcome *Michael Tchirikov, George Gatopoulos, Miriam Strohner International Center for Education of Prenatal Diagnosis and Mikroinvasive Fetal Surgery, Clinic of Obstetrics and Gynecology, Mainz, Germany Objective: The laser coagulation of placental anastomoses is nowadays the standard treatment of twin-to-twin transfusion syndrome (TTTS). The main complication of fetoscopy is the iatrogenic induced preliminary rupture of the membranes (PROM), which significantly increases the rate of prematurity accompanied by worse neonatal outcome. The extent of the fetoscopical damage of the amniotic membrane could be responsible for PROM. Materials and methods: The neonatal outcome after laser coagulation of placental anastomoses was compared in prospective study between groups with TTTS staging II to IV and 16th-26th weeks of gestation using modified ultra-thin sheath and flexible 1.0 to 1.2mm optic (n=15) and standard inflexible 2mm optic (n=45) (Karl Storz, Germany). Results: The survival rate for at least one child was 100% in ultra-thin fetoscope group vs. 97.1% in inflexible fetoscope group and 90% vs. 74.3% for both. Using ultra-thin equipment significantly prolonged the duration of the pregnancy from 231.5±27.2 days to 252.8±15.7 days (p<0.05). The neonatal weight of donor twin was significantly increased in ultra-thin fetoscope group from 1753±725 to 2,424±840g (p=0.04) and 1963±691 to 2519±734 of recipient (p=0.06). The TTTS staging, GA, APGAR 5min and used laser energy were not significantly different between both groups. Conclusion: The reduction of the extent of the fetoscopic amniotic membrane damage using modified ultra-thin fetoscope for laser coagulation of placental anastomoses in patients with TTTS significantly improves neonatal outcome. Corresponding author: Michael Tchirikov [email protected] Phone: ++49 6131 173291 Fax: ++49 6131 175581 726 Poster session II: Perinatal diagnosis
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