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P389 Ductus venosus Doppler velocimetry in twin pregnancies with placental insufficiency
S524
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
having the double test taken later (≥10+0 weeks). Regarding 40 cases of trisomy 18 and 13 we found no such difference. P385 Ultrasound findings during pregnancy in a woman with Noonan syndrome: A case report R. Lopez, E. Cervantes, E. Aranda, H. Alvarado, F. Morales, G. Soto, H. Flores, M. Garcia. Hospital San Jose Tec de Monterrey Background: Diagnosis of Noonan Syndrome is often difficult because of the high variability of clinical symptoms. In prenatal diagnosis symptoms sometimes may only be visible in a restricted time frame or are unspecific and will not lead to an unequivocal diagnosis. We report the ultrasound findings during pregnancy in a fetus of a woman with Noonan Syndrome. Case: A 24 year old primigravida woman with Noonan Syndrome diagnosed during childhood was referred to our unit with 17 weeks gestational age for an ultrasound examination. Antenatal surveillance was carried out by a multidisciplinary team involving a fetal medicine consultant and cardiologist. Fetal cardiac ultrasound was made at 21 weeks gestational age reported as normal. An anomaly scan was performed at 23 weeks gestational age and so far the fetal growth and amniotic fluid remained in normal ranges. During a routine scan at 28 weeks gestational age was observed polyhydramnios with amniotic fluid index of 27 and a decrease in the growth of femur and humerus length (both in the 10th centile). These changes persisted until delivery where a healthy boy was born by cesarean section at 38+5 weeks gestational age with a short length for gestational age and a heart murmur. The diagnosis of Noonan Syndrome was confirmed in the neonatal period. Conclusion: Although the karyotype is not specific, in women with Noonan Syndrome the ultrasound findings during pregnancy could be a useful test for prenatal diagnosis of a congenital affection providing proper maternal counseling. P387 Diagnosis and evolutionary control of a nuchal cord in the first term of gestation by means of three dimensional/four dimensional (3D/4D) echography and angiography A. Mart´ınez Aspas, F. Raga Baixauli, F. Bonilla Musoles. Hospital Cl´ınico Universitario de Valencia Objectives: To establish the incidence of a nuchal cord in the first term of gestation and to accomplish an evolutionary control of them with the aim of establishing the evolution and a prognosis of these cases. Material and Methods: Ten thousand unique gestations have been studied in the 12th week of gestation by means of 3D/4D echography and 3D angiography to establish the incidence of nuchal loops around the fetal neck in the first term of gestation. Likewise, in the cases in which a nuchal cord was discovered, an evolutionary monitoring until the childbirth in order to establish their evolution and prognosis was realized. Results: Nuchal cord was discovered in the first term of gestation in 18% of the studied gestations. Among these, 82% of the cases were single loop, 13% were double and only 5% showed three or more loops. The presence of one or two nuchal cord in the first term of gestation did not suppose a worse prognosis related to the control group. However, the presence of three or more nuchal cord increased the intrauterine mortality in a significant form. Conclusions: 3D/4D echography with the aid of 3D angiography represents a highly efficient method to detetc nuchal loops around the fetal neck in the first term of pregnancy. The presence of one nuchal cord does not influence the evolution of the pregnancy. On the other hand the presence of three or more nuchal cord in the first term of gestation carries a high risk of intrauterine mortality during the course of the gestation.
P388 Acidemia at birth and fetal cardiac injury in severe placental insufficiency before 34th week gestation S. Miyadahira, R. Nomura, F. Cabar, V. Costa, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Objectives: Placental insufficiency and fetal growth restriction may lead to fetal hypoxia and acidemia, which result in fetal cardiac injury and dysfunction. The aim was to study the correlation between acidemia at birth and fetal cardiac troponin T (cTnT) according to ductus venosus (DV) Doppler abnormalities. Methods: Between March 2007 and Dec 2008, 23 singleton pregnancies with severe placental insufficiency characterized by abnormal umbilical artery Doppler were prospectively studied. All the patients delivered by cesarean section and the Doppler exams were performed at the same day. Immediately after delivery, UA blood samples were obtained for pH measurement and for cTNT levels measurements. Acidemia at birth was detected when umbilical artery pH < 7.20 and abnormal level of fetal cTnT was characterized when ≥0.10 ng/mL. Statistical analysis included Mann Whitney U test, Chi-square test and Fisher’s exact test. Results: The fetuses that presented acidemia at birth (n = 15, 65.2%) were significantly associated with abnormal levels of fetal cTnT (73.3%) when compared to group with normal pH at birth (25%, p = 0.04, Fisher’s Exact test). In the group with acidemia at birth, DV PIV > 1.20 occurred in nine cases (60%), and in the group with pH ≥ 7.20 only 1 case presented DV PIV >1.20 (12.5%, p = 0.07, Fisher’s Exact test). Conclusion: Acidemia at birth correlated significantly with elevated fetal cTnT levels at delivery in growth-restricted fetuses by placental insufficiency detected before 34th weeks. Abnormal DV PIV represents severe cardiac compromise and cardiac injury would be present when abnormalities in the DV Doppler are detected. P389 Ductus venosus Doppler velocimetry in twin pregnancies with placental insufficiency T. Liao, R. Nomura, A. Liao, M. Brizot, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Introduction: Placental insufficiency in twin pregnancies may lead to fetal growth discordance and fetal distress. In intrauterine growth-restricted (IUGR) fetuses, ductus venosus (DV) dopplervelocimetry has been proposed in the clinical assessment of fetuses that have abnormal umbilical artery (UA) Doppler. The aim of this study was to describe the DV Doppler before birth in five twin pregnancies with severe placental insufficiency. Methods: Prospective observational study including five sets of twin pregnancies in which one fetus presented abnormal umbilical artery (UA) dopplervelocimetry and the co-twin, normal UA Doppler. Doppler studies were performed on the day of delivery. Results: One patient had a vaginal delivery (28w5d) and four were delivered by cesarean section (37w, 36w, 34w, 34w4d). Fetal growth discordance ranged from 20 to 68%. All four fetuses with normal growth and UA Dopplers had normal ductus venosus pulsatility index for veins (mean DV PIV 0.58, range 0.40–0.74). Three fetuses with growth restriction presented normal DV PIV (0.54, 0.47 and 0.86), and the cesarean were performed without fetal biophysical activities abnormalities, and birth conditions were respectively: 2,230 g, Apgar 8/9/9, pH = 7.19; 690 g, Apgar 7/9/9, pH = 7.14 and 1,370 g, Apgar 9/9/9, pH = 7.27. The other two growth restricted fetuses presented reversed a-wave in DV Doppler and abnormal DV PIV (1.22 and 4.61). One of them showed late decelerations (1,000 g, Apgar 9/9/10) and the other was stillbirth (410 g). Conclusions: Ductus venosus Doppler abnormalities is a parameter to evaluate the degree of fetal circulatory compromise in twin
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
pregnancies complicated by placental insufficiency and fetal growth discordance. P390 Construction of a database for the Chinese male fetal heart Q. Pei Objective: To provide an anatomic foundation and to establish an anatomy atlas and a three-dimensional model of the fetal heart, we established a 60 mm cross-sectional image database of the heart of a Chinese male fetus. Materials and Methods: A 31-week Chinese stillborn male fetus was used for the model. The fetus underwent a systemic ultrasonographic examination at 24-weeks gestation which revealed no abnormalities in the heart or other systems..A loss of fetal movement had been reported by the gravida at 31 weeks. A “W”-shaped impression appeared during ultrasound of the neck, and the heartbeat of the fetus was lost. All thoracic organs as a whole were removed from the thoracic cavity after formalin fixation and then frozen at −25º C for 2 hours. Frozen sections, 60 mm in thickness, were prepared and macro-shot with a digital camera to obtain image data for the serial section planes. Results: A total of 871 images of the cross-sections of the fetal heart were obtained at a high resolution (3888×2592 pixels). These images of the sections with a capacity of 2.28 G were stored in JPEG format. Images of the cross-sections not only showed the structures visible in the ultrasonic cardiogram, such as the atrioventricular cavity, cardiac valve, chorda tendineae, papillary muscles, superior and inferior vena cava, pulmonary vein, ductus arteriosus, and aortic arch and its branches, but also displayed clear cardiovascular structures that were difficult or even impossible to show in the ultrasonic cardiogram, such as the coronary sinus, main coronary artery and branches, vertical vein, azygos vein, and hemiazygos vein. The typical cross-sections can be viewed from the apex to the base of the heart as follows: section of two ventricles, section of the coronary sinus, section of the four-chamber heart, section of the five-chamber heart, section of three blood vessels, cross-section of the catheter bow, and cross-section of the aortic arch. All planes of the sections coincided with the fetal cross-section in the ultrasonic cardiogram. This database also reflected the positional relationship of the fetal heart to the descending aorta, vena cava, trachea, and esophagus at different levels of sectioning. Conclusion: A rich database showing the features of the fetal heart was built, and an anatomy atlas and three-dimensional model will be constructed for teaching, scientific research, and clinical applications. P391 Prenatal ultrasound assessment of development of fetal eyeballs and orbits according to gestational age M. Pietryga1 , M. Karolczak-Kulesza2 , A. Brazert2 , J. Kociecki2 , M. Brazert3 , J. Brazert1 . 1 Department of Obstetrics and Women’s Diseases, Poznan University of Medical Sciences; Head: Prof. Jacek Brazert, 2 Department of Ophthalmology, Poznan University of Medical Sciences, 3 Department of Endocrinology, Infertility and Reproductive Endocrinology Poznan University of Medical Sciences; Head: Prof. Leszek Pawelczyk Objectives: Prenatal ultrasound assessment of eyeballs’ and orbits’ development, their proportions and topographic relations according to gestational age. Materials and Methods: A group of 62 healthy pregnant women, directed every month (12–38 wks of gestation) to prenatal ultrasound assessment of fetuses’ eyeballs and orbits. Biometric measurements of eyeballs and orbits were performed. Fetus biometry, morphology and weight were also assessed. Authors have analyzed proportions of eyeballs’ and orbits’ development depending on gestational age and fetus biometry (BPD, HC).
S525
Results: The eyeballs’ growth between 12th–20th wks of gestation was 3.79–10.15 mm, in 32nd wks (15.48–15.61 mm) achieving values close to those obtained in perinatal period (16.04–16.72 mm in 38th wks). EOD/IOD ratio (external interangular diameter/ internal interangular diameter) also changes during prenatal period from 19.12–20.31 mm/7.60–9.30 mm in 12th wks to plateau in 32nd wks (57.34–62.12 mm/19.23–21.33 mm), reaching highest growth acceleration between 27th and 32nd wks. HC values from 186–187 mm in 20th wks to 245–247 mm in 27wks, achieving the highest growth rate in mentioned period. The highest development rate of EOD and IOD occurs between 27th and 32nd wks (EOD 42.19–43.18 mm in 27th to 62.12 mm in 32nd wks; IOD 16.21–16.48 mm in 27th to 19.23–21.33 mm in 32nd wks). Conclusions: 1. The highest dynamics of eyeballs development in prenatal period oscillates between 12th and 20th weeks of gestation; orbits between 20th and 32nd wks of gestation. 2. The highest growth rate of EOD and IOD diameters occurs between 27th and 32nd wks of gestation. 3. Significant change in EOD/IOD proportions is presented between 12th and 27th wks of gestation. P392 Primary heart fibroma complicated with fetal hydrops and fetal death in utero K. Ridnoi, E. Kaik, P. Andresson, L. Makarenkova. East-Tallinn Central Hospital Women’s Clinic Objectives: Case report presentation about 27 year old patient, who had been diagnosed at the gestational age of 29+0 weeks with fetal hydrops and heart rhythm failure along with heart structure anomaly, leading to the fetal death in uterus. Autopsy discovered primary heart tumor located on the mitral valve. Methods and Materials: Patient turned to our clinic because she hadn’t felt any fetal movements for 24 hours. Fetal ascites, pericardial effusion and hydrothorax with edema of the skin was diagnosed. Additional findings: atrial rhythm was 145×/min., ventricular rhythm was 75×/min. There was a possible atrial structure anomaly found. Leading clinical diagnosis was fetal heart AV block, resulting in fetal hydrops. Results: Mother’s serum tests showed no inflammation, no signs of TORCH group or parvovirus infections. Blood type was A, RH positive. Due to immaturity (29+0) of the fetus and fetal hydrops there was no possibility to implant the heart pacemaker to a newborn, even in case of the Cesarean delivery. Fetal death had occurred in 2 days. Stillborn was a male, 1780 grams. During the autopsy, primary heart tumor was diagnosed. Histological type of tumor was fibroma. Conclusion: Prevalence of heart tumors in the newborns is 1.7:100,000. Mostly tumors are rhabdomyomas, teratomas or fibromas. 40% of all heart fibromas are usually diagnosed within the first year of life. Etiology and pathogenesis are still unclear. When timely diagnosed, most of the fibromas can be successfully operated depending on the size and localization of tumor. However in our case heart fibroma was diagnosed only post mortem. The adequate diagnosis may raise a chance of the survival of the fetus because most of the heart tumors in the newborns are benign. P393 Identified versus non-identified intrauterine growth restriction at term: neonatal results J. Verlijsdonk1 , B. Winkens2 , I. Devies1 , F. Roumen3 . 1 Atrium Medical Centre Parkstad Heerlen, 2 Maastricht University Medical Centre, 3 Atrium Medical Centre Parkstad Objectives: To compare neonatal results of identified with those of non-identified intrauterine growth restricted (IUGR) foetuses at term. Materials and Methods: A retrospective cohort study was conducted of all singleton term foetuses with a birth weight below
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
having the double test taken later (≥10+0 weeks). Regarding 40 cases of trisomy 18 and 13 we found no such difference. P385 Ultrasound findings during pregnancy in a woman with Noonan syndrome: A case report R. Lopez, E. Cervantes, E. Aranda, H. Alvarado, F. Morales, G. Soto, H. Flores, M. Garcia. Hospital San Jose Tec de Monterrey Background: Diagnosis of Noonan Syndrome is often difficult because of the high variability of clinical symptoms. In prenatal diagnosis symptoms sometimes may only be visible in a restricted time frame or are unspecific and will not lead to an unequivocal diagnosis. We report the ultrasound findings during pregnancy in a fetus of a woman with Noonan Syndrome. Case: A 24 year old primigravida woman with Noonan Syndrome diagnosed during childhood was referred to our unit with 17 weeks gestational age for an ultrasound examination. Antenatal surveillance was carried out by a multidisciplinary team involving a fetal medicine consultant and cardiologist. Fetal cardiac ultrasound was made at 21 weeks gestational age reported as normal. An anomaly scan was performed at 23 weeks gestational age and so far the fetal growth and amniotic fluid remained in normal ranges. During a routine scan at 28 weeks gestational age was observed polyhydramnios with amniotic fluid index of 27 and a decrease in the growth of femur and humerus length (both in the 10th centile). These changes persisted until delivery where a healthy boy was born by cesarean section at 38+5 weeks gestational age with a short length for gestational age and a heart murmur. The diagnosis of Noonan Syndrome was confirmed in the neonatal period. Conclusion: Although the karyotype is not specific, in women with Noonan Syndrome the ultrasound findings during pregnancy could be a useful test for prenatal diagnosis of a congenital affection providing proper maternal counseling. P387 Diagnosis and evolutionary control of a nuchal cord in the first term of gestation by means of three dimensional/four dimensional (3D/4D) echography and angiography A. Mart´ınez Aspas, F. Raga Baixauli, F. Bonilla Musoles. Hospital Cl´ınico Universitario de Valencia Objectives: To establish the incidence of a nuchal cord in the first term of gestation and to accomplish an evolutionary control of them with the aim of establishing the evolution and a prognosis of these cases. Material and Methods: Ten thousand unique gestations have been studied in the 12th week of gestation by means of 3D/4D echography and 3D angiography to establish the incidence of nuchal loops around the fetal neck in the first term of gestation. Likewise, in the cases in which a nuchal cord was discovered, an evolutionary monitoring until the childbirth in order to establish their evolution and prognosis was realized. Results: Nuchal cord was discovered in the first term of gestation in 18% of the studied gestations. Among these, 82% of the cases were single loop, 13% were double and only 5% showed three or more loops. The presence of one or two nuchal cord in the first term of gestation did not suppose a worse prognosis related to the control group. However, the presence of three or more nuchal cord increased the intrauterine mortality in a significant form. Conclusions: 3D/4D echography with the aid of 3D angiography represents a highly efficient method to detetc nuchal loops around the fetal neck in the first term of pregnancy. The presence of one nuchal cord does not influence the evolution of the pregnancy. On the other hand the presence of three or more nuchal cord in the first term of gestation carries a high risk of intrauterine mortality during the course of the gestation.
P388 Acidemia at birth and fetal cardiac injury in severe placental insufficiency before 34th week gestation S. Miyadahira, R. Nomura, F. Cabar, V. Costa, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Objectives: Placental insufficiency and fetal growth restriction may lead to fetal hypoxia and acidemia, which result in fetal cardiac injury and dysfunction. The aim was to study the correlation between acidemia at birth and fetal cardiac troponin T (cTnT) according to ductus venosus (DV) Doppler abnormalities. Methods: Between March 2007 and Dec 2008, 23 singleton pregnancies with severe placental insufficiency characterized by abnormal umbilical artery Doppler were prospectively studied. All the patients delivered by cesarean section and the Doppler exams were performed at the same day. Immediately after delivery, UA blood samples were obtained for pH measurement and for cTNT levels measurements. Acidemia at birth was detected when umbilical artery pH < 7.20 and abnormal level of fetal cTnT was characterized when ≥0.10 ng/mL. Statistical analysis included Mann Whitney U test, Chi-square test and Fisher’s exact test. Results: The fetuses that presented acidemia at birth (n = 15, 65.2%) were significantly associated with abnormal levels of fetal cTnT (73.3%) when compared to group with normal pH at birth (25%, p = 0.04, Fisher’s Exact test). In the group with acidemia at birth, DV PIV > 1.20 occurred in nine cases (60%), and in the group with pH ≥ 7.20 only 1 case presented DV PIV >1.20 (12.5%, p = 0.07, Fisher’s Exact test). Conclusion: Acidemia at birth correlated significantly with elevated fetal cTnT levels at delivery in growth-restricted fetuses by placental insufficiency detected before 34th weeks. Abnormal DV PIV represents severe cardiac compromise and cardiac injury would be present when abnormalities in the DV Doppler are detected. P389 Ductus venosus Doppler velocimetry in twin pregnancies with placental insufficiency T. Liao, R. Nomura, A. Liao, M. Brizot, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Introduction: Placental insufficiency in twin pregnancies may lead to fetal growth discordance and fetal distress. In intrauterine growth-restricted (IUGR) fetuses, ductus venosus (DV) dopplervelocimetry has been proposed in the clinical assessment of fetuses that have abnormal umbilical artery (UA) Doppler. The aim of this study was to describe the DV Doppler before birth in five twin pregnancies with severe placental insufficiency. Methods: Prospective observational study including five sets of twin pregnancies in which one fetus presented abnormal umbilical artery (UA) dopplervelocimetry and the co-twin, normal UA Doppler. Doppler studies were performed on the day of delivery. Results: One patient had a vaginal delivery (28w5d) and four were delivered by cesarean section (37w, 36w, 34w, 34w4d). Fetal growth discordance ranged from 20 to 68%. All four fetuses with normal growth and UA Dopplers had normal ductus venosus pulsatility index for veins (mean DV PIV 0.58, range 0.40–0.74). Three fetuses with growth restriction presented normal DV PIV (0.54, 0.47 and 0.86), and the cesarean were performed without fetal biophysical activities abnormalities, and birth conditions were respectively: 2,230 g, Apgar 8/9/9, pH = 7.19; 690 g, Apgar 7/9/9, pH = 7.14 and 1,370 g, Apgar 9/9/9, pH = 7.27. The other two growth restricted fetuses presented reversed a-wave in DV Doppler and abnormal DV PIV (1.22 and 4.61). One of them showed late decelerations (1,000 g, Apgar 9/9/10) and the other was stillbirth (410 g). Conclusions: Ductus venosus Doppler abnormalities is a parameter to evaluate the degree of fetal circulatory compromise in twin
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
pregnancies complicated by placental insufficiency and fetal growth discordance. P390 Construction of a database for the Chinese male fetal heart Q. Pei Objective: To provide an anatomic foundation and to establish an anatomy atlas and a three-dimensional model of the fetal heart, we established a 60 mm cross-sectional image database of the heart of a Chinese male fetus. Materials and Methods: A 31-week Chinese stillborn male fetus was used for the model. The fetus underwent a systemic ultrasonographic examination at 24-weeks gestation which revealed no abnormalities in the heart or other systems..A loss of fetal movement had been reported by the gravida at 31 weeks. A “W”-shaped impression appeared during ultrasound of the neck, and the heartbeat of the fetus was lost. All thoracic organs as a whole were removed from the thoracic cavity after formalin fixation and then frozen at −25º C for 2 hours. Frozen sections, 60 mm in thickness, were prepared and macro-shot with a digital camera to obtain image data for the serial section planes. Results: A total of 871 images of the cross-sections of the fetal heart were obtained at a high resolution (3888×2592 pixels). These images of the sections with a capacity of 2.28 G were stored in JPEG format. Images of the cross-sections not only showed the structures visible in the ultrasonic cardiogram, such as the atrioventricular cavity, cardiac valve, chorda tendineae, papillary muscles, superior and inferior vena cava, pulmonary vein, ductus arteriosus, and aortic arch and its branches, but also displayed clear cardiovascular structures that were difficult or even impossible to show in the ultrasonic cardiogram, such as the coronary sinus, main coronary artery and branches, vertical vein, azygos vein, and hemiazygos vein. The typical cross-sections can be viewed from the apex to the base of the heart as follows: section of two ventricles, section of the coronary sinus, section of the four-chamber heart, section of the five-chamber heart, section of three blood vessels, cross-section of the catheter bow, and cross-section of the aortic arch. All planes of the sections coincided with the fetal cross-section in the ultrasonic cardiogram. This database also reflected the positional relationship of the fetal heart to the descending aorta, vena cava, trachea, and esophagus at different levels of sectioning. Conclusion: A rich database showing the features of the fetal heart was built, and an anatomy atlas and three-dimensional model will be constructed for teaching, scientific research, and clinical applications. P391 Prenatal ultrasound assessment of development of fetal eyeballs and orbits according to gestational age M. Pietryga1 , M. Karolczak-Kulesza2 , A. Brazert2 , J. Kociecki2 , M. Brazert3 , J. Brazert1 . 1 Department of Obstetrics and Women’s Diseases, Poznan University of Medical Sciences; Head: Prof. Jacek Brazert, 2 Department of Ophthalmology, Poznan University of Medical Sciences, 3 Department of Endocrinology, Infertility and Reproductive Endocrinology Poznan University of Medical Sciences; Head: Prof. Leszek Pawelczyk Objectives: Prenatal ultrasound assessment of eyeballs’ and orbits’ development, their proportions and topographic relations according to gestational age. Materials and Methods: A group of 62 healthy pregnant women, directed every month (12–38 wks of gestation) to prenatal ultrasound assessment of fetuses’ eyeballs and orbits. Biometric measurements of eyeballs and orbits were performed. Fetus biometry, morphology and weight were also assessed. Authors have analyzed proportions of eyeballs’ and orbits’ development depending on gestational age and fetus biometry (BPD, HC).
S525
Results: The eyeballs’ growth between 12th–20th wks of gestation was 3.79–10.15 mm, in 32nd wks (15.48–15.61 mm) achieving values close to those obtained in perinatal period (16.04–16.72 mm in 38th wks). EOD/IOD ratio (external interangular diameter/ internal interangular diameter) also changes during prenatal period from 19.12–20.31 mm/7.60–9.30 mm in 12th wks to plateau in 32nd wks (57.34–62.12 mm/19.23–21.33 mm), reaching highest growth acceleration between 27th and 32nd wks. HC values from 186–187 mm in 20th wks to 245–247 mm in 27wks, achieving the highest growth rate in mentioned period. The highest development rate of EOD and IOD occurs between 27th and 32nd wks (EOD 42.19–43.18 mm in 27th to 62.12 mm in 32nd wks; IOD 16.21–16.48 mm in 27th to 19.23–21.33 mm in 32nd wks). Conclusions: 1. The highest dynamics of eyeballs development in prenatal period oscillates between 12th and 20th weeks of gestation; orbits between 20th and 32nd wks of gestation. 2. The highest growth rate of EOD and IOD diameters occurs between 27th and 32nd wks of gestation. 3. Significant change in EOD/IOD proportions is presented between 12th and 27th wks of gestation. P392 Primary heart fibroma complicated with fetal hydrops and fetal death in utero K. Ridnoi, E. Kaik, P. Andresson, L. Makarenkova. East-Tallinn Central Hospital Women’s Clinic Objectives: Case report presentation about 27 year old patient, who had been diagnosed at the gestational age of 29+0 weeks with fetal hydrops and heart rhythm failure along with heart structure anomaly, leading to the fetal death in uterus. Autopsy discovered primary heart tumor located on the mitral valve. Methods and Materials: Patient turned to our clinic because she hadn’t felt any fetal movements for 24 hours. Fetal ascites, pericardial effusion and hydrothorax with edema of the skin was diagnosed. Additional findings: atrial rhythm was 145×/min., ventricular rhythm was 75×/min. There was a possible atrial structure anomaly found. Leading clinical diagnosis was fetal heart AV block, resulting in fetal hydrops. Results: Mother’s serum tests showed no inflammation, no signs of TORCH group or parvovirus infections. Blood type was A, RH positive. Due to immaturity (29+0) of the fetus and fetal hydrops there was no possibility to implant the heart pacemaker to a newborn, even in case of the Cesarean delivery. Fetal death had occurred in 2 days. Stillborn was a male, 1780 grams. During the autopsy, primary heart tumor was diagnosed. Histological type of tumor was fibroma. Conclusion: Prevalence of heart tumors in the newborns is 1.7:100,000. Mostly tumors are rhabdomyomas, teratomas or fibromas. 40% of all heart fibromas are usually diagnosed within the first year of life. Etiology and pathogenesis are still unclear. When timely diagnosed, most of the fibromas can be successfully operated depending on the size and localization of tumor. However in our case heart fibroma was diagnosed only post mortem. The adequate diagnosis may raise a chance of the survival of the fetus because most of the heart tumors in the newborns are benign. P393 Identified versus non-identified intrauterine growth restriction at term: neonatal results J. Verlijsdonk1 , B. Winkens2 , I. Devies1 , F. Roumen3 . 1 Atrium Medical Centre Parkstad Heerlen, 2 Maastricht University Medical Centre, 3 Atrium Medical Centre Parkstad Objectives: To compare neonatal results of identified with those of non-identified intrauterine growth restricted (IUGR) foetuses at term. Materials and Methods: A retrospective cohort study was conducted of all singleton term foetuses with a birth weight below