18–22 September 2011, Los Angeles, CA, USA Poster abstracts P22: CASE REPORTS IN FETAL INTERVENTIONS P22.01 Radiofrequency ablation of fetal sacrococcygeal teratoma H. Sago 1 , S. Hayashi 1 , H. Tanaka 2 , O. Miyazaki 3 , S. Nosaka 3 , K. Matsuoka 4 , Y. Ito 1 , T. Kuroda 2 , T. Honna 2 1 Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japan; 2 Surgery, National Center for Child Health and Development, Tokyo, Japan; 3 Radiology, National Center for Child Health and Development, Tokyo, Japan; 4 Pathology, National Center for Child Health and Development, Tokyo, Japan Fetal sacrococcygeal teratoma can lead to a high output cardiac failure resulting in significant perinatal morbidity and mortality. Fetal therapy for sacrococcygeal teratoma is controversial. This is a report in which ultrasound guided percutaneous radiofrequency ablation was used to reduce blood flow to a sacrococcygeal teratoma for prolongation of pregnancy. We present a case of fetus with solid, highly vascularized sacrococcygeal teratoma diagnosed at 24 weeks of gestation. The tumor increased in size of 12 cm diameter causing polyhydramnios and cardiac and placental enlargement at 29 weeks of gestation. Radiofrequency ablation was performed at 30 weeks’ gestation by percutaneously inserting the probe into the middle of the fetal tumor under ultrasonographic guidance. The blood supply to the tumor was successfully reduced with stabilization of high output cardiac failure of the fetus. A female infant weighing 3030 g with a large, vascular sacrococcygeal teratoma was born at 32 weeks’ gestation by Cesarean section. The pulmonary and circulatory condition of the infant was under control. Angiography showed large feeding vessels that were successfully embolized. The large, vascular sacrococcygeal teratoma weighing 950 g was surgically excised. The infant was discharged home at 73 days of age without injury. This case shows that successful radiofrequency ablation to reduce the blood supply to the fetal sacrococcygeal teratoma for prolongation of pregnancy is possible. P22.02 A case of intraamniotic thyroxine treatment in fetal goiter J. Yook 1 , M. Kim 1 , M. Lee 1 , S. Park 2 , D. Cho 3 1 Dept. of Ob/Gyn, Cheil General Hospital, Kwandong University, Seoul, Republic of Korea; 2 Dept. of Internal Medicine, Cheil General Hospital, Kwandong University, Seoul, Republic of Korea; 3 Dept. of Lab Medicine, Cheil General Hospital, Kwandong University, Seoul, Republic of Korea We describe our observation in treating a 24 weeks of gestational fetus with a goiter, monitored with serial 3D ultrasonography and amniotic hormonal measurements. A 35-years-old multigravida pregnant woman visited our department at 13 weeks’ gestation and has been treated with oral levothyroxine at 100 μg daily because of hypothyroidism. The ultrasonography screening was performed at 25 weeks’ gestation, and revealed a 21 × 14 (right lobe), 26 × 22 (left lobe) mm sized fetal goiter and an increased amniotic fluid volume. Fetal hypothyroidism was confirmed by cordocentesis and amniotic hormone levels at 26 weeks’ gestation. The results were as follows: TSH 390 μU/ml, and free T4 6.7 pmol/L. Free amniotic T4 concentration was 8.5 pmol/L and TSH 11.6 μU/ml consistent with hypothyroidism. To take advantage of the transplacental transfer, we treated the mother with oral levothyroxine at 200 μg daily. In- utero treatment was initiated with 200 μg of levothyroxine injected into the amniotic sac, and later increased to 400 μg. A total of four intra-amniotic injections of levothyroxine were administered between 30 and 37 weeks gestation, resulting in a progressive reduction in the fetal thyoid volume of goiter and increased amniotic fluid volume. The change in thyroid size was measured by 3D ultrasonography. The thyroid volume was 6.618 cm 3 at 29 weeks’ gestation, 4.921 cm 3 at 37 weeks’ gestation. The amniotic hormone levels were decreased. The fetus was delivered vaginally at 38 weeks gestation and weighed 2495 gm. Following birth, neonatal serum TSH levels were within the normal range but free T4 was reduced. The baby was started on daily oral thyroxine. Monitoring of amnotic fluid hormonal concentration and intraamniotic levothyroxine injection were useful for regression of the thyroid volume of goiter and prevention of polyhydramnios. P22.03 Regression of fetal hydrops and cerebral abnormalities by primary Cytomegalovirus infection after therapy with hyper immunoglobulin: a case report S. Molina 1,2 , R. Papanna 2 , A. Johnson 2 , K. J. Moise 2 1 Fetal Intervention and Maternal Fetal Medicine, Hospital de San Jose, Bogota, Colombia; 2 Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX, USA Cytomegalovirus (CMV) is one of the most common cause of intrauterine infection associated with prenatal and postnatal conse- quences. Prenatal ultrasound findings placentomegaly, intrauterine growth retardation, amniotic fluid changes, hepatosplenomegaly, and bowel calcifications, ventriculomegaly, brain calcifications and hydrops. We report a case a CMV prenatal infection with fetal find- ings that went to fetal therapy with hyper immunoglobulin presented good response to treatment and regression of the main fetal findings. A 24 years old G2P1 with 25, 5 weeks old pregnancy was evaluated in the fetal therapy unit. Fetal biometry was consistent with 25, 4 wo, periventricular calcificacions, ventriculomegaly, at the fetus cen- tral nervous system was described. Ascitis, hyperechogenic bowel, visceromegaly, placentomegaly and polihidramnios. CMV IgG was positive, IgM was negative but IgG avidity was low. Amniocen- tesis for PCR Parvovirus B19 and toxoplasma were negative and PCR CMV was positive. Fetal kariotype was normal. We began treatment for congenital CMV with Hyperimmune globulin total dose was (150 mg/kg). Patient was monitored closely during and after each rate change. After the first dose, plasma CMV viral load was less than 375 copies/ml. Fetal ultrasound follow up showed no ventriculomegaly, fetal regress of the hydrops and improved of the placentomegaly. She underwent second treatment after 2 weeks period placental thickness improved from 6 cm to 4 cm. At GA of 40–1/7 she went on to deliver a viable female infant with APGARs of 8 at 9. Weight 7 pounds 13 ounces. The infant was transferred to NICU. Neonatal deafness in right ear was diagnosed. No other neurological deficits were noted in the pediatric follow up. The pre- natal therapy with hyper immunoglobulin should be considered as an option after the prenatal diagnosis of congenital CMV. Further studies will be considered necessary in order to define the standard of care in CMV prenatal therapy. P22.04 Rectus sheath hematoma as a rare complication of amniocentesis–report of two cases M. Hynek , D. Smetanova, D. Stejskal Fetal Medicine, GENNET, Prague, Czech Republic Rectus sheath hematoma (RSH) is a very rare and potentially life- threatening entity resulting from bleeding of inferior epigastric artery into rectus abdominis sheath. Reported causes include abdominal wall trauma, pregnancy, infections, anticoagulation therapy, subcutaneous injection, acupuncture. We report two cases of RSH after amniocentesis. Case 1 (in 2006). 38-year- old woman underwent amniocentesis in 16 weeks of gestation. The procedure was ultrasound-guided, with a 19-gauge needle, performed by experienced operator. Four days after procedure the patient presented with progressive abdominal pain, worsening with Ultrasound in Obstetrics & Gynecology 2011; 38 (Suppl. 1): 168–281 241