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P345 Hypothyroidism in pregnancy
S512
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P341 Pattern of perineal tears during vaginal delivery at a public sector university hospital of Sindh
P344 Pregnancy and delivery outcome in a patient with bladder cystectomy and ileo conduit – a case report
S. Arain1 , R. Mustafa Abbasi2 , S. Arain3 . 1 Gyn Unit-I, liaquat University Hospital, Hyderabad, 2 Gyn Unit-I/ liaquat University Hospital Hyderabad, 3 Obst&Gyn, Liaquat University Hospital, Hyderabad
C. Kalumbi1 , J. Karuppaswamy1 , A. Thompson2 , A. Meskhi1 . 1 Department of Obstetrics and Gynaecology, Royal Albert Edward Infirmary Hospital, 2 Department of Urology, Royal Albert Edward Infirmary Hospital
Objective: To determine the pattern of perineal tears during vaginal delivery in our set up. Study design: A Descriptive study. Setting: Dept of Obst& Gynae, Unit-I at Liaquat University Hospital, Hyderabad, Pakistan from 1 Sept 2004 to 31 August 2005. Methods: 100 patients were selected. Women with full term singelton pregnancy in active labor were selectes. Twin pregnancy & Ante partum hemorrhage were excluded. Age, parity, type & degree of tear, mode of delivery, birth wt of baby, delivery conducted by, all possible risk factors & complications were noted. Data was collected through a pre-designed proforma & analyzed by using SPSS version 10.0. Descriptive statistics were computed for data presentation. Frequency & percentage of occurrence of perineal tears & identified risk factors were assessed. Results: During study time period, there were 2563 deliveries and 256 patients had some degree of perineal injury giving a frequency of 9.9%. Out of 100 patients 37% of multiparous & 63% of primiparous women sustainedsome degree os perineal injury. Ahigher incidence of first & second degree tears were noted and incidence was found to be more when NVD was conducted without episiotomy & baby’s wt of more than 4 kg. Conclusion: Obstetric perineal tear is still a common problem as depicted by its high frequency. Lack of perineal care, poor socio economic care, lack of experience were found to be contributing factors.
Objectives: We report our experience and obstetric challenges in managing a complex case of pregnancy and urinary diversion and through literature review address some of the challenges that obstetricians encounter in managing such cases. Methods: A case report of 27 year old Gravid 6 Para 2+3 miscarriages. She had a long history of enuresis and urge incontinence as a result of chronic cystitis secondary to gonococcal infection. She had 3 early miscarriages followed by uncomplicated elective caesarean section in 1997 due to breech presentation. She was then diagnosed with Fowler’s syndrome in 1999 and was on self intermittent catheterisation. A year later she had autoaugumentation of the bladder. In 2001 she had MRSA infection. For her 5th pregnancy, she had an elective caesarean section at 37 weeks through midline skin incision and a higher transverse lower incision to the uterus. She developed urinary retention 13 weeks post delivery for which a suprapubic catheter was inserted. In 2004 she had an ileo conduit. A year later had total bladder cystectomy following bladder rapture. She had relocated and was referred to our unit for the first time in her 6th pregnancy by her local GP at 5/40 of gestation. During this pregnancy she had 2 acute admissions with pyelonephritis and at 35/40 she presented with antepartum haemorrhage. Results: An emergency caesarean section at 35/40 under general anaesthesia with the surgical and urology team present was performed. Abdominal entry was through a midline incision and luckily had minimal adhesions. A lower transverse uterine segment incision was made. Patient had consented to bilateral tubal ligation which was also done. Both mother and baby had good outcome. Discussion: Most cases of urinary diversions are common in postmenopausal women and children. Unlike in the postmenopausal age group where the underlying pathology is mainly neoplasia, urinary diversions in children and young women is mainly as a result of begnin diseases. Among these are complex congenital malformation of the bladder, neurogenic bladder, contracted bladder secondary to interstitial cystitis and tuberculosis. Over the decades, the incidence among women in the reproductive age group has been low. A review of published literature revealed at least 252 reported cases from 1922. Advances in medical technology has led to improved management of these cases in childhood years resulting in a rising number of cases in the reproductive age group. Many obstetricians and gynaecologist have very little or no experience in managing pregnancy and infertility complications of such cases. Not much is written in literature. Some of the challenges encountered are; knowing which form of diversion is recommended for young patients, what information do obstetricians need to know on constructive urology, use of long term antibiotic prophylaxis, indications for pregnancy intervention, mode of delivery, uterus and position of ureters. Conclusions: Multidisciplinary management of pregnancies in this high risk category is essential in order to achieve successful fetal and maternal outcomes.
P343 Comparative efficacy of parenteral iron vs parenteral iron and erythropoietin therapy in moderate and severe anemia of pregnancy P. Gupta, J. Sharma, S. Kumar, K. Roy, N. Malhotra Objectives: The aim of the study was to evaluate the efficacy of parenteral iron versus parenteral iron and erythopoietin in moderate and severe anaemia of pregnancy. Materials and Methods: A total of 35 women with hemoglobin of less than 8 gm/dl in the third trimester of pregnancy were enrolled to receive either 500 mg of parenteral intramuscular iron (100 mg daily for 5 days) using highly fractionated low molecular weight iron dextran (Ferri, Emcure, Pune, India) (Group I – 15 women) or to 500 mg of parental iron as above with 3 doses of subcutaneous 6000 units each of erythropoietin on day 1, 3 and 5 (Group II – 20 women). Results: The range of hemoglobin was 5.2 to 8 gm/dl with mean being 6.8 gm/dl in Group I in contrast to 5.0 to 7.5 mg/dl with mean being 6.7 gm/dl in Group II. The range of post therapy hemoglobin was 6.3 to9.1 gm/dl with mean of 8.2 gm/dl in-group I in contrast to 6.5 to 10.0 gm/dl with mean of 9.4 in Group II. Thus while there was a mean rise of 1.4 gm with parenteral iron there was a mean increase of 2.8 gm/dl with parenteral iron and erythropoietin therapy. The range and mean of levels of PCV, MCV, MCH and MCHC were 0.28 to 0.34 (mean 0.32), 0.32 to 0.36 (mean 0.34), 74 to 92 (mean 83), 82 to 95 (mean 88), 26 to 32 (mean 29) 28 to 33 (mean 31), 29 to 35 (mean 33), 33 to 37 (mean 35) respectively in the two groups after 2 weeks of therapy. Conclusion: Addition of erythropoietin to parenteral iron gives superior results in improving hematological parameters in moderate and severe anemia during pregnancy.
P345 Hypothyroidism in pregnancy A. Khan, R. Sturley. Royal Devon and Exeter Hospital NHS Foundation Trust Introduction and Background: Thyroid dysfunction is the second most common endocrine disorder in pregnancy. The condition affects about 0.3–2% of the population (Glinoer, Abalovich; BMJ 2007; 335: 300–2.) Complications in pregnancy include early & late
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
miscarriages, maternal anemia, pregnancy induced hypertension, Placental abruption, Premature delivery, Postpartum hemorrhage and Post delivery admission in NNU for RDS. Aims and Objectives: The aim of the audit was to check our compliance with recommendation, which is currently based on a paper ‘Unresolved questions in managing Hypothyroidism during Pregnancy’ published in BMJ in 2007;335:300–2. The hospital protocol recommends routine pre-pregnancy counseling, maintain TSH 0.4 to <2.0 and 6–8weekly Thyroid Profile checks throughout pregnancy. Material and Methods: This audit was performed in a district general hospital with a delivery rate of 3500. A retrospective cohort study of all women who received prenatal care in the endocrine clinic were included. 36 patients were identified from Jan, 2007 to June, 2008 (18 months). An Audit proforma was designed and results were analysed using Microsoft Excel. Results: Total number of patients was 36. Patient age range 20–44 years; 56% of patients were primips. 39% women had BMI <30. 86% women had hypothyroidism due to unknown reasons, 5% due to post radioactive iodine and 5% due to post surgical reasons. Pre pregnancy thyroid profile results were available in only 69.4% patients. 50% dose increments of Thyroxine were noted in 16.6% of women in first trimester, 16.6% in 2nd trimester, none in 3rd trimester. 22.2% patients had TSH >2 in first trimester. Overall control in second and third trimesters was good (only 5.5% and 2.7% women with TSH >2). Only 11.1% women were delivered before 37 weeks (including one patient with second trimester miscarriage at 20 weeks). 72% women delivered vaginally; 22.2% required emergency caesarean section and 5.5% elective c/s. Only 3 women had PPH >500 mls; none required blood transfusions. One woman had a late second trimester miscarriage; none delivered <32 weeks (extreme pre maturity). 4 babies were admitted to neonatal unit with respiratory distress syndrome; none required ventilation. 64% women had 6 weeks postnatal check. No documentation on pre-pregnancy counselling was observed. Inadequate information for patients in antenatal clinic noted. Conclusions: Pre pregnancy thyroid profile results were available in only 69.4% patients. There was overall good control in 2nd and 3rd trimesters. First trimester TSH of < 2.0 was noted in 77.8% patients. No documentation on pre-pregnancy counselling was observed. Inadequate information for patients in antenatal clinic noted. A new hospital guideline is set up with strong emphasis on pre-pregnancy counseling and stricter control (TSH < 2) throughout pregnancy. A new patient information leaflet is also being devised to give adequate information regarding the maternal and neonatal risks associated with uncontrolled hypothyroidism. P346 Guillain-Barre syndrome in pregnancy S. Furara, F. Khan, M. Maw, K. Powell. Mid Staffordshire General Hospitals, Stafford, United Kingdom Guillain-Barre syndrome complicating pregnancy is a rare event. It is an acute inflammatory demyelinating polyradiculopathy (AIDP). Essential clinical criteria are progressive motor weakness and loss of reflexes. Other features include respiratory failure, facial nerve, bulbar and ocular nerves involvement, mild sensory symptoms and autonomic dysfunction. The management includes supportive therapy, IV immunoglobulins and plasmapheresis. Ventilatory support required in 25–30% of nonpregnant patients is worse in pregnant counterparts. The risk of premature birth is markedly increased. An 18 year old presented at 26 weeks of pregnancy with chest and shoulder pains associated with shortness of breath. She also complained of pins and needles in her fingers. Differential diagnosis of anxiety, hyperventilation and PE were excluded. She gradually developed progressively ascending motor weakness which finally involved respiratory muscles. A diagnosis of Guillain-
S513
Barre´ syndrome was supported by the results of lumbar puncture. She received ventilator support, labetolol to control high blood due to autonomic dysfunction and IV immunoglobulins. Mechanical ventilation was discontinued and she was discharged at 29+5 weeks gestation to a neuro-rehabilitation centre where she made an excellent recovery. Regular fetal surveillance continued throughout and demonstrated a normally growing fetus. She delivered a healthy female infant at 39 weeks vaginally. Guillain-Barre Syndrome is a potentially fatal condition. A timely intervention, multidisciplinary team action and rehabilitation as demonstrated in this case can result in optimum outcome. P347 Prognostic factors for prophylactic and emergency cerclages B. Rischner1 , E. David1 , R. Favre2 , I. Nisand1 , J. Baldauf1 , B. Langer1 . 1 Dept Gyn Obstet, Hop Hautepierre, CHU Strasbourg, France, 2 CMCO, Schiltigheim Objectives: Prognostic factor analysis for both prophylactic and emergency cerclages. Materials and Methods: This retrospective analysis (2004–2008) included all the prophylactic (P) or emergency (E) cerclages. Multiple pregnancies were excluded. Patients selected for E cerclages were those presenting with a reduction in ultrasonographic cervical length <20 mm or with membrane protrusion. Primary evaluation criteria were perinatal mortality and term of delivery. Studied risk factors were obstetric and gynaecologic histories (uterine malformations, diethylstilbestrol syndrome). Results: We recorded 89 cerclage patients (Table 1): 67 P cerclages (75.3%) and 22 E cerclages (24.7%). A pocket was visible upon speculum examination in 64% of E cerclages (14/22). Among P cerclages, 27% had had three or more previous abortions or premature births. In the context of P cerclages, no correlation was found between the number of previous abortions or premature births and the term of delivery. Of the P group’s 9 deaths, 7 experienced a PROM before 24 GW. In the E group, 3 presented a chorioamniotitis. Table 1
Cerclage data (GW) (range) History Abortion or premature delivery Uterine malformation Diethylstilbestrol syndrome Outcomes Premature delivery thread <34 GW Premature membrane rupture <34 GW Delivery <32 GW Delivery ≥37 GW Perinatal mortality 9(13%)
P Cerclage (n = 67)
E Cerclage (n = 22)
14.7±1.7 (12–17)
21.8±1.7 (20–25)
95% 21% 9%
72% 10% 9%
25(37%) 10(15%) 11(16%) 51(76%) 5(23%)
12(55%) 9(41%) 7(32%) 10(45%)
Conclusions: Following prophylactic cerclage, the number of previous abortions or premature births does not correlate with the term of delivery. P348 Do risk factors help to identify women from Africa with gestational diabetes mellitus? H. Lombaard1 , M. Mtsweni2 , D. Van Zyl3 , R. Pattinson3 . 1 University of Pretoria, Steve Biko Academic Hospital, 2 University of Pretoria, 3 University of Pretoria, Kalafong Hospital Aim: To evaluate the prevalence of Gestational Diabetes Mellitus (GDM) in pregnant women with and without risk factors. To compare different diagnostic criteria applied to the same patient. To establish what percentage of women who attend ante natal clinic in Southwest Tshwane have risk factors for GDM.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P341 Pattern of perineal tears during vaginal delivery at a public sector university hospital of Sindh
P344 Pregnancy and delivery outcome in a patient with bladder cystectomy and ileo conduit – a case report
S. Arain1 , R. Mustafa Abbasi2 , S. Arain3 . 1 Gyn Unit-I, liaquat University Hospital, Hyderabad, 2 Gyn Unit-I/ liaquat University Hospital Hyderabad, 3 Obst&Gyn, Liaquat University Hospital, Hyderabad
C. Kalumbi1 , J. Karuppaswamy1 , A. Thompson2 , A. Meskhi1 . 1 Department of Obstetrics and Gynaecology, Royal Albert Edward Infirmary Hospital, 2 Department of Urology, Royal Albert Edward Infirmary Hospital
Objective: To determine the pattern of perineal tears during vaginal delivery in our set up. Study design: A Descriptive study. Setting: Dept of Obst& Gynae, Unit-I at Liaquat University Hospital, Hyderabad, Pakistan from 1 Sept 2004 to 31 August 2005. Methods: 100 patients were selected. Women with full term singelton pregnancy in active labor were selectes. Twin pregnancy & Ante partum hemorrhage were excluded. Age, parity, type & degree of tear, mode of delivery, birth wt of baby, delivery conducted by, all possible risk factors & complications were noted. Data was collected through a pre-designed proforma & analyzed by using SPSS version 10.0. Descriptive statistics were computed for data presentation. Frequency & percentage of occurrence of perineal tears & identified risk factors were assessed. Results: During study time period, there were 2563 deliveries and 256 patients had some degree of perineal injury giving a frequency of 9.9%. Out of 100 patients 37% of multiparous & 63% of primiparous women sustainedsome degree os perineal injury. Ahigher incidence of first & second degree tears were noted and incidence was found to be more when NVD was conducted without episiotomy & baby’s wt of more than 4 kg. Conclusion: Obstetric perineal tear is still a common problem as depicted by its high frequency. Lack of perineal care, poor socio economic care, lack of experience were found to be contributing factors.
Objectives: We report our experience and obstetric challenges in managing a complex case of pregnancy and urinary diversion and through literature review address some of the challenges that obstetricians encounter in managing such cases. Methods: A case report of 27 year old Gravid 6 Para 2+3 miscarriages. She had a long history of enuresis and urge incontinence as a result of chronic cystitis secondary to gonococcal infection. She had 3 early miscarriages followed by uncomplicated elective caesarean section in 1997 due to breech presentation. She was then diagnosed with Fowler’s syndrome in 1999 and was on self intermittent catheterisation. A year later she had autoaugumentation of the bladder. In 2001 she had MRSA infection. For her 5th pregnancy, she had an elective caesarean section at 37 weeks through midline skin incision and a higher transverse lower incision to the uterus. She developed urinary retention 13 weeks post delivery for which a suprapubic catheter was inserted. In 2004 she had an ileo conduit. A year later had total bladder cystectomy following bladder rapture. She had relocated and was referred to our unit for the first time in her 6th pregnancy by her local GP at 5/40 of gestation. During this pregnancy she had 2 acute admissions with pyelonephritis and at 35/40 she presented with antepartum haemorrhage. Results: An emergency caesarean section at 35/40 under general anaesthesia with the surgical and urology team present was performed. Abdominal entry was through a midline incision and luckily had minimal adhesions. A lower transverse uterine segment incision was made. Patient had consented to bilateral tubal ligation which was also done. Both mother and baby had good outcome. Discussion: Most cases of urinary diversions are common in postmenopausal women and children. Unlike in the postmenopausal age group where the underlying pathology is mainly neoplasia, urinary diversions in children and young women is mainly as a result of begnin diseases. Among these are complex congenital malformation of the bladder, neurogenic bladder, contracted bladder secondary to interstitial cystitis and tuberculosis. Over the decades, the incidence among women in the reproductive age group has been low. A review of published literature revealed at least 252 reported cases from 1922. Advances in medical technology has led to improved management of these cases in childhood years resulting in a rising number of cases in the reproductive age group. Many obstetricians and gynaecologist have very little or no experience in managing pregnancy and infertility complications of such cases. Not much is written in literature. Some of the challenges encountered are; knowing which form of diversion is recommended for young patients, what information do obstetricians need to know on constructive urology, use of long term antibiotic prophylaxis, indications for pregnancy intervention, mode of delivery, uterus and position of ureters. Conclusions: Multidisciplinary management of pregnancies in this high risk category is essential in order to achieve successful fetal and maternal outcomes.
P343 Comparative efficacy of parenteral iron vs parenteral iron and erythropoietin therapy in moderate and severe anemia of pregnancy P. Gupta, J. Sharma, S. Kumar, K. Roy, N. Malhotra Objectives: The aim of the study was to evaluate the efficacy of parenteral iron versus parenteral iron and erythopoietin in moderate and severe anaemia of pregnancy. Materials and Methods: A total of 35 women with hemoglobin of less than 8 gm/dl in the third trimester of pregnancy were enrolled to receive either 500 mg of parenteral intramuscular iron (100 mg daily for 5 days) using highly fractionated low molecular weight iron dextran (Ferri, Emcure, Pune, India) (Group I – 15 women) or to 500 mg of parental iron as above with 3 doses of subcutaneous 6000 units each of erythropoietin on day 1, 3 and 5 (Group II – 20 women). Results: The range of hemoglobin was 5.2 to 8 gm/dl with mean being 6.8 gm/dl in Group I in contrast to 5.0 to 7.5 mg/dl with mean being 6.7 gm/dl in Group II. The range of post therapy hemoglobin was 6.3 to9.1 gm/dl with mean of 8.2 gm/dl in-group I in contrast to 6.5 to 10.0 gm/dl with mean of 9.4 in Group II. Thus while there was a mean rise of 1.4 gm with parenteral iron there was a mean increase of 2.8 gm/dl with parenteral iron and erythropoietin therapy. The range and mean of levels of PCV, MCV, MCH and MCHC were 0.28 to 0.34 (mean 0.32), 0.32 to 0.36 (mean 0.34), 74 to 92 (mean 83), 82 to 95 (mean 88), 26 to 32 (mean 29) 28 to 33 (mean 31), 29 to 35 (mean 33), 33 to 37 (mean 35) respectively in the two groups after 2 weeks of therapy. Conclusion: Addition of erythropoietin to parenteral iron gives superior results in improving hematological parameters in moderate and severe anemia during pregnancy.
P345 Hypothyroidism in pregnancy A. Khan, R. Sturley. Royal Devon and Exeter Hospital NHS Foundation Trust Introduction and Background: Thyroid dysfunction is the second most common endocrine disorder in pregnancy. The condition affects about 0.3–2% of the population (Glinoer, Abalovich; BMJ 2007; 335: 300–2.) Complications in pregnancy include early & late
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
miscarriages, maternal anemia, pregnancy induced hypertension, Placental abruption, Premature delivery, Postpartum hemorrhage and Post delivery admission in NNU for RDS. Aims and Objectives: The aim of the audit was to check our compliance with recommendation, which is currently based on a paper ‘Unresolved questions in managing Hypothyroidism during Pregnancy’ published in BMJ in 2007;335:300–2. The hospital protocol recommends routine pre-pregnancy counseling, maintain TSH 0.4 to <2.0 and 6–8weekly Thyroid Profile checks throughout pregnancy. Material and Methods: This audit was performed in a district general hospital with a delivery rate of 3500. A retrospective cohort study of all women who received prenatal care in the endocrine clinic were included. 36 patients were identified from Jan, 2007 to June, 2008 (18 months). An Audit proforma was designed and results were analysed using Microsoft Excel. Results: Total number of patients was 36. Patient age range 20–44 years; 56% of patients were primips. 39% women had BMI <30. 86% women had hypothyroidism due to unknown reasons, 5% due to post radioactive iodine and 5% due to post surgical reasons. Pre pregnancy thyroid profile results were available in only 69.4% patients. 50% dose increments of Thyroxine were noted in 16.6% of women in first trimester, 16.6% in 2nd trimester, none in 3rd trimester. 22.2% patients had TSH >2 in first trimester. Overall control in second and third trimesters was good (only 5.5% and 2.7% women with TSH >2). Only 11.1% women were delivered before 37 weeks (including one patient with second trimester miscarriage at 20 weeks). 72% women delivered vaginally; 22.2% required emergency caesarean section and 5.5% elective c/s. Only 3 women had PPH >500 mls; none required blood transfusions. One woman had a late second trimester miscarriage; none delivered <32 weeks (extreme pre maturity). 4 babies were admitted to neonatal unit with respiratory distress syndrome; none required ventilation. 64% women had 6 weeks postnatal check. No documentation on pre-pregnancy counselling was observed. Inadequate information for patients in antenatal clinic noted. Conclusions: Pre pregnancy thyroid profile results were available in only 69.4% patients. There was overall good control in 2nd and 3rd trimesters. First trimester TSH of < 2.0 was noted in 77.8% patients. No documentation on pre-pregnancy counselling was observed. Inadequate information for patients in antenatal clinic noted. A new hospital guideline is set up with strong emphasis on pre-pregnancy counseling and stricter control (TSH < 2) throughout pregnancy. A new patient information leaflet is also being devised to give adequate information regarding the maternal and neonatal risks associated with uncontrolled hypothyroidism. P346 Guillain-Barre syndrome in pregnancy S. Furara, F. Khan, M. Maw, K. Powell. Mid Staffordshire General Hospitals, Stafford, United Kingdom Guillain-Barre syndrome complicating pregnancy is a rare event. It is an acute inflammatory demyelinating polyradiculopathy (AIDP). Essential clinical criteria are progressive motor weakness and loss of reflexes. Other features include respiratory failure, facial nerve, bulbar and ocular nerves involvement, mild sensory symptoms and autonomic dysfunction. The management includes supportive therapy, IV immunoglobulins and plasmapheresis. Ventilatory support required in 25–30% of nonpregnant patients is worse in pregnant counterparts. The risk of premature birth is markedly increased. An 18 year old presented at 26 weeks of pregnancy with chest and shoulder pains associated with shortness of breath. She also complained of pins and needles in her fingers. Differential diagnosis of anxiety, hyperventilation and PE were excluded. She gradually developed progressively ascending motor weakness which finally involved respiratory muscles. A diagnosis of Guillain-
S513
Barre´ syndrome was supported by the results of lumbar puncture. She received ventilator support, labetolol to control high blood due to autonomic dysfunction and IV immunoglobulins. Mechanical ventilation was discontinued and she was discharged at 29+5 weeks gestation to a neuro-rehabilitation centre where she made an excellent recovery. Regular fetal surveillance continued throughout and demonstrated a normally growing fetus. She delivered a healthy female infant at 39 weeks vaginally. Guillain-Barre Syndrome is a potentially fatal condition. A timely intervention, multidisciplinary team action and rehabilitation as demonstrated in this case can result in optimum outcome. P347 Prognostic factors for prophylactic and emergency cerclages B. Rischner1 , E. David1 , R. Favre2 , I. Nisand1 , J. Baldauf1 , B. Langer1 . 1 Dept Gyn Obstet, Hop Hautepierre, CHU Strasbourg, France, 2 CMCO, Schiltigheim Objectives: Prognostic factor analysis for both prophylactic and emergency cerclages. Materials and Methods: This retrospective analysis (2004–2008) included all the prophylactic (P) or emergency (E) cerclages. Multiple pregnancies were excluded. Patients selected for E cerclages were those presenting with a reduction in ultrasonographic cervical length <20 mm or with membrane protrusion. Primary evaluation criteria were perinatal mortality and term of delivery. Studied risk factors were obstetric and gynaecologic histories (uterine malformations, diethylstilbestrol syndrome). Results: We recorded 89 cerclage patients (Table 1): 67 P cerclages (75.3%) and 22 E cerclages (24.7%). A pocket was visible upon speculum examination in 64% of E cerclages (14/22). Among P cerclages, 27% had had three or more previous abortions or premature births. In the context of P cerclages, no correlation was found between the number of previous abortions or premature births and the term of delivery. Of the P group’s 9 deaths, 7 experienced a PROM before 24 GW. In the E group, 3 presented a chorioamniotitis. Table 1
Cerclage data (GW) (range) History Abortion or premature delivery Uterine malformation Diethylstilbestrol syndrome Outcomes Premature delivery thread <34 GW Premature membrane rupture <34 GW Delivery <32 GW Delivery ≥37 GW Perinatal mortality 9(13%)
P Cerclage (n = 67)
E Cerclage (n = 22)
14.7±1.7 (12–17)
21.8±1.7 (20–25)
95% 21% 9%
72% 10% 9%
25(37%) 10(15%) 11(16%) 51(76%) 5(23%)
12(55%) 9(41%) 7(32%) 10(45%)
Conclusions: Following prophylactic cerclage, the number of previous abortions or premature births does not correlate with the term of delivery. P348 Do risk factors help to identify women from Africa with gestational diabetes mellitus? H. Lombaard1 , M. Mtsweni2 , D. Van Zyl3 , R. Pattinson3 . 1 University of Pretoria, Steve Biko Academic Hospital, 2 University of Pretoria, 3 University of Pretoria, Kalafong Hospital Aim: To evaluate the prevalence of Gestational Diabetes Mellitus (GDM) in pregnant women with and without risk factors. To compare different diagnostic criteria applied to the same patient. To establish what percentage of women who attend ante natal clinic in Southwest Tshwane have risk factors for GDM.