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355. Maternal and neonatal seizures secondary to severe hyponatraemia from acute intrapartum water intoxication
S134
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
Methods: A cross sectional study was conducted in Sir GangaRam Hospital Lahore during February 2015 to June 2016. Total 80 pregnant women diagnosed with hypertension during their 2nd trimester were included in the study. Blood pressure and certain laboratory investigations were done including total cholesterol, LDL, VLDL and HDL. A personalized health questionnaire was used to classify depression among women. Hypertension distress scale was used to identify hypertension distress and other factors such as social distress, interpersonal distress, physician related distress, emotional distress and regimen related distress. Results: The rate of depression was 39% among women diagnosed with hypertension. 8% were categorised as mild depression, 14% moderate depression and 17% with severe depression. Hypertensive depression was found in 71% of the selected population. Rates of social distress, interpersonal distress, and physician related distress, emotional distress, infant death distress, regimen related distress were 23%, 33.5%, 17.8%, 73.4% and 42.6 respectively. There was no association between depression and low HDL. Conclusion: Our study concludes that hypertensive distress is very common among pregnant women in Pakistan and this is an alarming condition for Pakistani population. We need to develop and modify our management plans in order to combat this deadly distress. Mass media should be involved in order to raise awareness about. doi:10.1016/j.preghy.2018.08.396
353. Knowledge assessment of cardiovascular diseases among Pakistani pregnant women Arooj Fatima a, Syed Sammar Abbas Zaidi b (a Sir GangaRam Hospital, Lahore, Pakistan, b Wecare medical centre, Lahore, Pakistan) Objectives: Cardiovascular diseases are the leading cause of death worldwide. The most interesting feature of cardiovascular diseases is that they can be prevented. Majority of the risk factors are controllable including hypertension, dyslipidemia, obesity, diabetes, smoking, stress and sedentary life style etc. We aim to assess knowledge, awareness, perception of cardiovascular diseases and risk factors among pregnant women living in rural areas of Pakistan. We also aim to evaluate the level of prevention of cardiovascular diseases as a result of awareness and knowledge. Methods: The study was conducted in peripheral areas of Lahore, Pakistan during the year 2016. A structured questionnaire was established that targeted 350 female population >20 years during their 1st and 2nd trimester. Informed consent was obtained and questionnaire were filled. The data was analysed using SPSS 16.0. Results: Only 26% of the participating pregnant women agreed that cardiovascular diseases are the most leading causes of mortality. Knowledge regarding cause, risk factors and complications was found inadequate. There was identified lack of health promoting behaviours and practices among the subjects. Practices regarding diet and lifestyle were also found unsatisfactory. Awareness of risk factors was present in 110 (31%) of targeted population. On risk assessment scale, 62% were found at high risk and 38% at low risk of developing cardiovascular diseases. Conclusion: It has been concluded that a significant number of people had little or now awareness regarding the cardiovascular diseases and its complications. We can surely lessen the morbidity and mortality of both mother and fetus by primary prevention followed by early detection of the diseases and early interventions. The proportion of individuals found high risk and low risk should be
screened regularly. We should prevent CVD though outreach programs and mass media. doi:10.1016/j.preghy.2018.08.397
354. Counselling and consenting for diagnostic imaging in pregnancy Sandra Lowe (Australia) Diagnostic imaging in pregnancy requires a detailed understanding of the risks and benefits of the imaging options. This will ensure the most appropriate and safest imaging modality is performed to provide maximal information for diagnosis and management. Counselling and obtaining informed consent for imaging that involves radiation requires the clinician to communicate with the woman and her family a realistic estimate of the potential radiation dose to herself and her fetus, to describe and quantitate the risks of this estimated dose, to outline the benefits of the imaging procedure and to respond to any questions or concerns. Although the ‘‘as low as reasonably achievable” (ALARA) should be applied, pregnant women should be imaged using the standard imaging protocols used for any other patients. If dose reduction strategies do not compromise image quality, then they should be used for all patients. The American College of Radiology particularly note that ‘‘It is best to create written protocols for all imaging of pregnant patients to avoid reactive, non-optimal protocol adjustments by physicians attempting to reduce radiation exposures.” All allied staff must also be well informed to ensure the patient receives a consistent message about the risks and benefits of the proposed test(s). In almost all diagnostic imaging,with or without contrast or nuclear isotopes, maternal and fetal risks are negligible and therefore the most sensitive and specific imaging should be performed at the most appropriate time whether during or after pregnancy. With adequate information and knowledge, the reflex ‘‘no radiation” approach to selection of diagnostic imaging modalities in pregnancy should be replaced with principle of ensuring that nonionising radiation options are considered first, whether during or after pregnancy; but when X ray, CT, nuclear scan or PET are the most suitable modality; these should be applied with appropriate care and counselling. doi:10.1016/j.preghy.2018.08.398
355. Maternal and neonatal seizures secondary to severe hyponatraemia from acute intrapartum water intoxication Sophie Walter, Anna Fabre-Gray, Ashwini Bilagi (St Michaels Hospital, Bristol, United Kingdom) Introduction: We wish to highlight how unregulated intrapartum water ingestion can result in significant maternal and neonatal morbidity. Early symptoms can be non-specific or confused with common pregnancy complications such as pre-eclampsia. We present a case of maternal and neonatal seizures secondary to severe hyponatremia following water intoxication. We will discuss the challenges in identifying high risk patients and their subsequent management. Case presentation: A healthy primiparous women presented at term in spontaneous labour. She developed a generalized seizure followed a short period of acute confusion and disorientation intrapartum. She was mildly hypertensive without proteinuria.
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
Magnesium sulphate was given and an emergency caesarean section performed. Following delivery the neonate developed seizures. Cord blood gases were normal. Maternal and fetal bloods showed severe hyponatraemia. Their biochemical and hormonal profile was otherwise normal. Brain and renal imaging were normal. Both required intensive care treatment. Fluid excess was calculated and they were fluid restricted accordingly. Supplementary hypertonic saline was given. Both made a full neurological recovery. Collateral history revealed that the mother drank up to 4 litres of water following advice to remain well hydrated following severe hyperemesis during the first and second trimester. Discussion: Identifying antenatal risk factors for hyponatraemia, strict fluid balance monitoring and renal function testing in labour may identify at risk women and reduce the incidence of seizures and associated morbidity secondary to water intoxication. doi:10.1016/j.preghy.2018.08.399
356. The eclampsia maternal mortality in Dr. Soetomo General Hospital January 2015–December 2017: Evidence from Dr. Soetomo General Hospital Budi Wicaksono, Handi Firmansyah (Sutomo General Hospital, Surabaya, Indonesia) Introduction: The incidence of Eclampsia in developed country is 1,5–10 cases per 10.000 delivery. The incidence of Eclampsia in developing country is 6–157 cases per 10.000 delivery. More than 50.000 women annually because of Eclampsia. Maternal Mortality Ratio more than 1–2% in developed country. Maternal Mortality Ratio more than 10% in developing country. Objective: To know the incidence of Eclampsia and Case Fatality Rate of Eclampsia in Dr. Soetomo General Hospital from January 2015–December 2017. Methods: This research was Case Control Study. Results: There was 134 Eclampsia cases with 35 maternal death cases. The highest percentage of Eclampsia was maternal age 20– 35 year old (62,7%). Place of delivery at Soetomo Hospital 84,18%, hospitalized 1–5 days 49,3%, gestasional age P36 weeks 81,7%; Multigravida 84,3%, performed Caesarean Section (74,6%). Case fatality rate from maternal age 620 year old 34,6%, the address out of Surabaya 66,46%, place of delivery out of Soetomo General Hospital has highest case fatality rate (31,8%), the highest case fatality rate from duration of hospitalization was 6–10 days (50%), the gestasional age 634 weeks gestation (58,3%), the highest case fatality rate was primigravida 57,1 % and the case fatality rate of vaginal delivery 14,28%. Conclusion: Eclampsia was highest in age 20–35 years old, the case fatality rate was highest in age 6 20 years old. The duration of hospitalization the highest was 1–6 days hospitalization, the highest case fatality rate was 6–10 days hospitalization. the highest eclampsia incidence was P36 weeks gestation, the highest case fatality rate was 634 weeks gestation. The incidence of Eclampsia was highest in Multigravida, the highest case fatality rate was primigravida. The highest mode of delivery was Caesarean Section, case fatality no different between caesarean and vaginaly. doi:10.1016/j.preghy.2018.08.400
357. Pregnancy in Cardiac disease – An audit on outcomes in the Joint Cardiac Pregnancy Clinic, Singapore General Hospital. Lay-Kok Tan, Ying Hao Tan, Ju Le Tan, Serene Thain, Eng Loy Tan (Singapore)
S135
Introduction: Cardiac disease is an increasingly important cause of maternal morbidity and mortality. Joint multidisciplinary care of these pregnancies is strongly advocated. Aim: Pregnancy outcomes in cardiac patients seen at the cardiac joint clinic. Method and results: All pregnant mothers with acquired or congenital heart diseases are referred to CJC, which is jointly run by consultant obstetricians and cardiologists., with easy access to anaesthesia and neonatal referrals. Delivery was in a tertiary level teaching hospital. 60 new cases were seen from 2009 to 2013. Median maternal age was 29 (19–40). Most had WHO class 1 disease (66.6%) with NYHA status 1 (90%). 10% of the population had WHO class 4 disease but none had a NYHA score worse than 2. Two thirds had congenital heart disease, which 55% were valvular. Acquired heart conditions made up the remaining third of which only 15 % were valvular. The most common cardiac diagnoses include MVP (21.7%), AS/VSD (16.7%) and cardiomyopathy (16.7%). Caesarian sections rate was 59.3% (40% emergency sections) with a median hospital stay of 3 days. Vaginal delivery rates were 40.7% with 16% being assisted. There were no neonatal or maternal mortalities. Patients who developed cardiomyopathy postpartum or have a history of previous or existing cardiomyopathy had longer hospitalisation stays. Median gestational age was 38 + 2 days (32–41 weeks) and median birth weight was 3072.5 g. Median APGAR scores were 8, 9 at 1 and 5 min respectively. Median length of stay for the baby was 4 days with average length of stay being 5.58 days. Conclusion: Congenital heart disease remains an important contributing aetiology to cardiac disease in pregnancy. The majority of our patients achieved good maternal and neonatal outcomes, underpinning the importance of providing a seamless joint service providing multi-disciplinary pre-pregnancy, antepartum, intrapartum and postpartum care. doi:10.1016/j.preghy.2018.08.401
358. Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in South Western Sydney A.L. Daly, N. Sriram, C. Woodall, K. Selvakumar, K. Briggs, P. Garg, L. Russell, M. Yu, K. Beetson, A. Hennessy, on behalf of Tharawal AMS Board Australia) Background: The prevalence of hypertensive disorders of pregnancy (HDP) in Australia’s urban Indigenous women is unknown. Aim: To explore the risk factors associated with HDP for a cohort of urban Indigenous women in South-Western Sydney, Australia. Methods and Materials: This study was conducted in partnership with the Tharawal Aboriginal Medical Service (TAMS). Women (18–45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates. Results: Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for Indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (S.D. 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m[b] (S.D. 9.5 kg/m2) and BMI was not related to HDP (p = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (p = 0.020) (OR 4.29; 95%CI; 1.42–12.93) and
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
Methods: A cross sectional study was conducted in Sir GangaRam Hospital Lahore during February 2015 to June 2016. Total 80 pregnant women diagnosed with hypertension during their 2nd trimester were included in the study. Blood pressure and certain laboratory investigations were done including total cholesterol, LDL, VLDL and HDL. A personalized health questionnaire was used to classify depression among women. Hypertension distress scale was used to identify hypertension distress and other factors such as social distress, interpersonal distress, physician related distress, emotional distress and regimen related distress. Results: The rate of depression was 39% among women diagnosed with hypertension. 8% were categorised as mild depression, 14% moderate depression and 17% with severe depression. Hypertensive depression was found in 71% of the selected population. Rates of social distress, interpersonal distress, and physician related distress, emotional distress, infant death distress, regimen related distress were 23%, 33.5%, 17.8%, 73.4% and 42.6 respectively. There was no association between depression and low HDL. Conclusion: Our study concludes that hypertensive distress is very common among pregnant women in Pakistan and this is an alarming condition for Pakistani population. We need to develop and modify our management plans in order to combat this deadly distress. Mass media should be involved in order to raise awareness about. doi:10.1016/j.preghy.2018.08.396
353. Knowledge assessment of cardiovascular diseases among Pakistani pregnant women Arooj Fatima a, Syed Sammar Abbas Zaidi b (a Sir GangaRam Hospital, Lahore, Pakistan, b Wecare medical centre, Lahore, Pakistan) Objectives: Cardiovascular diseases are the leading cause of death worldwide. The most interesting feature of cardiovascular diseases is that they can be prevented. Majority of the risk factors are controllable including hypertension, dyslipidemia, obesity, diabetes, smoking, stress and sedentary life style etc. We aim to assess knowledge, awareness, perception of cardiovascular diseases and risk factors among pregnant women living in rural areas of Pakistan. We also aim to evaluate the level of prevention of cardiovascular diseases as a result of awareness and knowledge. Methods: The study was conducted in peripheral areas of Lahore, Pakistan during the year 2016. A structured questionnaire was established that targeted 350 female population >20 years during their 1st and 2nd trimester. Informed consent was obtained and questionnaire were filled. The data was analysed using SPSS 16.0. Results: Only 26% of the participating pregnant women agreed that cardiovascular diseases are the most leading causes of mortality. Knowledge regarding cause, risk factors and complications was found inadequate. There was identified lack of health promoting behaviours and practices among the subjects. Practices regarding diet and lifestyle were also found unsatisfactory. Awareness of risk factors was present in 110 (31%) of targeted population. On risk assessment scale, 62% were found at high risk and 38% at low risk of developing cardiovascular diseases. Conclusion: It has been concluded that a significant number of people had little or now awareness regarding the cardiovascular diseases and its complications. We can surely lessen the morbidity and mortality of both mother and fetus by primary prevention followed by early detection of the diseases and early interventions. The proportion of individuals found high risk and low risk should be
screened regularly. We should prevent CVD though outreach programs and mass media. doi:10.1016/j.preghy.2018.08.397
354. Counselling and consenting for diagnostic imaging in pregnancy Sandra Lowe (Australia) Diagnostic imaging in pregnancy requires a detailed understanding of the risks and benefits of the imaging options. This will ensure the most appropriate and safest imaging modality is performed to provide maximal information for diagnosis and management. Counselling and obtaining informed consent for imaging that involves radiation requires the clinician to communicate with the woman and her family a realistic estimate of the potential radiation dose to herself and her fetus, to describe and quantitate the risks of this estimated dose, to outline the benefits of the imaging procedure and to respond to any questions or concerns. Although the ‘‘as low as reasonably achievable” (ALARA) should be applied, pregnant women should be imaged using the standard imaging protocols used for any other patients. If dose reduction strategies do not compromise image quality, then they should be used for all patients. The American College of Radiology particularly note that ‘‘It is best to create written protocols for all imaging of pregnant patients to avoid reactive, non-optimal protocol adjustments by physicians attempting to reduce radiation exposures.” All allied staff must also be well informed to ensure the patient receives a consistent message about the risks and benefits of the proposed test(s). In almost all diagnostic imaging,with or without contrast or nuclear isotopes, maternal and fetal risks are negligible and therefore the most sensitive and specific imaging should be performed at the most appropriate time whether during or after pregnancy. With adequate information and knowledge, the reflex ‘‘no radiation” approach to selection of diagnostic imaging modalities in pregnancy should be replaced with principle of ensuring that nonionising radiation options are considered first, whether during or after pregnancy; but when X ray, CT, nuclear scan or PET are the most suitable modality; these should be applied with appropriate care and counselling. doi:10.1016/j.preghy.2018.08.398
355. Maternal and neonatal seizures secondary to severe hyponatraemia from acute intrapartum water intoxication Sophie Walter, Anna Fabre-Gray, Ashwini Bilagi (St Michaels Hospital, Bristol, United Kingdom) Introduction: We wish to highlight how unregulated intrapartum water ingestion can result in significant maternal and neonatal morbidity. Early symptoms can be non-specific or confused with common pregnancy complications such as pre-eclampsia. We present a case of maternal and neonatal seizures secondary to severe hyponatremia following water intoxication. We will discuss the challenges in identifying high risk patients and their subsequent management. Case presentation: A healthy primiparous women presented at term in spontaneous labour. She developed a generalized seizure followed a short period of acute confusion and disorientation intrapartum. She was mildly hypertensive without proteinuria.
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 13 (2018) S50–S150
Magnesium sulphate was given and an emergency caesarean section performed. Following delivery the neonate developed seizures. Cord blood gases were normal. Maternal and fetal bloods showed severe hyponatraemia. Their biochemical and hormonal profile was otherwise normal. Brain and renal imaging were normal. Both required intensive care treatment. Fluid excess was calculated and they were fluid restricted accordingly. Supplementary hypertonic saline was given. Both made a full neurological recovery. Collateral history revealed that the mother drank up to 4 litres of water following advice to remain well hydrated following severe hyperemesis during the first and second trimester. Discussion: Identifying antenatal risk factors for hyponatraemia, strict fluid balance monitoring and renal function testing in labour may identify at risk women and reduce the incidence of seizures and associated morbidity secondary to water intoxication. doi:10.1016/j.preghy.2018.08.399
356. The eclampsia maternal mortality in Dr. Soetomo General Hospital January 2015–December 2017: Evidence from Dr. Soetomo General Hospital Budi Wicaksono, Handi Firmansyah (Sutomo General Hospital, Surabaya, Indonesia) Introduction: The incidence of Eclampsia in developed country is 1,5–10 cases per 10.000 delivery. The incidence of Eclampsia in developing country is 6–157 cases per 10.000 delivery. More than 50.000 women annually because of Eclampsia. Maternal Mortality Ratio more than 1–2% in developed country. Maternal Mortality Ratio more than 10% in developing country. Objective: To know the incidence of Eclampsia and Case Fatality Rate of Eclampsia in Dr. Soetomo General Hospital from January 2015–December 2017. Methods: This research was Case Control Study. Results: There was 134 Eclampsia cases with 35 maternal death cases. The highest percentage of Eclampsia was maternal age 20– 35 year old (62,7%). Place of delivery at Soetomo Hospital 84,18%, hospitalized 1–5 days 49,3%, gestasional age P36 weeks 81,7%; Multigravida 84,3%, performed Caesarean Section (74,6%). Case fatality rate from maternal age 620 year old 34,6%, the address out of Surabaya 66,46%, place of delivery out of Soetomo General Hospital has highest case fatality rate (31,8%), the highest case fatality rate from duration of hospitalization was 6–10 days (50%), the gestasional age 634 weeks gestation (58,3%), the highest case fatality rate was primigravida 57,1 % and the case fatality rate of vaginal delivery 14,28%. Conclusion: Eclampsia was highest in age 20–35 years old, the case fatality rate was highest in age 6 20 years old. The duration of hospitalization the highest was 1–6 days hospitalization, the highest case fatality rate was 6–10 days hospitalization. the highest eclampsia incidence was P36 weeks gestation, the highest case fatality rate was 634 weeks gestation. The incidence of Eclampsia was highest in Multigravida, the highest case fatality rate was primigravida. The highest mode of delivery was Caesarean Section, case fatality no different between caesarean and vaginaly. doi:10.1016/j.preghy.2018.08.400
357. Pregnancy in Cardiac disease – An audit on outcomes in the Joint Cardiac Pregnancy Clinic, Singapore General Hospital. Lay-Kok Tan, Ying Hao Tan, Ju Le Tan, Serene Thain, Eng Loy Tan (Singapore)
S135
Introduction: Cardiac disease is an increasingly important cause of maternal morbidity and mortality. Joint multidisciplinary care of these pregnancies is strongly advocated. Aim: Pregnancy outcomes in cardiac patients seen at the cardiac joint clinic. Method and results: All pregnant mothers with acquired or congenital heart diseases are referred to CJC, which is jointly run by consultant obstetricians and cardiologists., with easy access to anaesthesia and neonatal referrals. Delivery was in a tertiary level teaching hospital. 60 new cases were seen from 2009 to 2013. Median maternal age was 29 (19–40). Most had WHO class 1 disease (66.6%) with NYHA status 1 (90%). 10% of the population had WHO class 4 disease but none had a NYHA score worse than 2. Two thirds had congenital heart disease, which 55% were valvular. Acquired heart conditions made up the remaining third of which only 15 % were valvular. The most common cardiac diagnoses include MVP (21.7%), AS/VSD (16.7%) and cardiomyopathy (16.7%). Caesarian sections rate was 59.3% (40% emergency sections) with a median hospital stay of 3 days. Vaginal delivery rates were 40.7% with 16% being assisted. There were no neonatal or maternal mortalities. Patients who developed cardiomyopathy postpartum or have a history of previous or existing cardiomyopathy had longer hospitalisation stays. Median gestational age was 38 + 2 days (32–41 weeks) and median birth weight was 3072.5 g. Median APGAR scores were 8, 9 at 1 and 5 min respectively. Median length of stay for the baby was 4 days with average length of stay being 5.58 days. Conclusion: Congenital heart disease remains an important contributing aetiology to cardiac disease in pregnancy. The majority of our patients achieved good maternal and neonatal outcomes, underpinning the importance of providing a seamless joint service providing multi-disciplinary pre-pregnancy, antepartum, intrapartum and postpartum care. doi:10.1016/j.preghy.2018.08.401
358. Risk factors associated with hypertensive disorders of pregnancy within an urban indigenous population in South Western Sydney A.L. Daly, N. Sriram, C. Woodall, K. Selvakumar, K. Briggs, P. Garg, L. Russell, M. Yu, K. Beetson, A. Hennessy, on behalf of Tharawal AMS Board Australia) Background: The prevalence of hypertensive disorders of pregnancy (HDP) in Australia’s urban Indigenous women is unknown. Aim: To explore the risk factors associated with HDP for a cohort of urban Indigenous women in South-Western Sydney, Australia. Methods and Materials: This study was conducted in partnership with the Tharawal Aboriginal Medical Service (TAMS). Women (18–45 years) were recruited at the clinic and community events. The quantitative questionnaire included obstetric history, personal and family history of hypertension. Anthropometric measurements and blood pressure were conducted. Rates were compared with Australian Bureau of Statistics (ABS) national rates. Results: Eighty-three participants completed the questionnaire. The rate of ever having HDP in a pregnancy was 36.1%. The overall ABS rate was 9.8% and for Indigenous women, 14%. The mean maternal age at first pregnancy was 20.8 years (S.D. 3.7 years). The mean body mass index (BMI) of the sample population (n = 81) was 32.2 kg/m[b] (S.D. 9.5 kg/m2) and BMI was not related to HDP (p = 0.197). Of those questioned, 25.3% had an individual history and 63.9% had a family history of hypertension. The effect of family history of hypertension (p = 0.020) (OR 4.29; 95%CI; 1.42–12.93) and