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Antenatal care in rural Africa — is there a benefit?
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P1.01.09 PERINATAL PROGNOSIS (ORIGINAL METHOD) S. Vitushko, M. Fedorova, V. Petrukhin, V. Gurieva, F. Burumkulova, Moscow Regional Scientific Research Institute of OBIGYN, Moscow, Russia Objectives: The aim of our work was to elaborate the new method perinatal prognosis on the basis of qualitative and quantitative assessment of a fetoplacental complex (FPC) function. Study Methods: For 65 pregnant women with diabetes mellitus (DM) during all gestation is conduced not less than 8-9 series of blood analyses on 5 parameters: a placental lactogen, progesteron, estriol, cortisol, a-fetoprotein. Results: On parameters of a FPC function, expressed in percentile, for each woman was determined the “adaptive corridor”, restricted by lowest and extremely upper (“marginal”) values. It is ground analyses of nature and features of an “adaptive corridor” are discharged 6 signs of pathological fetus adaptation and different qualitative condition of FPC: stability, instability, high instability and “attrition”. The dynamics accumulation of pathological signs of adaptation has allowed calculating a coefficient of “deterioration” (CD) of FPC. At CD less than 1.0 perinatal prognosis is favorable, at CD 1.0 and more - is doubtful. The test-sensitivity of this method has made 80.0% specificity -93.3%. Conclusions: The system approach to a series of parameters of a FPC function has allowed giving both qualitative and quantitative assessment of a fetus condition. The definition of stability and CD of FPC as systems is new and practically significant method of the perinatal prognosis for the pregnant woman with DM.
P1.01.10 DISTRIBUTION OF PERINATAL MORTALITY RATES IN TWO REGIONS OF RUSSIA USING NORDIC-BALTIC PERINATAL DEATH CLASSIFICATION S.V. Pavlovitch (l), E.M. Vikhlyaeva (l), L.V. Posiseeva (2), T.P. Vasilyeva (2), K.G. Serebrennikova (3) (1) Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia (2) Ivanovo Research Institute of Obstetrics and Pediatrics, Ivanovo, Russia (3) Izevsk medical academy, Izevsk, Russia Objectives: To analyze the structure of the perinatal mortality in the European part of Russia using Nordic-Baltic Perinatal Death Classification (NBPDC) with evaluation of the risk rates for each of the categories of that Classification. Study Method: The study has been undertaken in the framework of the WHO project #95909. All cases of perinatal losses in 1998 in Ivanovo region and Republic of Udmurtia (153 and 227 cases correspondingly) and their distribution according to the 12 categories of the NBPDC had been analyzed with the “PND” computer program (author -Dr. S. Larsen, Denmark). Perinatal death rates, total risk rates and deaths risk rates were evaluated for each of the classification categories. Results: Significant differences between regions have been revealed in the perinatal death rates in neonatal (VIII-XII) categories, especially for the newborns with gestational age of 22-28 weeks. Relatively high indices of the perinatal death and perinatal death risk rates in both regions for intranatal (VI) category (1.24; 1.46 and 1.28;1.47, correspondingly) as well as for VIII-XII categories testify of some reserves for introducing of the preventive measures. ConclusionsApplication of the NBPDC in perinatal practice is of great assistance for detailed analysis of the perinatal losses structure and thus reveal the priorities for improving the perinatal care system.
P1.01.11 ANTENATAL CARE IN RURAL AFRICA - IS THERE A BENEFIT? D Urassa, Dpt of Community Medicine, University of Dar-esSalaam,Tanzania A Carlstedt and G Lindmark, Dpt of Women’s and Children’s Health, Uppsala,Sweden Objective: To assess the ability of antenatal care to improve common health problems such as anemia in a developing country. Methods: We observed and interviewed 379 women from 16 randomly selected antenatal clinics in Rufiji district, Tanzania with respect to the care received. Process quality was assessed for clinical and laboratory
MONDAY,
SEPTEMBER
investigation and individual counselling to get the proportion of women receiving the standard quality of antenatal care. Hemoque hemoglobinometer operated by trained observers was used as a golden standard for prevalence of anemia. Results: The majority of pregnant women (58%) were not checked for anaemia at all. Only 9.5% were clinically examined, 36.7% had hemoglobin (HB) assessed by Tallquist method. Health workers defined a larger proportion of women as moderately anaemic (Hb >8.5 and
P1.01.12 PHOSPHOISOFORMS OF INSULIN-LIKE GROWTH FACTOR BINDING PROTEIN-l IN APPROPRIATE-FOR-GESTATIONAL AGE AND SMALL-FOR-GESTATIONAL AGE FETUSES T. Mochizuki (l), Y. Katsumata (l), T. Hoshiai (l), T. Ozaki (l), T. Yazaki (l), M. Iwashita (l), Y. Nakamura (l), K. Maruyama (2), H Aoki (3) (1) Dept. OBIGYN, Kyorin University School of Medicine, Tokyo, Japan (2) Yoshida Clinic, Saitaima, Japan (3) Dept. OBIGYN, Fussa Hospital, Tokyo, Japan Objectives: The aim of the study is to analyze phosphoisoforms of insulin-like growth factor-binding protein-l (IGFBP-1) in maternal and cord sera from pre-term and term fetus with different growth status. Study Methods: Phosphoisoforms were separated by non-SDSpolyacrylamide gel electrophoresis and detected by immunoblot. Phosphoisoforms were also analyzed by anion exchange chromatography on HPLC. Results: The proportion of nonphosphorylated IGFBP-1 to total IGFP-1 was significantly higher in pre-term fetus than their mothers, however, the relative amounts of each IGFBP-1 isoforms were similar between pre-term and term fetus. The levels of nonphosphorylated IGFBP-1 were similar between appropriate for gestational age (AGA) and small for gestational age (SGA) fetus at term, however, phosphorylated isoforms of IGFBP-1 were increased in SGA fetus compared to those of AGA fetus and the proportion of nonphosphorylated IGFBP-1 to total IGFBP1 was lower in SGA fetus than those in AGA fetus. Conclusions: The profiles of nonphosphorylated and phosphorylated IGFBP-1 in the fetus varies corresponding to fetal growth suggesting that not only total amounts of IGFBP-1 but also the proportion of phosphoisoforms of IGFBP-1 is important for fetal growth.
P1.01.13 THE EFFECT OF ANTENATAL PELVIC FLOOR EXERCISE WITH A VAGINAL DILATOR ON PERINEAL TRAUMA DURING CHILDBIRTH: A RANDOMISED CONTROLLED TRIAL. Sorensen L, Noglebzk .I, Nonboe A,_Skaiaa K, University Hospital of Aarhus, Skejby Hospital, DK-8200 Aarhus, Denmark Objective: The aim of the study was to evaluate the effect of antenatal pelvic floor exercise with a vaginal dilator on perineal trauma during childbirth. Design: A randomised, single-blind prospective study Setting: Midwifery antenatal care centre and the labour ward at the department of obstetrics and gynaecology at Aarhus University Hospital. Participants: From August 1998 to December 1999 five hundred and twenty-five nulliparous women with singleton pregnancy and fulfilling the entry criteria to the trial were randomised by a automated voice response programme to one of two groups. Group one was assigned to pelvic floor exercise ten to fifteen minutes twice daily from thirty-five week of pregnancy to delivery, and group two was assigned to no exercise. The pelvic floor exercise consisted of isometric contractions of
P1.01.09 PERINATAL PROGNOSIS (ORIGINAL METHOD) S. Vitushko, M. Fedorova, V. Petrukhin, V. Gurieva, F. Burumkulova, Moscow Regional Scientific Research Institute of OBIGYN, Moscow, Russia Objectives: The aim of our work was to elaborate the new method perinatal prognosis on the basis of qualitative and quantitative assessment of a fetoplacental complex (FPC) function. Study Methods: For 65 pregnant women with diabetes mellitus (DM) during all gestation is conduced not less than 8-9 series of blood analyses on 5 parameters: a placental lactogen, progesteron, estriol, cortisol, a-fetoprotein. Results: On parameters of a FPC function, expressed in percentile, for each woman was determined the “adaptive corridor”, restricted by lowest and extremely upper (“marginal”) values. It is ground analyses of nature and features of an “adaptive corridor” are discharged 6 signs of pathological fetus adaptation and different qualitative condition of FPC: stability, instability, high instability and “attrition”. The dynamics accumulation of pathological signs of adaptation has allowed calculating a coefficient of “deterioration” (CD) of FPC. At CD less than 1.0 perinatal prognosis is favorable, at CD 1.0 and more - is doubtful. The test-sensitivity of this method has made 80.0% specificity -93.3%. Conclusions: The system approach to a series of parameters of a FPC function has allowed giving both qualitative and quantitative assessment of a fetus condition. The definition of stability and CD of FPC as systems is new and practically significant method of the perinatal prognosis for the pregnant woman with DM.
P1.01.10 DISTRIBUTION OF PERINATAL MORTALITY RATES IN TWO REGIONS OF RUSSIA USING NORDIC-BALTIC PERINATAL DEATH CLASSIFICATION S.V. Pavlovitch (l), E.M. Vikhlyaeva (l), L.V. Posiseeva (2), T.P. Vasilyeva (2), K.G. Serebrennikova (3) (1) Research Center of Obstetrics, Gynecology and Perinatology, Moscow, Russia (2) Ivanovo Research Institute of Obstetrics and Pediatrics, Ivanovo, Russia (3) Izevsk medical academy, Izevsk, Russia Objectives: To analyze the structure of the perinatal mortality in the European part of Russia using Nordic-Baltic Perinatal Death Classification (NBPDC) with evaluation of the risk rates for each of the categories of that Classification. Study Method: The study has been undertaken in the framework of the WHO project #95909. All cases of perinatal losses in 1998 in Ivanovo region and Republic of Udmurtia (153 and 227 cases correspondingly) and their distribution according to the 12 categories of the NBPDC had been analyzed with the “PND” computer program (author -Dr. S. Larsen, Denmark). Perinatal death rates, total risk rates and deaths risk rates were evaluated for each of the classification categories. Results: Significant differences between regions have been revealed in the perinatal death rates in neonatal (VIII-XII) categories, especially for the newborns with gestational age of 22-28 weeks. Relatively high indices of the perinatal death and perinatal death risk rates in both regions for intranatal (VI) category (1.24; 1.46 and 1.28;1.47, correspondingly) as well as for VIII-XII categories testify of some reserves for introducing of the preventive measures. ConclusionsApplication of the NBPDC in perinatal practice is of great assistance for detailed analysis of the perinatal losses structure and thus reveal the priorities for improving the perinatal care system.
P1.01.11 ANTENATAL CARE IN RURAL AFRICA - IS THERE A BENEFIT? D Urassa, Dpt of Community Medicine, University of Dar-esSalaam,Tanzania A Carlstedt and G Lindmark, Dpt of Women’s and Children’s Health, Uppsala,Sweden Objective: To assess the ability of antenatal care to improve common health problems such as anemia in a developing country. Methods: We observed and interviewed 379 women from 16 randomly selected antenatal clinics in Rufiji district, Tanzania with respect to the care received. Process quality was assessed for clinical and laboratory
MONDAY,
SEPTEMBER
investigation and individual counselling to get the proportion of women receiving the standard quality of antenatal care. Hemoque hemoglobinometer operated by trained observers was used as a golden standard for prevalence of anemia. Results: The majority of pregnant women (58%) were not checked for anaemia at all. Only 9.5% were clinically examined, 36.7% had hemoglobin (HB) assessed by Tallquist method. Health workers defined a larger proportion of women as moderately anaemic (Hb >8.5 and
P1.01.12 PHOSPHOISOFORMS OF INSULIN-LIKE GROWTH FACTOR BINDING PROTEIN-l IN APPROPRIATE-FOR-GESTATIONAL AGE AND SMALL-FOR-GESTATIONAL AGE FETUSES T. Mochizuki (l), Y. Katsumata (l), T. Hoshiai (l), T. Ozaki (l), T. Yazaki (l), M. Iwashita (l), Y. Nakamura (l), K. Maruyama (2), H Aoki (3) (1) Dept. OBIGYN, Kyorin University School of Medicine, Tokyo, Japan (2) Yoshida Clinic, Saitaima, Japan (3) Dept. OBIGYN, Fussa Hospital, Tokyo, Japan Objectives: The aim of the study is to analyze phosphoisoforms of insulin-like growth factor-binding protein-l (IGFBP-1) in maternal and cord sera from pre-term and term fetus with different growth status. Study Methods: Phosphoisoforms were separated by non-SDSpolyacrylamide gel electrophoresis and detected by immunoblot. Phosphoisoforms were also analyzed by anion exchange chromatography on HPLC. Results: The proportion of nonphosphorylated IGFBP-1 to total IGFP-1 was significantly higher in pre-term fetus than their mothers, however, the relative amounts of each IGFBP-1 isoforms were similar between pre-term and term fetus. The levels of nonphosphorylated IGFBP-1 were similar between appropriate for gestational age (AGA) and small for gestational age (SGA) fetus at term, however, phosphorylated isoforms of IGFBP-1 were increased in SGA fetus compared to those of AGA fetus and the proportion of nonphosphorylated IGFBP-1 to total IGFBP1 was lower in SGA fetus than those in AGA fetus. Conclusions: The profiles of nonphosphorylated and phosphorylated IGFBP-1 in the fetus varies corresponding to fetal growth suggesting that not only total amounts of IGFBP-1 but also the proportion of phosphoisoforms of IGFBP-1 is important for fetal growth.
P1.01.13 THE EFFECT OF ANTENATAL PELVIC FLOOR EXERCISE WITH A VAGINAL DILATOR ON PERINEAL TRAUMA DURING CHILDBIRTH: A RANDOMISED CONTROLLED TRIAL. Sorensen L, Noglebzk .I, Nonboe A,_Skaiaa K, University Hospital of Aarhus, Skejby Hospital, DK-8200 Aarhus, Denmark Objective: The aim of the study was to evaluate the effect of antenatal pelvic floor exercise with a vaginal dilator on perineal trauma during childbirth. Design: A randomised, single-blind prospective study Setting: Midwifery antenatal care centre and the labour ward at the department of obstetrics and gynaecology at Aarhus University Hospital. Participants: From August 1998 to December 1999 five hundred and twenty-five nulliparous women with singleton pregnancy and fulfilling the entry criteria to the trial were randomised by a automated voice response programme to one of two groups. Group one was assigned to pelvic floor exercise ten to fifteen minutes twice daily from thirty-five week of pregnancy to delivery, and group two was assigned to no exercise. The pelvic floor exercise consisted of isometric contractions of