- Email: [email protected]
Case presentation and review of literature for a rare case of adolescent premature ovarian insufficiency
e52
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
analysis indicated that the pessary is more effective method of preventing PTB (odds ratio for term pregnancy OR = 2.22 – compared with cerclage). The most important risk factor for PTB, regardless of the method of treatment turned out to be: uterus operations in the past (OR = 2.63). In addition, patients with a POH had a worse prognosis compared to the pregnant women that were qualified only on the bases of short cervix (OR = 4.17). The analysis concerning indications for treatment indicated that in patients with short cervix pessary was almost 4 times more effective (OR = 3.71) than cerclage in prevention of PTB. In the study group pessary achieved better efficacy of preventing PTB. PROM occurred less frequently in the group treated with pessary. The study population was too small to reach the significance level (in all test P > 0.05), however the survey showed interesting trends in the treatment of pregnant women at high risk of PTB. Conclusions: Based on our results pessary seems to be an effective method of preventing the PTB, particularly in the group of patients with a short cervix without POH. This pilot study emphasis the need of evaluation on a larger group in the future.
scan and fetal MRI, the asymmetry of cerebral hemispheres and of the ventricular system were confirmed. A mild dilatation of the occipital horn of the right side lateral ventricle to 10 mm was observed. An irregular shape of the interhemisphere fissure and the absence of the cavum septi pellucidi were observed. The lack of the anterior part of the cerebral falx was also described. Additionally MRI of the fetus brain did not demonstrate any hemorrhagic areas in the CNS. Because of the diagnosis of the severe, congenital CNS defect the patient decided to terminate the pregnancy. Conclusions: Agenesis of the corpus callosum is a rare condition with a complex etiology and a controversial prognosis. Direct visualization of the corpus callosum can be difficult during prenatal ultrasound scan and requires an expertise of an experienced specialist. However, ACC can be suspected in the presence of indirect features. Additional MRI examination can help to confirm the diagnosis and evaluate the presence of other brain abnormalities coexisting with the agenesis of the corpus callosum.
http://dx.doi.org/10.1016/j.ejogrb.2016.07.154
Menopause and post reproductive health Oral Presentation
Imaging in obstetrics Poster Presentation Prenatal diagnosis of agenesis of corpus callosum Kacprzak 1,∗ ,
http://dx.doi.org/10.1016/j.ejogrb.2016.07.155
Moczulska 1,2 ,
Marta Hanna Chrzanowska 1 , Piotr Sieroszewski 1
Marta
1 Department of Fetal Medicine and Gynaecology, Medical University of Lodz, Poland 2 Department of Clinical Genetics and Laboratory, Medical University of Lodz, Poland E-mail address: [email protected] (M. Kacprzak).
Background: The corpus callosum is a part of the brain responsible for the integration of information and the coordination of the activities of cortical centers located in the right and left hemisphere. Visualization of the corpus callosum in ultrasound starts from the 16th week of gestation. However, an optimal imaging of this structure can be performed after the 20th week of gestation, when its final shape is developed. The prevalence of the corpus callosum agenesis (ACC) is 0.5–1.4 per 10,000 live births. It ranges 230–600 per 10,000 cases among children with neurological disorders. ACC may be isolated or associated with additional cerebral abnormalities as well as other organs and systems disorders. The etiology of this disability is of the genetic background: monogenic, polygenic or chromosomal (e.g. trisomies 13,18). Other possible causes include metabolic diseases and environmental factors- antenatal alcohol exposure, antenatal infections or vascular insults. Case report: A 28-year-old multipara in the 17th week of gestation was admitted to the referral university hospital because of suspected defects of the fetus central nervous system. Medical history showed one spontaneous abortion at 5 weeks of gestation and one healthy child delivery on time. Neither the patient nor her husband had significant family history or pathological conditions. The transabdominal ultrasound showed: an irregular shape of the fetus skull, asymmetry of the brain hemispheres, the lateral ventricles and choroid plexus. On the left side of the fetal brain, a hypoechogenic area was described that maid correspond with subdural hematoma. No other abnormalities in the fetus were detected. The amniocentesis result was considered as normal: karyotype 46, XX. To continue the diagnostics of the fetal defects the patient was admitted again in the 21st week of gestation. In the next ultrasound
Case presentation and review of literature for a rare case of adolescent premature ovarian insufficiency Pragati Kakkar ∗ , Urmila Singh Darent Valley Hospital, Darenth Wood Rd, Dartford, Kent DA2 8DA, United Kingdom E-mail address: [email protected] (P. Kakkar). Introduction: Premature ovarian insufficiency (POI) in a well adolescent is an extremely rare event and its occurrence raises important questions about causation, which may signal other systemic concerns. Its occurrence may have a significant impact on a woman’s future health, fertility and motherhood. Beyond the psychological devastation and the symptomatic havoc that dominate the “now” lie long-term health implications of relatively swift and sometime dramatic loss of ovarian function seen with it. The background age-specific incidence of idiopathic POI in early to midadolescence is so rare as to be also unknown, with the annual incidence reported as 10/100,000 in girls younger than 20 years. (1) Whether spontaneous or induced, POI renders a woman deficient in ovarian endocrine and reproductive function and hold myriad implications, both short and long term. In literature there is limited research and very few cases reported with adolescent POI. In view of its inimitability we hereby present a very interesting and unique case of POI in Miss A, an adolescent girl. Case presentation: Miss A attended gynaecology outpatients with secondary amenorrhoea and episodes of hot flushes and sweats on and off for 9 month duration. It as preceded by one episode of prolonged heavy periods for which was treated with provera by general practitioner for one month following which amenorrhoea developed. She attained menarche at the age of 11 years and had regular menstrual cycles thereafter. She has not had any medical problems in the past and is not known to be on regular medications. There is no contributory surgical or family history. She has two elder sisters absolutely well and fine. Examination showed well-developed secondary sexual characteristics with a normal BMI. Systemic examination was unremarkable. A battery of investigations conducted on her did not reveal any reason for her complaints. Raised levels of follicle stimulating hormone and low serum estradiol levels done 6 weeks apart-confirmed diagnosis of POI. Subsequently she was referred to tertiary care centre
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
where they further investigated and started her on oral combined oral contraceptive pill. Discussion and review of literature: POI is defined as depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years, and it has previously been referred to as premature menopause or primary ovarian failure or premature ovarian failure. Hence achieving a heightened level of awareness of symptomatology, timely diagnosis, counselling and intervention may alleviate few of the consequences and long term sequelae. A greater understanding of female reproductive biology and the physiologic effect of primary ovarian insufficiency enable health care providers to offer counselling for these young women. http://dx.doi.org/10.1016/j.ejogrb.2016.07.156 Infections in obstetrics and gynaecology Poster Presentation Obstetrical and perinatal complications in HIV-infected pregnant women with herpes virus infection Vyacheslav Kaminskiy 1,∗ , Oleksii Zhdanovich 2 , Tetiana Anoshina 1 1 P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine 2 State institution «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy).
According to results of some authors the increasing of incidence of obstetrical and perinatal complications in HIV-infected women is the sequence of HIV-associated infections, but not native HIV. The clinical and statistical analysis of 1177 records of pregnancy women with HIV delivered in Reprudoctology and Perinatal Medicine Kyiv’s City Center from 2009 to 2013 was performed. The control group consists from 200 gravid females with physiological course of gestation and labor. It was revealed that 5-years incidence of human herpes virus infection (HVI) was 42.3% among HIV-infected pregnancy women and 28.0% in control group (p < 0.05). The primary infection of HVI was noted in 8.5% of HIV-infected pregnant women and the reactivation of infection in 27.2% and this was interpreted as important risk factor for obstetrical and perinatal complications. The course of such gestation was complicated in 84.3% pregnancy women from group of observations. The incidence of fetal distress in women with HVI was increased both during gestation and labor (22.3 vs. 16.5% in HIV-infected women without HVI, p < 0.05). The incidence of cesarean section in HIV-infected gravid with HVI was 26,2% vs. 18.1% (p < 0.05). Preterm labors in HIV infection presence were noted in 15.4% women with HVI and in 9.0% without HVI (p < 0.05). Preterm labors at gestational age up to 34 weeks were occurred in 4.2 and 1.5%, respectively. Five-year perinatal lethality was established in 12 cases – 8 (21.5 ‰) women with HVI; 6 (16.1 ‰) and 2 (5.4 ‰) – in antenatal and perinatal period, respectively. The health of infants delivered by HIV-infected mothers with HVI also was worse: heavy asphyxia neonatorum has 12.1% vs. 6.2% infants from mothers without HVI (p < 0.05), and hypotrophy – 31.3 vs. 25.7%, respectively (p < 0.05). It should be noted that in 14 (3.8%) infants from HIV-infected mothers with HVI and in 4 (0.8%) infants from mothers without HVI (p < 0.05) the congenital pneumonia was diagnosed at the end of 1 day of life. Analysis results (illustration) show that at inactive form of infection the incidence of studied complications was similar to HIV-infected gravid without HVI, but during primary infection
e53
or reactivation phase the increasing at 1.5–2 times was noted. Performed analysis demonstrated the negative effect of herpesvirus on course of gestation/labor, health of fetal and newborns in HIVinfected women. The mechanisms of such effect and methods of its minimization or prevention are subjects for further research. http://dx.doi.org/10.1016/j.ejogrb.2016.07.157 Assisted reproduction Poster Presentation The role of vascular deregulation in induction of perinatal disorders among the women with high-risk inducted pregnancy Vyacheslav Kaminskiy ∗ , Anatolij Kaminskiy, Tetiana Kolomiichenko, Oleksandra Boychuk P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy). Currently the endothelium dysfunction is considered as general trigger mechanism of reproductive disorders with involving vascular transformations in disturbances of the placentation processes. In females with infertility and hepatobiliary system disorders we find out the genetic predisposition to endothelial dysfunction. In consideration of the abovementioned we consider necessary to explore in this women the levels of nitrogen oxide donor l-arginine, endothelium impairment factor homocysteine, and angiogenesis factor – placental growth factor (PlGF). The 50 gravid females after assisted reproductive technology (ART) with hepatobiliary system disorders (study group), 50 pregnancy women after ART without such disorders (comparison group), and 50 somatically healthy females with spontaneous pregnancy (control group) at a gestational age 14–16 weeks were studied. In women of study group it was noted the significant reduction of l-arginine up to 44.2 ± 1.1 mmol/L vs. 52.6 ± 1.4 mmol/L in control group (p < 0.05) and increasing of homocysteine. It should be noted the essential reduction of PlGF levels in blood (91.4 ± 8.6 vs. 132.4 ± 11.5 pg/mL in women of control group, p < 0.05), which confirmed the negative effect of angiogenesis process abnormalities on growth and functioning of placenta with such sequences as pregnancy complications and fetal distress. The study group included two subgroups: first subgroup – 19 females with remarkable obstetrical and gynecological abnormalities (miscarriages and non-developing pregnancies, severe preeclampsia, decompensated fetal distress); second subgroup – 31 women without such abnormalities. The study demonstrated the severe compromising of gestation after ART programs (table) in women with hepatobiliary system disorders who at early terms of gestation have the influences of endothelial dysfunction, negative action of homocysteine and abnormalities of angiogenesis processes on the growth and formation of placenta. Thereby these factors may be used as early prognostic markers of severe obstetrical and perinatal disturbances of induced pregnancy in the women with hepatobiliary system disorders. Under homeostatic imbalance conditions in this population the pathogenesis of reproductive, obstetrical and perinatal complications is determined by the endothelium abnormalities and deregulation of vascular factors. This is theoretical prerequisite for the development of pathogenetically-based package of measures for treatment and preventing of such complications with the correction of detected abnormalities. http://dx.doi.org/10.1016/j.ejogrb.2016.07.158
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
analysis indicated that the pessary is more effective method of preventing PTB (odds ratio for term pregnancy OR = 2.22 – compared with cerclage). The most important risk factor for PTB, regardless of the method of treatment turned out to be: uterus operations in the past (OR = 2.63). In addition, patients with a POH had a worse prognosis compared to the pregnant women that were qualified only on the bases of short cervix (OR = 4.17). The analysis concerning indications for treatment indicated that in patients with short cervix pessary was almost 4 times more effective (OR = 3.71) than cerclage in prevention of PTB. In the study group pessary achieved better efficacy of preventing PTB. PROM occurred less frequently in the group treated with pessary. The study population was too small to reach the significance level (in all test P > 0.05), however the survey showed interesting trends in the treatment of pregnant women at high risk of PTB. Conclusions: Based on our results pessary seems to be an effective method of preventing the PTB, particularly in the group of patients with a short cervix without POH. This pilot study emphasis the need of evaluation on a larger group in the future.
scan and fetal MRI, the asymmetry of cerebral hemispheres and of the ventricular system were confirmed. A mild dilatation of the occipital horn of the right side lateral ventricle to 10 mm was observed. An irregular shape of the interhemisphere fissure and the absence of the cavum septi pellucidi were observed. The lack of the anterior part of the cerebral falx was also described. Additionally MRI of the fetus brain did not demonstrate any hemorrhagic areas in the CNS. Because of the diagnosis of the severe, congenital CNS defect the patient decided to terminate the pregnancy. Conclusions: Agenesis of the corpus callosum is a rare condition with a complex etiology and a controversial prognosis. Direct visualization of the corpus callosum can be difficult during prenatal ultrasound scan and requires an expertise of an experienced specialist. However, ACC can be suspected in the presence of indirect features. Additional MRI examination can help to confirm the diagnosis and evaluate the presence of other brain abnormalities coexisting with the agenesis of the corpus callosum.
http://dx.doi.org/10.1016/j.ejogrb.2016.07.154
Menopause and post reproductive health Oral Presentation
Imaging in obstetrics Poster Presentation Prenatal diagnosis of agenesis of corpus callosum Kacprzak 1,∗ ,
http://dx.doi.org/10.1016/j.ejogrb.2016.07.155
Moczulska 1,2 ,
Marta Hanna Chrzanowska 1 , Piotr Sieroszewski 1
Marta
1 Department of Fetal Medicine and Gynaecology, Medical University of Lodz, Poland 2 Department of Clinical Genetics and Laboratory, Medical University of Lodz, Poland E-mail address: [email protected] (M. Kacprzak).
Background: The corpus callosum is a part of the brain responsible for the integration of information and the coordination of the activities of cortical centers located in the right and left hemisphere. Visualization of the corpus callosum in ultrasound starts from the 16th week of gestation. However, an optimal imaging of this structure can be performed after the 20th week of gestation, when its final shape is developed. The prevalence of the corpus callosum agenesis (ACC) is 0.5–1.4 per 10,000 live births. It ranges 230–600 per 10,000 cases among children with neurological disorders. ACC may be isolated or associated with additional cerebral abnormalities as well as other organs and systems disorders. The etiology of this disability is of the genetic background: monogenic, polygenic or chromosomal (e.g. trisomies 13,18). Other possible causes include metabolic diseases and environmental factors- antenatal alcohol exposure, antenatal infections or vascular insults. Case report: A 28-year-old multipara in the 17th week of gestation was admitted to the referral university hospital because of suspected defects of the fetus central nervous system. Medical history showed one spontaneous abortion at 5 weeks of gestation and one healthy child delivery on time. Neither the patient nor her husband had significant family history or pathological conditions. The transabdominal ultrasound showed: an irregular shape of the fetus skull, asymmetry of the brain hemispheres, the lateral ventricles and choroid plexus. On the left side of the fetal brain, a hypoechogenic area was described that maid correspond with subdural hematoma. No other abnormalities in the fetus were detected. The amniocentesis result was considered as normal: karyotype 46, XX. To continue the diagnostics of the fetal defects the patient was admitted again in the 21st week of gestation. In the next ultrasound
Case presentation and review of literature for a rare case of adolescent premature ovarian insufficiency Pragati Kakkar ∗ , Urmila Singh Darent Valley Hospital, Darenth Wood Rd, Dartford, Kent DA2 8DA, United Kingdom E-mail address: [email protected] (P. Kakkar). Introduction: Premature ovarian insufficiency (POI) in a well adolescent is an extremely rare event and its occurrence raises important questions about causation, which may signal other systemic concerns. Its occurrence may have a significant impact on a woman’s future health, fertility and motherhood. Beyond the psychological devastation and the symptomatic havoc that dominate the “now” lie long-term health implications of relatively swift and sometime dramatic loss of ovarian function seen with it. The background age-specific incidence of idiopathic POI in early to midadolescence is so rare as to be also unknown, with the annual incidence reported as 10/100,000 in girls younger than 20 years. (1) Whether spontaneous or induced, POI renders a woman deficient in ovarian endocrine and reproductive function and hold myriad implications, both short and long term. In literature there is limited research and very few cases reported with adolescent POI. In view of its inimitability we hereby present a very interesting and unique case of POI in Miss A, an adolescent girl. Case presentation: Miss A attended gynaecology outpatients with secondary amenorrhoea and episodes of hot flushes and sweats on and off for 9 month duration. It as preceded by one episode of prolonged heavy periods for which was treated with provera by general practitioner for one month following which amenorrhoea developed. She attained menarche at the age of 11 years and had regular menstrual cycles thereafter. She has not had any medical problems in the past and is not known to be on regular medications. There is no contributory surgical or family history. She has two elder sisters absolutely well and fine. Examination showed well-developed secondary sexual characteristics with a normal BMI. Systemic examination was unremarkable. A battery of investigations conducted on her did not reveal any reason for her complaints. Raised levels of follicle stimulating hormone and low serum estradiol levels done 6 weeks apart-confirmed diagnosis of POI. Subsequently she was referred to tertiary care centre
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
where they further investigated and started her on oral combined oral contraceptive pill. Discussion and review of literature: POI is defined as depletion or dysfunction of ovarian follicles with cessation of menses before age 40 years, and it has previously been referred to as premature menopause or primary ovarian failure or premature ovarian failure. Hence achieving a heightened level of awareness of symptomatology, timely diagnosis, counselling and intervention may alleviate few of the consequences and long term sequelae. A greater understanding of female reproductive biology and the physiologic effect of primary ovarian insufficiency enable health care providers to offer counselling for these young women. http://dx.doi.org/10.1016/j.ejogrb.2016.07.156 Infections in obstetrics and gynaecology Poster Presentation Obstetrical and perinatal complications in HIV-infected pregnant women with herpes virus infection Vyacheslav Kaminskiy 1,∗ , Oleksii Zhdanovich 2 , Tetiana Anoshina 1 1 P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine 2 State institution «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine», Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy).
According to results of some authors the increasing of incidence of obstetrical and perinatal complications in HIV-infected women is the sequence of HIV-associated infections, but not native HIV. The clinical and statistical analysis of 1177 records of pregnancy women with HIV delivered in Reprudoctology and Perinatal Medicine Kyiv’s City Center from 2009 to 2013 was performed. The control group consists from 200 gravid females with physiological course of gestation and labor. It was revealed that 5-years incidence of human herpes virus infection (HVI) was 42.3% among HIV-infected pregnancy women and 28.0% in control group (p < 0.05). The primary infection of HVI was noted in 8.5% of HIV-infected pregnant women and the reactivation of infection in 27.2% and this was interpreted as important risk factor for obstetrical and perinatal complications. The course of such gestation was complicated in 84.3% pregnancy women from group of observations. The incidence of fetal distress in women with HVI was increased both during gestation and labor (22.3 vs. 16.5% in HIV-infected women without HVI, p < 0.05). The incidence of cesarean section in HIV-infected gravid with HVI was 26,2% vs. 18.1% (p < 0.05). Preterm labors in HIV infection presence were noted in 15.4% women with HVI and in 9.0% without HVI (p < 0.05). Preterm labors at gestational age up to 34 weeks were occurred in 4.2 and 1.5%, respectively. Five-year perinatal lethality was established in 12 cases – 8 (21.5 ‰) women with HVI; 6 (16.1 ‰) and 2 (5.4 ‰) – in antenatal and perinatal period, respectively. The health of infants delivered by HIV-infected mothers with HVI also was worse: heavy asphyxia neonatorum has 12.1% vs. 6.2% infants from mothers without HVI (p < 0.05), and hypotrophy – 31.3 vs. 25.7%, respectively (p < 0.05). It should be noted that in 14 (3.8%) infants from HIV-infected mothers with HVI and in 4 (0.8%) infants from mothers without HVI (p < 0.05) the congenital pneumonia was diagnosed at the end of 1 day of life. Analysis results (illustration) show that at inactive form of infection the incidence of studied complications was similar to HIV-infected gravid without HVI, but during primary infection
e53
or reactivation phase the increasing at 1.5–2 times was noted. Performed analysis demonstrated the negative effect of herpesvirus on course of gestation/labor, health of fetal and newborns in HIVinfected women. The mechanisms of such effect and methods of its minimization or prevention are subjects for further research. http://dx.doi.org/10.1016/j.ejogrb.2016.07.157 Assisted reproduction Poster Presentation The role of vascular deregulation in induction of perinatal disorders among the women with high-risk inducted pregnancy Vyacheslav Kaminskiy ∗ , Anatolij Kaminskiy, Tetiana Kolomiichenko, Oleksandra Boychuk P.L. Shupyc National Medical Academy of Postgraduate Education, Kyiv, Ukraine E-mail address: [email protected] (V. Kaminskiy). Currently the endothelium dysfunction is considered as general trigger mechanism of reproductive disorders with involving vascular transformations in disturbances of the placentation processes. In females with infertility and hepatobiliary system disorders we find out the genetic predisposition to endothelial dysfunction. In consideration of the abovementioned we consider necessary to explore in this women the levels of nitrogen oxide donor l-arginine, endothelium impairment factor homocysteine, and angiogenesis factor – placental growth factor (PlGF). The 50 gravid females after assisted reproductive technology (ART) with hepatobiliary system disorders (study group), 50 pregnancy women after ART without such disorders (comparison group), and 50 somatically healthy females with spontaneous pregnancy (control group) at a gestational age 14–16 weeks were studied. In women of study group it was noted the significant reduction of l-arginine up to 44.2 ± 1.1 mmol/L vs. 52.6 ± 1.4 mmol/L in control group (p < 0.05) and increasing of homocysteine. It should be noted the essential reduction of PlGF levels in blood (91.4 ± 8.6 vs. 132.4 ± 11.5 pg/mL in women of control group, p < 0.05), which confirmed the negative effect of angiogenesis process abnormalities on growth and functioning of placenta with such sequences as pregnancy complications and fetal distress. The study group included two subgroups: first subgroup – 19 females with remarkable obstetrical and gynecological abnormalities (miscarriages and non-developing pregnancies, severe preeclampsia, decompensated fetal distress); second subgroup – 31 women without such abnormalities. The study demonstrated the severe compromising of gestation after ART programs (table) in women with hepatobiliary system disorders who at early terms of gestation have the influences of endothelial dysfunction, negative action of homocysteine and abnormalities of angiogenesis processes on the growth and formation of placenta. Thereby these factors may be used as early prognostic markers of severe obstetrical and perinatal disturbances of induced pregnancy in the women with hepatobiliary system disorders. Under homeostatic imbalance conditions in this population the pathogenesis of reproductive, obstetrical and perinatal complications is determined by the endothelium abnormalities and deregulation of vascular factors. This is theoretical prerequisite for the development of pathogenetically-based package of measures for treatment and preventing of such complications with the correction of detected abnormalities. http://dx.doi.org/10.1016/j.ejogrb.2016.07.158