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Do fetuses “at risk” benefit from hospital stay?
THURSDAY,
SEPTEMBER
FC4.19 GENERAL
7
OBSTETRICS
57
AND GYNECOLOGY
FC4.19.01
QUALITY OF PATIENT INFORMATION ON FEMALE STERILIZATION AND MENORRHAGIA ON THE INTERNET P. M. Latthe, K. Khan, Birmingham’s Women’s Hospital, Birmingham, UK. Objectives: To assess the quality of information available on-line on female sterilization and menorrhagia. Study methods: The search consisted of the phrases “female sterilisation” OR “female sterilization” which were entered into the query box of seven Internet search engines: Altavista, Excite, Hotbot, Infoseek, Lycos, Northern Light and Webcrawler. We assessed the most relevant sites as found by each search engine. For menorrhagia, the key phrases used were “heavy periods” and “patient information”. All the Web pages of the selected sites were printed out and two of the authors assessed them independently for inclusion in the study and for fulfillment of quality criteria (credibility and content). For assessing accuracy of contents, specific items were derived from the EvidenceBased Clinical Guidelines of the Royal College of Obstetricians and Gynecologists, UK, 1999. Results: None of the Web sites complied with all of the criteria for quality. Credibility was assessed by source that was described in 9 & 7 Web sites, currency in 5 sties each and review process in none. We assessed the content by hierarchy of evidence that was fulfilled by 5 & 4 sites and accuracy of content by 1 site each respectively for female sterilization and heavy periods. Conclusion: There is a need to be vigilant about the quality of health information before incorporating it in health-care decision-making.
FC4.19.02 NEURAL NETWORK ANALYSIS OR PREOPERATIVE VARIABLES AND OUTCOME IN ANAL SPHINCTER REPAIR A. Gardiner, A. Baxter, G. Kaur, K. Phillips, G.S. Duthie, Castle Hill
Hospital, Hull, United Kingdom Objectives: Appropriate patient selection is essential for achieving successful outcome after anterior repair (ASR) and there is need for more sensitive methods of predicting postoperative continence control than are provided by standard multivariate techniques, which have been only 7580% accurate. Artificial intelligence techniques, including neural networks (ANN), have been used for analysing complex data and have been successful in predicting surgical outcome; to date, this has not been used in data from incontinent patients. We use a neural network algorithm to assess probability of success after ASR. Method: Prospectively collected anal physiology data of patients having undergone ASR was used. Information from about 75% of the study group was used to train an ANN and the remainder was used for validation. Change in continence, categorised as improvement, was the output result. Results: Outcome at 3, 6 and 12 months was assessed. ANN achieved a mean overall accuracy of 95%. The correlation between ANN and actual data values was best at 12 months (r = 0.931; p = 0.0001). Strong correlations were also found at 3 months (r = 0.898; p = 0.0001) and 6 months (r = 0.742; p = 0.002). Conclusion: ANN’s are more accurate than statistics in predicting outcome after anterior sphincter repair. The next stage is a prospective application on patients selected for sphincter repair.
FC4.19.03 INFLUENCE OF FETAL HEART RATE DECELERATIONS, IN THE COMPUTERIZED STUDY OF FETAL HEART RATE VARIABILITY DURING LABOR. L. Briozzo’, .I. Alonso’, A. Martinez’, A.‘E.R. Migliaro. ’
’Clinica Ginecotocoldgica “c” Prof. J.C. Cuadro Maternidad de1 Centro Hospitalario “Pereira Rossell” Facultad de Medicina. Universidad de la Reptiblica. Montevideo. URUGUAY ’ Departamento de Fisiologia Facultad de Medicina. Universidad de la Reptiblica. Montevideo. URUGUAY Objectives Short-term Fetal Heart Rate Variability (sFHRV) is an indicator of fetal wellbeing. The uterine contractions induce vagalrelated reductions in fetal heart rate (HR) often called as DIPS.
Reduction of HR related with DIPS (of either mechanisms) is not strictly related with fetal heart function. The aim of this work is the comparison of sFHRV measured including changes induced by DIPS, and those obtained and after its elimination. Methods HR and uterine contractions were measured in 18 fetus during the last 30 min of labor. Measurements were made by means a of cephalic electrode connected to a commercial equipment. Digital acquisition was performed using original software. sFHRV was assessed using the index rMSSD (which estimates STV). After the first measurement of rMSSD, changes in HR related with DIPS were eliminated in each case,. Then a new rMSSD was calculated. The identification DIPS was performed by an experimented obstetrician. Results Mean values of RR intervals were (451.78 f 39.92) in original recordings and (434.44 f 34.06) after removal of DIPS (p=O.O026). Mean values of rMSSD were 18.18 f 12 before and 9.34 f 7 after DIPS removal (p = 0.0046). Conclusions The inclusion of HR changes related with DIPS could induce an erroneously evaluated variability. Therefore a correct evaluation of sFHRV should eliminate the influence of DIPS. Our results show strong differences between values of sFHRV before and after removal of influences DIPS. We believe that sFHRV measured without DIPS influence will provide a better picture of the fetus HR regulation.
FC4.19.04 DO FETUSES “AT RISK” BENEFIT FROM HOSPITAL STAY? B. Petrikovsky (1) (2), E. Schneider (2), B. Rochelson (2)
(1) (2)
Nassau County Medical Center, Dept. OB.GYN, East Meadow, NY, USA. North Shore University Hospital, Manhasset, NY, USA.
Objective: To study neonatal outcome in fetuses at risk depending on the mode of management (in-patient vs. out-patient). Study Methods: Neonatal outcome, live births, cesarean section rates were analyzed in 2 groups of potentially viable fetuses greater than 24 weeks; those managed in the hospital (Group I) and those who refused admission (Group II). Indications for admission: fetal growth restriction (FGR) - 112 fetuses, pre-term PROM- 98, abnormal antenatal testing results - 67. Admission was offered to all patients (278), 211 accepted, 67 refused or signed out against medical advice within 7 days of admission. Results: Live births were achieved in 207 fetuses in Group I vs. 64 in Group II (96%) (NS). Adverse neonatal outcome was reported in 23 fetuses in Group I (11%) versus 9 fetuses (13%) in Group II. Cesarean section rate was 36% in Group I versus 24% in Group II (p
FC4.19.05 ANTIPHOSPHOLIPID ANTIBODIES IN PREECLAMPSIA
Mourashko L.E., Gorodnitcheva J.A., Khodova S.I., Sukhikh G.T. Research Center of Obstetrics, Gynaecology. & Perinatology, Oparina street, 4, Moscow, 117815, Russia The aim of this study was to examine spectrum, frequency and levels of antiphospholipid antibodies (aPLs) in sera of preeclamptic women. Materials and metods: 74 preeclamptic women with family history of severe preeclampsia were observed. aPL was detected in sera by enzymoimmunoassay, using agents of 6 phospholipids: cardiolipin (CL), phosphatidylserine (PS), phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol (PI), sphyngomyelin (SPH). Results: according to the analysis conducted, the pregnant women were divided in two groups: I 47 patients with the abnormal levels of aPL (IgM and IgG); II 27 patients with normal levels of aFL. Having studied the spectrum and frequency of aPL, it was established, that most often aPL idiotypes of IgM and/or IgG occured to CL (45.9% and 21.6% accordingly), PS (36.5% and 16.2% accordingly) and PC (40.5% and 23.0% accordingly). The evaluation of aPL IgM and/or IgG idiotypes in these groups showed, that in the first group they were significantly increased beginning from the first trimester and they were twice as large (254.9~ 40.0 and 166.9322.9 accordingly), as in normal pregnancy (140.5 ~5.4 and 111.7 ~6.2 accordingly). Abnormal levels of aPL remained during
SEPTEMBER
FC4.19 GENERAL
7
OBSTETRICS
57
AND GYNECOLOGY
FC4.19.01
QUALITY OF PATIENT INFORMATION ON FEMALE STERILIZATION AND MENORRHAGIA ON THE INTERNET P. M. Latthe, K. Khan, Birmingham’s Women’s Hospital, Birmingham, UK. Objectives: To assess the quality of information available on-line on female sterilization and menorrhagia. Study methods: The search consisted of the phrases “female sterilisation” OR “female sterilization” which were entered into the query box of seven Internet search engines: Altavista, Excite, Hotbot, Infoseek, Lycos, Northern Light and Webcrawler. We assessed the most relevant sites as found by each search engine. For menorrhagia, the key phrases used were “heavy periods” and “patient information”. All the Web pages of the selected sites were printed out and two of the authors assessed them independently for inclusion in the study and for fulfillment of quality criteria (credibility and content). For assessing accuracy of contents, specific items were derived from the EvidenceBased Clinical Guidelines of the Royal College of Obstetricians and Gynecologists, UK, 1999. Results: None of the Web sites complied with all of the criteria for quality. Credibility was assessed by source that was described in 9 & 7 Web sites, currency in 5 sties each and review process in none. We assessed the content by hierarchy of evidence that was fulfilled by 5 & 4 sites and accuracy of content by 1 site each respectively for female sterilization and heavy periods. Conclusion: There is a need to be vigilant about the quality of health information before incorporating it in health-care decision-making.
FC4.19.02 NEURAL NETWORK ANALYSIS OR PREOPERATIVE VARIABLES AND OUTCOME IN ANAL SPHINCTER REPAIR A. Gardiner, A. Baxter, G. Kaur, K. Phillips, G.S. Duthie, Castle Hill
Hospital, Hull, United Kingdom Objectives: Appropriate patient selection is essential for achieving successful outcome after anterior repair (ASR) and there is need for more sensitive methods of predicting postoperative continence control than are provided by standard multivariate techniques, which have been only 7580% accurate. Artificial intelligence techniques, including neural networks (ANN), have been used for analysing complex data and have been successful in predicting surgical outcome; to date, this has not been used in data from incontinent patients. We use a neural network algorithm to assess probability of success after ASR. Method: Prospectively collected anal physiology data of patients having undergone ASR was used. Information from about 75% of the study group was used to train an ANN and the remainder was used for validation. Change in continence, categorised as improvement, was the output result. Results: Outcome at 3, 6 and 12 months was assessed. ANN achieved a mean overall accuracy of 95%. The correlation between ANN and actual data values was best at 12 months (r = 0.931; p = 0.0001). Strong correlations were also found at 3 months (r = 0.898; p = 0.0001) and 6 months (r = 0.742; p = 0.002). Conclusion: ANN’s are more accurate than statistics in predicting outcome after anterior sphincter repair. The next stage is a prospective application on patients selected for sphincter repair.
FC4.19.03 INFLUENCE OF FETAL HEART RATE DECELERATIONS, IN THE COMPUTERIZED STUDY OF FETAL HEART RATE VARIABILITY DURING LABOR. L. Briozzo’, .I. Alonso’, A. Martinez’, A.‘E.R. Migliaro. ’
’Clinica Ginecotocoldgica “c” Prof. J.C. Cuadro Maternidad de1 Centro Hospitalario “Pereira Rossell” Facultad de Medicina. Universidad de la Reptiblica. Montevideo. URUGUAY ’ Departamento de Fisiologia Facultad de Medicina. Universidad de la Reptiblica. Montevideo. URUGUAY Objectives Short-term Fetal Heart Rate Variability (sFHRV) is an indicator of fetal wellbeing. The uterine contractions induce vagalrelated reductions in fetal heart rate (HR) often called as DIPS.
Reduction of HR related with DIPS (of either mechanisms) is not strictly related with fetal heart function. The aim of this work is the comparison of sFHRV measured including changes induced by DIPS, and those obtained and after its elimination. Methods HR and uterine contractions were measured in 18 fetus during the last 30 min of labor. Measurements were made by means a of cephalic electrode connected to a commercial equipment. Digital acquisition was performed using original software. sFHRV was assessed using the index rMSSD (which estimates STV). After the first measurement of rMSSD, changes in HR related with DIPS were eliminated in each case,. Then a new rMSSD was calculated. The identification DIPS was performed by an experimented obstetrician. Results Mean values of RR intervals were (451.78 f 39.92) in original recordings and (434.44 f 34.06) after removal of DIPS (p=O.O026). Mean values of rMSSD were 18.18 f 12 before and 9.34 f 7 after DIPS removal (p = 0.0046). Conclusions The inclusion of HR changes related with DIPS could induce an erroneously evaluated variability. Therefore a correct evaluation of sFHRV should eliminate the influence of DIPS. Our results show strong differences between values of sFHRV before and after removal of influences DIPS. We believe that sFHRV measured without DIPS influence will provide a better picture of the fetus HR regulation.
FC4.19.04 DO FETUSES “AT RISK” BENEFIT FROM HOSPITAL STAY? B. Petrikovsky (1) (2), E. Schneider (2), B. Rochelson (2)
(1) (2)
Nassau County Medical Center, Dept. OB.GYN, East Meadow, NY, USA. North Shore University Hospital, Manhasset, NY, USA.
Objective: To study neonatal outcome in fetuses at risk depending on the mode of management (in-patient vs. out-patient). Study Methods: Neonatal outcome, live births, cesarean section rates were analyzed in 2 groups of potentially viable fetuses greater than 24 weeks; those managed in the hospital (Group I) and those who refused admission (Group II). Indications for admission: fetal growth restriction (FGR) - 112 fetuses, pre-term PROM- 98, abnormal antenatal testing results - 67. Admission was offered to all patients (278), 211 accepted, 67 refused or signed out against medical advice within 7 days of admission. Results: Live births were achieved in 207 fetuses in Group I vs. 64 in Group II (96%) (NS). Adverse neonatal outcome was reported in 23 fetuses in Group I (11%) versus 9 fetuses (13%) in Group II. Cesarean section rate was 36% in Group I versus 24% in Group II (p
FC4.19.05 ANTIPHOSPHOLIPID ANTIBODIES IN PREECLAMPSIA
Mourashko L.E., Gorodnitcheva J.A., Khodova S.I., Sukhikh G.T. Research Center of Obstetrics, Gynaecology. & Perinatology, Oparina street, 4, Moscow, 117815, Russia The aim of this study was to examine spectrum, frequency and levels of antiphospholipid antibodies (aPLs) in sera of preeclamptic women. Materials and metods: 74 preeclamptic women with family history of severe preeclampsia were observed. aPL was detected in sera by enzymoimmunoassay, using agents of 6 phospholipids: cardiolipin (CL), phosphatidylserine (PS), phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol (PI), sphyngomyelin (SPH). Results: according to the analysis conducted, the pregnant women were divided in two groups: I 47 patients with the abnormal levels of aPL (IgM and IgG); II 27 patients with normal levels of aFL. Having studied the spectrum and frequency of aPL, it was established, that most often aPL idiotypes of IgM and/or IgG occured to CL (45.9% and 21.6% accordingly), PS (36.5% and 16.2% accordingly) and PC (40.5% and 23.0% accordingly). The evaluation of aPL IgM and/or IgG idiotypes in these groups showed, that in the first group they were significantly increased beginning from the first trimester and they were twice as large (254.9~ 40.0 and 166.9322.9 accordingly), as in normal pregnancy (140.5 ~5.4 and 111.7 ~6.2 accordingly). Abnormal levels of aPL remained during