- Email: [email protected]
Hydatidiform mole coexistent with a twin live fetus: a national collaborative study in Japan
MONDAY,
SEPTEMBER
4
Mathematical basis for IIPR application is an assumption that mothers with high risk theoretically have a high probability to bear a child also with high perinatal risk. This model enables to use for calculation IIPR various approaches and criteria of shaping of perinatal risk groups. But there is one stipulation: number of perinatal risk group for mothers and for newborns must be equal. Thus, the border value of index of labor assessment is “one”. Small values of IIPR show that labor care was optimal. IIPR reflects interaction between basic components of obstetrical care assessment: interaction between basic components of obstetrical care assessment: initial condition (maternal risk), tactics of labor management, labor outcome (newborn risk). IIPR can be used as a model of integral assessment of medical care.
P1.16.10 QUALITY OF CARE IN PRIVATE SECTOR IUD SERVICES IN CAMBODIA S. Sprechmann, CARE Int. Phnom Penh, Cambodia, N. Son, FHI, Phnom Penh, Cambodia, T. SSDS, Boston, MA, USA Objectives: The IUD is the most popular contraceptive in urban Cambodia. No follow up of IUD users has been done in Cambodia. Quality of care is unknown. The aim of this study was to investigate quality of care aspects of IUD services in a private sector clinic. Study Methods: Five hundred and seventy-six randomly selected women who had an IUD inserted between October 1994 and May 1996 were enrolled in this retrospective cohort study and were interviewed at home. Results: Clients received their method of choice in 92.2%. Some 88.4% know the correct lifespan of an IUD, 78% recalled being shown an IUD, 90% recalled being shown how to check the strings but only 59.6% reported checking the strings regularly. Some 59.3% are not sure if the IUD protects from STDs. In the first week after insertion no less than 3.6% reported abdominal pain plus vaginal discharge plus fever, operationally defined as possible endometritis. There were no pregnancies. The l-year continuation rate is 89.1%. Spontaneous expulsion occurred in 1%. Discontinuation was in 86.9% for side effects, and in 8.6% for a desire for more children. Discontinuers currently use contraception in only 50% of cases. Of all respondents, 98% said they would recommend the IUD to other women. Conclusions: Quality of care is good. However, attention needs to be given to counseling on the consequences of IUD use for STD complications. Discontinuers should be counseled on the use of other contraceptive methods. Large differences were noted between the low spontaneous recall of being counseled on specific messages and high actual knowledge of these messages. Spontaneous recall is not an adequate measure of the quality of counseling.
P1.16.11 CHEMOTHERAPY NEOADJUVANTE FOR THE TREATMENT OF BEARERS OF THE CANCER OF UTERINE CERVIX (EC II AND III): PSYCHOLOGICAL EVALUATION COMPARED TO RESPONSE C.N.Resende. C.R. Miranda, J.A. Cavendish, A.C. Cunha, University of Brasilia, Brasilia, Brasilia, Brazil. With the objective of evaluating the response to adjuvant chemotherapy treatment based on cisplatin and ifosfamide, we studied 22 patient with histology evidence of epidermoid uterine cervix cancer stage II and III. The patients were appraised for the Response Rate (RR) compared to the psychological profile by Beck Depression Inventory (BDI), before and after the treatment quimioter8pico. The average of age was of 40 years (29 to 57 years). For stadium I RR was EC IIA l/l, EC IIB 11113 and EC IIIB5/8 (p=O,47, test of Fisher). I ANGER was IT of 77,3% (17/22), with complete response (CR) in five patients (22,7%) and partial response (PR) in 12 patients (54,5%). Survival rate at the first was 20122 (91%). In 22 months of follow-up five patients died 1117 of the group that responded and 415 of the group that he/she didn’t responded chemotherapy. To BDI the depression levels were smaller due to decrease of the punctuation in the somatic levels and of acting (p <0,05). The response to the chemotherapy was the main prognostic factor for our patients. Why the patients no responsive to the chemotherapy do also answer to other therapies and do they perish so early? This question,
13.5
more than all of the answers that we obtained are, we believed, the definitive contribution of our work.
P1.16.12 WHAT BRITISH GYNECOLOGISTS SAY TO WOMEN REQUESTING LAPAROSCOPIC STERILIZATION OPERATION? Safwat I. Hassan. Hartlepool General Hospital, Holdforth Road, Hartlepool, UK TS24 9AH. Introduction; Laparoscopic sterilization is the comments cause of litigation facing gynecologists nowadays. The procedure itself is straightforward, several cases went to British court have failed because of the consent and the documentation were the main weakness of the gynecologist defense. Aims; to establish the current standard of current British Gynecologist practice. Methodology; 243 postal questionnaires were sent to the Royal College of Obstetricians and Gynecologists tutors of every hospital in England, Wales and Northern island. The response was statistically analyzed. Result; 78.5 was the primary response. 98.4% has informed the patient that the operation is permanent. 99.55 mentioned failure rate (the range was between 5 to 3 in 100). 97.4% inquire about previous contraceptive history. 81% discussed other alternative methods of contraception (vasectomy only 69.3% of practitioner). Patient was altered about the Possibility of ectopic pregnancy in 68.3%. 60.8% do warn the patient about the possibility of heavy periods. 96.8 inform the patient about day care procedure. 80.4% tell the patient about the possible need for laparotomy. Intestinal injury is discussed by 49.7% while the urinary bladder injury is discussed in 28.6% only 1.1% discuss death related to this operation. Other rare complications as pulmonary and gas embolism, major blood vessels injury and infection are small number of gynecologists. Only 14% Of British Gynecologists have written handout about this procedure. Conclusion; most gynecologist is sound, this paper has highlighted certain variation in counseling which leads to medicolegal cases. This paper makes the case for national guidelines and handout for this procedure in Britain.
P1.17 THROPHOBLASTIC
DISEASE
P1.17.01 MAMMARY GLAND METASTASIS OF PLACENTAL SITE TROPHOBLASTIC TUMOR. THE FIRST CASE REPORT. 0. Yamamuro, S. Jinbo, S. Kurotsuchi, S. Hosono, M. Taguchi, N. Kate, 0. Kurauchi, I. Kobayashi, Dept. OBIGYN, Nagoya Daini Red Cross Hospital, Aichi, Japan. Placental site trophoblastic tumor (PSTT) is a rare neoplasm of intermediate trophoblastic cells of the placenta. Approximately 100 cases of PSTT have been reported, and there is wide range of biologic behavior with metastases occurring in about 15% of cases. We report the first case of mammary gland metastasis of PSTT. We describe a 39.year-old G2P2004 woman who was treated for PSTT with a total abdominal hysterectomy and 5 cycles of chemotherapy (methotreate, actinomycin D, cyclophosphamide) four years ago. She noted the induration (5 x 2 cm) of her right breast in January 1998. A quadrantectomy of right mammary gland was performed and histology of the specimen confirmed the diagnosis of the metastasis of PSTT. Preoperative subunit of fl human chorionic gonadotropin @HCG) level was 2.2 mIU/ml, and human placental lactogen (HPL) level was 0.15 pg/ml. She received 5 cycles of chemotherapy (etoposide, actinomycin D) and was alive with no evidence of disease two years later.
P1.17.02 HYDATIDIFORM MOLE COEXISTENT WITH A TWIN LIVE FETUS: A NATIONAL COLLABORATIVE STUDY IN JAPAN H. Matsui, K. Suzuka, Y. Iitsuka, S. Seki, S. Sekiya, Dept. OBIGYN, Chiba University School of Medecine, Chiba, Japan. Objectives: The purpose of the present study was to evaluate the clinical course and the sequelae of hydatidiform mole coexistent with a twin live fetus (es) (HMTF).
136 Study Methods: 72 patients with HMTF were diagnosed by macroscopic and histopathologic criteria in Japan. In 18 patients, molar parts were cytogenetically confirmed to be an androgenetic origin (complete mole). Results: The development of persistent trophoblastic tumor (PrT) in patients with HMTF was 30.6%, and it raised to 50.0% in patients with androgenetic complete mole coexistent with a twin live fetus. The mean terminated gestational age in these 18 patients with developing PTT and without developing mT was 20.6 weeks and 19.4 weeks, respectively. Severe maternal complications were accompanied significantly higher in patients subsequently developed PTT. Conclusions: The development of subsequent PTT in patients with HMTF was significantly higher than that of single complete mole. However, since the potential for malignancy was unchanged with advancing gestational age, it may be allowed to continue pregnancy when severe maternal complications are not accompanied and fetal karyotype and development are normal.
P1.17.03 SURGICAL INTERVENTION AND COMPLICATIONS FOR LOWRISK GESTATIONAL TROPHOBLASTIC TUMOR K. Y. Iitsuka, H. Matsui, K Seki, S. Sekiya, Dept. OBIGYN, Chiba University School of Medecine, Chiba, Japan. Objectives: Our purpose was to determine the efficacy and complications of surgical intervention during chemotherapy in low-risk gestational trophoblastic tumor (GTT). Study Methods: During 12 years, 74 patients with low-risk GTT have achieved remission with single-agent chemotherapy of etoposide in our hospital. 36 patients (48.67)D were diagnosed metastatic GTT with macroscopic findings, chest X-ray and computed tomography. Surgical intervention was performed in 15 (41.7% : 15136) patients with metastatic low-risk GTT and in 10 patients (26% : 10138) with nonmetastatic low-risk GTT. Results: All patients attained complete remission with single-agent chemotherapy of etoposide, while one patient relapsed. In patients with metastatic GTT, the total cumulative dose of etoposide was less in patient with operative intervention (2,833*816mg) than in those without operation (2,696*836mg), though the difference did not reach statistical significance. In contrast, in patients with nonmetastatic GTT, the dose of etoposide was significantly less in patients with operation (2,000*782mg) compared to those without operation (2,696*836mg). (P=O.O4) Conclusions: Surgical therapy, performed coincident with the institution of systemic chemotherapy, was shown to reduce the amount of chemotherapeutic agent used to achieve remission in nonmetastatic GTT.
P1.17.04 INHIBIN A AND INHIBIN PRO-aC IN PATIENTS WITH HYDATIDIFORM MOLE T. Kate, F. Koma, H. Matsui, K. Seki, S. Sekiya, Dept. OBIGYN, Chiba University School of Medecine, Chiba, Japan. Objectives: Circulating inhibin levels are reported to be increased in some patients with hydatidiform mole (HM). However, subunits of inhibin have not heretofore been evaluated in them. In this study, inhibin A and pro-aC concentrations were evaluated in patients with molar pregnancy. Study Methods: Serum inhibin A and pro-aC were measured by ELISA in 14 patients with HM before and 1,2,4 and 8 weeks after evacuation. They were also determined in 35 normal pregnant women (NPW) (7-14 weeks). Results: Before evacuation, serum pro-aC levels were significantly increased compared to NPW, but serum inhibin A levels were not. While serum inhibin A levels rapidly decreased in patients with HM except for one with persistent trophoblastic disease (PrD), the decrease in serum pro-aC was more gradual. Before evacuation, serum pro-aC but not inhibin A levels were significantly increased in patients with mD than in those without mD. After evacuation, both inhibin A an pro-aC levels were higher in patients with PTD than in those without mD. Conclusions: Excess hCG in molar pregnancy may further stimulate the secretion of pro-aC. According to the falling patterns of serum inhibin A and pro-aC after evacuation, the main source of circulating inhibin A
MONDAY,
SEPTEMBER
may be trophoblasts, and that of pro-aC corpora lutea. After evacuation, inhibin A and pro-aC levels were higher in patients with PTD than in those without mD. Thus, they may be potentially useful for the monitoring of trophoblastic disease.
P1.18 ULTRASOUND
1
P1.18.01 CAN LOW-LOCATED GESTATIONAL SAC AT EARLY FIRST TRIMESTER PREDICT PLACENTA PREVIA? S., S. Tsutsumi, H. Ouchi, M. Banzai, M. Sate, H. Kanasugi, Dept. OBIGYN, Saiseikai Yamagata Hospital, Yamagata, Japan. Objective: To determine if low-located gestational sac (GS) at early first trimester can predict placenta previa. Study Methods: Out patients who visited our hospital between January 1997 and December 1998 and were diagnosed as 4 to 6 weeks of intrauterine singleton pregnancy by transvaginal ultrasonography were included in our study group. At 20 weeks of pregnancy, each case underwent ultrasound screening with transabdominal probe. Identified location of GS at 4-6 weeks and placenta at 20 weeks were mapped out on a chart with an illustration of the uterus divided into three zones, i.e. upper (zone U), middle (zone M) and lower (zone L). We referred to our delivery record for their mode and outcome of delivery. Cases of miscarriage were excluded. Results: A total of 182 cases were entered into the study with GS at 4-6 weeks and placenta at 20 weeks. At 4-6 weeks’ pregnancy, 125 (68.7%) GS’s were mapped in the zone U, 56 (30.8%) in the zone M, and only one (0.5%) in the zone L. At 20 weeks’ pregnancy, 14 (7.7%) placentas were located in the zone U, 99 (54.5%) in the zone M and 12 (6.6%) in the zone L. Two out of the 12 cases whose placentas were located in the zone L at 20 weeks underwent cesarean section because of placenta previa at 36 and 37 weeks of pregnancy. In both cases, GS’s had been located in the zone M at 4-6 weeks of gestation. There were no other cases diagnosed with placenta previa in the present study group. In the only case whose GS was mapped in the zone L at 5 weeks of gestation, the placenta was located in the zone M at 20 weeks, and the delivery was a normal one at term. Conclusion: This study suggests that low-located GS at early first trimester cannot predict placenta previa.
P2.18.02 ULTRASOUND SCREENING FOR SINGLE UMBILICAL ARTERY AT 20 WEEKS’ GESTATION: A PROSPECTIVE EVALUATION S. Tsutsumi, S. Sate, M. Banzai, H. Ouchi, M. Sate, H. Kanasugi, Dept. OBIGYN, Saiseikai Yamagata Hospital, Yamagata, Japan. Objectives: 1) To determine the prevalence of single umbilical artery (SUA) by ultrasound screening at 20 weeks’ gestation, and 2) to assess the efficacy and benefit of screening at this stage of pregnancy. Study Methods: From l/l/96 to 12/31/99,4813 women underwent a screening test at our hospital to detect anomalies including SUA at 20 weeks’ gestation. Ultrasound (real-time and color Doppler) was used by a single observer. Cases of fetal loss before 20 weeks were excluded. 4529 of the women who underwent the screening have delivered at our hospital thus far. Outcome of delivery, associated congenital anomalies and other perinatal morbidities of all the infants with SUA were identified. Results: Out of 4529 screenings, 12 cases (0.26%) of SUA were detected at 20 weeks’ gestation and were born alive at term. All of them were singleton. 2 out of the 12 (16.7%) had some anomalies. One had ventricular septal defect (VSD), the other had a combination of VSD, atria1 septal defect (ASD) and syndactyly. Intrauterine growth retardation was seen in one (8.37)D case. These were no false positive cases. Conclusions: In the present study, the prevalence of SUA was about 0.26%, slightly lower than what has been reported in similar studies investigating other gestational ages. Both high sensitivity and specificity can be expected with this screening of SUA at 20 weeks’ gestation. Considering its high incidence of combined anomalies, the screening of SUA at this gestational age appears to be effective and beneficial.
4
SEPTEMBER
4
Mathematical basis for IIPR application is an assumption that mothers with high risk theoretically have a high probability to bear a child also with high perinatal risk. This model enables to use for calculation IIPR various approaches and criteria of shaping of perinatal risk groups. But there is one stipulation: number of perinatal risk group for mothers and for newborns must be equal. Thus, the border value of index of labor assessment is “one”. Small values of IIPR show that labor care was optimal. IIPR reflects interaction between basic components of obstetrical care assessment: interaction between basic components of obstetrical care assessment: initial condition (maternal risk), tactics of labor management, labor outcome (newborn risk). IIPR can be used as a model of integral assessment of medical care.
P1.16.10 QUALITY OF CARE IN PRIVATE SECTOR IUD SERVICES IN CAMBODIA S. Sprechmann, CARE Int. Phnom Penh, Cambodia, N. Son, FHI, Phnom Penh, Cambodia, T. SSDS, Boston, MA, USA Objectives: The IUD is the most popular contraceptive in urban Cambodia. No follow up of IUD users has been done in Cambodia. Quality of care is unknown. The aim of this study was to investigate quality of care aspects of IUD services in a private sector clinic. Study Methods: Five hundred and seventy-six randomly selected women who had an IUD inserted between October 1994 and May 1996 were enrolled in this retrospective cohort study and were interviewed at home. Results: Clients received their method of choice in 92.2%. Some 88.4% know the correct lifespan of an IUD, 78% recalled being shown an IUD, 90% recalled being shown how to check the strings but only 59.6% reported checking the strings regularly. Some 59.3% are not sure if the IUD protects from STDs. In the first week after insertion no less than 3.6% reported abdominal pain plus vaginal discharge plus fever, operationally defined as possible endometritis. There were no pregnancies. The l-year continuation rate is 89.1%. Spontaneous expulsion occurred in 1%. Discontinuation was in 86.9% for side effects, and in 8.6% for a desire for more children. Discontinuers currently use contraception in only 50% of cases. Of all respondents, 98% said they would recommend the IUD to other women. Conclusions: Quality of care is good. However, attention needs to be given to counseling on the consequences of IUD use for STD complications. Discontinuers should be counseled on the use of other contraceptive methods. Large differences were noted between the low spontaneous recall of being counseled on specific messages and high actual knowledge of these messages. Spontaneous recall is not an adequate measure of the quality of counseling.
P1.16.11 CHEMOTHERAPY NEOADJUVANTE FOR THE TREATMENT OF BEARERS OF THE CANCER OF UTERINE CERVIX (EC II AND III): PSYCHOLOGICAL EVALUATION COMPARED TO RESPONSE C.N.Resende. C.R. Miranda, J.A. Cavendish, A.C. Cunha, University of Brasilia, Brasilia, Brasilia, Brazil. With the objective of evaluating the response to adjuvant chemotherapy treatment based on cisplatin and ifosfamide, we studied 22 patient with histology evidence of epidermoid uterine cervix cancer stage II and III. The patients were appraised for the Response Rate (RR) compared to the psychological profile by Beck Depression Inventory (BDI), before and after the treatment quimioter8pico. The average of age was of 40 years (29 to 57 years). For stadium I RR was EC IIA l/l, EC IIB 11113 and EC IIIB5/8 (p=O,47, test of Fisher). I ANGER was IT of 77,3% (17/22), with complete response (CR) in five patients (22,7%) and partial response (PR) in 12 patients (54,5%). Survival rate at the first was 20122 (91%). In 22 months of follow-up five patients died 1117 of the group that responded and 415 of the group that he/she didn’t responded chemotherapy. To BDI the depression levels were smaller due to decrease of the punctuation in the somatic levels and of acting (p <0,05). The response to the chemotherapy was the main prognostic factor for our patients. Why the patients no responsive to the chemotherapy do also answer to other therapies and do they perish so early? This question,
13.5
more than all of the answers that we obtained are, we believed, the definitive contribution of our work.
P1.16.12 WHAT BRITISH GYNECOLOGISTS SAY TO WOMEN REQUESTING LAPAROSCOPIC STERILIZATION OPERATION? Safwat I. Hassan. Hartlepool General Hospital, Holdforth Road, Hartlepool, UK TS24 9AH. Introduction; Laparoscopic sterilization is the comments cause of litigation facing gynecologists nowadays. The procedure itself is straightforward, several cases went to British court have failed because of the consent and the documentation were the main weakness of the gynecologist defense. Aims; to establish the current standard of current British Gynecologist practice. Methodology; 243 postal questionnaires were sent to the Royal College of Obstetricians and Gynecologists tutors of every hospital in England, Wales and Northern island. The response was statistically analyzed. Result; 78.5 was the primary response. 98.4% has informed the patient that the operation is permanent. 99.55 mentioned failure rate (the range was between 5 to 3 in 100). 97.4% inquire about previous contraceptive history. 81% discussed other alternative methods of contraception (vasectomy only 69.3% of practitioner). Patient was altered about the Possibility of ectopic pregnancy in 68.3%. 60.8% do warn the patient about the possibility of heavy periods. 96.8 inform the patient about day care procedure. 80.4% tell the patient about the possible need for laparotomy. Intestinal injury is discussed by 49.7% while the urinary bladder injury is discussed in 28.6% only 1.1% discuss death related to this operation. Other rare complications as pulmonary and gas embolism, major blood vessels injury and infection are small number of gynecologists. Only 14% Of British Gynecologists have written handout about this procedure. Conclusion; most gynecologist is sound, this paper has highlighted certain variation in counseling which leads to medicolegal cases. This paper makes the case for national guidelines and handout for this procedure in Britain.
P1.17 THROPHOBLASTIC
DISEASE
P1.17.01 MAMMARY GLAND METASTASIS OF PLACENTAL SITE TROPHOBLASTIC TUMOR. THE FIRST CASE REPORT. 0. Yamamuro, S. Jinbo, S. Kurotsuchi, S. Hosono, M. Taguchi, N. Kate, 0. Kurauchi, I. Kobayashi, Dept. OBIGYN, Nagoya Daini Red Cross Hospital, Aichi, Japan. Placental site trophoblastic tumor (PSTT) is a rare neoplasm of intermediate trophoblastic cells of the placenta. Approximately 100 cases of PSTT have been reported, and there is wide range of biologic behavior with metastases occurring in about 15% of cases. We report the first case of mammary gland metastasis of PSTT. We describe a 39.year-old G2P2004 woman who was treated for PSTT with a total abdominal hysterectomy and 5 cycles of chemotherapy (methotreate, actinomycin D, cyclophosphamide) four years ago. She noted the induration (5 x 2 cm) of her right breast in January 1998. A quadrantectomy of right mammary gland was performed and histology of the specimen confirmed the diagnosis of the metastasis of PSTT. Preoperative subunit of fl human chorionic gonadotropin @HCG) level was 2.2 mIU/ml, and human placental lactogen (HPL) level was 0.15 pg/ml. She received 5 cycles of chemotherapy (etoposide, actinomycin D) and was alive with no evidence of disease two years later.
P1.17.02 HYDATIDIFORM MOLE COEXISTENT WITH A TWIN LIVE FETUS: A NATIONAL COLLABORATIVE STUDY IN JAPAN H. Matsui, K. Suzuka, Y. Iitsuka, S. Seki, S. Sekiya, Dept. OBIGYN, Chiba University School of Medecine, Chiba, Japan. Objectives: The purpose of the present study was to evaluate the clinical course and the sequelae of hydatidiform mole coexistent with a twin live fetus (es) (HMTF).
136 Study Methods: 72 patients with HMTF were diagnosed by macroscopic and histopathologic criteria in Japan. In 18 patients, molar parts were cytogenetically confirmed to be an androgenetic origin (complete mole). Results: The development of persistent trophoblastic tumor (PrT) in patients with HMTF was 30.6%, and it raised to 50.0% in patients with androgenetic complete mole coexistent with a twin live fetus. The mean terminated gestational age in these 18 patients with developing PTT and without developing mT was 20.6 weeks and 19.4 weeks, respectively. Severe maternal complications were accompanied significantly higher in patients subsequently developed PTT. Conclusions: The development of subsequent PTT in patients with HMTF was significantly higher than that of single complete mole. However, since the potential for malignancy was unchanged with advancing gestational age, it may be allowed to continue pregnancy when severe maternal complications are not accompanied and fetal karyotype and development are normal.
P1.17.03 SURGICAL INTERVENTION AND COMPLICATIONS FOR LOWRISK GESTATIONAL TROPHOBLASTIC TUMOR K. Y. Iitsuka, H. Matsui, K Seki, S. Sekiya, Dept. OBIGYN, Chiba University School of Medecine, Chiba, Japan. Objectives: Our purpose was to determine the efficacy and complications of surgical intervention during chemotherapy in low-risk gestational trophoblastic tumor (GTT). Study Methods: During 12 years, 74 patients with low-risk GTT have achieved remission with single-agent chemotherapy of etoposide in our hospital. 36 patients (48.67)D were diagnosed metastatic GTT with macroscopic findings, chest X-ray and computed tomography. Surgical intervention was performed in 15 (41.7% : 15136) patients with metastatic low-risk GTT and in 10 patients (26% : 10138) with nonmetastatic low-risk GTT. Results: All patients attained complete remission with single-agent chemotherapy of etoposide, while one patient relapsed. In patients with metastatic GTT, the total cumulative dose of etoposide was less in patient with operative intervention (2,833*816mg) than in those without operation (2,696*836mg), though the difference did not reach statistical significance. In contrast, in patients with nonmetastatic GTT, the dose of etoposide was significantly less in patients with operation (2,000*782mg) compared to those without operation (2,696*836mg). (P=O.O4) Conclusions: Surgical therapy, performed coincident with the institution of systemic chemotherapy, was shown to reduce the amount of chemotherapeutic agent used to achieve remission in nonmetastatic GTT.
P1.17.04 INHIBIN A AND INHIBIN PRO-aC IN PATIENTS WITH HYDATIDIFORM MOLE T. Kate, F. Koma, H. Matsui, K. Seki, S. Sekiya, Dept. OBIGYN, Chiba University School of Medecine, Chiba, Japan. Objectives: Circulating inhibin levels are reported to be increased in some patients with hydatidiform mole (HM). However, subunits of inhibin have not heretofore been evaluated in them. In this study, inhibin A and pro-aC concentrations were evaluated in patients with molar pregnancy. Study Methods: Serum inhibin A and pro-aC were measured by ELISA in 14 patients with HM before and 1,2,4 and 8 weeks after evacuation. They were also determined in 35 normal pregnant women (NPW) (7-14 weeks). Results: Before evacuation, serum pro-aC levels were significantly increased compared to NPW, but serum inhibin A levels were not. While serum inhibin A levels rapidly decreased in patients with HM except for one with persistent trophoblastic disease (PrD), the decrease in serum pro-aC was more gradual. Before evacuation, serum pro-aC but not inhibin A levels were significantly increased in patients with mD than in those without mD. After evacuation, both inhibin A an pro-aC levels were higher in patients with PTD than in those without mD. Conclusions: Excess hCG in molar pregnancy may further stimulate the secretion of pro-aC. According to the falling patterns of serum inhibin A and pro-aC after evacuation, the main source of circulating inhibin A
MONDAY,
SEPTEMBER
may be trophoblasts, and that of pro-aC corpora lutea. After evacuation, inhibin A and pro-aC levels were higher in patients with PTD than in those without mD. Thus, they may be potentially useful for the monitoring of trophoblastic disease.
P1.18 ULTRASOUND
1
P1.18.01 CAN LOW-LOCATED GESTATIONAL SAC AT EARLY FIRST TRIMESTER PREDICT PLACENTA PREVIA? S., S. Tsutsumi, H. Ouchi, M. Banzai, M. Sate, H. Kanasugi, Dept. OBIGYN, Saiseikai Yamagata Hospital, Yamagata, Japan. Objective: To determine if low-located gestational sac (GS) at early first trimester can predict placenta previa. Study Methods: Out patients who visited our hospital between January 1997 and December 1998 and were diagnosed as 4 to 6 weeks of intrauterine singleton pregnancy by transvaginal ultrasonography were included in our study group. At 20 weeks of pregnancy, each case underwent ultrasound screening with transabdominal probe. Identified location of GS at 4-6 weeks and placenta at 20 weeks were mapped out on a chart with an illustration of the uterus divided into three zones, i.e. upper (zone U), middle (zone M) and lower (zone L). We referred to our delivery record for their mode and outcome of delivery. Cases of miscarriage were excluded. Results: A total of 182 cases were entered into the study with GS at 4-6 weeks and placenta at 20 weeks. At 4-6 weeks’ pregnancy, 125 (68.7%) GS’s were mapped in the zone U, 56 (30.8%) in the zone M, and only one (0.5%) in the zone L. At 20 weeks’ pregnancy, 14 (7.7%) placentas were located in the zone U, 99 (54.5%) in the zone M and 12 (6.6%) in the zone L. Two out of the 12 cases whose placentas were located in the zone L at 20 weeks underwent cesarean section because of placenta previa at 36 and 37 weeks of pregnancy. In both cases, GS’s had been located in the zone M at 4-6 weeks of gestation. There were no other cases diagnosed with placenta previa in the present study group. In the only case whose GS was mapped in the zone L at 5 weeks of gestation, the placenta was located in the zone M at 20 weeks, and the delivery was a normal one at term. Conclusion: This study suggests that low-located GS at early first trimester cannot predict placenta previa.
P2.18.02 ULTRASOUND SCREENING FOR SINGLE UMBILICAL ARTERY AT 20 WEEKS’ GESTATION: A PROSPECTIVE EVALUATION S. Tsutsumi, S. Sate, M. Banzai, H. Ouchi, M. Sate, H. Kanasugi, Dept. OBIGYN, Saiseikai Yamagata Hospital, Yamagata, Japan. Objectives: 1) To determine the prevalence of single umbilical artery (SUA) by ultrasound screening at 20 weeks’ gestation, and 2) to assess the efficacy and benefit of screening at this stage of pregnancy. Study Methods: From l/l/96 to 12/31/99,4813 women underwent a screening test at our hospital to detect anomalies including SUA at 20 weeks’ gestation. Ultrasound (real-time and color Doppler) was used by a single observer. Cases of fetal loss before 20 weeks were excluded. 4529 of the women who underwent the screening have delivered at our hospital thus far. Outcome of delivery, associated congenital anomalies and other perinatal morbidities of all the infants with SUA were identified. Results: Out of 4529 screenings, 12 cases (0.26%) of SUA were detected at 20 weeks’ gestation and were born alive at term. All of them were singleton. 2 out of the 12 (16.7%) had some anomalies. One had ventricular septal defect (VSD), the other had a combination of VSD, atria1 septal defect (ASD) and syndactyly. Intrauterine growth retardation was seen in one (8.37)D case. These were no false positive cases. Conclusions: In the present study, the prevalence of SUA was about 0.26%, slightly lower than what has been reported in similar studies investigating other gestational ages. Both high sensitivity and specificity can be expected with this screening of SUA at 20 weeks’ gestation. Considering its high incidence of combined anomalies, the screening of SUA at this gestational age appears to be effective and beneficial.
4