Nitric oxide (NO) donors in the treatment of pregnancy-induced hypertension (PIH) — Echodoppler evaluation

TUESDAY, SEPTEMBER 5 28 weeks of gestation. Plasma spot glucose was taken before the GCT. A 7.5 gram OGTT was performed within two to four weeks after the GCT for all patients. They were also scheduled to have a blood sugar series and plasma fructosamine afterwards. Plasma spot glucose, fasting glucose, post-breakfast glucose, one hour GCT and plasma fructosamine were compared for the prediction of GIGT and GDM using WHO criteria. Receiver-Operator Characteristic (ROC) analysis (15) was used to compare the prediction model of sensitivity and specificity on the five screening tests. Results: The ROC curves show that the area under the curve (AOC) of 1-hr GCT (0.773, SEM=0.025) was not different from that of fasting glucose (0.766, SEM=0.026) and 2 hour post-breakfast glucose level (0.743, SEM=0.025). They were significantly greater than that of random spot glucose and plasma fructosamine. The optimal cutoff values were 7.0 mmol/l, 4.lmmol/l and 5.0 mmol/l for one hour GCT, fasting glucose and two hour post breakfast respectively. The sensitivity were 71.3%, 73.0% and 72.7% while the specificity were 68.7%, 63.3% and 60.8% respectively. Conclusions: We found that fasting glucose and two-hour post-breakfast glucose level were as good as GCT in the screening of glucose intolerance (GUGT and GDM). Spot glucose and plasma fructosamine are poor predictors of GIGT. We found the optimal cut-off level as 7.1 mmolfl instead of 7.8 mmol/I if we aimed for screening a milder degree of glucose intolerance.

P2.11.02 ANTIOXIDANT NUTRIENTS AND LIPID PEROXIDE LEVELS IN PREECLAMPSIA P. W. Phuapradit, 0. Puchaiwatananon, Dept. OB/GYN, Faulty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Objectives: To compare the antioxidant nutrients and lipid peroxide levels in preeclampsia and normal pregnant women. Study Methods: Antioxidant nutrients (vitamin A and E) were measured by high-pressure liquid chromatography and vitamin C was measured by the dinitrophenyl hydrazine method. Lipid peroxides were measured by the malonyedialdehyde method. There were 10 sever preeclampsia, 20 mild preeclampsia and 50 normal pregnant women. Results: The studies revealed that vitamin C levels in severe and mild preeclampsia were significantly less than those in normal pregnancy. The corrected vitamin E and vitamin A levels were significantly decreased only in severe preeclampsia. While the lipid peroxide levels in both mild and severe preeclampsia were significantly increased, when compared with the normal pregnancy. Conclusions: Preeclampsia is associated with the imbalance between lipid peroxides and antioxidant nutrients (vitamin C and E). The imbalances favor lipid peroxides with the increasing severity of preeclampsia.

P2.11.03 MATERNAL AND PERINATAL OUTCOMES IN PATIENTS WITH HEART DISEASES R.Jose Christian Medical College Hospital, Vellore, India Objectives: To assess the maternal and perinatal outcomes in patients with heart diseases. Study methods: A retrospective analysis of 284 pregnant women with heart disease, beyond 20 weeks of gestation, and delivered between January 1995 and November 1999 was done. Results: 244 patients had Rheumatic heart disease(RHD) and 40 had congenital heart disease( CHD). 75% of both groups were between 20 and 30 years of age. 52% of RHD patients and 80% of CHD patients were assessed to be class 1 NYHA. 18% of RHD patients were in class III /IV. 5 of whom died postnatally after vaginal delivery. All of them had multivalvular disease. 18% of patients(RHD and CHD) had corrective surgery prior to pregnancy, while 9% had balloon mitral valvotomy during pregnancy. 3.7% of RHD patients were on anticoagulants and 2.9% of them had Warfarin during the first trimester with no fetal anomalies. Most patients went into spontaneous labor at term, only in 20% labor was induced. 56% and 42.5% of patients in both groups respectively delivered normally. 30% had instrumental delivery. There were 9 still births of which 3 were term pregnancies and the rest

141 were pre term. All still births occurred in class III/IV patients. Conclusion: Maternal and perinatal deaths were confined to class III and IV patients and so they should be advised correction of lesions prior to pregnancy.

P2.11.04 ECLAMPSIA - A BA7TLE STILL TO WIN (STUDY OF 130 CASES IN TWO YEARS) R. Sinha, A. Sinha, Dept. OB/GYN, S.K. Medical College Hospital, Mozaffarpur, India. Objectives: Eclampsia is the major cause of maternal mortality in some regions in India. It is evident from the review of literature that there is no intervention which can reduce the incidence of pre-eclampsia/eclampsia except early detection of hypertension by regular antenatal examinations. This is an observational study to demonstrate the high incidence of eclampsia in developing countries where minimum antenatal examination is not available. Study Methods: I am presenting a review of 130 cases of eclampsia from a rural medical college of North Bihar where 83% of pregnant women do not get any kind of antenatal examination. Results: The data reflects the contribution of the eclampsia to the high maternal and perinatal death rate in rural India, even at the dawn of the 21* century. Incidence of eclampsia was 12.5% with 20% maternal mortality. Maternal mortality rate in 1998 was 41/1000 live births. Eclampsia was responsible for 40% of the maternal deaths. Still birth was in 43% of cases. Baby was asphyxiated in 36% of cases. Conclusion: Maternal mortality is unacceptably high in rural North Bihar (India) with eclampsia still the major cause of maternal and perinatal death. Reason for high maternal mortality in this medical college hospital may be due to the referral nature of cases from surrounding primary health centers and district hospitals.

P2.11.05 THE CHANGES OF THE CESAREAN SECTION FREQUENCY IN OUR LAST TEN YEARS OF MATERIAL S. Bagdim, F. Tam&i, .I. Kerhnyi, G. Szathdry, Dept. OB/GYN, Weiss Manfred Postgraduate Hospital, Budapest, Hungary. Objectives: The aim of the study was to analyze the changes of the cesarean section’s frequency in our last ten years of materials. It is interesting, because ten years ago in 1990 the ratio was 2.4 percent and nowadays it is more than 12 percent. Study Methods: The data of 6286 labors were analyzed in this retrospective study. In this study we were investigating the age of women, the number of earlier deliveries, the different complications and of course any ethical and law problems. Results: The results show that the indications of cesarean section have changed. In a few cases the other fields of medicine, internal medicine, ophthalmology and orthopedics give absolute indication. Our experiences show that in the presence of a minimum two indications, we can perform the cesarean sections with antibiotic prophilaxis. It is important, and the analysis of 36 cases showed that a previous cesarean section is not an absolute indication. Nowadays, there is a new problem when we perform the cesarean section for the wish of the pregnant woman. It has a lot of ethical and law problems, and we do not agree with this kind of cesarean section. Conclusion: The frequency of the cesarean sections has developed in the past decades. The absolute and relative indications today are not determined. The efforts to reduce the maternal and fetal mortality gave a result of an increased number of cesarean sections.

P2.11.06 NITRIC OXIDE (NO) DONORS IN THE TREATMENT OF PREGNANCY-INDUCED HYPERTENSION (PIH) - ECHODOPPLER EVALUATION P. Virtej (l), C. Grigoriu (l), I. Virtej (2), M. Dumitrascu (1) (1) Dept. OB/GYN, University Hospital, Bucharest, Romania. (2) National Institut of Endocrinology, Bucharest, Romania. Objectives: Starting from the theories of NO involvement in the pathogenesis of PIH, we studied the effects of nitroglycerin administration (as NO donor) on the utero-placentar flow in pregnancies complicated by

142 PIHIPE. Study Method: We studied 12 pregnant women with PIH (8) and PE (4) with gestational age between 20 -40 weeks. We administered them, on three consecutive days, 10 mg Nitroglycerin (2 transdermal patches, 5 mg each, each in the same time). We determined (echo Doppler on Sony - Dynamic Imaging, 3SMHz) the resistance index at the level of the umbilical artery, before starting the treatment, daily during the treatment, and on the following two days after completing the treatment (nifedipin, labetalol). Blood pressure was measured twice a day. Results: In two patients, headache was so severe that we interrupted the drug administration. During the treatment with Nitroglycerin, mean blood pressure dropped with 10 mm Hg. The resistance index in the umbilical artery dropped with 12 13% in the first 12 hours after nitroglycerin application, and this drop was stable during the following days (16 - 20%). After the last patch was withdrawn, the resistance index rose again at the pretreatment values in 12 hours. Conclusions: Our results confirm the studies published in literature, regarding the beneficial effects of NO donors in PIHPE, in reducing the flow resistance in the utero-placental circulation resistance index in the umbilical artery decreases with 20%)

P2.11.07 TREATMENT OF PER-URETHRAL AND PERI-ANAL WARTS DURING PREGNANCY USING LOW POWER DENSITY CO2 LASER Am El-Noore and Sherif Khattab. MRCOG, FRCS(Ed), M.D. Lecturer of Obstetrics and Gynaecology, Depart. of Medical and Biological application, Cairo University Objectives: The purpose of this study is to evaluate CO2 laser treatment of human papliloma virus warts during pregnancy. In a clinical setting, patients treated for genital warts, especially in peri-urethral and peri-anal lesions, were found to experience discomfort and intolerance due to the use of local anesthesia during treatment. The sensitivity of the periurethral and peri-anal areas does not allow for adequate infiltration of local anesthesia, thus rendering the use of high power density CO2 laser uncomfortable to the patient. This study attempts to introduce a new approach to treat human papliloma virus warts by using a low power density of CO2 laser to the peri-urethral and peri-anal area, which will avoid the use of local anesthesia infiltration. Methodology: A prospective study was conducted for a period of two years between January 1998. December 1999. Fifteen pregnant women between the ages of 20 and 40 diagnosed with human papiloma virus lesions were treated with low power density CO2 laser under colposcopic guidance. Treatments were performed during the second and third trimester of pregnancy. Peri-urethral lesions and peri-anal lesions were treated by coagulation using low power density of 400-600 W/cm2. All patients received one treatment initially and were followed up for an average of four months after delivery to assess the following: 1) laser failure and recurrence of the lesions; 2) patient’s assessment of pain, and 3) infections. Results: At the end of the study, results have shown that laser failure and persistence of lesions occurred in three out of the 1.5 patients (20%). This required further treatment where one additional session was needed to abolish the lesion using the same low power laser density. After the second treatment, there was no recurrence of lesions up to four months follow up after pregnancy. Assessment of patients’ rating of the pain showed that 80% of the patients experienced minimal discomfort and were pleased to complete the procedure. None of the patients experienced postoperative infections. Conclusion: The use of low power density laser was found to be an effective method of treating peer-anal and peer-urethra warts in two ways: 1) recurrence was controlled after the second session; 2) discomfort of local anesthetic infiltration in these sensitive areas was avoided; and 3) no increase in post operative infections.

TUESDAY, SEPTEMBER 5 P2.11.08 A REVIEW OF THE SAFETY OF FLUOXETINE DURING PREGNANCY D.J. Goldstein, K. Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN, USA Objective: Because untreated depression increases risk to mother and fetus, antidepressant treatment may be desirable or necessary during pregnancy; however, the benefit of treatment must balance the risk to the developing fetus. Understanding any risks associated with in-utero antidepressant exposure is important for making educated, patient-specific, benefit-to-risk assessments. Study Methods: As clinical data provide the most relevant information for evaluating risks of prenatal antidepressant exposure, we reviewed all published cohort-controlled studies (n=3) and prospective surveys (n=4) regarding fluoxetine use in pregnancy. Results: Outcomes from over 1OOOprospectively ascertained fluoxetineexposed pregnancies are reported in the literature, more than for any other antidepressant. Fluoxetine used during the first trimester does not statistically significantly increase risk for spontaneous abortion or major malformation; lack of a pattern or cluster of major or minor malformations suggests that fluoxetine is not teratogenic. Following in-utero fluoxetine exposure, birthweight and rates of prematurity and postnatal complications appears similar to control values. By preschool age, children exposed to fluoxetine in-utero show no significant differences from controls in global IQ, language, or behavior; such data are not available for other SSRIs. Conclusion: Because depression itself can increase the risk to pregnancy outcome, the maternal and fetal benefits of initiating or continuing antidepressant therapy during pregnancy need to be weighed against any potential risks. The substantial clinical experience with fluoxetine-exposed pregnancies is reassuring when considering depression for women of childbearing potential.

P2.11.09 AUTOIMMUNE THYROIDITIS PART IN THE MISCARRIAGE PATHOGENESIS E.M. Demidova, M.A. Leonova, .E.P. Gitel, Dept. OB/GYN, I.M. Sechenov Moscow Medical Academy, Moscow, Russia. Objective: To work out the diagnostic criteria and the principles of the Lthyroxin therapy in females with autoimmune thyroiditis and miscarriage. Study Methods: We evaluated thyroid function by determination of the FT3, FT4, TSH levels by ACS technique, thyroid sonography and performed radioimmune assay of the TBG-antibodies in 224 females with history and present risk of miscarriage, who were divided into two groups. The l* group consisted of 139 P trimester pregnant females with present risk of miscarriage. In the second group 8.5 non-pregnant females were united. Of the 224 persons 180 (80%) had the history of miscarriage: in 68.3% (95) of the l* group and in 100% of the 2”d one. Results: Of the 224 examined females the autoimmune thyroiditis was diagnosed in 37% (83) persons consisting of 55 pregnant females with the present risk of abortion with a history of miscarriage in 24 cases and 28 non-pregnant females. Sonographic features thyroid dysfunction were observed in most of the cases. Primary hypothyroidism (elevated serum TSH, normal or decreased FT4) as diagnosed in 47 patients; 76.5% of them had subclinical form. Primary hypothyroidism was observed in 58.2% (32) of pregnant females with autoimmune thyroiditis: in 45.8% (11) of pregnant females with history of miscarriage, and in 53.5% of nonpregnant females. All patients with primary hypothyroidism underwent thyroxin hormone replacement. Pregnant persons received HRT under TSH, FT4: TBGantibodies levels control twice before the 12’h week and in the 20th and 30th weeks of gestation in connection with fetal requirements gain in thyroid hormone. Of 32 pregnant females, 30 had term delivery, 2 underwent preterm delivery for medical indications of fetal malformation. All newborns underwent screening for hypothyroidism. Conclusion: This data suggests reliably high rate AT is associated with primary hypothyroidism in females with risk of miscarriage, and allows us to recommend thyroid hormone screening and thyroid sonography. Patients with verified hypothyroidism should undergo adequate dosecontrolled treatment.