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O197 OBSTETRIC NEAR-MISS CASES AMONG WOMEN ADMITTED TO INTENSIVE CARE UNITS IN ITALY
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O195 RESULTS OF UTERINE ARTERY EMBOLISATION IN TREATMENT OF UTERINE FIBROIDS OF PATIENTS WITH REVEALED FEATURES OF BLOOD SUPPLY OF THE ORGANS OF THE SMALL PELVIS A. Dmitry1 , I. Krasnova1 , V. Aksenova1 , I. Esipova1 . 1 Obstetrics and Gynecology, The Russian National Research Mediical University name after N.I. Pirogov, Moscow, Moscow, Russian Federation Objectives: To estimate efficiency of selective uterine artery embolisation (UAE) at patients with uterine fibroids and with the revealed features of blood supply of the organs of the small pelvis. Materials: Assessing the effectiveness of selective UAE in the early and late post-operative periods is carried out among 280 (female) patients of reproductive age diagnosed with fibroids in terms of the detected on angiography evidence characteristics of blood supply of the organs of the small pelvis. Observation time for patients composed from 6 till 60 months. Methods: The UAE was carried out routinely for all the patients. Particles of the PVA or tris-acryl gelatin microspheres with dimensions from 350 to 900 m served as embolus. Ultrasound investigation (US) and DG were performed on an ultrasound machine Voluson 730 E. Results: On the preoperative stage the presence of utero-ovarian arterial anastomosis according to the ultrasound investigation and DG was detected in 28.9% of observations. Quantitative adjectives of blood circulation in the ovarian artery served as criterions of diagnostics. In 8 observations the presence of additional sources of blood supply of uterus and fibroid from ovarial artery required carrying out of additional superselective catheterization of these arterias and retrograde insertion of embolus. In case of presence of rudimentary blood circulation in ganglions according to ultrasound investigation and DG the technical inefficiency of the uterine artery embolisation (UAE) was discovered in 4 cases during the early postoperative period. However reduction of uterus dimension and of ganglions was detected in the case of dynamic observation during primary 6 months. It was appraised as positive clinical endpoint of treatment. Normal findings of patients hormonal profile and normal character of menstrual period showed an absence of ovary dysfunction. Conclusions: Well-timed revelation of utero-ovarian arterial communications allows to work out suitable strategies of carrying out of the UAE, to avoid of ovary alteration and unacceptable result of treatment. The procedure of UAE has been improved and relevance of a repeated UAE session has been determined according to the data received. O196 MATERNAL MORTALITY IN ITALY: A RECORD-LINKAGE STUDY S. Donati1 , S. Senatore1 , A. Ronconi1 . 1 National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanita’-Italian National Institute of Health, Rome, Italy Objectives: Recently, the Lancet reported that Italy ranked first among 181 countries with the lowest maternal mortality ratio of 3.9 per 100,000 live births. This study was conducted to assess the validity of the official Italian figures based on death certification alone. Materials: Five Regions dislocated in northern (Piedmont and Emilia Romagna), central (Tuscany and Lazio) and southern Italy (Sicily) participated in the study. The women in reproductive age resident in these regions represent 38% of all Italian women aged 15–49 years. Methods: Maternal deaths were identified through record-linkage procedures between death registry and the hospital discharge database. All women with one or more hospitalizations for pregnancy or any pregnancy outcome between 2000 and 2007 represents the study population. Causes of death have been classified according to 10th International Classification of Diseases. Maternal mortality ratios as well as stratified ratios by woman’s
S329
age and mode of delivery according to Peristat indicators, were also calculated. Results: Underreporting of official figures based on death certification in the participating Regions is 63% according to our results. Computed MMR for participating regions is 11.8 per 100,000 live births with considerably variation across regions. Highest values (21.8) were observed in Sicily. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. Specific MMR are significantly higher for women older than 35 years of age (RR = 1.8; 95% CI 1.2–2.6) and for women who underwent Caesarean section (RR of 3.0, 95% CI 1.9–4.8) compared to those who delivered vaginally. Conclusions: The presence of significant underreporting indicates that pregnancy related mortality as well as severe morbidity ascertainment remains unsatisfactory also in developed countries like Italy. Causes of maternal death are important in order to define prevention strategies of avoidable deaths. This study provides the background for a prospective study on registration and evaluation of maternal mortality in order to identify risk factors for maternal deaths and improve obstetric care. O197 OBSTETRIC NEAR-MISS CASES AMONG WOMEN ADMITTED TO INTENSIVE CARE UNITS IN ITALY S. Donati1 , S. Senatore1 , A. Ronconi1 . 1 CNESPS, Istituto Superiore di Sanit` a, Rome, Italy Objectives: In industrialized countries the study of severe maternal morbidity represents a complement to the study of maternal death events. The purpose of this study was to compute the absolute number of near-miss cases and the rate of near-miss cases associated with delivery and induced abortion and analyze associated causes in a population-based study in six Regions of northern, central and southern Italy. Materials: The women in reproductive age resident in the six participating regions represent 49% of all resident women aged 15–49 years. The study period was the years 2004 and 2005. Methods: The hospitals’ discharge databases were used to identify cases defined as women aged 15–49 years with one or more hospitalizations in an intensive care unit or a coronary care unit during pregnancy, childbirth or within 42 days of termination of pregnancy. Enrolled cases have been diagnosed according to the 9th International Classification of Diseases. Maternal near-miss rate (number of women experiencing an admission to intensive care units/all women with live or stillborn babies) is the main outcome measure. Relative risks (RR) with 95% confidence interval (95% CI) were estimated for the maternal near-miss rates stratified for woman’s age, educational level, mode of delivery and nationality. Results: The ICU severe maternal morbidity rate in the participating regions was 2,0 per 1000 deliveries (0.9 in Campania; 4.5 in Piedmont). Seventy percent of the women were admitted to intensive care units or coronary units after a cesarean section. The maternal near-miss rate was higher among women aged ≥35 years (RR = 1.6; 95% CI 1.4–1.8) and among women who delivered by cesarean section (RR 5.3; 95% CI 4.6–6.1). The maternal nearmiss rate among immigrant women was higher compared to that of Italian women (RR 1.6; 95%; CI 1.3–1.9). The leading associated risk factors were obstetric hemorrhage/disseminated intravascular coagulation (40%) and hypertensive disorders of pregnancy (29%). Conclusions: Severe obstetric morbidity may be more sensitive measures of pregnancy outcome than mortality alone. Monitoring of near-miss morbidity in conjunction with mortality surveillance could help to identify effective preventive measures of potentially life-threatening episodes.
O195 RESULTS OF UTERINE ARTERY EMBOLISATION IN TREATMENT OF UTERINE FIBROIDS OF PATIENTS WITH REVEALED FEATURES OF BLOOD SUPPLY OF THE ORGANS OF THE SMALL PELVIS A. Dmitry1 , I. Krasnova1 , V. Aksenova1 , I. Esipova1 . 1 Obstetrics and Gynecology, The Russian National Research Mediical University name after N.I. Pirogov, Moscow, Moscow, Russian Federation Objectives: To estimate efficiency of selective uterine artery embolisation (UAE) at patients with uterine fibroids and with the revealed features of blood supply of the organs of the small pelvis. Materials: Assessing the effectiveness of selective UAE in the early and late post-operative periods is carried out among 280 (female) patients of reproductive age diagnosed with fibroids in terms of the detected on angiography evidence characteristics of blood supply of the organs of the small pelvis. Observation time for patients composed from 6 till 60 months. Methods: The UAE was carried out routinely for all the patients. Particles of the PVA or tris-acryl gelatin microspheres with dimensions from 350 to 900 m served as embolus. Ultrasound investigation (US) and DG were performed on an ultrasound machine Voluson 730 E. Results: On the preoperative stage the presence of utero-ovarian arterial anastomosis according to the ultrasound investigation and DG was detected in 28.9% of observations. Quantitative adjectives of blood circulation in the ovarian artery served as criterions of diagnostics. In 8 observations the presence of additional sources of blood supply of uterus and fibroid from ovarial artery required carrying out of additional superselective catheterization of these arterias and retrograde insertion of embolus. In case of presence of rudimentary blood circulation in ganglions according to ultrasound investigation and DG the technical inefficiency of the uterine artery embolisation (UAE) was discovered in 4 cases during the early postoperative period. However reduction of uterus dimension and of ganglions was detected in the case of dynamic observation during primary 6 months. It was appraised as positive clinical endpoint of treatment. Normal findings of patients hormonal profile and normal character of menstrual period showed an absence of ovary dysfunction. Conclusions: Well-timed revelation of utero-ovarian arterial communications allows to work out suitable strategies of carrying out of the UAE, to avoid of ovary alteration and unacceptable result of treatment. The procedure of UAE has been improved and relevance of a repeated UAE session has been determined according to the data received. O196 MATERNAL MORTALITY IN ITALY: A RECORD-LINKAGE STUDY S. Donati1 , S. Senatore1 , A. Ronconi1 . 1 National Centre for Epidemiology, Surveillance, and Health Promotion, Istituto Superiore di Sanita’-Italian National Institute of Health, Rome, Italy Objectives: Recently, the Lancet reported that Italy ranked first among 181 countries with the lowest maternal mortality ratio of 3.9 per 100,000 live births. This study was conducted to assess the validity of the official Italian figures based on death certification alone. Materials: Five Regions dislocated in northern (Piedmont and Emilia Romagna), central (Tuscany and Lazio) and southern Italy (Sicily) participated in the study. The women in reproductive age resident in these regions represent 38% of all Italian women aged 15–49 years. Methods: Maternal deaths were identified through record-linkage procedures between death registry and the hospital discharge database. All women with one or more hospitalizations for pregnancy or any pregnancy outcome between 2000 and 2007 represents the study population. Causes of death have been classified according to 10th International Classification of Diseases. Maternal mortality ratios as well as stratified ratios by woman’s
S329
age and mode of delivery according to Peristat indicators, were also calculated. Results: Underreporting of official figures based on death certification in the participating Regions is 63% according to our results. Computed MMR for participating regions is 11.8 per 100,000 live births with considerably variation across regions. Highest values (21.8) were observed in Sicily. Haemorrhage, thromboembolism, and hypertensive disorders of pregnancy are the leading causes of direct deaths. Specific MMR are significantly higher for women older than 35 years of age (RR = 1.8; 95% CI 1.2–2.6) and for women who underwent Caesarean section (RR of 3.0, 95% CI 1.9–4.8) compared to those who delivered vaginally. Conclusions: The presence of significant underreporting indicates that pregnancy related mortality as well as severe morbidity ascertainment remains unsatisfactory also in developed countries like Italy. Causes of maternal death are important in order to define prevention strategies of avoidable deaths. This study provides the background for a prospective study on registration and evaluation of maternal mortality in order to identify risk factors for maternal deaths and improve obstetric care. O197 OBSTETRIC NEAR-MISS CASES AMONG WOMEN ADMITTED TO INTENSIVE CARE UNITS IN ITALY S. Donati1 , S. Senatore1 , A. Ronconi1 . 1 CNESPS, Istituto Superiore di Sanit` a, Rome, Italy Objectives: In industrialized countries the study of severe maternal morbidity represents a complement to the study of maternal death events. The purpose of this study was to compute the absolute number of near-miss cases and the rate of near-miss cases associated with delivery and induced abortion and analyze associated causes in a population-based study in six Regions of northern, central and southern Italy. Materials: The women in reproductive age resident in the six participating regions represent 49% of all resident women aged 15–49 years. The study period was the years 2004 and 2005. Methods: The hospitals’ discharge databases were used to identify cases defined as women aged 15–49 years with one or more hospitalizations in an intensive care unit or a coronary care unit during pregnancy, childbirth or within 42 days of termination of pregnancy. Enrolled cases have been diagnosed according to the 9th International Classification of Diseases. Maternal near-miss rate (number of women experiencing an admission to intensive care units/all women with live or stillborn babies) is the main outcome measure. Relative risks (RR) with 95% confidence interval (95% CI) were estimated for the maternal near-miss rates stratified for woman’s age, educational level, mode of delivery and nationality. Results: The ICU severe maternal morbidity rate in the participating regions was 2,0 per 1000 deliveries (0.9 in Campania; 4.5 in Piedmont). Seventy percent of the women were admitted to intensive care units or coronary units after a cesarean section. The maternal near-miss rate was higher among women aged ≥35 years (RR = 1.6; 95% CI 1.4–1.8) and among women who delivered by cesarean section (RR 5.3; 95% CI 4.6–6.1). The maternal nearmiss rate among immigrant women was higher compared to that of Italian women (RR 1.6; 95%; CI 1.3–1.9). The leading associated risk factors were obstetric hemorrhage/disseminated intravascular coagulation (40%) and hypertensive disorders of pregnancy (29%). Conclusions: Severe obstetric morbidity may be more sensitive measures of pregnancy outcome than mortality alone. Monitoring of near-miss morbidity in conjunction with mortality surveillance could help to identify effective preventive measures of potentially life-threatening episodes.