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O220 Concurrent eclampsia and HELLP syndrome is a catastrophic event
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O220 Concurrent eclampsia and HELLP syndrome is a catastrophic event X. Di, H. Liu, D. Chen, J. Kuang, D. Huang. Dept of Obstetrics, Third Affiliated Hospital of Guangzhou Medical College Purpose: The purpose was to describe the characteristics of concurrent eclampsia and HELLP syndrome. Methods: We retrospectively collected the materials between December 1999 and December 2008 in Obstetric Critical Care Center of Guangzhou. There were 76 patients with eclampsia during this period and 17 of them were concurrent eclampsia and HELLP syndrome. We analyzed the characteristics (age, gestational weeks, death rate of maternal, the need for mechanical ventilation, the rate for ICU admittion, GCS, CT or MRI, hemotransfusions and so on) of the 17 patients and contrasted with the eclampsia without HELLP syndrome. Fisher exact test and c2 test were used to test categorical variables. P < 0.05 was considered statistically significant. Results: There were 17 patients admitted concurrent eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of concurrent eclampsia and HELLP syndrome was 22.4%. The maternal death rate was 35.3% (6/17) in concurrent eclampsia and HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (P < 0.05). There were more patients admitted to ICU and more patients need mechanical ventilation in concurrent eclampsia and HELLP syndrome (13/17 VS 20/59, 9/17 VS 14/59, P < 0.05), also more patients with GCS ≤ 8 in concurrent eclampsia and HELLP syndrome when admitted (P < 0.05), compared to the eclampsia without HELLP syndrome. Nine patients were performed computed tomography scan (CT) or magnetic resonance imaging (MRI) and five (5/9) of them showed cerebral hemorrhage in concurrent eclampsia and HELLP syndrome group, while only 14 patients performed CT or MRI in eclampsia without HELLP syndrome and 3 of them showed cerebral hemorrhage. Conclusion: The incidence of concurrent eclampsia and HELLP syndrome was not rare, and also the maternal mortality rate was really high. It should be warning that the obstetrician should take great attention for these women, and consider life support treatment for them if necessarily. O221 Mechanical ventilation in critical illness obstetric patients X. Di, H. Liu. The third affiliated hospital of Guangzhou Medical College Objective: The objective of this study was to analyze the characteristics and outcomes of critical ill obstetric patients who required mechanical ventilation (MV). Study design: This was a retrospective study. The critical ill obstetric patients who required MV at obstetric intensive care unit (ICU) in the Obstetric Critical Care Center of Guangzhou between January 1999 and January 2008 were involved. Data collection included maternal demographics, the causes for ventilation, the duration of ventilation, mode of delivery, and maternal mortality, etc. Results: 114 women were involved; only 12 women (10.5%) have taken regular prenatal care. Fourteen women (12.3%) were undelivered when required MV, eleven (78.6%) of them underlying medical complications, seven of them were performed cesarean delivery. The major pregnancy related primary diagnoses for MV were preeclampsia/eclampsia with severe complications (34.2%) and hemorrhagic shock (27.2%). The major medical complications for MV were rheumatic heart disease with heart failure (6.1%) and serious hepatitis (6.1%). Fifty (43.9%) women had underlying medical diseases. The indications for MV were hyoxemia (61.3%), inadequate ventilatory capacity (35.9%). The maternal mortality rate was 22.8% (26/114 women), and the one time liberation of MV rate was 85.7% in the survivors.
Conclusion: The major two primary diagnoses for mechanical ventilation were preeclampsia/eclampsia with severe complications and hemorrhagic shock in critical ill obstetric patients. The major reason for mechanical ventilation in undelivered patients was severe medical complications. The obstetricians and intensive care specialists should work together to decide the management protocol. O222 Evidence of oxidative stress in women with secondary hypoadrenalism A. Mancini1 , E. Leone1 , V. Di Donna1 , R. Festa1 , A. Silvestrini2 , A. Pontecorvi1 , E. Meucci2 . 1 Chair of Endocrinology, Catholic University School of Medicine, Rome, Italy, 2 Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine, Rome, Italy Objective: Conflicting results about cortisol role in antioxidant regulation are reported: adrenalectomy in rat significantly reduces malondialdehyde in gastric tissue and erythrocytes, and decreases lipid peroxidation in liver, lung and kidney; but augmented liver thiobarbituric acid-reactants are also reported. In humans, increased lipid peroxidation and decreased plasma tocopherol were described in adrenocortical insufficiency; indices of oxidative stress were present in Cushing’s syndrome, joint to markers of endothelial dysfunction. To further investigate this topic, we evaluated women affected by secondary hypoadrenalism, evaluating plasma total antioxidant capacity (TAC). Methods: 9 patients, with hypoadrenalism, due to empty sella or surgery (after trans-sphenoidal removal of craniopharyngioma, non-secreting adenoma, PRL-, ACTH- or GH-secreting adenoma, meningioma), aged 25–77 ys, were studied. They assumed hydrocortisone (30 mg/daily); a blood sample was collected at 08.00 hr, 24 hr after the last drug administration, for cortisol and ACTH determination; TAC was assayed by a method based on interaction between H2O2-metmyoglobin, as source of radicals, and a chromogen (ABTS), whose radical cation is spectroscopically revealed, with a latency time (LAG) proportional to antioxidants concentration (expected range 50–150 sec). Results: Mean cortisol levels were 97.66±16.96 ng/ml; ACTH levels were 25±3.16 pg/ml; LAG values were extremely low (48.33±5.13 sec). Conclusions: Lower levels in antioxidant systems were present in hypoadrenalic women, suggesting a condition of oxidative stress. Further studies can clarify the need of antioxidants in addition to steroid replacement therapy. O223 Social immersion strategy for reintegration and empowerment of obstetric fistula survivors M. Diallo. Fistula Care Project, EngenderHealth Guinea Objectives: Women who develop obstetric fistula in Guinea often suffer stigma, abandonment, loss of self-esteem, and varying degrees of social isolation. Considered perpetually unclean, women with fistula may be excluded from food preparation, social events, and prayer ceremonies. While surgical repair can physically heal, the psychological trauma of fistula may persist. The Fistula Care project in Guinea aims to empower fistula survivors to regain their self-esteem and reintegrate back into society. Methods: The Fistula Care Project is working with the people of Kissidougou to initiate a reintegration program that begins in the Regional Hospital and continues to the community. While healing from fistula surgery, women receive both physical and psychological therapy. After discharge, women live on a voluntary basis with local host families as part of a social immersion strategy. During the social immersion period host families are thanked by government officials and selected women provide sensitizations at baptism and wedding ceremonies. Women are trained in interpersonal
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O220 Concurrent eclampsia and HELLP syndrome is a catastrophic event X. Di, H. Liu, D. Chen, J. Kuang, D. Huang. Dept of Obstetrics, Third Affiliated Hospital of Guangzhou Medical College Purpose: The purpose was to describe the characteristics of concurrent eclampsia and HELLP syndrome. Methods: We retrospectively collected the materials between December 1999 and December 2008 in Obstetric Critical Care Center of Guangzhou. There were 76 patients with eclampsia during this period and 17 of them were concurrent eclampsia and HELLP syndrome. We analyzed the characteristics (age, gestational weeks, death rate of maternal, the need for mechanical ventilation, the rate for ICU admittion, GCS, CT or MRI, hemotransfusions and so on) of the 17 patients and contrasted with the eclampsia without HELLP syndrome. Fisher exact test and c2 test were used to test categorical variables. P < 0.05 was considered statistically significant. Results: There were 17 patients admitted concurrent eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of concurrent eclampsia and HELLP syndrome was 22.4%. The maternal death rate was 35.3% (6/17) in concurrent eclampsia and HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (P < 0.05). There were more patients admitted to ICU and more patients need mechanical ventilation in concurrent eclampsia and HELLP syndrome (13/17 VS 20/59, 9/17 VS 14/59, P < 0.05), also more patients with GCS ≤ 8 in concurrent eclampsia and HELLP syndrome when admitted (P < 0.05), compared to the eclampsia without HELLP syndrome. Nine patients were performed computed tomography scan (CT) or magnetic resonance imaging (MRI) and five (5/9) of them showed cerebral hemorrhage in concurrent eclampsia and HELLP syndrome group, while only 14 patients performed CT or MRI in eclampsia without HELLP syndrome and 3 of them showed cerebral hemorrhage. Conclusion: The incidence of concurrent eclampsia and HELLP syndrome was not rare, and also the maternal mortality rate was really high. It should be warning that the obstetrician should take great attention for these women, and consider life support treatment for them if necessarily. O221 Mechanical ventilation in critical illness obstetric patients X. Di, H. Liu. The third affiliated hospital of Guangzhou Medical College Objective: The objective of this study was to analyze the characteristics and outcomes of critical ill obstetric patients who required mechanical ventilation (MV). Study design: This was a retrospective study. The critical ill obstetric patients who required MV at obstetric intensive care unit (ICU) in the Obstetric Critical Care Center of Guangzhou between January 1999 and January 2008 were involved. Data collection included maternal demographics, the causes for ventilation, the duration of ventilation, mode of delivery, and maternal mortality, etc. Results: 114 women were involved; only 12 women (10.5%) have taken regular prenatal care. Fourteen women (12.3%) were undelivered when required MV, eleven (78.6%) of them underlying medical complications, seven of them were performed cesarean delivery. The major pregnancy related primary diagnoses for MV were preeclampsia/eclampsia with severe complications (34.2%) and hemorrhagic shock (27.2%). The major medical complications for MV were rheumatic heart disease with heart failure (6.1%) and serious hepatitis (6.1%). Fifty (43.9%) women had underlying medical diseases. The indications for MV were hyoxemia (61.3%), inadequate ventilatory capacity (35.9%). The maternal mortality rate was 22.8% (26/114 women), and the one time liberation of MV rate was 85.7% in the survivors.
Conclusion: The major two primary diagnoses for mechanical ventilation were preeclampsia/eclampsia with severe complications and hemorrhagic shock in critical ill obstetric patients. The major reason for mechanical ventilation in undelivered patients was severe medical complications. The obstetricians and intensive care specialists should work together to decide the management protocol. O222 Evidence of oxidative stress in women with secondary hypoadrenalism A. Mancini1 , E. Leone1 , V. Di Donna1 , R. Festa1 , A. Silvestrini2 , A. Pontecorvi1 , E. Meucci2 . 1 Chair of Endocrinology, Catholic University School of Medicine, Rome, Italy, 2 Institute of Biochemistry and Clinical Biochemistry, Catholic University School of Medicine, Rome, Italy Objective: Conflicting results about cortisol role in antioxidant regulation are reported: adrenalectomy in rat significantly reduces malondialdehyde in gastric tissue and erythrocytes, and decreases lipid peroxidation in liver, lung and kidney; but augmented liver thiobarbituric acid-reactants are also reported. In humans, increased lipid peroxidation and decreased plasma tocopherol were described in adrenocortical insufficiency; indices of oxidative stress were present in Cushing’s syndrome, joint to markers of endothelial dysfunction. To further investigate this topic, we evaluated women affected by secondary hypoadrenalism, evaluating plasma total antioxidant capacity (TAC). Methods: 9 patients, with hypoadrenalism, due to empty sella or surgery (after trans-sphenoidal removal of craniopharyngioma, non-secreting adenoma, PRL-, ACTH- or GH-secreting adenoma, meningioma), aged 25–77 ys, were studied. They assumed hydrocortisone (30 mg/daily); a blood sample was collected at 08.00 hr, 24 hr after the last drug administration, for cortisol and ACTH determination; TAC was assayed by a method based on interaction between H2O2-metmyoglobin, as source of radicals, and a chromogen (ABTS), whose radical cation is spectroscopically revealed, with a latency time (LAG) proportional to antioxidants concentration (expected range 50–150 sec). Results: Mean cortisol levels were 97.66±16.96 ng/ml; ACTH levels were 25±3.16 pg/ml; LAG values were extremely low (48.33±5.13 sec). Conclusions: Lower levels in antioxidant systems were present in hypoadrenalic women, suggesting a condition of oxidative stress. Further studies can clarify the need of antioxidants in addition to steroid replacement therapy. O223 Social immersion strategy for reintegration and empowerment of obstetric fistula survivors M. Diallo. Fistula Care Project, EngenderHealth Guinea Objectives: Women who develop obstetric fistula in Guinea often suffer stigma, abandonment, loss of self-esteem, and varying degrees of social isolation. Considered perpetually unclean, women with fistula may be excluded from food preparation, social events, and prayer ceremonies. While surgical repair can physically heal, the psychological trauma of fistula may persist. The Fistula Care project in Guinea aims to empower fistula survivors to regain their self-esteem and reintegrate back into society. Methods: The Fistula Care Project is working with the people of Kissidougou to initiate a reintegration program that begins in the Regional Hospital and continues to the community. While healing from fistula surgery, women receive both physical and psychological therapy. After discharge, women live on a voluntary basis with local host families as part of a social immersion strategy. During the social immersion period host families are thanked by government officials and selected women provide sensitizations at baptism and wedding ceremonies. Women are trained in interpersonal