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O52 Perinatal outcome of unexplained oligohydramnios
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
Negative strong correlation between insulin and TNF-a levels was revealed. The specificity of this phenomenon for the AN anorectic stage is indicated by glucose-stimulated hyperinsulinemia in the comparison group. Hipoinsulinemia resulted in absolute hypoleptinemia and hypoestrogenia, which is proved by a strong positive correlation. BMI in the comparison group did not differ from AN but the leptin exceeded values of the patients with AN (p ≤ 0.05) and did not differ from the control (p ≥ 0.05). Therefore the leptin level in the comparison group was not associated with low BMI, and probably was determined by a higher level of oestrogens, as suggested by the results of the correlation analysis. Conclusion: These results are supportive of an association between hypoleptinemia and hypoestrogenia, and specific disorder of the nutrition behavior; they also emphasize the lack of hypoleptinemia in immature underweight girls suffering from oligomenorrhea and relative hyperfolliculoidism. O52 Perinatal outcome of unexplained oligohydramnios A. Antsaklis, N. Papantoniou, E. Anastasakis, M. Sindos, M. Theodora, T. Ikonomou, G. Daskalakis Aim: To evaluate the perinatal outcome of cases with midtrimester oligohydramnios without premature rupture of membranes (PROM). Materials and Methods: Our Hospital is a referral center for highrisk pregnancy. During the last three years (2005–2008) all cases with unexplained oligohydramnios were reviewed. The age, parity, obstetric or medical history, investigations, treatment, mode of delivery and perinatal outcome were examined and found from the medical records. Only women with a diagnosis made before 34 weeks were incuded in the study. We excluded from analysis women with PROM, fetal congenital anomalies, preeclampsia, fetal growth restriction, Potter syndrome, and maternal antiinflammatory treatment. Results: During the above mentioned period 17 women with unexplained (idiopathic) oligohydramnios were found. The mean maternal age was 31.2 years. The mean gestational age at diagnosis was 29.4 weeks (range: 26–34 weeks). No other ultrasonographic findings were found in any of them. 11 women were hospitalized for more than a week, while the others entered the Hospital a few days before delivery. All hospitalized women were monitored with daily CTG and biophysical profile twice per week. The mean gestational age at delivery was 34.9 weeks (range 33–38 weeks). One woman delivered following a spontaneous normal vaginal delivery and 11 others with an elective cesarean section. Five women were induced and four of them gave birth vaginally, while the other one with an emergency cesarean section. Conclusions: Oligohydramnios is associated with a high rate of peripartum complications and a high perinatal morbidity rate. Our experience with unexplained isolated oligohydramnios showed that the perinatal outcome was good, although a high cesarean section rate was observed. Close maternal and fetal surveillance and timely delivery, either by labor induction or by an elective cesarean section are necessary. O53 Prenatal prediction of placenta praevia accreta G. Ara1 , S. Nargis1 , A. Hoque1 , Z. Sultana2 . 1 Shaheed Ziaur Rahman Medical College, Bangladesh, 2 Popular Diagnostic Centre, Bangladesh Objectives: Placenta praevia accreta is potentially lifethreatning condition associated with high maternal and fetal morbidity and mortality. The commonest association of this is previous cesarean section. Prenatal prediction and diagnosis can reduce morbidity and during cesarean delivery. The aim of this study was to determine the predictive features and diagnosis of placenta praevia accreta prenatally to reduce maternal morbidity and mortality.
Materials and Methods: This study was undertaken in Department of Obstetrics and Gynaecology, Shaheed Ziaur Rahman Medical college Hospital, Sadar hospital and obstetric clinics, Bogra from January 2008 to December 2008. 235 patients were indentified as placenta praevia. Among 6440 patients were admitted in the obstetrics wards during the study period. Whenever placenta previa or an anterior placenta is noted in patients with previous uterine surgery, the sonographic evaluation was done by Color Doppler sonography and power doppler sonography. Results: Incidence of placenta praevia was 3.7%. Age of the participant 19–37 yrs. 41.67% was 25–30 yrs of age 8.33% were associated with risk factors. Among them 16.67% patients had history of caesarean delivery, 35.00% had history of abortion Most of them were multigravida, 41.67% of placenta praevia occurred in the gravida more than 3rd. 4.16% patients had history of multiple pregnancy, 8.33% patients had history of manual removal of placenta, 1.67% patients had history of myomectomy, 2.50% patients had history of assisted conception. 41.67% patients were admitted with severe anaemic condition, 7.50% patients had history of recurrece. In this study 53.33% patients were associated with central type of placenta praevia. Seventeen patients was predicted as case of placenta previa accreta by using doppler and power ultrasonography. Associated factors was previous cesarean delivery and and history of myomectomy. Obstetric hysterectomy was done in 15 cases and for 2 cases conservative surgery was done. Histopathology confirmed diagnosis. Conclusion: Prenatal prediction of placenta previa accreta is possible by using doppler ultrasonography. So high risk group of pregnancy for development of placenta praevia accreta should evaluate carefully to reduce catastrophic complications. O54 Prognostic factors for successful immune treatment in primary implantation failure T. Michelon, M. Badalotti, A. Petracco, A. Arent, J. Michelon, M. Graudenz, J. Newmann Introduction: There is increasing evidence for immunological factors involved in infertility, and the benefit of distinct therapeutic approaches is still difficult to analyze. Objective: To identify prognostic factors for successful immune treatment (IT) in primary implantation failure (PIF). Methods: Analysis of 129 cycles (102 patients) of Reproductive Assisted-procedure performed after an IT (paternal alloimmunization, IVIg or both) were performed. All allocated patients were treated after a negative crossmatch against paternal lymphocytes. PIF was defined as >2 frustrated fresh embryos transfer. Secretory phase endometrial NK cells (CD16+56; NK), and procedure factors were analyzed concerning the birth rate. Odds ratio (OR), quisquare, and logistic regression were applied, being significant P < 0.10 and CI95%. Results: Endometriosis was a negative factor (OR = 0.5; 0.2–1.0; P = 0.06), and 30–60%NK cells was the single favorable factor concerning the birth rate (OR = 2.0; 0.9–4.4; P = 0.10). After logistic regression model, policistic ovarian syndrome (POS) and endometriosis were independent factors against the outcome (OR = 0.1; 0.0–1.0; P = 0.05 and OR = 0.4; 0.2–1.0; P = 0.06, respectively). Previous pregnancy and 30–60% NK cells were independently associated with better results (OR = 2.4; 0.9–6.9; P = 0.09 and OR = 2.4; 1.0–5.8; P = 0.05, respectively). Compared to the alloimunization, IVIg seemed to be better (30.8% x 52.4%, respectively; OR = 1.9; 0.6–5.9; P = 0.26). Conclusion: Endometriosis is a negative factor in PIF even after an immune treatment. The endometrial NK evaluation is indicated because up to 30% of birth occurs only among patients with 30 to 60%NK cells before the immunological treatment.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
Negative strong correlation between insulin and TNF-a levels was revealed. The specificity of this phenomenon for the AN anorectic stage is indicated by glucose-stimulated hyperinsulinemia in the comparison group. Hipoinsulinemia resulted in absolute hypoleptinemia and hypoestrogenia, which is proved by a strong positive correlation. BMI in the comparison group did not differ from AN but the leptin exceeded values of the patients with AN (p ≤ 0.05) and did not differ from the control (p ≥ 0.05). Therefore the leptin level in the comparison group was not associated with low BMI, and probably was determined by a higher level of oestrogens, as suggested by the results of the correlation analysis. Conclusion: These results are supportive of an association between hypoleptinemia and hypoestrogenia, and specific disorder of the nutrition behavior; they also emphasize the lack of hypoleptinemia in immature underweight girls suffering from oligomenorrhea and relative hyperfolliculoidism. O52 Perinatal outcome of unexplained oligohydramnios A. Antsaklis, N. Papantoniou, E. Anastasakis, M. Sindos, M. Theodora, T. Ikonomou, G. Daskalakis Aim: To evaluate the perinatal outcome of cases with midtrimester oligohydramnios without premature rupture of membranes (PROM). Materials and Methods: Our Hospital is a referral center for highrisk pregnancy. During the last three years (2005–2008) all cases with unexplained oligohydramnios were reviewed. The age, parity, obstetric or medical history, investigations, treatment, mode of delivery and perinatal outcome were examined and found from the medical records. Only women with a diagnosis made before 34 weeks were incuded in the study. We excluded from analysis women with PROM, fetal congenital anomalies, preeclampsia, fetal growth restriction, Potter syndrome, and maternal antiinflammatory treatment. Results: During the above mentioned period 17 women with unexplained (idiopathic) oligohydramnios were found. The mean maternal age was 31.2 years. The mean gestational age at diagnosis was 29.4 weeks (range: 26–34 weeks). No other ultrasonographic findings were found in any of them. 11 women were hospitalized for more than a week, while the others entered the Hospital a few days before delivery. All hospitalized women were monitored with daily CTG and biophysical profile twice per week. The mean gestational age at delivery was 34.9 weeks (range 33–38 weeks). One woman delivered following a spontaneous normal vaginal delivery and 11 others with an elective cesarean section. Five women were induced and four of them gave birth vaginally, while the other one with an emergency cesarean section. Conclusions: Oligohydramnios is associated with a high rate of peripartum complications and a high perinatal morbidity rate. Our experience with unexplained isolated oligohydramnios showed that the perinatal outcome was good, although a high cesarean section rate was observed. Close maternal and fetal surveillance and timely delivery, either by labor induction or by an elective cesarean section are necessary. O53 Prenatal prediction of placenta praevia accreta G. Ara1 , S. Nargis1 , A. Hoque1 , Z. Sultana2 . 1 Shaheed Ziaur Rahman Medical College, Bangladesh, 2 Popular Diagnostic Centre, Bangladesh Objectives: Placenta praevia accreta is potentially lifethreatning condition associated with high maternal and fetal morbidity and mortality. The commonest association of this is previous cesarean section. Prenatal prediction and diagnosis can reduce morbidity and during cesarean delivery. The aim of this study was to determine the predictive features and diagnosis of placenta praevia accreta prenatally to reduce maternal morbidity and mortality.
Materials and Methods: This study was undertaken in Department of Obstetrics and Gynaecology, Shaheed Ziaur Rahman Medical college Hospital, Sadar hospital and obstetric clinics, Bogra from January 2008 to December 2008. 235 patients were indentified as placenta praevia. Among 6440 patients were admitted in the obstetrics wards during the study period. Whenever placenta previa or an anterior placenta is noted in patients with previous uterine surgery, the sonographic evaluation was done by Color Doppler sonography and power doppler sonography. Results: Incidence of placenta praevia was 3.7%. Age of the participant 19–37 yrs. 41.67% was 25–30 yrs of age 8.33% were associated with risk factors. Among them 16.67% patients had history of caesarean delivery, 35.00% had history of abortion Most of them were multigravida, 41.67% of placenta praevia occurred in the gravida more than 3rd. 4.16% patients had history of multiple pregnancy, 8.33% patients had history of manual removal of placenta, 1.67% patients had history of myomectomy, 2.50% patients had history of assisted conception. 41.67% patients were admitted with severe anaemic condition, 7.50% patients had history of recurrece. In this study 53.33% patients were associated with central type of placenta praevia. Seventeen patients was predicted as case of placenta previa accreta by using doppler and power ultrasonography. Associated factors was previous cesarean delivery and and history of myomectomy. Obstetric hysterectomy was done in 15 cases and for 2 cases conservative surgery was done. Histopathology confirmed diagnosis. Conclusion: Prenatal prediction of placenta previa accreta is possible by using doppler ultrasonography. So high risk group of pregnancy for development of placenta praevia accreta should evaluate carefully to reduce catastrophic complications. O54 Prognostic factors for successful immune treatment in primary implantation failure T. Michelon, M. Badalotti, A. Petracco, A. Arent, J. Michelon, M. Graudenz, J. Newmann Introduction: There is increasing evidence for immunological factors involved in infertility, and the benefit of distinct therapeutic approaches is still difficult to analyze. Objective: To identify prognostic factors for successful immune treatment (IT) in primary implantation failure (PIF). Methods: Analysis of 129 cycles (102 patients) of Reproductive Assisted-procedure performed after an IT (paternal alloimmunization, IVIg or both) were performed. All allocated patients were treated after a negative crossmatch against paternal lymphocytes. PIF was defined as >2 frustrated fresh embryos transfer. Secretory phase endometrial NK cells (CD16+56; NK), and procedure factors were analyzed concerning the birth rate. Odds ratio (OR), quisquare, and logistic regression were applied, being significant P < 0.10 and CI95%. Results: Endometriosis was a negative factor (OR = 0.5; 0.2–1.0; P = 0.06), and 30–60%NK cells was the single favorable factor concerning the birth rate (OR = 2.0; 0.9–4.4; P = 0.10). After logistic regression model, policistic ovarian syndrome (POS) and endometriosis were independent factors against the outcome (OR = 0.1; 0.0–1.0; P = 0.05 and OR = 0.4; 0.2–1.0; P = 0.06, respectively). Previous pregnancy and 30–60% NK cells were independently associated with better results (OR = 2.4; 0.9–6.9; P = 0.09 and OR = 2.4; 1.0–5.8; P = 0.05, respectively). Compared to the alloimunization, IVIg seemed to be better (30.8% x 52.4%, respectively; OR = 1.9; 0.6–5.9; P = 0.26). Conclusion: Endometriosis is a negative factor in PIF even after an immune treatment. The endometrial NK evaluation is indicated because up to 30% of birth occurs only among patients with 30 to 60%NK cells before the immunological treatment.