- Email: [email protected]
O619 Fetal body measurement in gestational diabetes
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
activity and enjoyment of sex. Women with sexual health problems should be assessed for OAB and other LUTS. O617 Pregnancy after renal transplant – Oman perspective U. Sharma, S. Minocha Objective: To study the outcome of pregnancy in renal allograft recipients & to analyse the impact of pregnancy on transplanted kidney. Material and Methods: It was a retrospective study conducted at Royal Hospital, a tertiary referral centre in Oman from 1988–2006. Computer data & hospital files were utilised for data analysis. Results: A total of 313 females had undergone renal transplant out of which 141 were in reproductive age group.42 females conceived with 82 pregnancies & 29% conception rate was noted. Mean transplant-conception interval was 17 months.11 females had 3 or more pregnancies after renal transplant. 71% had live births, 6% had termination of pregnancy, 3.7% had neonatal death, 9% had still birth & 14% had miscarriages. Caesarean section rate was 33% & graft rejection was seen in 12% patients. Maternal mortality was noted in 7% of patients. Conclusion: Conception rate (29%) in omani women has been much higher than reported in literature (2–4%). Incidence of pregnancy induced hypertension (11%) has been very low as compared to global review (40%). No congenital anomalies were noted in our patients & graft rejection was more time related than pregnancy induced. Unstable renal functions at the time of conception had definite risks to mother, fetus, newborn & allograft. The patients with renal transplant should have preconception counselling & the renal functions should be stabilised at optimal levels before contemplating pregnancy. A diligent follow up in combined clinic of obstetrics & nephrology has to be emphasised for optimal maternal & fetal outcome. O618 Unsafe abortion in the East Central South African (ECSA) region – FIGO initiative F. Mirembe. Makerere University, Department of Ob/Gyn Introduction: Unsafe abortion contributes between 15% and 35% of the overall maternal death in participating countries. Objectives: • To assess the burden of the problem of unsafe abortion in the region. • To identify efforts to reduce unsafe abortion. Methods: The countries reviewed existing grey data and published and made reports of the findings. Results were shared with national stakeholders which led to priorities and plans of action. Results: • High burden in the region and contributes substantially to the high maternal mortality. • Unwanted pregnancy was found to be highly prevalent and contraceptive prevalence is generally low in the region. • The law in the five (5) out of the seven (7) countries participated is restrictive but there are unexploited provisions for providing safe abortion. • Access to post – abortion care is limited in scope and availability. Conclusions: • Unsafe abortion remains a huge burden in the region and strategies for prevention remain limited. • The participating countries have identified key strategies and activities towards prevention.
S269
O619 Fetal body measurement in gestational diabetes H. Mirghani1 , G. Bekdache2 , M. Begum2 , F. Khan3 . 1 United Arab Emirates University, 2 Tawam Hospital, UAE, 3 Tawam Hospital Objective: 1. To assess the value of fetal body measurement in GDM patients on insulin. 2. To determine the outcome of pregnancies in mothers with GDM on insulin followed in the Fetal Endocrine Clinic. Subjects and Methods: Forty-nine pregnant women diagnosed with gestational diabetes (GDM) and require insulin for glycemic control were prospectively followed at. specialized Fetal Endocrine Clinic (FEC). Patients had an anomaly scan at 24 weeks gestation. This is followed by a growth scan at 28–32 weeks, 33–36 weeks and a final scan at 37–40 weeks gestation. In each visit sonographic measurement of fetal biometry, estimated fetal weight, placenta thickness, amniotic fluid deepest pool, liver length, abdominal wall subcutaneous fat thickness and interventricular septum thickness. Results: A total of 49 GDM on insulin were included in the study. Their mean age was 35±6.2 years, mean parity was 3.9±2.9, the mean gestational age (GA) at first visit to the FEC was 27±4.3 weeks. The mean first trimester booking BMI was 34.1±7.7. Forty three (87.8%) patients had a family history of diabetes and 42 (85.7%) had a history of GDM. Fetal growth and body measurements were within normal values. The mean GA at delivery was 39.2±1.3 weeks. Labour was induced in 12 (25%) patients. Fifteen (30%) patients were delivered by Caesarean section. The mean birth weight was 3388±531 g. Only one (2%) neonate required admission to NICU. Conclusion: Fetal body measurements during pregnancy correlate well with pregnancy outcome. Pregnancy outcome in patients with GDM on insulin could be as good as non GDM patients when followed in specialized maternal and fetal clinics. O620 Role of letrozole in IVF K. Mitra1 , B. Mitra, M. Das, M. Roychoudhury. 1 Federation of Obstetrics and Gynaecological society of India Ideal stimulation protocol for IVF/ET specially in cases of resistant PCOS and poor responders remain eluding. In a developing country like India, high dose stimulation protocol not only results in increasing cost but also the chances of multiple pregnancy and OHSS remain high. Letrozole a third generation aromatase inhibitor, has a place in PCOS and poor responders. Stimulation protocol for poor responders remain uncertain, specially in the high age bracket. In our study stimulation with Letrozole 2.5 mg one tab twice daily from day 2 – day 6 followed by a couple of HMG from Day 6/7 onwards resulted in the development of 3–4 equimature follicle with good E2 levels and endometrium. This was followed by GnRH antagonist to prevent LH surge, followed by pick up with final maturation by HCG. This resulted in 3–5 good quality embryos. Following this ET was done on day 2/3 and progesterone supplementation was given. This resulted in good pregnancy rates with a reduction in the cost and stimulation regimns. The resultant pregnancy rates were comparable, had lesser # of miscarriage, cost effectiveness and virtually no multiple pregnancy or OHSS. A detailed analysis will be provided in the final text. Thus letrozole remains a low cost effective stimulation protocol specially for poor responders and resistant PCOS, particularly in a developing country like India.
activity and enjoyment of sex. Women with sexual health problems should be assessed for OAB and other LUTS. O617 Pregnancy after renal transplant – Oman perspective U. Sharma, S. Minocha Objective: To study the outcome of pregnancy in renal allograft recipients & to analyse the impact of pregnancy on transplanted kidney. Material and Methods: It was a retrospective study conducted at Royal Hospital, a tertiary referral centre in Oman from 1988–2006. Computer data & hospital files were utilised for data analysis. Results: A total of 313 females had undergone renal transplant out of which 141 were in reproductive age group.42 females conceived with 82 pregnancies & 29% conception rate was noted. Mean transplant-conception interval was 17 months.11 females had 3 or more pregnancies after renal transplant. 71% had live births, 6% had termination of pregnancy, 3.7% had neonatal death, 9% had still birth & 14% had miscarriages. Caesarean section rate was 33% & graft rejection was seen in 12% patients. Maternal mortality was noted in 7% of patients. Conclusion: Conception rate (29%) in omani women has been much higher than reported in literature (2–4%). Incidence of pregnancy induced hypertension (11%) has been very low as compared to global review (40%). No congenital anomalies were noted in our patients & graft rejection was more time related than pregnancy induced. Unstable renal functions at the time of conception had definite risks to mother, fetus, newborn & allograft. The patients with renal transplant should have preconception counselling & the renal functions should be stabilised at optimal levels before contemplating pregnancy. A diligent follow up in combined clinic of obstetrics & nephrology has to be emphasised for optimal maternal & fetal outcome. O618 Unsafe abortion in the East Central South African (ECSA) region – FIGO initiative F. Mirembe. Makerere University, Department of Ob/Gyn Introduction: Unsafe abortion contributes between 15% and 35% of the overall maternal death in participating countries. Objectives: • To assess the burden of the problem of unsafe abortion in the region. • To identify efforts to reduce unsafe abortion. Methods: The countries reviewed existing grey data and published and made reports of the findings. Results were shared with national stakeholders which led to priorities and plans of action. Results: • High burden in the region and contributes substantially to the high maternal mortality. • Unwanted pregnancy was found to be highly prevalent and contraceptive prevalence is generally low in the region. • The law in the five (5) out of the seven (7) countries participated is restrictive but there are unexploited provisions for providing safe abortion. • Access to post – abortion care is limited in scope and availability. Conclusions: • Unsafe abortion remains a huge burden in the region and strategies for prevention remain limited. • The participating countries have identified key strategies and activities towards prevention.
S269
O619 Fetal body measurement in gestational diabetes H. Mirghani1 , G. Bekdache2 , M. Begum2 , F. Khan3 . 1 United Arab Emirates University, 2 Tawam Hospital, UAE, 3 Tawam Hospital Objective: 1. To assess the value of fetal body measurement in GDM patients on insulin. 2. To determine the outcome of pregnancies in mothers with GDM on insulin followed in the Fetal Endocrine Clinic. Subjects and Methods: Forty-nine pregnant women diagnosed with gestational diabetes (GDM) and require insulin for glycemic control were prospectively followed at. specialized Fetal Endocrine Clinic (FEC). Patients had an anomaly scan at 24 weeks gestation. This is followed by a growth scan at 28–32 weeks, 33–36 weeks and a final scan at 37–40 weeks gestation. In each visit sonographic measurement of fetal biometry, estimated fetal weight, placenta thickness, amniotic fluid deepest pool, liver length, abdominal wall subcutaneous fat thickness and interventricular septum thickness. Results: A total of 49 GDM on insulin were included in the study. Their mean age was 35±6.2 years, mean parity was 3.9±2.9, the mean gestational age (GA) at first visit to the FEC was 27±4.3 weeks. The mean first trimester booking BMI was 34.1±7.7. Forty three (87.8%) patients had a family history of diabetes and 42 (85.7%) had a history of GDM. Fetal growth and body measurements were within normal values. The mean GA at delivery was 39.2±1.3 weeks. Labour was induced in 12 (25%) patients. Fifteen (30%) patients were delivered by Caesarean section. The mean birth weight was 3388±531 g. Only one (2%) neonate required admission to NICU. Conclusion: Fetal body measurements during pregnancy correlate well with pregnancy outcome. Pregnancy outcome in patients with GDM on insulin could be as good as non GDM patients when followed in specialized maternal and fetal clinics. O620 Role of letrozole in IVF K. Mitra1 , B. Mitra, M. Das, M. Roychoudhury. 1 Federation of Obstetrics and Gynaecological society of India Ideal stimulation protocol for IVF/ET specially in cases of resistant PCOS and poor responders remain eluding. In a developing country like India, high dose stimulation protocol not only results in increasing cost but also the chances of multiple pregnancy and OHSS remain high. Letrozole a third generation aromatase inhibitor, has a place in PCOS and poor responders. Stimulation protocol for poor responders remain uncertain, specially in the high age bracket. In our study stimulation with Letrozole 2.5 mg one tab twice daily from day 2 – day 6 followed by a couple of HMG from Day 6/7 onwards resulted in the development of 3–4 equimature follicle with good E2 levels and endometrium. This was followed by GnRH antagonist to prevent LH surge, followed by pick up with final maturation by HCG. This resulted in 3–5 good quality embryos. Following this ET was done on day 2/3 and progesterone supplementation was given. This resulted in good pregnancy rates with a reduction in the cost and stimulation regimns. The resultant pregnancy rates were comparable, had lesser # of miscarriage, cost effectiveness and virtually no multiple pregnancy or OHSS. A detailed analysis will be provided in the final text. Thus letrozole remains a low cost effective stimulation protocol specially for poor responders and resistant PCOS, particularly in a developing country like India.