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O682 Fetal cardiac injury and ductus venosus doppler velocimetry in severe placental insufficiency before 34th week of gestation
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
procedure to treat the patients of vaginal agenesis. The technique is simple and safe and provides a satisfactory and functional vagina in majority of patients. O680 AMH and Inhibin B to determine ovarian toxicity of chemotherapies and efficiency of GnRH-a in cancer patients M. Nitzschke1 , J. Raddatz2 , T. Strowitzki2 , M. Von Wolff1 . 1 University Hospital of Bern, Switzerland, 2 University Hospital of Heidelberg, Germany Introduction: An increasing number of patients is treated by GnRH-a to protect ovaries from chemotherapies, even though data on the efficiency of GnRH-a are still limited and study results are controversial. This is in part due to the fact that the efficiency of GnRH-a has also exclusively been studied by analysing the risk of secondary amenorrhoea. This carefully designed pilot study was set up to analyse the efficiency of AMH and Inhibin B to detect minor ovarian damages, caused by chemotherapies and to study the protective capacity of GnRH-a. Materials and Methods: 10 patients (mean age 24 y) who had received chemotherapies for Hodgkin Lymphoma (Group A) were matched first with patients at a similar age who had received exactly the same chemotherapy and who were co-treated with GnRH-a to protect ovarian function (Group B) and second with healthy patients at the same age (Control Group). AMH, Inhibin B, FSH, AFC and ovary volume were compared in the three patient groups to study first minor ovarian damages, caused by chemotherapies and second to analyse the protective effect of GnRH-a. Results: 10% of the patients in group A and B developed a secondary amenorrhoea. In group A and B versus control, the following parameters were significantly different: FSH 14.6 U/l vs. 5.3 U/l, AMH 1.5 vs. 3.9 ng/ml, Inhibin B 23.7 vs. 64.9 pg/ml, AFC 6.2 vs. 11.6 follicles und ovary volume 6.4 vs. 9.7 cm3. No difference was found by the comparison of these parameters in patients with or without co-treatment with GnRH-a. Conclusions: AMH and Inhibin B are sensitive parameters to analyse ovarian damage, caused by chemotherapy. The results of this study do not support previous studies, showing GnRH-a to protect ovarian function. O681 Recurrent abortions – Systematic diagnostics and evidence based therapies can reduce the risk of further abortions M. Nitzschke1 , B. Dembinski2 , M. Bohlmann3 , T. Strowitzki2 , M. Von Wolff1 . 1 University Hospital of Bern, Switzerland, 2 University Hospital of Heidelberg, Germany, 3 University Hospital of L¨ ubeck, Germany Introduction: To compare the incidence of pathologies in patients with 3–5 and with 2 previous recurrent abortions and to analyze the risk of further abortions. Materials and Methods: 189 of 260 patients with 2 (n = 80) and 3–5 (n = 109) recurrent abortions were successfully contacted (72.6%) to report on the outcome of their following pregnancy after profound abortion related diagnostics. All patients were diagnosed by hysteroscopy, chromosomal analysis of both the patient and her partner, endocrine analysis including increased concentrations of testosterone, DHEA-S, prolactin, basal LH and TSH, autoimmune analysis including anti-phospholipid antibodies, anti-cardiolipin, anti-thyroid globulin, anti-thyroid peroxidase, anti-nuclear antibodies and analysis of coagulation disorders such as Factor V Leiden-, Factor II- and MTHFR-mutation, APCresistance, decreased protein S-, protein C-, ATIII-, and factor XIIconcentrations and increased factor VIII-concentrations. Patients had received surgical intervention (16.8%), genetic counseling (3.5%), treatments with thyroid hormones (18.9%), bromocriptine
(4.2%), aspirin (49.7%), heparin (43.4%) or folic acid 5 mg (42%) during the following pregnancy (n = 143). Results: The incidence of hemostaseological and MTHFR-mutations was 3.3 respectively 2.4 times higher (p = 0.0004 respectively p = 0.0092) in the group with previous 3–5 abortions. The risk of further abortions was 32.9% after 3–5 abortions in comparison with 13.1% after 2 abortions (p = 0.0064). Conclusions: Hemostaseological and MTHFR-associated pathologies seem to play a major role in recurrent abortions. In spite of the treatment of these pathologies, the risk of further abortions remains significantly higher following 3–5 previous abortions in comparison to 2 abortions. O682 Fetal cardiac injury and ductus venosus doppler velocimetry in severe placental insufficiency before 34th week of gestation R. Nomura, S. Miyadahira, F. Cabar, V. Costa, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Objectives: Placental insufficiency and fetal growth restriction may lead to fetal hypoxia, cardiac injury and dysfunction. The aim of this study was to determine the correlation between ductus venosus (DV) dopplervelocimetry and fetal cardiac troponin T (cTnT). Methods: Between March 2007 and Dec 2008, 24 singleton pregnancies with severe placental insufficiency characterized by abnormal umbilical artery Doppler were prospectively studied. All the patients delivered by cesarean section and the Doppler exams were performed at the same day. The following variables were studied: maternal age, parity, hypertension, diabetes, gestational age at delivery, umbilical artery (UA) pulsatility index (PI), absent or reversed end-diastolic velocity (AREDV) in the UA, middle cerebral artery (MCA) PI, and DV pulsatility index for veins (PIV). Immediately after delivery, UA blood samples were obtained for pH measurement and cardiac troponin T (cTNT) levels. Statistical analysis included Mann Whitney U test, Chi-square test and Fisher’s exact test. Results: The results showed a positive correlation between elevated DV-PIV and fetal cTnT levels (p = 0.009, r = 0.52). The fetuses that presented DV PIV ≤ 1.2 (n = 13) showed significantly lower cTnT at birth (median = 0.07, min 0.03, max 0.26) than group with DV PIV > 1.2 (n = 11, median = 0.14, n = 0.08, max 0.26, p = 0.04). Conclusion: The DV-PIV correlated significantly with the fetal cTnT levels at delivery in growth-restricted fetuses by placental insufficiency detected before the 34th week. Abnormal DV PIV represents severe cardiac compromise demonstrated by myocardial injury and elevated fetal cTnT. O683 Severe preeclampsia is associated with increased risk of fetal malformation S. Norden ´ Lindeberg, U. Hanson. Dept Obst Gyn Uppsala University Hospital Background: Severe preeclampsia is associated with increased markers for oxidative stress and angiogenetic markers at least during the two last trimesters of pregnancy. There are no reports about differences related to organogenesis. The aim of this study was to find out if there is an increased risk of fetal malformation in pregnancies complicated by preeclampsia. Methods: We used The Swedish Medical Birth Registry 1999–2003. Chromosomal anomalies were excluded. The odds ratios for major fetal malformation, cardiac malformation and hypospadia were calculated. Logistic regression was used and the following maternal characteristics known to affect the risk for fetal malformation controlled for: Age, body mass index and diabetes. Results: Severe preeclampsia is associated with OR for major malformations 2.0 (1.8–2.3), cardiac malformations, OR 1.7 (1.3–2.1),
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
procedure to treat the patients of vaginal agenesis. The technique is simple and safe and provides a satisfactory and functional vagina in majority of patients. O680 AMH and Inhibin B to determine ovarian toxicity of chemotherapies and efficiency of GnRH-a in cancer patients M. Nitzschke1 , J. Raddatz2 , T. Strowitzki2 , M. Von Wolff1 . 1 University Hospital of Bern, Switzerland, 2 University Hospital of Heidelberg, Germany Introduction: An increasing number of patients is treated by GnRH-a to protect ovaries from chemotherapies, even though data on the efficiency of GnRH-a are still limited and study results are controversial. This is in part due to the fact that the efficiency of GnRH-a has also exclusively been studied by analysing the risk of secondary amenorrhoea. This carefully designed pilot study was set up to analyse the efficiency of AMH and Inhibin B to detect minor ovarian damages, caused by chemotherapies and to study the protective capacity of GnRH-a. Materials and Methods: 10 patients (mean age 24 y) who had received chemotherapies for Hodgkin Lymphoma (Group A) were matched first with patients at a similar age who had received exactly the same chemotherapy and who were co-treated with GnRH-a to protect ovarian function (Group B) and second with healthy patients at the same age (Control Group). AMH, Inhibin B, FSH, AFC and ovary volume were compared in the three patient groups to study first minor ovarian damages, caused by chemotherapies and second to analyse the protective effect of GnRH-a. Results: 10% of the patients in group A and B developed a secondary amenorrhoea. In group A and B versus control, the following parameters were significantly different: FSH 14.6 U/l vs. 5.3 U/l, AMH 1.5 vs. 3.9 ng/ml, Inhibin B 23.7 vs. 64.9 pg/ml, AFC 6.2 vs. 11.6 follicles und ovary volume 6.4 vs. 9.7 cm3. No difference was found by the comparison of these parameters in patients with or without co-treatment with GnRH-a. Conclusions: AMH and Inhibin B are sensitive parameters to analyse ovarian damage, caused by chemotherapy. The results of this study do not support previous studies, showing GnRH-a to protect ovarian function. O681 Recurrent abortions – Systematic diagnostics and evidence based therapies can reduce the risk of further abortions M. Nitzschke1 , B. Dembinski2 , M. Bohlmann3 , T. Strowitzki2 , M. Von Wolff1 . 1 University Hospital of Bern, Switzerland, 2 University Hospital of Heidelberg, Germany, 3 University Hospital of L¨ ubeck, Germany Introduction: To compare the incidence of pathologies in patients with 3–5 and with 2 previous recurrent abortions and to analyze the risk of further abortions. Materials and Methods: 189 of 260 patients with 2 (n = 80) and 3–5 (n = 109) recurrent abortions were successfully contacted (72.6%) to report on the outcome of their following pregnancy after profound abortion related diagnostics. All patients were diagnosed by hysteroscopy, chromosomal analysis of both the patient and her partner, endocrine analysis including increased concentrations of testosterone, DHEA-S, prolactin, basal LH and TSH, autoimmune analysis including anti-phospholipid antibodies, anti-cardiolipin, anti-thyroid globulin, anti-thyroid peroxidase, anti-nuclear antibodies and analysis of coagulation disorders such as Factor V Leiden-, Factor II- and MTHFR-mutation, APCresistance, decreased protein S-, protein C-, ATIII-, and factor XIIconcentrations and increased factor VIII-concentrations. Patients had received surgical intervention (16.8%), genetic counseling (3.5%), treatments with thyroid hormones (18.9%), bromocriptine
(4.2%), aspirin (49.7%), heparin (43.4%) or folic acid 5 mg (42%) during the following pregnancy (n = 143). Results: The incidence of hemostaseological and MTHFR-mutations was 3.3 respectively 2.4 times higher (p = 0.0004 respectively p = 0.0092) in the group with previous 3–5 abortions. The risk of further abortions was 32.9% after 3–5 abortions in comparison with 13.1% after 2 abortions (p = 0.0064). Conclusions: Hemostaseological and MTHFR-associated pathologies seem to play a major role in recurrent abortions. In spite of the treatment of these pathologies, the risk of further abortions remains significantly higher following 3–5 previous abortions in comparison to 2 abortions. O682 Fetal cardiac injury and ductus venosus doppler velocimetry in severe placental insufficiency before 34th week of gestation R. Nomura, S. Miyadahira, F. Cabar, V. Costa, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Objectives: Placental insufficiency and fetal growth restriction may lead to fetal hypoxia, cardiac injury and dysfunction. The aim of this study was to determine the correlation between ductus venosus (DV) dopplervelocimetry and fetal cardiac troponin T (cTnT). Methods: Between March 2007 and Dec 2008, 24 singleton pregnancies with severe placental insufficiency characterized by abnormal umbilical artery Doppler were prospectively studied. All the patients delivered by cesarean section and the Doppler exams were performed at the same day. The following variables were studied: maternal age, parity, hypertension, diabetes, gestational age at delivery, umbilical artery (UA) pulsatility index (PI), absent or reversed end-diastolic velocity (AREDV) in the UA, middle cerebral artery (MCA) PI, and DV pulsatility index for veins (PIV). Immediately after delivery, UA blood samples were obtained for pH measurement and cardiac troponin T (cTNT) levels. Statistical analysis included Mann Whitney U test, Chi-square test and Fisher’s exact test. Results: The results showed a positive correlation between elevated DV-PIV and fetal cTnT levels (p = 0.009, r = 0.52). The fetuses that presented DV PIV ≤ 1.2 (n = 13) showed significantly lower cTnT at birth (median = 0.07, min 0.03, max 0.26) than group with DV PIV > 1.2 (n = 11, median = 0.14, n = 0.08, max 0.26, p = 0.04). Conclusion: The DV-PIV correlated significantly with the fetal cTnT levels at delivery in growth-restricted fetuses by placental insufficiency detected before the 34th week. Abnormal DV PIV represents severe cardiac compromise demonstrated by myocardial injury and elevated fetal cTnT. O683 Severe preeclampsia is associated with increased risk of fetal malformation S. Norden ´ Lindeberg, U. Hanson. Dept Obst Gyn Uppsala University Hospital Background: Severe preeclampsia is associated with increased markers for oxidative stress and angiogenetic markers at least during the two last trimesters of pregnancy. There are no reports about differences related to organogenesis. The aim of this study was to find out if there is an increased risk of fetal malformation in pregnancies complicated by preeclampsia. Methods: We used The Swedish Medical Birth Registry 1999–2003. Chromosomal anomalies were excluded. The odds ratios for major fetal malformation, cardiac malformation and hypospadia were calculated. Logistic regression was used and the following maternal characteristics known to affect the risk for fetal malformation controlled for: Age, body mass index and diabetes. Results: Severe preeclampsia is associated with OR for major malformations 2.0 (1.8–2.3), cardiac malformations, OR 1.7 (1.3–2.1),