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Obstetric Management and Perinatal Outcome in Pregnancies with AFI Less Than 10 and Intact Fetal Membranes
Abstracts Purpose: Pre-operative imaging studies are useful in planning the most effective abdominal wall incision when dealing with ventral hernias. The optimal location for incision can be estimated through thin sliced CT or high resolution ultrasound: the latter allows a fast and sharp evaluation of the site of the hernia, the size of the fascial leak and the content of the hernia sac. When a "swiss cheese’’ hernia is detected, with multiple small fascial defects inhabited by pre-peritoneal tissue, ultrasonic study can, in our opinion, change surgical approach. Material & Methods: 20 patients have been selected according to the following criteria: ventral hernia with no more than three fascial defects, not exceeding 2.5 cm width; good aspect of the surrounding fascial layer. The procedure can be performed under general or local anesthesia, depending on the number and size of fascial defects, and compliance of the patient. Results: No major post-operative complications were recorded and the outcome was positive with no relapsing hernias. Patients were discharged after 1-3 days. Conclusion: Instead of positioning a wide and probably unnecessary large mesh, small incisions can be done as pointed out by ultrasound and, after dissecting the fascial defect, polipropilene plugs can be inserted in the pre-peritoneal space, in as many defects as required, and fixed to the fascial layer by means of non absorbable sutures.
Mon, Aug 29, 2011 Hall D SS 38 16:00-17:30 Obstetrics SS 38.02 Fetal Weight and Maternal Ethnicity: Our Experience in a Region with a High Immigration Rate L. Driul,1 A. Fruscalzo,2 A. P. Londero,3 G. Tonizzo,1 A. Biasioli,1 S. Bertozzi,4 D. Marchesoni1 1 Clinic of Obstetrics and Gynecology, University of Udine, Udine/IT, 2 Gynecology and Obstetrics, Mathias-Spital, Rheine/DE, 3Gynecology and Obstetrics, University of Udine, Udine/IT, 4Department of Surgery, University of Udine, Udine/IT Purpose: Our region experienced a high immigration in the last decade. The aim of this study is to evaluate the accuracy of fetal weight estimation in women of different ethnicity. Material & Methods: We retrospectively analyzed clinical and obstetric data collected during 2008 in a tertiary center for feto-maternal medicine in the North-East Italy. We included in the study the first 611 deliveries, excluding twin pregnancies and those with incomplete files. 70% of the patients came from Italy, 15% from East-Europe, 10% from Sub-Saharan Africa, and 5% from Northern Countries and America. Results: The ultrasonographically estimated MoM of neonatal weight based on the Hadlock formula results significantly lower in the Italian population and significantly higher in the Sub-Saharan one, whereas it results accurate in the group of women who came from Northern Countries and East-Europe. Conclusion: Even if without any clinical significant difference among actual and estimated fetal weight in our sample, the Hadlock formula seems to overestimate the weight of the Sub-Saharan African fetuses and to underestimate the Italian ones. This may consequently lead to an under-monitoring of small sub-Saharan fetuses, even considering
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that the Sub-Saharan African population in our setting results to have the highest incidence of intrauterine fetal deaths.
SS 38.03 Obstetric Management and Perinatal Outcome in Pregnancies with AFI Less Than 10 and Intact Fetal Membranes K. Blanas,1 M. Theodora,1 N. Papantoniou,1 M. Syndos,1 E. Domali,1 G. Daskalakis,1 S. Mesogitis,1 P. S. Zoumpoulis,2 A. Antsaklis1 1 1st of Obsetrics & Gynecology, University of Athens, Alexandra Hospital, Athens/GR, 2Ultrasound, Diagnostic Echotomography SA, Kifissia/GR Purpose: To examine the attitude of the obstetricians and the perinatal outcome of pregnancies complicated by the finding of borderline oligohydramnios in the third trimester. Borderline oligohydramnios was defined as an AFI between 5 and 10. Material & Methods: 24 singleton pregnancies with borderline oligohydramnios and without history of ruptured amniotic membranes or congenital fetal malformations were included. The patients were Hospitalized for various reasons in the antenatal ward. Initial ultrasound assessment of the pregnancy happened shortly after admission. The fetal-placental circulation as assessed with umbilical artery Doppler was normal. No patients had invasive karyotype testing. The patients were divided in two groups depending on whether the borderline oligohydramnios was isolated (37,5%) or associated with other pregnancy complications or risk factors (62,5%). Results: Increased obstetric interventions (caesarean section) occurred in our study. Particularly in the cases of borderline oligohydramnios associated with other complications or risk factors, the rate of caesarean section approached 87%. 44% was the caesarean section rate in the cases of isolated borderline oligohydramnios. The perinatal outcome was good especially after 34 weeks. There were no perinatal deaths or major perinatal morbidity. Two neonates born before the 34th week of gestation were admitted to neonatal intensive care unit. Conclusion: Meticulous surveillance of the pregnancy and increased intervention follows the finding of borderline oligohydramnios. The perinatal outcomes appear satisfactory. Are such perinatal outcomes feasible without a cascade of obstetric intervention?
SS 38.04 Premature Rupture of the Amniotic Membranes. Obstetric Management and Perinatal Outcome in Borderline Oligohydramnios M. Theodora,1 N. Papantoniou,1 K. Blanas,1 I. Arabatzis,1 M. Syndos,1 G. Daskalakis,1 S. Mesogitis,1 P. S. Zoumpoulis,2 A. Antsaklis1 1 1st of Obsetrics & Gynecology, University of Athens, Alexandra Hospital, Athens/GR, 2Ultrasound, Diagnostic Echotomography SA, Kifissia/GR Purpose: To examine the attitude of the obstetricians and the perinatal outcome of pregnancies complicated by premature rupture of the amniotic membranes (PROM) with associated borderline oligohydramnios. Borderline oligohydramnios was defined as an AFI between 5 and 10. Material & Methods: Over six months we reviewed all singleton pregnancies who were admitted because of PROM in the antenatal ward. Initial assessment of the pregnancy with ultrasound happened shortly after admission. Cases with borderline oligohydramnios were included in the study. The fetal-placental circulation as assessed with umbilical
Mon, Aug 29, 2011 Hall D SS 38 16:00-17:30 Obstetrics SS 38.02 Fetal Weight and Maternal Ethnicity: Our Experience in a Region with a High Immigration Rate L. Driul,1 A. Fruscalzo,2 A. P. Londero,3 G. Tonizzo,1 A. Biasioli,1 S. Bertozzi,4 D. Marchesoni1 1 Clinic of Obstetrics and Gynecology, University of Udine, Udine/IT, 2 Gynecology and Obstetrics, Mathias-Spital, Rheine/DE, 3Gynecology and Obstetrics, University of Udine, Udine/IT, 4Department of Surgery, University of Udine, Udine/IT Purpose: Our region experienced a high immigration in the last decade. The aim of this study is to evaluate the accuracy of fetal weight estimation in women of different ethnicity. Material & Methods: We retrospectively analyzed clinical and obstetric data collected during 2008 in a tertiary center for feto-maternal medicine in the North-East Italy. We included in the study the first 611 deliveries, excluding twin pregnancies and those with incomplete files. 70% of the patients came from Italy, 15% from East-Europe, 10% from Sub-Saharan Africa, and 5% from Northern Countries and America. Results: The ultrasonographically estimated MoM of neonatal weight based on the Hadlock formula results significantly lower in the Italian population and significantly higher in the Sub-Saharan one, whereas it results accurate in the group of women who came from Northern Countries and East-Europe. Conclusion: Even if without any clinical significant difference among actual and estimated fetal weight in our sample, the Hadlock formula seems to overestimate the weight of the Sub-Saharan African fetuses and to underestimate the Italian ones. This may consequently lead to an under-monitoring of small sub-Saharan fetuses, even considering
S75
that the Sub-Saharan African population in our setting results to have the highest incidence of intrauterine fetal deaths.
SS 38.03 Obstetric Management and Perinatal Outcome in Pregnancies with AFI Less Than 10 and Intact Fetal Membranes K. Blanas,1 M. Theodora,1 N. Papantoniou,1 M. Syndos,1 E. Domali,1 G. Daskalakis,1 S. Mesogitis,1 P. S. Zoumpoulis,2 A. Antsaklis1 1 1st of Obsetrics & Gynecology, University of Athens, Alexandra Hospital, Athens/GR, 2Ultrasound, Diagnostic Echotomography SA, Kifissia/GR Purpose: To examine the attitude of the obstetricians and the perinatal outcome of pregnancies complicated by the finding of borderline oligohydramnios in the third trimester. Borderline oligohydramnios was defined as an AFI between 5 and 10. Material & Methods: 24 singleton pregnancies with borderline oligohydramnios and without history of ruptured amniotic membranes or congenital fetal malformations were included. The patients were Hospitalized for various reasons in the antenatal ward. Initial ultrasound assessment of the pregnancy happened shortly after admission. The fetal-placental circulation as assessed with umbilical artery Doppler was normal. No patients had invasive karyotype testing. The patients were divided in two groups depending on whether the borderline oligohydramnios was isolated (37,5%) or associated with other pregnancy complications or risk factors (62,5%). Results: Increased obstetric interventions (caesarean section) occurred in our study. Particularly in the cases of borderline oligohydramnios associated with other complications or risk factors, the rate of caesarean section approached 87%. 44% was the caesarean section rate in the cases of isolated borderline oligohydramnios. The perinatal outcome was good especially after 34 weeks. There were no perinatal deaths or major perinatal morbidity. Two neonates born before the 34th week of gestation were admitted to neonatal intensive care unit. Conclusion: Meticulous surveillance of the pregnancy and increased intervention follows the finding of borderline oligohydramnios. The perinatal outcomes appear satisfactory. Are such perinatal outcomes feasible without a cascade of obstetric intervention?
SS 38.04 Premature Rupture of the Amniotic Membranes. Obstetric Management and Perinatal Outcome in Borderline Oligohydramnios M. Theodora,1 N. Papantoniou,1 K. Blanas,1 I. Arabatzis,1 M. Syndos,1 G. Daskalakis,1 S. Mesogitis,1 P. S. Zoumpoulis,2 A. Antsaklis1 1 1st of Obsetrics & Gynecology, University of Athens, Alexandra Hospital, Athens/GR, 2Ultrasound, Diagnostic Echotomography SA, Kifissia/GR Purpose: To examine the attitude of the obstetricians and the perinatal outcome of pregnancies complicated by premature rupture of the amniotic membranes (PROM) with associated borderline oligohydramnios. Borderline oligohydramnios was defined as an AFI between 5 and 10. Material & Methods: Over six months we reviewed all singleton pregnancies who were admitted because of PROM in the antenatal ward. Initial assessment of the pregnancy with ultrasound happened shortly after admission. Cases with borderline oligohydramnios were included in the study. The fetal-placental circulation as assessed with umbilical