- Email: [email protected]
P119 Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
in itching score with the therapy. The incidence of perinatal complications i.e preterm labour, MSL, fetal distress and cesarean section rates were high in study group and were directly correlated to bile acid levels. Serum bilirubin was raised only in 12% patients. Conclusions: Rise in serum bile acids helps in diagnosis of ICP and to differentiate it from other conditions. Their levels also help in prediction of severity of disease and perinatal outcome. Ursodeoxycholic acid is very effective therapy in reducing serum bile acid levels and other liver parameters. P117 An urgent need for national guidelines on thromboprophylaxis for the obese woman in pregnancy? A. Majumdar, C. Candelier. Stepping Hill Hospital Recent reports of the UK Confidential Enquiry into Maternal Deaths have highlighted obesity as an independent risk factor in an increasing number of maternal deaths. Thromboembolism remains the leading direct cause of maternal death and the 2003–05 Report recommends a need for a specific guideline on thromboprophylaxis for morbidly obese women (BMI >35). The aims of this study were to ascertain if women with a BMI >30 were risk assessed for thromboprophylaxis as per RCOG guidelines (2004) and received adequate thromboprophylaxis. Data was collected on 103 women with BMI >30 further divided into 3 groups, BMI >30–35 (n = 39); BMI >35–40 (n = 43); BMI >40 (n = 21) and on a control group of 100 women with BMI 18.5–30. Eighteen women (18%) with a normal range BMI should have received low-molecular weight heparin (LMWH) prophylaxis but failed to. Nine women (23%) with BMI >30–35 should have received thromboprophylaxis, only 5 women (14%) did, and of these only 4.6% received the correct dose. 17 women (40%) with BMI >35–40 should have received thromboprophylaxis, only 7 women (16%) did, and of these only 7% received the correct dose. 17 women (80%) with BMI >40 should have received thromboprophylaxis, only 8 women (38%) did, and of these 18% received the correct dose. Overall, risk assessment identified 44 women (43%) with BMI>30 necessitating LMWH prophylaxis, but only 18% received this with 6.7% getting the correct dose. This study reinforces an urgent need for a specific guideline for obese pregnant women with emphasis on detailed risk assessment and on prescribing an adequate dose of LMWH. P118 Potential for prophilaxis in parents with genetically determined hyperhomocysteinemia and history of antenatal fetal death V. Bitsadze, I. Talalaeva, S. Baimuradova, Z. Gadaeva, S. Akinshina. I.M. Sechenov Moscow Medical Academy, Department of Obstetrics and Gynecology Objectives: We have assessed the role of folates and homocysteine in the developmental abnormalities and intrauterine fetal death. Materials and Methods: We measured plasma homocysteine levels and genetic forms of thrombophilia (MTHFR C677T, MTRR, 2756 MTS, 1958 G/A MTDD, 1298 A/C MTAC) in 100 married couple with a history of antenatal fetal loss in term 28–39 weeks after 2–12 months after episode of fetal death, who received preventive therapy (folates and vitamins group B) before conception, and in 50 healthy controls. Results: Homocysteine level was elevated in 86% of mothers with history antenatal fetal death and in 84% of fathers. In 96% homocysteine was elevated in both parents. In 70% of mild hyperhomocysteinemia there were diagnosed fetal abnormalities such as malformations, Down syndrome, neural tube defects and cardiovascular system defects (p < 0.05 for all comparisions). Conclusions: Genetic hyperhomocysteinemia is associated with the involvement of folate metabolism and homocysteine in developmental abnormalities and in pregnancy complications.
S445
P119 Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies H. Marija, H. Makuli, S. Adela, L. Vesna, D. Ana, A. Gordana, J. Viktorija, K. Gordana. University Hospital for Gynecology and Obstetrics, Skopje Objectives: To calculate the normal range for the fetal middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio in the third trimester of pregnancy and to assess its value, compared with that of the MCA/umbilical artery PI ratio, in predicting an unfavorable outcome of pregnancies complicated by pre-eclampsia. Methods: Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was performed. We calculated the ratios between 1) the PI of the MCA and the mean PI value of both uterine arteries, and 2) the PI of the MCA and the PI of the umbilical artery. All women were examined at or beyond 26 weeks of gestation. A cross-sectional study of 231 normal pregnancies was conducted to construct the reference range. Values below the 5th percentile or an MCA/umbilical artery PI ratio lower than 1.08 were defined as brain-sparing. A further 115 pregnancies with preeclampsia (50 mild and 65 severe) were assessed prospectively and the results were related to perinatal outcome. The accuracy of MCA/uterine artery and MCA/umbilical artery PI ratios for prediction of unfavorable pregnancy outcome was compared. Results: Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n = 15) and 46% of the severe (n = 30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile. However, there was no difference between the groups in the rate of low 5-min Apgar scores, admission to the neonatal intensive care unit, or deliveries before 34 weeks. The MCA/uterine artery and MCA/umbilical artery PI ratios were similar in the prediction of adverse perinatal outcome. Both ratios were better at predicting the outcome of pregnancy than were signs of increased vascular impedance in either the umbilical or uterine arteries. Conclusions: Normal MCA/uterine artery PI ratio decreases with gestational age. Abnormally low MCA/ uterine artery PI ratios are related to unfavorable pregnancy outcome. The predictive value of the MCA/uterine artery PI ratio is similar to that of the MCA/umbilical artery PI ratio. P120 How effective is the maternity care in obese women? A. Ullal1 , R. Meneni2 , K. Nayini1 . 1 University Hospital of North Durham, United Kingdom, 2 South Tyneside Hospital, United Kingdom Background: The increasing prevalence of obesity in young women has become a major public health issue. In 2004, 23% of female population was obese compared to 16% in 1993 in UK. The North East region, particularly County Durham and Tees’ valley has the highest incidence in the country. There is substantial evidence that it contributes to increased morbidity and mortality for both mother and fetus. CEMACH has identified “Obesity in Pregnancy” as a principal project with a maternal health focus for 2008–2011. Aims: • To identify whether the current service provision at UHND meets the guidelines. • To identify gaps and suggest recommendations.
in itching score with the therapy. The incidence of perinatal complications i.e preterm labour, MSL, fetal distress and cesarean section rates were high in study group and were directly correlated to bile acid levels. Serum bilirubin was raised only in 12% patients. Conclusions: Rise in serum bile acids helps in diagnosis of ICP and to differentiate it from other conditions. Their levels also help in prediction of severity of disease and perinatal outcome. Ursodeoxycholic acid is very effective therapy in reducing serum bile acid levels and other liver parameters. P117 An urgent need for national guidelines on thromboprophylaxis for the obese woman in pregnancy? A. Majumdar, C. Candelier. Stepping Hill Hospital Recent reports of the UK Confidential Enquiry into Maternal Deaths have highlighted obesity as an independent risk factor in an increasing number of maternal deaths. Thromboembolism remains the leading direct cause of maternal death and the 2003–05 Report recommends a need for a specific guideline on thromboprophylaxis for morbidly obese women (BMI >35). The aims of this study were to ascertain if women with a BMI >30 were risk assessed for thromboprophylaxis as per RCOG guidelines (2004) and received adequate thromboprophylaxis. Data was collected on 103 women with BMI >30 further divided into 3 groups, BMI >30–35 (n = 39); BMI >35–40 (n = 43); BMI >40 (n = 21) and on a control group of 100 women with BMI 18.5–30. Eighteen women (18%) with a normal range BMI should have received low-molecular weight heparin (LMWH) prophylaxis but failed to. Nine women (23%) with BMI >30–35 should have received thromboprophylaxis, only 5 women (14%) did, and of these only 4.6% received the correct dose. 17 women (40%) with BMI >35–40 should have received thromboprophylaxis, only 7 women (16%) did, and of these only 7% received the correct dose. 17 women (80%) with BMI >40 should have received thromboprophylaxis, only 8 women (38%) did, and of these 18% received the correct dose. Overall, risk assessment identified 44 women (43%) with BMI>30 necessitating LMWH prophylaxis, but only 18% received this with 6.7% getting the correct dose. This study reinforces an urgent need for a specific guideline for obese pregnant women with emphasis on detailed risk assessment and on prescribing an adequate dose of LMWH. P118 Potential for prophilaxis in parents with genetically determined hyperhomocysteinemia and history of antenatal fetal death V. Bitsadze, I. Talalaeva, S. Baimuradova, Z. Gadaeva, S. Akinshina. I.M. Sechenov Moscow Medical Academy, Department of Obstetrics and Gynecology Objectives: We have assessed the role of folates and homocysteine in the developmental abnormalities and intrauterine fetal death. Materials and Methods: We measured plasma homocysteine levels and genetic forms of thrombophilia (MTHFR C677T, MTRR, 2756 MTS, 1958 G/A MTDD, 1298 A/C MTAC) in 100 married couple with a history of antenatal fetal loss in term 28–39 weeks after 2–12 months after episode of fetal death, who received preventive therapy (folates and vitamins group B) before conception, and in 50 healthy controls. Results: Homocysteine level was elevated in 86% of mothers with history antenatal fetal death and in 84% of fathers. In 96% homocysteine was elevated in both parents. In 70% of mild hyperhomocysteinemia there were diagnosed fetal abnormalities such as malformations, Down syndrome, neural tube defects and cardiovascular system defects (p < 0.05 for all comparisions). Conclusions: Genetic hyperhomocysteinemia is associated with the involvement of folate metabolism and homocysteine in developmental abnormalities and in pregnancy complications.
S445
P119 Fetal middle cerebral to uterine artery pulsatility index ratios in normal and pre-eclamptic pregnancies H. Marija, H. Makuli, S. Adela, L. Vesna, D. Ana, A. Gordana, J. Viktorija, K. Gordana. University Hospital for Gynecology and Obstetrics, Skopje Objectives: To calculate the normal range for the fetal middle cerebral artery (MCA)/uterine artery pulsatility index (PI) ratio in the third trimester of pregnancy and to assess its value, compared with that of the MCA/umbilical artery PI ratio, in predicting an unfavorable outcome of pregnancies complicated by pre-eclampsia. Methods: Doppler blood flow velocimetry of the uterine and umbilical arteries and fetal MCA was performed. We calculated the ratios between 1) the PI of the MCA and the mean PI value of both uterine arteries, and 2) the PI of the MCA and the PI of the umbilical artery. All women were examined at or beyond 26 weeks of gestation. A cross-sectional study of 231 normal pregnancies was conducted to construct the reference range. Values below the 5th percentile or an MCA/umbilical artery PI ratio lower than 1.08 were defined as brain-sparing. A further 115 pregnancies with preeclampsia (50 mild and 65 severe) were assessed prospectively and the results were related to perinatal outcome. The accuracy of MCA/uterine artery and MCA/umbilical artery PI ratios for prediction of unfavorable pregnancy outcome was compared. Results: Normal MCA/uterine artery PI ratios decreased with advancing gestational age. Redistribution of the fetal circulation indicated by a low MCA/uterine artery PI ratio was seen in 30% of the mild (n = 15) and 46% of the severe (n = 30) pre-eclamptic cases. There was a significant difference between those without and those with signs of brain-sparing, respectively, in mean birth weight (2456.0 vs. 1424.5 g), gestational age at delivery (35.6 vs. 31.3 weeks) and gestational age at the time of examination (34.9 vs. 30.9 weeks). Furthermore, there was a significantly higher rate of small-for-gestational-age (SGA) neonates (57.8% vs. 25.7%), preterm delivery (100% vs. 81.8%) and Cesarean section (90.7% vs. 66.7%) in cases with an MCA/uterine artery PI ratio below the 5th percentile. However, there was no difference between the groups in the rate of low 5-min Apgar scores, admission to the neonatal intensive care unit, or deliveries before 34 weeks. The MCA/uterine artery and MCA/umbilical artery PI ratios were similar in the prediction of adverse perinatal outcome. Both ratios were better at predicting the outcome of pregnancy than were signs of increased vascular impedance in either the umbilical or uterine arteries. Conclusions: Normal MCA/uterine artery PI ratio decreases with gestational age. Abnormally low MCA/ uterine artery PI ratios are related to unfavorable pregnancy outcome. The predictive value of the MCA/uterine artery PI ratio is similar to that of the MCA/umbilical artery PI ratio. P120 How effective is the maternity care in obese women? A. Ullal1 , R. Meneni2 , K. Nayini1 . 1 University Hospital of North Durham, United Kingdom, 2 South Tyneside Hospital, United Kingdom Background: The increasing prevalence of obesity in young women has become a major public health issue. In 2004, 23% of female population was obese compared to 16% in 1993 in UK. The North East region, particularly County Durham and Tees’ valley has the highest incidence in the country. There is substantial evidence that it contributes to increased morbidity and mortality for both mother and fetus. CEMACH has identified “Obesity in Pregnancy” as a principal project with a maternal health focus for 2008–2011. Aims: • To identify whether the current service provision at UHND meets the guidelines. • To identify gaps and suggest recommendations.