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P352 Intrauterine fetal demise (IUFD) and subsequent pregnancy outcomes in patients with positive and negative thrombophilia evaluations
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
The median QUICKI index for women with risk factors was 0.420 (CI 0.362 to 0.602) which did not differ significantly from that of women without risk factors 0.44 (CI 0.418 to 0.461) (p = 0.052). The median HOMA index for high risk patients was 0.558 (CI 0.442 to 0.881) and for low risk patients 0.447 (CI 0.3628 to 0.6023), the difference was not statistically significant (p = 0.052). Conclusion: Fasting insulin levels were significantly different between pregnant individuals with risk factors and women without risk factors revealed for the development of GDM. No difference could be demonstrated for insulin levels 15 minutes after a 75 g glucose bolus as well as for the HOMA and QUICKI indexes.
S515
Results: 58 patients were found to have negative thrombophilia evaluation while 31 had positive. Both pregnancies were associated with significant complications (Table). Conclusion: Pregnancy outcome after IUFD is associated with significant risk of obstetrical complications. The thrombophilia group had increased risk of recurrent early intrauterine fetal demise and the birth weight of the surviving fetuses was higher. Premature birth was more frequent in the negative group. Treatment with anticoagulants of the positive thrombophilia group resulted in succesful pregnancy in 90% of patients. Characteristics of positive and negative groups
P351 A rare case of gastric torsion in pregnancy after gastric banding C. Mallappa Saroja. Nevill hall Hospital, Abergavenny, Wales, UK Introduction: Laparoscopic adjustable gastric banding (LABG) is a surgical procedure involving insertion of inflatable band to form a gastric pouch near the cardia with 15 ml capacity. The first LABG was done in Belgium in 1993. Gastric torsion after band slippage is extremely rare. We report this rare case as the literature review of gastric banding and complications in pregnancy did not reveal any case of gastric torsion. Case report: Mrs VB who had undergone LABG which was deflated prior to pregnancy was admitted at 29 weeks with upper abdominal pain and vomiting for rehydration and total parenteral nutrition. Two weeks after admission ALT increased to 591 and acute fatty liver of pregnancy was suspected. The gastroenterologist advised immediate delivery. She underwent scheduled Caesarean section at 32 weeks. Her ALT improved but symptoms persisted. Hence, she underwent laparotomy five days post section by surgeons. She had slipped band with adhesions and torsion of the stomach of 180 degrees. Post operative period was uneventful. Discussion: This is the first case reporting complication of torsion of stomach in a pregnant patient who had undergone LABG. Most women who require surgical intervention during pregnancy present with non-specific abdominal complaints and delays often occurred before surgical intervention. Pregnant patients with banding procedure presenting with intractable vomiting present unique clinical dilemma. In addition, our case was complicated by acute fatty liver of pregnancy, probably secondary to intractable vomiting. Hence, we suggest close monitoring and timely surgical intervention must be considered when a surgical emergency is suspected. P352 Intrauterine fetal demise (IUFD) and subsequent pregnancy outcomes in patients with positive and negative thrombophilia evaluations D. Mastrogiannis. Temple University School of Medicine, Obstetrics, Gynecology & Reproductive Sciences, Philadelphia, Pennsylvania Objective: Intrauterine fetal demise (IUFD) is one of the most common adverse pregnancy outcomes. A controversial association of thrombophilia and IUFD exists and its management in future pregnancies remains largely empiric. In this study we evaluated pregnancy outcomes after IUFD in patients with positive or negative thrombophilia workup. Study design: A retrospective review of subsequent pregnancy outcomes after an IUFD of 89 patients. These patients had counseling and evaluation before the next pregnancy and they were classified into 2 groups based on thrombophilia testing consisting of anticardiolipin antibodies, lupus anticoagulant, factor V Leiden mutation, prothrombin mutation, protein S, C, antithrombin III deficiencies and fasting serum homocysteine. Group 1 had negative thrombophilia testing (defined as all negative tests) while group 2 had positive (defined as any positive test). Group 1 and 2 had preconceptual counseling, folic acid and vitamin supplementation. Group 2 was given heparin or enoxaparin thromboprophylaxis.
Recurrent IUFD <24 weeks Birth weight Premature birth IUGR
Group 1(−) N = 58
Group 2(+) N = 31
P value
0 2774 14 6
3 3178 1 3
0.040 0.046 0.015 NS
P353 The association between the level of fetal descent during the second stage of labor and extension of cesarean section (CS) incision F. Montazeri, M. Sayyah Melli Purpose: Failure to progress in the second stage of labor is a common problem and accounts for 30–68% of unplanned CS. To define the association between the level of fetal descent during the second stage of labor and the extension of CS incision, this study was carried out. Methods: All singleton, vertex, term deliveries with an unscarred uterus were complicated by arrest of descent, and necessitating intervention by surgical delivery between the years 2007 and 2009, were included. The diagnosis of arrest of descent was made by the attending physician or senior resident. The physical examination was including the depth, presence or absence of damage. Pregnancy characteristics, labor characteristics and surgery complications were analyzed. The Statistics Package for Social Science (SPSS 15.0) was used for statistical analyses. Results: In this study 111 deliveries, were met the inclusion criteria. Twenty-eight percent of patient were in stage zero and 25% in stage ≥2. In 35.7% of cases, the depth of extension were more than 3 cm and in 42.9% less than 3 cm (p < 0.05). There was no association between the level of station and the extension of CS incision (p = 0.258, OR = 0.579). There was a significant difference in groups according to the phase of cervical dilatation (p = 0.059, OR = 0.337), and age of mothers (p = 0.019). But there was no association between the station of fetus and extension of CS incision (p = 0.189). Conclusion: The results show that the most determinant factor is the maternal age and should be considered in the management of obstructed labor. P354 Shock associated ischemic colitis following massive obstetric hemorrhage T. Naidoo1 , N. Paruk2 , J. Moodley3 . 1 Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, 2 Department of General Surgery, Nelson R Mandela School of Medicine, 3 Department of Obstetrics and Gynaecology and MRC/UN Pregnancy Hypertension Research Unit, Nelson R Mandela School of Medicine Gangrenous ischemic colitis usually presents diagnostic and therapeutic problems associated with poor survival. Two types are described, viz. type I – spontaneous development of colonic ischemia secondary to occlusive or non-occlusive vascular disease; type II – ischemia associated with hypovolemic shock. Ischemic
The median QUICKI index for women with risk factors was 0.420 (CI 0.362 to 0.602) which did not differ significantly from that of women without risk factors 0.44 (CI 0.418 to 0.461) (p = 0.052). The median HOMA index for high risk patients was 0.558 (CI 0.442 to 0.881) and for low risk patients 0.447 (CI 0.3628 to 0.6023), the difference was not statistically significant (p = 0.052). Conclusion: Fasting insulin levels were significantly different between pregnant individuals with risk factors and women without risk factors revealed for the development of GDM. No difference could be demonstrated for insulin levels 15 minutes after a 75 g glucose bolus as well as for the HOMA and QUICKI indexes.
S515
Results: 58 patients were found to have negative thrombophilia evaluation while 31 had positive. Both pregnancies were associated with significant complications (Table). Conclusion: Pregnancy outcome after IUFD is associated with significant risk of obstetrical complications. The thrombophilia group had increased risk of recurrent early intrauterine fetal demise and the birth weight of the surviving fetuses was higher. Premature birth was more frequent in the negative group. Treatment with anticoagulants of the positive thrombophilia group resulted in succesful pregnancy in 90% of patients. Characteristics of positive and negative groups
P351 A rare case of gastric torsion in pregnancy after gastric banding C. Mallappa Saroja. Nevill hall Hospital, Abergavenny, Wales, UK Introduction: Laparoscopic adjustable gastric banding (LABG) is a surgical procedure involving insertion of inflatable band to form a gastric pouch near the cardia with 15 ml capacity. The first LABG was done in Belgium in 1993. Gastric torsion after band slippage is extremely rare. We report this rare case as the literature review of gastric banding and complications in pregnancy did not reveal any case of gastric torsion. Case report: Mrs VB who had undergone LABG which was deflated prior to pregnancy was admitted at 29 weeks with upper abdominal pain and vomiting for rehydration and total parenteral nutrition. Two weeks after admission ALT increased to 591 and acute fatty liver of pregnancy was suspected. The gastroenterologist advised immediate delivery. She underwent scheduled Caesarean section at 32 weeks. Her ALT improved but symptoms persisted. Hence, she underwent laparotomy five days post section by surgeons. She had slipped band with adhesions and torsion of the stomach of 180 degrees. Post operative period was uneventful. Discussion: This is the first case reporting complication of torsion of stomach in a pregnant patient who had undergone LABG. Most women who require surgical intervention during pregnancy present with non-specific abdominal complaints and delays often occurred before surgical intervention. Pregnant patients with banding procedure presenting with intractable vomiting present unique clinical dilemma. In addition, our case was complicated by acute fatty liver of pregnancy, probably secondary to intractable vomiting. Hence, we suggest close monitoring and timely surgical intervention must be considered when a surgical emergency is suspected. P352 Intrauterine fetal demise (IUFD) and subsequent pregnancy outcomes in patients with positive and negative thrombophilia evaluations D. Mastrogiannis. Temple University School of Medicine, Obstetrics, Gynecology & Reproductive Sciences, Philadelphia, Pennsylvania Objective: Intrauterine fetal demise (IUFD) is one of the most common adverse pregnancy outcomes. A controversial association of thrombophilia and IUFD exists and its management in future pregnancies remains largely empiric. In this study we evaluated pregnancy outcomes after IUFD in patients with positive or negative thrombophilia workup. Study design: A retrospective review of subsequent pregnancy outcomes after an IUFD of 89 patients. These patients had counseling and evaluation before the next pregnancy and they were classified into 2 groups based on thrombophilia testing consisting of anticardiolipin antibodies, lupus anticoagulant, factor V Leiden mutation, prothrombin mutation, protein S, C, antithrombin III deficiencies and fasting serum homocysteine. Group 1 had negative thrombophilia testing (defined as all negative tests) while group 2 had positive (defined as any positive test). Group 1 and 2 had preconceptual counseling, folic acid and vitamin supplementation. Group 2 was given heparin or enoxaparin thromboprophylaxis.
Recurrent IUFD <24 weeks Birth weight Premature birth IUGR
Group 1(−) N = 58
Group 2(+) N = 31
P value
0 2774 14 6
3 3178 1 3
0.040 0.046 0.015 NS
P353 The association between the level of fetal descent during the second stage of labor and extension of cesarean section (CS) incision F. Montazeri, M. Sayyah Melli Purpose: Failure to progress in the second stage of labor is a common problem and accounts for 30–68% of unplanned CS. To define the association between the level of fetal descent during the second stage of labor and the extension of CS incision, this study was carried out. Methods: All singleton, vertex, term deliveries with an unscarred uterus were complicated by arrest of descent, and necessitating intervention by surgical delivery between the years 2007 and 2009, were included. The diagnosis of arrest of descent was made by the attending physician or senior resident. The physical examination was including the depth, presence or absence of damage. Pregnancy characteristics, labor characteristics and surgery complications were analyzed. The Statistics Package for Social Science (SPSS 15.0) was used for statistical analyses. Results: In this study 111 deliveries, were met the inclusion criteria. Twenty-eight percent of patient were in stage zero and 25% in stage ≥2. In 35.7% of cases, the depth of extension were more than 3 cm and in 42.9% less than 3 cm (p < 0.05). There was no association between the level of station and the extension of CS incision (p = 0.258, OR = 0.579). There was a significant difference in groups according to the phase of cervical dilatation (p = 0.059, OR = 0.337), and age of mothers (p = 0.019). But there was no association between the station of fetus and extension of CS incision (p = 0.189). Conclusion: The results show that the most determinant factor is the maternal age and should be considered in the management of obstructed labor. P354 Shock associated ischemic colitis following massive obstetric hemorrhage T. Naidoo1 , N. Paruk2 , J. Moodley3 . 1 Department of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, 2 Department of General Surgery, Nelson R Mandela School of Medicine, 3 Department of Obstetrics and Gynaecology and MRC/UN Pregnancy Hypertension Research Unit, Nelson R Mandela School of Medicine Gangrenous ischemic colitis usually presents diagnostic and therapeutic problems associated with poor survival. Two types are described, viz. type I – spontaneous development of colonic ischemia secondary to occlusive or non-occlusive vascular disease; type II – ischemia associated with hypovolemic shock. Ischemic