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P68 Value of novel fetal monitoring methods in prediction of metabolic acidosis at birth
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P67 Does the amniotic fluid of mother of fetus with gastroschisis differ significantly from the standard amniotic fluid? H. Bulhak-Guz1 , A. Chilarski1 , M. Banasik2 , M. Grzesiak3 , D. Nowakowska3 , B. Sałacinska4 , K. Szaflik5 , J. Wilczynski3 . 1 Department of Pediatric Surgery and Urology, Polish Mother’s Health Centre, 2 Department of Clinical Immunology, Polish Mother’s Health Centre, 3 Department of Maternal and Fetal Medicine and Gynecology, Polish Mother’s Health Centre, 4 Department of Laboratory Diagnostic, Polish Mother’s Health Centre, 5 Department of Fetus Treatment, Polish Mother’s Health Centre Objectives: The aim of the study was to assess amniotic fluid changes in pregnant women with prenatally diagnosed gastroschisis in fetus. Materials and Methods: Between May 2006 and December 2008 we performed amniotic fluid exchange (AFE) in prenatal period in 13 pregnant women with prenatally diagnosed gastroschisis in fetus. We conducted 28 amnioexchanges in general (from 1 to 3 procedures in each gravida) between 24 and 35 gestational weeks. The course of all prenatal procedures was uneventful. We assessed: morphology and bacteriology of amniotic fluid and the level of selected cytokines in amniotic fluid during AFE (TNF-a, IL-1b, IL-6, IL-8, TGF-b). Results: Physical and chemical examination of samples from subsequent procedures did not show any differences as compared with the values normal for a given pregnancy week. An increase of the concentration of IL-1b, IL-6, IL-8, decrease in the concentration of TNF-a and non-characteristic changes of TGF-b were noted. Bacteriological culture of amniotic fluid in all samples was aseptic. Clinical results show beneficial influence of the AFE on the fetal bowel. Conclusion: Early prenatal diagnosis of gastroschisis enables low invasive interventions in fetus such as amniotic fluid exchange or supplementation, which may improve the condition of intestines and chances of surgical treatment of newborns after delivery. P68 Value of novel fetal monitoring methods in prediction of metabolic acidosis at birth K. Dokus, P. Zubor, K. Biskupska-Bodova, J. Danko. Jessenius Faculty of Medic´ıne, Comenius University, Dept. of Obstetrics and Gynecology, Martin, Slovakia Objective: Purpose of the study was to evaluate the value of fetal pulse oximetry (FPO) and ST-analysis of the fetal ECG (STAN) in prediction of fetal acidosis in labors complicated by abnormal CTG patterns. Methods: A prospective clinical study was conducted at the Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Martin, Slovakia. In total, 63 out of 70 women in labor complicated by abnormal CTG patterns were enrolled. Fetal surveillance continued with simultaneous CTG and FPO+STAN monitoring. A receiver operating curve analysis (ROC) was performed to test diagnostic accuracies of all methods. As birth acidosis we assumed neonates with umbilical arterial pH < 7.2. Result: This study showed that only FPO featured a significant diagnostic accuracy, however, only 2 out of 5 cases with the defined birth acidosis could have been correctly recognized. The optimum detection cut-off was SpO2 = 33%, with sensitivity 60% and specificity 85.2%. There were no significant differences in diagnostic accuracies among the methods if these were compared in between. Conclusion: Diagnostic performances of the fetal pulse oximetry and/or the ST-analysis of fetal ECG in labors complicated by abnormal CTG patterns probably do not substantiate related costs and methods’ clinical usage. This work was supported by Science and Technology Assistance Agency under the contract No. APVT-20–033104.
S431
P69 Cesarean section for fetal distress in Dubai Hospital, Dubai, UAE N. Hobaishy, A. Kauhail, A. Al-Nazer. Dubai Hospital Introduction: The increasing Cesarean delivery rates are imposing a compressing pressure on the health care organizations. Reducing Cesarean section rate is among the high priority in many countries. Methods: In an attempt to explore the problem we investigated the cesarean sections records in Dubai hospital between January 2006 and July 2007. Cases in which Cesarean delivery was performed for fetal distress were investigated regarding their antenatal care, any risk factors, the timing of the decision, the decision incision time, the CTG prior to decision, Apgar score, cord blood ph and baby’s admission to SBCU. Results: The Cesarean delivery was 31.1% (1625 out of 5215 cases); those for fetal distress were present in 21.6% (352 out of 1625). Only 21% (74 cases) were unbooked and 28% (98 cases) had underlying disease. The decision delivery time was 38.1±20.9 minutes and the CTG did not support the diagnosis of fetal distress in 158 cases (44%). The baby’s outcome was satisfactory with 5 minutes Apgar of 9.4±0.9, a mean cord blood ph of 7.2 ±0.06 and admission to SBCU in only 30 cases (8.5%). In conclusion, cesarean delivery due to fetal distress was quoted in 20% of cases, the CTG readings did not always support the decision and the good perinatal outcome may justify the high cesarean delivery rates. P70 Estimation of fetal cardiac periodicity using timing events in Doppler ultrasound signal A. Gacek1 , J. Zietek2 , J. Jezewski1 , T. Kupka1 , A. Matonia1 . 1 Department of Medical Informatics, ITAM Institute, Roosevelt Str. 118, Zabrze 41–800, Poland, 2 Department of Obstetrics & Gynecology, Medical University of Silesia, Warszawska Str. 14, Katowice 40–006, Poland Objectives: The aim was to compare Doppler echoes coming from movements of two different objects within the fetal heart reflecting ultrasound (US) beam: valve and wall. Material and Methods: Simultaneous acquisition of US signal from fetal monitor and fetal electrocardiogram (FECG) using electrodes on maternal abdomen was performed. In group of 15 patients thirty five-second segments (average duration – 20 minutes) were chosen. Joint time frequency analysis was applied to compare the power spectra corresponding to cardiac events: atrial and ventricular wall contraction – Atc (87% – percentage of occurrences) and Vc (27%), mitral valve opening and closure – Mo (60%) and Mc (87%), aortic valve opening and closure – Ao (53%) and Ac (60%). Results: Spectra within the same wall event had high value of correlation coefficient and low value of standard deviation (r = 0.98±0.02 for Atc). For valve events the best result was noted for Mc (r = 0.91±0.10) while for Ao was only 0.63±0.26. Resulted high correlation between spectra of different events denoted a possibility of erroneous periodicity measurements. The highest value of adverse correlation r = 0.93±0.04 was achieved for wall events: Vc with Atc. Conclusions: Synchronous recording of mechanical and electrical fetal heart activity enabled identifying events observed in US signal. Analysis showed a higher correlation of timing event spectra corresponding to wall movements than for those originating from valves.
P67 Does the amniotic fluid of mother of fetus with gastroschisis differ significantly from the standard amniotic fluid? H. Bulhak-Guz1 , A. Chilarski1 , M. Banasik2 , M. Grzesiak3 , D. Nowakowska3 , B. Sałacinska4 , K. Szaflik5 , J. Wilczynski3 . 1 Department of Pediatric Surgery and Urology, Polish Mother’s Health Centre, 2 Department of Clinical Immunology, Polish Mother’s Health Centre, 3 Department of Maternal and Fetal Medicine and Gynecology, Polish Mother’s Health Centre, 4 Department of Laboratory Diagnostic, Polish Mother’s Health Centre, 5 Department of Fetus Treatment, Polish Mother’s Health Centre Objectives: The aim of the study was to assess amniotic fluid changes in pregnant women with prenatally diagnosed gastroschisis in fetus. Materials and Methods: Between May 2006 and December 2008 we performed amniotic fluid exchange (AFE) in prenatal period in 13 pregnant women with prenatally diagnosed gastroschisis in fetus. We conducted 28 amnioexchanges in general (from 1 to 3 procedures in each gravida) between 24 and 35 gestational weeks. The course of all prenatal procedures was uneventful. We assessed: morphology and bacteriology of amniotic fluid and the level of selected cytokines in amniotic fluid during AFE (TNF-a, IL-1b, IL-6, IL-8, TGF-b). Results: Physical and chemical examination of samples from subsequent procedures did not show any differences as compared with the values normal for a given pregnancy week. An increase of the concentration of IL-1b, IL-6, IL-8, decrease in the concentration of TNF-a and non-characteristic changes of TGF-b were noted. Bacteriological culture of amniotic fluid in all samples was aseptic. Clinical results show beneficial influence of the AFE on the fetal bowel. Conclusion: Early prenatal diagnosis of gastroschisis enables low invasive interventions in fetus such as amniotic fluid exchange or supplementation, which may improve the condition of intestines and chances of surgical treatment of newborns after delivery. P68 Value of novel fetal monitoring methods in prediction of metabolic acidosis at birth K. Dokus, P. Zubor, K. Biskupska-Bodova, J. Danko. Jessenius Faculty of Medic´ıne, Comenius University, Dept. of Obstetrics and Gynecology, Martin, Slovakia Objective: Purpose of the study was to evaluate the value of fetal pulse oximetry (FPO) and ST-analysis of the fetal ECG (STAN) in prediction of fetal acidosis in labors complicated by abnormal CTG patterns. Methods: A prospective clinical study was conducted at the Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Martin, Slovakia. In total, 63 out of 70 women in labor complicated by abnormal CTG patterns were enrolled. Fetal surveillance continued with simultaneous CTG and FPO+STAN monitoring. A receiver operating curve analysis (ROC) was performed to test diagnostic accuracies of all methods. As birth acidosis we assumed neonates with umbilical arterial pH < 7.2. Result: This study showed that only FPO featured a significant diagnostic accuracy, however, only 2 out of 5 cases with the defined birth acidosis could have been correctly recognized. The optimum detection cut-off was SpO2 = 33%, with sensitivity 60% and specificity 85.2%. There were no significant differences in diagnostic accuracies among the methods if these were compared in between. Conclusion: Diagnostic performances of the fetal pulse oximetry and/or the ST-analysis of fetal ECG in labors complicated by abnormal CTG patterns probably do not substantiate related costs and methods’ clinical usage. This work was supported by Science and Technology Assistance Agency under the contract No. APVT-20–033104.
S431
P69 Cesarean section for fetal distress in Dubai Hospital, Dubai, UAE N. Hobaishy, A. Kauhail, A. Al-Nazer. Dubai Hospital Introduction: The increasing Cesarean delivery rates are imposing a compressing pressure on the health care organizations. Reducing Cesarean section rate is among the high priority in many countries. Methods: In an attempt to explore the problem we investigated the cesarean sections records in Dubai hospital between January 2006 and July 2007. Cases in which Cesarean delivery was performed for fetal distress were investigated regarding their antenatal care, any risk factors, the timing of the decision, the decision incision time, the CTG prior to decision, Apgar score, cord blood ph and baby’s admission to SBCU. Results: The Cesarean delivery was 31.1% (1625 out of 5215 cases); those for fetal distress were present in 21.6% (352 out of 1625). Only 21% (74 cases) were unbooked and 28% (98 cases) had underlying disease. The decision delivery time was 38.1±20.9 minutes and the CTG did not support the diagnosis of fetal distress in 158 cases (44%). The baby’s outcome was satisfactory with 5 minutes Apgar of 9.4±0.9, a mean cord blood ph of 7.2 ±0.06 and admission to SBCU in only 30 cases (8.5%). In conclusion, cesarean delivery due to fetal distress was quoted in 20% of cases, the CTG readings did not always support the decision and the good perinatal outcome may justify the high cesarean delivery rates. P70 Estimation of fetal cardiac periodicity using timing events in Doppler ultrasound signal A. Gacek1 , J. Zietek2 , J. Jezewski1 , T. Kupka1 , A. Matonia1 . 1 Department of Medical Informatics, ITAM Institute, Roosevelt Str. 118, Zabrze 41–800, Poland, 2 Department of Obstetrics & Gynecology, Medical University of Silesia, Warszawska Str. 14, Katowice 40–006, Poland Objectives: The aim was to compare Doppler echoes coming from movements of two different objects within the fetal heart reflecting ultrasound (US) beam: valve and wall. Material and Methods: Simultaneous acquisition of US signal from fetal monitor and fetal electrocardiogram (FECG) using electrodes on maternal abdomen was performed. In group of 15 patients thirty five-second segments (average duration – 20 minutes) were chosen. Joint time frequency analysis was applied to compare the power spectra corresponding to cardiac events: atrial and ventricular wall contraction – Atc (87% – percentage of occurrences) and Vc (27%), mitral valve opening and closure – Mo (60%) and Mc (87%), aortic valve opening and closure – Ao (53%) and Ac (60%). Results: Spectra within the same wall event had high value of correlation coefficient and low value of standard deviation (r = 0.98±0.02 for Atc). For valve events the best result was noted for Mc (r = 0.91±0.10) while for Ao was only 0.63±0.26. Resulted high correlation between spectra of different events denoted a possibility of erroneous periodicity measurements. The highest value of adverse correlation r = 0.93±0.04 was achieved for wall events: Vc with Atc. Conclusions: Synchronous recording of mechanical and electrical fetal heart activity enabled identifying events observed in US signal. Analysis showed a higher correlation of timing event spectra corresponding to wall movements than for those originating from valves.