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P79 Value of third trimester uterine artery Doppler for prediction of adverse perinatal outcome in high risk pregnancies
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
age of 36–40 weeks (n = 25), respectively: mean basal FHR (143.6±5.2 bpm vs. 134.2±13.8bpm, p = 0.04), mean number of FHR accelerations >10 bpm (4.3±2.1 vs. 8.2±4.6, p = 0.01), mean number of FHR accelerations >15 bpm (1.0±0.8 vs. 5.2±3.7, p = 0.001), mean high variation episodes duration (8.5±7.8min vs. 14.9±8.5min, p = 0.04), and mean short term variation (7.7±1.9 vs. 10.6±4.2, p = 0.03). Conclusion: This study suggests that there are differences in the computerized cardiotocography parameters in normal pregnancies of 36–40 weeks compared to pregnancies of 24–26 weeks’ gestation, showing immaturity of central nervous system. P76 Computerized cardiotocography in fetuses with central nervous system abnormalities C. Kwon, R. Nomura, M. Gordon, M. Carvalho, A. Amorim Filho, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo
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was studied. Data analysis included student’s t test, chi-square and Fisher’s exact test. Statistical significance was defined as p < 0.05. Results: The mean maternal age at the anemic group (n = 14) was 25.0 years (SD = 4.8) and in the control group (n = 22) was 27.3 years (SD = 6.0). No significant difference was found between the groups The FHR parameters analyzed by computerized cardiotocography in the group with maternal anemia did not differ from control group, respectively: mean basal FHR (130.8±11.2bpm vs. 133.7±14.7bpm, p = 0.547), mean number of fetal movements per hour (46.6±37.4 vs. 53.6±48.4, p = 0.648), mean number of FHR accelerations >10 bpm (7.4±4.1 vs. 8.2±4.7, p = 0.594), mean number of FHR accelerations >15 bpm (4.5±3.3 vs. 5.4±3.8, p = 0.489), high variation episodes duration (15.4±8.5min vs. 15.5±8.7min, p = 0.980), low variation episodes duration (5.1±8.1min vs. 3.6±5.5min, p = 0.530), and mean short term variation (10.7±3.2 vs. 10.9±4.4, p = 0.880). Conclusion: This study suggests that mild maternal anemia is not associated with abnormal FHR parameters in the computerized cardiotocography.
Objective: To evaluate a fetal heart rate (FHR) patterns of fetuses with a variety of central nervous system abnormalities. Methods: Forty-four fetuses were studied at 32–38 weeks were studied prospectively, between December 2007 and December 2008. Twenty four were morphologically normal fetuses and 20 had congenital structural abnormalities of the central nervous system. All the patients performed computerized cardiotocography (System 8002, Sonicaid) during 30 minutes. Tracings with signal loss more than 20% were excluded from the analysis. The FHR parameters studied were FHR, number of accelerations >10 bpm and >15 bpm, high episodes duration (min), low episodes duration (min) and short term variation. Data analysis included student’s t test, chisquare and Fisher’s exact test. Statistical significance was defined as p < 0.05. Results: The following abnormalities were evidenced: marked ventriculomegaly (8 cases), mild ventriculomegaly (4cases), holoprosencephaly (3cases), aracnoid cyst (2 cases), hypoplastic cerebellum (1case), Dandy walker syndrome (1case) and vascular lesion (1 case). No significant difference was found between the analyzed groups The FHR parameters analyzed by computerized cardiotocography in the group with central nervous system anomalies did not differ from normal fetuses, respectively: mean basal FHR (132.2±10.1 bpm vs. 134.2±13.8 bpm, p = 0.590), mean number of FHR accelerations >10 bpm (6.7±4.2 vs. 8.2±4.6, p = 0.276), mean number of FHR accelerations >15 bpm (4.0±3.9 vs. 5.2±3.7, p = 0.283), high variation episodes (14.9±7.4 min vs. 14.9±8.5 min, p = 0.993), low variation episodes (1.9±4.6 min vs. 4.1±5.7 min, p = 0.158), and mean short term variation (9.6±2.7 vs. 10.6±4.2, p = 0.376). Conclusion: This study suggests that such a computerized cardiotocography analysis of FHR may serve as a functional adjunct to the evaluation of a fetus oxygenation status even when the fetus presents central nervous system structural abnormalities.
P78 Fetal echocardiography abnormalities in systemic lupus erythematosus pregnancies in a Brazilian university hospital
P77 Computerized cardiotocography in pregnancies complicated by maternal anemia at term: preliminary results
L. Rai, L. Shivananda. Manipal University
M. Gordon, R. Nomura, C. Kwon, A. Igai, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Objective: To evaluate a fetal heart rate (FHR) patterns in pregnancies complicated by maternal anemia at term. Methods: Pregnant women presenting anemia were studied prospectively at 36–40 weeks, between December 2007 and December 2008. Maternal anemia was characterized by hemoglobin level below 11 g/dL. The control group was normal pregnancies at the same gestational age. Pregnancies with signs of fetal growth restriction were excluded. The computerized cardiotocography (System8002, Sonicaid) was performed and 30minutes analysis
A. Caetano1 , C. Lopes1 , F. Fernandes1 , J. Mazzola2 , S. Daher1 , L. Nardozza1 , R. Mattar1 , A. Moron1 . 1 S˜ ao Paulo Federal University, 2 Sao Paula Federal University Aims: To assay the prevalence of fetal cardiac abnormalities detected by fetal echocardiography in systemic lupus erythematosus (SLE) women delivered in a Brazilian University Hospital. Methods: A review off all SLE pregnancies delivered at S˜ao Paulo Hospital between 2004–2008 was done, evaluating maternal autoantibodies anti-SSA/Ro and anti-SSB/La and fetal echocardiograms. Results: A total of 53 patients were surveyed. Eight (15%) were anti-Ro positive and four (7.5%) anti-Ro/La positive. Three fetuses had heart abnormalities: one had complete atrioventricular block with atrial flutter and mother was anti-Ro/La positive, the other mother was anti-Ro positive and the fetus had minimal tricuspid regurgitation, the last one showed arrhythmia with supraventricular extra-systoles and ausence of maternal autoantibodies. Conclusion: SLE pregnancies can frequently be complicated by fetal cardiac abormalities, complete heart block is the commonest one (2% of mothers with autoantibodies), has a mortality of 30% in the absence of major structural abnormalities and is associated with transplacental transfer of autoantibodies (anti-Ro/anti-La). All SLE pregnant women should do fetal echocardiogram to early diagnosis and treatment. Therapy includes corticosteroids, beta adrenergic agonists, immunoglobulin, plasmapheresis and pacemarkers, depending on the severity of bradicardya. P79 Value of third trimester uterine artery Doppler for prediction of adverse perinatal outcome in high risk pregnancies
Objective: To determine the usefulness of uterine artery Doppler in third trimester high risk pregnancies for prediction of adverse perinatal outcome. Methods: This prospective study was performed in a tertiary care centre in the West Coast of India. Inclusion criteria for the study were patients admitted with hypertensive complications in pregnancy, fetal growth restriction and women with previous recurrent pregnancy loss with no living children. Both uterine and umbilical artery Doppler were performed using Doppler ultrasound LOGIQ700 (3.5 MHz) with a high pass filter. Uterine artery Doppler parameters recorded were pulsatility index (PI > 1.2 considered abnormal) and presence of early diastolic notch. Uterine artery score (UAS) was calculated from the Doppler parameters as described by Hernandez et al and a score ≥2 was considered
S434
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
abnormal. Umbilical artery Doppler was considered abnormal when PI > 2 SD for gestational age or absence/reversal of end diastolic flow. Repeat Doppler was done after one week if the patient did not deliver. The last Doppler findings closer to delivery were correlated with perinatal outcome. Results: There were sixty cases of high risk pregnancy mainly consisting of Preeclampsia and fetal growth restriction included in this study. The mean gestational age was 34 weeks with a range of 28–37 weeks. Forty percent of pregnancies were below 34 weeks of gestation. Abnormal UAS was noted in 72% of the study group while umbilical artery Doppler was abnormal in only 35%. Almost 33% had abnormal Doppler findings in both vessels. All the five perinatal deaths and high rate of perinatal morbidity was observed when both uterine and umbilical artery Dopplers were abnormal. Over all perinatal mortality was 83/1000 live births. Neonatal morbidity was significant with almost 50% requiring neonatal intensive care unit (NICU) admissions. Perinatal morbidity parameters such as birth weight below 2000 gm, gestational age <34 weeks and NICU admission was significantly high in 23 women who had abnormal UAS with normal umbilical artery Doppler. There were 36 patients who were beyond 34 weeks of gestation. In this subgroup abnormal UAS was noted in 18 (50%) while only 6 (16.7%) had abnormal umbilical artery Doppler. Small for gestational age babies, neonatal morbidity and cesarean delivery was three fold higher in those with abnormal UAS and normal umbilical artery Doppler in this group. Conclusion: Abnormal uterine artery Doppler in the third trimester is a reliable predictor of adverse perinatal outcome in high risk pregnancies with preeclampsia and fetal growth restriction. Uterine artery Doppler scoring system makes interpretation simple for clinical practice. Perinatal outcome was poor when both uterine and umbilical artery Doppler were abnormal. We observed less neonatal morbidity in preeclampsia and fetal growth restriction when uterine artery Doppler was normal in 3rd trimester. This important fact can be reassuring. In pregnancies beyond 34 weeks abnormal uterine artery Doppler was a better predictor of adverse outcome than umbilical artery Doppler. Thus inclusion of uterine artery Doppler along with umbilical artery Doppler in high risk pregnancies in third trimester will improve fetal surveillance. P80 Two different modalities to end a pregnancy with severe neurological fetal malformations F. Szasz, T. Pop, D. Craiut, R. Herczegh, D. Mocuta, A. Bodog, C. Noja. University of Oradea, Faculty of Medicine and Pharmacy Unfortunately, at the beginning of this millennium we are confronted with the increasing of fetal genetic diseases, induced by a numerous known or unknown causes, and which represents an undeserved failure, unacceptable for the women, especially if the pregnancy followed fertility treatment and in the same time for the physician. The delivery, preterm or at term of the undiagnosed fetal malformations are severely punished by the malpractice law, in the majority of the western countries. The validation of the lethal malformations do not arise moral and ethical issues, which could harden our medical attitude. Contrary, the diagnosis of non-lethal malformations could induce major bioethical and religious concerns, regarding the rights of the unborn child. After overstepping them, the obstetrical attitude has to be adapted for each case. There is the possibility that our attempts to induce delivery could fail, due to various factors, like: age, parity, educational background, gestational age or the existing pathology. Because of this, but not only, the best way to end the pregnancy can be either vaginal delivery or histerotomy, with a close clinical and high-tech monitoring, because the complications can be very difficult to treat and very dangerous. In the next lines we are going to present and discuss the possibilities of
terminating second trimester pregnancies, finalizations needed because major neurological malformations have been detected. Our observations and conclusions were set up after studying two different clinical cases of pathological pregnancy, at two young women, both diagnosed and resolved in July 2008, in SCOG Oradea. P81 Cloacal dysgenesis masquerades as monoamnionicity S. Teo, S. Tagore. KK Women’s and Children’s Hospital, Singapore The early identification of chorionicity (and amnionicity) in twin pregnancy is of paramount importance in the prognostication of the pregnancy outcome and the planning of antenatal care. Monochorionic twins (especially monoamniotic pairs) are undisputedly recognized to have poorer outcome than dichorionic twins, as they are at risk of twin-twin transfusion syndrome and have higher incidences of fetal anomalies. P82 Outcome of a very high risk pregnancy in difficult setting, an inspiring experience H. Abuzeid1 , N. Soliman2 . 1 University of Khartoum, Faculty of Medicine, Khartoum Teaching Hospital, 2 Ribat University Hospital The objectives of presenting this abstract is to document the outcome of a high risk pregnancy in Khartoum Teaching Hospital, in Khartoum. The author will highlight the lessons learnt from dealing with such a patient and will share the difficult experience and will figure out ways to make it a positive example. A 38 year old lady, gravida V para IV at her 32 week gestation presented with full bloown history of congestive cardiac faliure that were on for 2 months period. Antenatal Followup missed diagnosing any abnormality. She prestented at her 32nd week gestation with an exercise tolerance of few yards and othopneoa and paroxysmal nocturnal dyspnoea. Clinical assessment confirmed a heamodynamic instability with low Blood pressure, and full blown feautes of congestive heart failure and atrial fibrillation. Transthoracic Echocardiography documented a globally hypokinetic heart and an ejection fraction <30%. The Challenge was to abruptly progeeding towards stabilization of her status and to urgently terminate her pregnancy. We went through the steps of involoving a multidiscplinary team effort a jargon that is not well believed in my country and proved the fact that planning will lead to better outcome in difficult and deprived settings. It was a lesson and will be a lesson to juniors and seniors and the adoption of the lessons helped establish a better facility of care in my local hospital. P83 Congenital malformations of newborns delivered by diabetic mothers R. Adamowicz, B. Krolak-Olejnik, ´ M. Muszer, D. Grzonka, J. Łagan. Medical University of Silesia, Dept. of Gynecology, Perinatology and Neonatology in Zabrze The risk of congenital malformations is 2–3 times higher among women with diabetes before pregnancy, also gestational diabetes is a risk factor for malformations. The effect of maternal diabetes on the risk of congenital malformations were investigated between 2003 and 2007 years, in 6124 pregnancies women, who delivered in Departement of Perinatology and Gynecology in Zabrze (Poland). A total 126 women (2.05%) had diabetes (gestational in 1.2%, pregestational in 0.85%). The prevalence of congenital malformations was 5.9% and 4.2% among mothers with pregestational and gestational diabetes, respectively. Prevalence of congenital malformations among nondiabetic women was 4.7%. We do not observe the significance differences among study groups in malformations. In our Departement women with risk factors of diabetes or diabetic ones are taken over special care before
age of 36–40 weeks (n = 25), respectively: mean basal FHR (143.6±5.2 bpm vs. 134.2±13.8bpm, p = 0.04), mean number of FHR accelerations >10 bpm (4.3±2.1 vs. 8.2±4.6, p = 0.01), mean number of FHR accelerations >15 bpm (1.0±0.8 vs. 5.2±3.7, p = 0.001), mean high variation episodes duration (8.5±7.8min vs. 14.9±8.5min, p = 0.04), and mean short term variation (7.7±1.9 vs. 10.6±4.2, p = 0.03). Conclusion: This study suggests that there are differences in the computerized cardiotocography parameters in normal pregnancies of 36–40 weeks compared to pregnancies of 24–26 weeks’ gestation, showing immaturity of central nervous system. P76 Computerized cardiotocography in fetuses with central nervous system abnormalities C. Kwon, R. Nomura, M. Gordon, M. Carvalho, A. Amorim Filho, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo
S433
was studied. Data analysis included student’s t test, chi-square and Fisher’s exact test. Statistical significance was defined as p < 0.05. Results: The mean maternal age at the anemic group (n = 14) was 25.0 years (SD = 4.8) and in the control group (n = 22) was 27.3 years (SD = 6.0). No significant difference was found between the groups The FHR parameters analyzed by computerized cardiotocography in the group with maternal anemia did not differ from control group, respectively: mean basal FHR (130.8±11.2bpm vs. 133.7±14.7bpm, p = 0.547), mean number of fetal movements per hour (46.6±37.4 vs. 53.6±48.4, p = 0.648), mean number of FHR accelerations >10 bpm (7.4±4.1 vs. 8.2±4.7, p = 0.594), mean number of FHR accelerations >15 bpm (4.5±3.3 vs. 5.4±3.8, p = 0.489), high variation episodes duration (15.4±8.5min vs. 15.5±8.7min, p = 0.980), low variation episodes duration (5.1±8.1min vs. 3.6±5.5min, p = 0.530), and mean short term variation (10.7±3.2 vs. 10.9±4.4, p = 0.880). Conclusion: This study suggests that mild maternal anemia is not associated with abnormal FHR parameters in the computerized cardiotocography.
Objective: To evaluate a fetal heart rate (FHR) patterns of fetuses with a variety of central nervous system abnormalities. Methods: Forty-four fetuses were studied at 32–38 weeks were studied prospectively, between December 2007 and December 2008. Twenty four were morphologically normal fetuses and 20 had congenital structural abnormalities of the central nervous system. All the patients performed computerized cardiotocography (System 8002, Sonicaid) during 30 minutes. Tracings with signal loss more than 20% were excluded from the analysis. The FHR parameters studied were FHR, number of accelerations >10 bpm and >15 bpm, high episodes duration (min), low episodes duration (min) and short term variation. Data analysis included student’s t test, chisquare and Fisher’s exact test. Statistical significance was defined as p < 0.05. Results: The following abnormalities were evidenced: marked ventriculomegaly (8 cases), mild ventriculomegaly (4cases), holoprosencephaly (3cases), aracnoid cyst (2 cases), hypoplastic cerebellum (1case), Dandy walker syndrome (1case) and vascular lesion (1 case). No significant difference was found between the analyzed groups The FHR parameters analyzed by computerized cardiotocography in the group with central nervous system anomalies did not differ from normal fetuses, respectively: mean basal FHR (132.2±10.1 bpm vs. 134.2±13.8 bpm, p = 0.590), mean number of FHR accelerations >10 bpm (6.7±4.2 vs. 8.2±4.6, p = 0.276), mean number of FHR accelerations >15 bpm (4.0±3.9 vs. 5.2±3.7, p = 0.283), high variation episodes (14.9±7.4 min vs. 14.9±8.5 min, p = 0.993), low variation episodes (1.9±4.6 min vs. 4.1±5.7 min, p = 0.158), and mean short term variation (9.6±2.7 vs. 10.6±4.2, p = 0.376). Conclusion: This study suggests that such a computerized cardiotocography analysis of FHR may serve as a functional adjunct to the evaluation of a fetus oxygenation status even when the fetus presents central nervous system structural abnormalities.
P78 Fetal echocardiography abnormalities in systemic lupus erythematosus pregnancies in a Brazilian university hospital
P77 Computerized cardiotocography in pregnancies complicated by maternal anemia at term: preliminary results
L. Rai, L. Shivananda. Manipal University
M. Gordon, R. Nomura, C. Kwon, A. Igai, M. Zugaib. Department of Obstetrics and Gynecology, Faculty of Medicine, University of S˜ ao Paulo Objective: To evaluate a fetal heart rate (FHR) patterns in pregnancies complicated by maternal anemia at term. Methods: Pregnant women presenting anemia were studied prospectively at 36–40 weeks, between December 2007 and December 2008. Maternal anemia was characterized by hemoglobin level below 11 g/dL. The control group was normal pregnancies at the same gestational age. Pregnancies with signs of fetal growth restriction were excluded. The computerized cardiotocography (System8002, Sonicaid) was performed and 30minutes analysis
A. Caetano1 , C. Lopes1 , F. Fernandes1 , J. Mazzola2 , S. Daher1 , L. Nardozza1 , R. Mattar1 , A. Moron1 . 1 S˜ ao Paulo Federal University, 2 Sao Paula Federal University Aims: To assay the prevalence of fetal cardiac abnormalities detected by fetal echocardiography in systemic lupus erythematosus (SLE) women delivered in a Brazilian University Hospital. Methods: A review off all SLE pregnancies delivered at S˜ao Paulo Hospital between 2004–2008 was done, evaluating maternal autoantibodies anti-SSA/Ro and anti-SSB/La and fetal echocardiograms. Results: A total of 53 patients were surveyed. Eight (15%) were anti-Ro positive and four (7.5%) anti-Ro/La positive. Three fetuses had heart abnormalities: one had complete atrioventricular block with atrial flutter and mother was anti-Ro/La positive, the other mother was anti-Ro positive and the fetus had minimal tricuspid regurgitation, the last one showed arrhythmia with supraventricular extra-systoles and ausence of maternal autoantibodies. Conclusion: SLE pregnancies can frequently be complicated by fetal cardiac abormalities, complete heart block is the commonest one (2% of mothers with autoantibodies), has a mortality of 30% in the absence of major structural abnormalities and is associated with transplacental transfer of autoantibodies (anti-Ro/anti-La). All SLE pregnant women should do fetal echocardiogram to early diagnosis and treatment. Therapy includes corticosteroids, beta adrenergic agonists, immunoglobulin, plasmapheresis and pacemarkers, depending on the severity of bradicardya. P79 Value of third trimester uterine artery Doppler for prediction of adverse perinatal outcome in high risk pregnancies
Objective: To determine the usefulness of uterine artery Doppler in third trimester high risk pregnancies for prediction of adverse perinatal outcome. Methods: This prospective study was performed in a tertiary care centre in the West Coast of India. Inclusion criteria for the study were patients admitted with hypertensive complications in pregnancy, fetal growth restriction and women with previous recurrent pregnancy loss with no living children. Both uterine and umbilical artery Doppler were performed using Doppler ultrasound LOGIQ700 (3.5 MHz) with a high pass filter. Uterine artery Doppler parameters recorded were pulsatility index (PI > 1.2 considered abnormal) and presence of early diastolic notch. Uterine artery score (UAS) was calculated from the Doppler parameters as described by Hernandez et al and a score ≥2 was considered
S434
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
abnormal. Umbilical artery Doppler was considered abnormal when PI > 2 SD for gestational age or absence/reversal of end diastolic flow. Repeat Doppler was done after one week if the patient did not deliver. The last Doppler findings closer to delivery were correlated with perinatal outcome. Results: There were sixty cases of high risk pregnancy mainly consisting of Preeclampsia and fetal growth restriction included in this study. The mean gestational age was 34 weeks with a range of 28–37 weeks. Forty percent of pregnancies were below 34 weeks of gestation. Abnormal UAS was noted in 72% of the study group while umbilical artery Doppler was abnormal in only 35%. Almost 33% had abnormal Doppler findings in both vessels. All the five perinatal deaths and high rate of perinatal morbidity was observed when both uterine and umbilical artery Dopplers were abnormal. Over all perinatal mortality was 83/1000 live births. Neonatal morbidity was significant with almost 50% requiring neonatal intensive care unit (NICU) admissions. Perinatal morbidity parameters such as birth weight below 2000 gm, gestational age <34 weeks and NICU admission was significantly high in 23 women who had abnormal UAS with normal umbilical artery Doppler. There were 36 patients who were beyond 34 weeks of gestation. In this subgroup abnormal UAS was noted in 18 (50%) while only 6 (16.7%) had abnormal umbilical artery Doppler. Small for gestational age babies, neonatal morbidity and cesarean delivery was three fold higher in those with abnormal UAS and normal umbilical artery Doppler in this group. Conclusion: Abnormal uterine artery Doppler in the third trimester is a reliable predictor of adverse perinatal outcome in high risk pregnancies with preeclampsia and fetal growth restriction. Uterine artery Doppler scoring system makes interpretation simple for clinical practice. Perinatal outcome was poor when both uterine and umbilical artery Doppler were abnormal. We observed less neonatal morbidity in preeclampsia and fetal growth restriction when uterine artery Doppler was normal in 3rd trimester. This important fact can be reassuring. In pregnancies beyond 34 weeks abnormal uterine artery Doppler was a better predictor of adverse outcome than umbilical artery Doppler. Thus inclusion of uterine artery Doppler along with umbilical artery Doppler in high risk pregnancies in third trimester will improve fetal surveillance. P80 Two different modalities to end a pregnancy with severe neurological fetal malformations F. Szasz, T. Pop, D. Craiut, R. Herczegh, D. Mocuta, A. Bodog, C. Noja. University of Oradea, Faculty of Medicine and Pharmacy Unfortunately, at the beginning of this millennium we are confronted with the increasing of fetal genetic diseases, induced by a numerous known or unknown causes, and which represents an undeserved failure, unacceptable for the women, especially if the pregnancy followed fertility treatment and in the same time for the physician. The delivery, preterm or at term of the undiagnosed fetal malformations are severely punished by the malpractice law, in the majority of the western countries. The validation of the lethal malformations do not arise moral and ethical issues, which could harden our medical attitude. Contrary, the diagnosis of non-lethal malformations could induce major bioethical and religious concerns, regarding the rights of the unborn child. After overstepping them, the obstetrical attitude has to be adapted for each case. There is the possibility that our attempts to induce delivery could fail, due to various factors, like: age, parity, educational background, gestational age or the existing pathology. Because of this, but not only, the best way to end the pregnancy can be either vaginal delivery or histerotomy, with a close clinical and high-tech monitoring, because the complications can be very difficult to treat and very dangerous. In the next lines we are going to present and discuss the possibilities of
terminating second trimester pregnancies, finalizations needed because major neurological malformations have been detected. Our observations and conclusions were set up after studying two different clinical cases of pathological pregnancy, at two young women, both diagnosed and resolved in July 2008, in SCOG Oradea. P81 Cloacal dysgenesis masquerades as monoamnionicity S. Teo, S. Tagore. KK Women’s and Children’s Hospital, Singapore The early identification of chorionicity (and amnionicity) in twin pregnancy is of paramount importance in the prognostication of the pregnancy outcome and the planning of antenatal care. Monochorionic twins (especially monoamniotic pairs) are undisputedly recognized to have poorer outcome than dichorionic twins, as they are at risk of twin-twin transfusion syndrome and have higher incidences of fetal anomalies. P82 Outcome of a very high risk pregnancy in difficult setting, an inspiring experience H. Abuzeid1 , N. Soliman2 . 1 University of Khartoum, Faculty of Medicine, Khartoum Teaching Hospital, 2 Ribat University Hospital The objectives of presenting this abstract is to document the outcome of a high risk pregnancy in Khartoum Teaching Hospital, in Khartoum. The author will highlight the lessons learnt from dealing with such a patient and will share the difficult experience and will figure out ways to make it a positive example. A 38 year old lady, gravida V para IV at her 32 week gestation presented with full bloown history of congestive cardiac faliure that were on for 2 months period. Antenatal Followup missed diagnosing any abnormality. She prestented at her 32nd week gestation with an exercise tolerance of few yards and othopneoa and paroxysmal nocturnal dyspnoea. Clinical assessment confirmed a heamodynamic instability with low Blood pressure, and full blown feautes of congestive heart failure and atrial fibrillation. Transthoracic Echocardiography documented a globally hypokinetic heart and an ejection fraction <30%. The Challenge was to abruptly progeeding towards stabilization of her status and to urgently terminate her pregnancy. We went through the steps of involoving a multidiscplinary team effort a jargon that is not well believed in my country and proved the fact that planning will lead to better outcome in difficult and deprived settings. It was a lesson and will be a lesson to juniors and seniors and the adoption of the lessons helped establish a better facility of care in my local hospital. P83 Congenital malformations of newborns delivered by diabetic mothers R. Adamowicz, B. Krolak-Olejnik, ´ M. Muszer, D. Grzonka, J. Łagan. Medical University of Silesia, Dept. of Gynecology, Perinatology and Neonatology in Zabrze The risk of congenital malformations is 2–3 times higher among women with diabetes before pregnancy, also gestational diabetes is a risk factor for malformations. The effect of maternal diabetes on the risk of congenital malformations were investigated between 2003 and 2007 years, in 6124 pregnancies women, who delivered in Departement of Perinatology and Gynecology in Zabrze (Poland). A total 126 women (2.05%) had diabetes (gestational in 1.2%, pregestational in 0.85%). The prevalence of congenital malformations was 5.9% and 4.2% among mothers with pregestational and gestational diabetes, respectively. Prevalence of congenital malformations among nondiabetic women was 4.7%. We do not observe the significance differences among study groups in malformations. In our Departement women with risk factors of diabetes or diabetic ones are taken over special care before