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P81 Cloacal dysgenesis masquerades as monoamnionicity
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
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