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P97 Pregnancy after breast carcinoma and chemotherapy treatment – case overview
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Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P95 Pregnancy in patients with non-cirrhotic portal hypertension B. Dash, A. Kriplani, N. Agarwal, R. Mahey, N. Bhatla. Federation of Obstetrics & Gynaecologic Society of India (FOGSI) Objectives: To know the safety limits of pregnancy in patients with non-cirrhotic portal hypertension (NCPH)in terms of maternal and perinatal outcome. Materials and Methods: In a retrospective study the pregnancy outcome of 12 patients with non-cirrhotic portal hypertension, managed in All India Institute of Medical Sciences from January 2004 to September 2008 was analysed. The clinical presentations of the patients, time of diagnosis and mode of delivery were considered as the maternal parameters. Birth weight, Apgar score and fetal distress are considered as the perinatal outcome. Results: The mean age of the patients was 23.58 years. Out of twelve patients seven (58%) were with extrahepatic portal vein obstruction and five (42%)with non-cirrhotic portal fibrosis. The disease was detected first time during pregnancy in five (41%) patients. The most common complication in pregnancy was splenomegaly with cytopenias (decrease in one or more blood cell components). The commonest intervention required during pregnancy waw splenectomy. The mean period of gestation of delivery was 38.2 weeks and the mean birth weight was 2.548 Kg. Conclusion: Pregnancy is apparently safe in patients with NCPH but they need intensive monitoring in a multidisciplinary hospital. They need surgical interventions like spleenectomy and endoscopic variceal ligation. There is higher incidence of meconium stained liquor in these patients, however birth asphyxia was seen in only one neonate. P96 Emergency cervical cerclage in the presence of protruding membranes – Predictors of success or failure P. Deb1 , R. Yousef1 , M. Alrawi. 1 Al Wasl Hospital Dubai,
2
Background: The aim of the retrospective study is to verify whether some maternal features are related to pregnancy outcome of emergency cerclage when membranes are protruding through the dilated cervix. Emergency cervical cerclage is a procedure not commonly performed in general clinical practice. The outcome of pregnancy with emergency cervical cerclage is based on limited information. The factors that predict success are not well known. Previous studies suggest that advanced cervical dilatation, significant cervical effacement, presence of prolapsed membranes, presence of vaginal infection cause cerclage failure. We present a retrospective review of maternal characteristics predictive of perinatal survival. Analysis shows presence of membrane prolapse with infection the cause of rupture membranes to be the strongest predictor of poor outcome. Analysis also reveals a significant association of initial white blood cell count and perinatal outcome. This information may be helpful in decision making, counselling patients regarding the likely outcome. P97 Pregnancy after breast carcinoma and chemotherapy treatment – case overview S. Dekovic, I. Bukvic, J. Dizdarevic, S. Izetbegovic, K. Begic, E. Basic, N. Hadzic. Clinical Center of University in Sarajevo, Gynecology and Obstetric Clinic Introduction: After the breast cancer treatment, pregnancy occurs in 1 to 3% of cases. However, when pregnancy occurs in women who has previously been diagnosed with breast cancer, who were surgically treated or treated with chemotherapy, clinical staff is faced by numerous dilemmas and problems of diagnostics, as well as continuation, course and outcome of such a pregnancy. Case overview: Female patient, 35 years old, bipara, condition after Cesarean section eight years ago, who, after the pregnancy was established in a smaller center during the second trimester
of pregnancy, was sent to treatment in the Gyn/Ob Clinic in Sarajevo at the beginning of 2008. Right breast carcinoma without axillary’s metastases had been discovered two years before she become pregnant. She was not surgically treated, but she received two chemotherapy cycles, after which she quit the treatment herself because of bad therapy tolerance, and got pregnant within a year after the second chemotherapy. The patient decided to maintain the pregnancy. During the pregnancy, because of essential hypertension, she was treated with anti hypertensives. The pregnancy was running under control until the 30th week, when it was surgically concluded because of preeclampsia, producing a male child with 960 grams BW, and 38 cm length, Apgar scoore 5. The child was then transferred to intensive Pediatric care ward where the postnatal course went well, so that child after month and half weight 1700 gr. and after 3 months leave Pediatric Clinic. The check-up of the breast of the mother showed status quo in relation to the condition before pregnancy. Conclusion: This case confirms that in spite of rare incidence of pregnancy among breast cancer patients, we face numerous dilemmas in treatment, diagnostic and therapy of such patients with a necessary multidisciplinary approach.According to data from literature, pregnancy after a previously treated breast cancer does not aggravate the disease prognosis, and in spite of numerous controversies, it can be allowed, but a termination of pregnancy can also be justified from a sociological and psychological aspect. Experiences to date show that increased perinatal loss of children is not recorded in such pregnancies. P98 Systemic lupus erythematosus pregnancies profile in a Brazilian hospital F. Fernandes, A. Caetano, C. Lopes, J. Mazzola, A. Zamarian, L. Nardozza, R. Mattar, A. Moron. S˜ ao Paulo Federal University Aims: Our purpose was to draw a profile of the systemic lupus erythematosus (SLE) patients delivered in a Brazilian University Hospital. Methods: Was carried out a cross-sectional study, analyzing the medical records of all SLE pregnancies attended in S˜ao Paulo Hospital between 2004–2008. A questionnaire was made and data were collected on age, time of disease, flares, pregnancy complications, type of delivery and weight of birth. Results: The mean age of patients was 28.3 years (range 17 to 43), the mean previous duration of SLE was 6.1 years (range 0 to 17) and 3 cases of SLE were diagnosed during pregnancy. There were 23 lupus flares (43.4%), 12 (22.6%) pregnancies in patients with nephropathy, 3 patients admitted to an intensive care unit and 1 maternal death (1.8%). There were 3 (5.6%) miscarriages, 2 (3.7%) therapeutic abortions and 1(1.8%) intrauterine death. The main obstetric complications were: preterm delivery (41.6%), intrauterine growth retardation (25%), oligohydramnios (18.75%), preeclampsia and brain sparing effect (14.5% each). The cesarian section was 37 (77%) and 18 (37.5%) neonates had a bitrhweight lower than 2500 g. Conclusion: Although the outcome in SLE pregnancies is improving over the last forty years, its still associated with important matern and fetal complications. To develop a good outcome in SLE pregnancies, conception should be carefully planned and patients followed by a multidisciplinary shedule. P99 Why are Cesarean section rates so high in diabetics? M. Torloni, A. Caetano, A. Zamarian, C. Lopes, R. Puccini, R. Mattar. S˜ ao Paulo Federal University Aims: Worldwide, diabetics have higher cesarean section (CS) rates than general obstetric population. The aim of this study was to analyze the rate and indications of CS in Brazilian diabetics delivered in a Brazilian tertiary hospital.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
P95 Pregnancy in patients with non-cirrhotic portal hypertension B. Dash, A. Kriplani, N. Agarwal, R. Mahey, N. Bhatla. Federation of Obstetrics & Gynaecologic Society of India (FOGSI) Objectives: To know the safety limits of pregnancy in patients with non-cirrhotic portal hypertension (NCPH)in terms of maternal and perinatal outcome. Materials and Methods: In a retrospective study the pregnancy outcome of 12 patients with non-cirrhotic portal hypertension, managed in All India Institute of Medical Sciences from January 2004 to September 2008 was analysed. The clinical presentations of the patients, time of diagnosis and mode of delivery were considered as the maternal parameters. Birth weight, Apgar score and fetal distress are considered as the perinatal outcome. Results: The mean age of the patients was 23.58 years. Out of twelve patients seven (58%) were with extrahepatic portal vein obstruction and five (42%)with non-cirrhotic portal fibrosis. The disease was detected first time during pregnancy in five (41%) patients. The most common complication in pregnancy was splenomegaly with cytopenias (decrease in one or more blood cell components). The commonest intervention required during pregnancy waw splenectomy. The mean period of gestation of delivery was 38.2 weeks and the mean birth weight was 2.548 Kg. Conclusion: Pregnancy is apparently safe in patients with NCPH but they need intensive monitoring in a multidisciplinary hospital. They need surgical interventions like spleenectomy and endoscopic variceal ligation. There is higher incidence of meconium stained liquor in these patients, however birth asphyxia was seen in only one neonate. P96 Emergency cervical cerclage in the presence of protruding membranes – Predictors of success or failure P. Deb1 , R. Yousef1 , M. Alrawi. 1 Al Wasl Hospital Dubai,
2
Background: The aim of the retrospective study is to verify whether some maternal features are related to pregnancy outcome of emergency cerclage when membranes are protruding through the dilated cervix. Emergency cervical cerclage is a procedure not commonly performed in general clinical practice. The outcome of pregnancy with emergency cervical cerclage is based on limited information. The factors that predict success are not well known. Previous studies suggest that advanced cervical dilatation, significant cervical effacement, presence of prolapsed membranes, presence of vaginal infection cause cerclage failure. We present a retrospective review of maternal characteristics predictive of perinatal survival. Analysis shows presence of membrane prolapse with infection the cause of rupture membranes to be the strongest predictor of poor outcome. Analysis also reveals a significant association of initial white blood cell count and perinatal outcome. This information may be helpful in decision making, counselling patients regarding the likely outcome. P97 Pregnancy after breast carcinoma and chemotherapy treatment – case overview S. Dekovic, I. Bukvic, J. Dizdarevic, S. Izetbegovic, K. Begic, E. Basic, N. Hadzic. Clinical Center of University in Sarajevo, Gynecology and Obstetric Clinic Introduction: After the breast cancer treatment, pregnancy occurs in 1 to 3% of cases. However, when pregnancy occurs in women who has previously been diagnosed with breast cancer, who were surgically treated or treated with chemotherapy, clinical staff is faced by numerous dilemmas and problems of diagnostics, as well as continuation, course and outcome of such a pregnancy. Case overview: Female patient, 35 years old, bipara, condition after Cesarean section eight years ago, who, after the pregnancy was established in a smaller center during the second trimester
of pregnancy, was sent to treatment in the Gyn/Ob Clinic in Sarajevo at the beginning of 2008. Right breast carcinoma without axillary’s metastases had been discovered two years before she become pregnant. She was not surgically treated, but she received two chemotherapy cycles, after which she quit the treatment herself because of bad therapy tolerance, and got pregnant within a year after the second chemotherapy. The patient decided to maintain the pregnancy. During the pregnancy, because of essential hypertension, she was treated with anti hypertensives. The pregnancy was running under control until the 30th week, when it was surgically concluded because of preeclampsia, producing a male child with 960 grams BW, and 38 cm length, Apgar scoore 5. The child was then transferred to intensive Pediatric care ward where the postnatal course went well, so that child after month and half weight 1700 gr. and after 3 months leave Pediatric Clinic. The check-up of the breast of the mother showed status quo in relation to the condition before pregnancy. Conclusion: This case confirms that in spite of rare incidence of pregnancy among breast cancer patients, we face numerous dilemmas in treatment, diagnostic and therapy of such patients with a necessary multidisciplinary approach.According to data from literature, pregnancy after a previously treated breast cancer does not aggravate the disease prognosis, and in spite of numerous controversies, it can be allowed, but a termination of pregnancy can also be justified from a sociological and psychological aspect. Experiences to date show that increased perinatal loss of children is not recorded in such pregnancies. P98 Systemic lupus erythematosus pregnancies profile in a Brazilian hospital F. Fernandes, A. Caetano, C. Lopes, J. Mazzola, A. Zamarian, L. Nardozza, R. Mattar, A. Moron. S˜ ao Paulo Federal University Aims: Our purpose was to draw a profile of the systemic lupus erythematosus (SLE) patients delivered in a Brazilian University Hospital. Methods: Was carried out a cross-sectional study, analyzing the medical records of all SLE pregnancies attended in S˜ao Paulo Hospital between 2004–2008. A questionnaire was made and data were collected on age, time of disease, flares, pregnancy complications, type of delivery and weight of birth. Results: The mean age of patients was 28.3 years (range 17 to 43), the mean previous duration of SLE was 6.1 years (range 0 to 17) and 3 cases of SLE were diagnosed during pregnancy. There were 23 lupus flares (43.4%), 12 (22.6%) pregnancies in patients with nephropathy, 3 patients admitted to an intensive care unit and 1 maternal death (1.8%). There were 3 (5.6%) miscarriages, 2 (3.7%) therapeutic abortions and 1(1.8%) intrauterine death. The main obstetric complications were: preterm delivery (41.6%), intrauterine growth retardation (25%), oligohydramnios (18.75%), preeclampsia and brain sparing effect (14.5% each). The cesarian section was 37 (77%) and 18 (37.5%) neonates had a bitrhweight lower than 2500 g. Conclusion: Although the outcome in SLE pregnancies is improving over the last forty years, its still associated with important matern and fetal complications. To develop a good outcome in SLE pregnancies, conception should be carefully planned and patients followed by a multidisciplinary shedule. P99 Why are Cesarean section rates so high in diabetics? M. Torloni, A. Caetano, A. Zamarian, C. Lopes, R. Puccini, R. Mattar. S˜ ao Paulo Federal University Aims: Worldwide, diabetics have higher cesarean section (CS) rates than general obstetric population. The aim of this study was to analyze the rate and indications of CS in Brazilian diabetics delivered in a Brazilian tertiary hospital.