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Perinatal audit in Sudan
MONDAY,
SEPTEMBER
4
69
FC1.28.07 DIAGNOSTIC ACCURACY OF THE BIOHYSICAL PROFILE SCORE IN PREDICTING ADVERSE PERINATAL OUTCOMES IN HYPERTENSIVE DISORDERS OF PREGNANCY G. Ivanovic, D. Ivanovic, P. Momcilov, 0. Kontic-Vucinic, S. Kadija, D. Plecas, M. Pervulov, Institute of OBIGYN, Clinical Center of Serbia, Belgrade, Yugoslavia. Objectives: To estimate the accuracy and usefulness of the Biophysical profile score (BPS) in predicting adverse perinatal outcomes in hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, chronic hypertension, superimposed preeclampsia). Study Methods: One hundred and seventy-four fetuses jeopardized by maternal hypertension were monitored by BPS. Sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), efficacy (E) and ratio of LR+ to LR- (LR+/LR-) were estimated for BPS 5 6110 (positive test value). The adverse perinatal outcomes were: stillbirth, perinatal death (PD), 5 minute Apgar score less than 7, need for NICU admission, premature birth (PB) and intrauterine growth retardation (IUGR). Results
adm. PB
55.0
89.2
75.0
77.1
76.5
10.1
IUGR
52.1
92.3
84.1
71.2
74.7
13.1
Conclusions: Ability of BPS to distinguish between “true” positive from “true” negative results in prediction of perinatal mortality is excellent. Low sensitivity of BPS in prediction of perinatal morbidity (probably due to fetal adaptive responses to condition of chronic hypoxemia) reduces value of BPS as a screening test and LR+/LR- ratio. For this reason we consider that BPS is not suitable as a single fetal surveillance test in pregnancies complicated by hypertensive disorders.
FC1.28.08 HYPOCOILED CORD AS A MARKER FOR UMBILICAL CORD ENCIRCLEMENTS J. U. Pvrsikova, L. I. Titchenko, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia Objectives: The aim of this study was to determine the relationship between hypocoiled umbilical cord and fetal outcome. Study Methods: Fifty pregnant women were examined in third term. The umbilical coiling index (UCI) of each cord was calculated using sonographia, by dividing number of helices by cord length from several segments antenatally. Doppler flow velocities were obtained from umbilical arteries and aorta in each fetus. The number of cord encirclements were noted. Fetal outcome was determined by using Apgar scores after 5 minutes. Results: The umbilical coiling index in this group was 0.2*0.08 coils/cm(p<0.05). Systolo-dyastolic ratio in umbilical arteries and aorta were increased in 68% of cases. Umbilical cord encirclements noted in 82% of cases, tight nuchal cord 34%, loose nuchal cord 66%, 61% of fetuses had asphyxia, Apgar scores<7 had 24% fetuses, operative deliver - 8 cases (16%), growth-restricted fetuses was determined in 12 cases (24%) and one fetus (2%) died during early postnatal period. Conclusions: Hypocoiled umbilical cord may be a marker for nuchal cord and bad outcomes of deliveries.
FC1.28.09 PERINATAL AUDIT IN SUDAN S. Elamin’,J. Langhoff-Roes’, B. Bodker’, S. Larsen’, S.A. Ibrahim”, A.L. Ashmeig”, G. Lindmark”‘. ‘Dept. Obstetrics, Rigshospitalet, University of Copenhagen, Denmark. “University of Khartoum, Sudan. *** Dept Women’s and Children’s Health, Uppsala University, Sweden. Objectives: To classify the perinatal deaths in Omdurman region, Sudan, compare with perinatal deaths in European countries, perform perinatal
audit and evaluate the procedure as a tool for quality improvement of perinatal care. Study Methods: Perinatal deaths were identified in two hospitals and a community based health area in the Omdurman region in 1999 giving an estimated perinatal mortality rate of 8 % All cases were classified and categorized by the Nordic-Baltic perinatal death classification, and the distribution was compared with that of Scandinavian and Eastern European countries, to identify categories that contributes most to the higher perinatal mortality rate of Sudan. Results: Intrapartum deaths of nonmalformed fetuses and neonatal death of infants week 34 + were more than 10 times higher than in European countries. At a Danish-Sudanese workshop the results were discussed and a perinatal audit on specific Danish and Sudanese cases was introduced. The experience and its impacts on perinatal care and future data collecting activities is presented. Conclusions: The application of a common classification of perinatal deaths may be a starting point for appropiate data collecting activities, perinatal audit, and improvement of perinatal care in Sudan.
FC1.29 ULTRASOUND
IN GYNECOLOGY
2
FC1.29.01 WHICH SONOGRAPHIC CRITERIA ARE IMPORTANT IN THE DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME (PCOS) ? W. U. Atiomo, Dept. OBIGYN, Royal Devon and Exeter Hospital, Exeter, UK A Prentice, Dept of Hematology, Derriford Hospital, Plymouth UK. P Dubbins, Dept. of Radiology, Derriford Hospital, Plymouth UK. Objectives: The aim of this study was to determine the value of individual ultrasound features of polycystic ovaries in detecting PCOS as not all women with polycystic ovaries on ultrasound will have the syndrome and clinical or biochemical features of PCOS may be present without ultrasound features Study methods: Thirty two women with PCOS and 40 controls were prospectively recruited into the study. Interested participants were invited to the hospital for the diagnosis or exclusion of PCOS by history and serum biochemical tests. Pelvic ultrasound scans were performed with the operator blind to the diagnosis. For this study, PCOS was defined as a combination of a history of chronic oligo- or amenorrhoea and a raised free androgen index or a raised LWFSH ratio in the absence of diseases of the adrenals or pituitary such as congenital adrenal hyperplasia or hyper-prolactinaemia. Results: The most sensitive ultrasound features were the presence of 10 or more follicles (82% and 69% in the left and right ovary) and a peripheral distribution of follicles (81.8% and 71.9% in the left and right ovary). Although ovarian enlargement and stromal brightness were not as sensitive as the previous criteria, stromal brightness was most specific. Combi ning all the criteria predicted a diagnosis of PCOS or control correctly in 86.4% of cases. Conclusion: This study shows that established sonographic criteria of polycystic ovaries remain of value in the diagnosis of PCOS however the discrepancy between the left and right ovaries is an interesting but unexplained finding.
FC1.29.02 DECREASED UTERINE PERFUSION IN POLYCYSTIC OVARY SYNDROME: IS IT ALWAYS PRESENT ? Aiossa S, Guerriero S, Paoletti AM, Floris S, Mannias M, Manno S, Lai MP, Melis GB, Department of Obstetrics and Gynecology- University of Cagliari- Italy Controversial results have been obtained evaluating uterine perfusion in patients affected by Polycystic ovary syndrome (PCOS)and this could be due to the differences in subgroups of PCOS-patients considered in the studies. The aims of this study were to verify whether it is possible to identify a subgroups of PCOS-patients with pathologic value of Pulsatility Index (PI)of uterine artery and to find factors affecting PI in PCOS-patients. Prospectively, 88 patients affected by PCOS were enrolled in the study and underwent transvaginal ultrasonography associated with color Doppler evaluation of uterine artery, serum hormone determination and Body Mass Index (BMI) analysis during early follicular phase. The PI values were considered pathologic when they were 2 3 in according to
SEPTEMBER
4
69
FC1.28.07 DIAGNOSTIC ACCURACY OF THE BIOHYSICAL PROFILE SCORE IN PREDICTING ADVERSE PERINATAL OUTCOMES IN HYPERTENSIVE DISORDERS OF PREGNANCY G. Ivanovic, D. Ivanovic, P. Momcilov, 0. Kontic-Vucinic, S. Kadija, D. Plecas, M. Pervulov, Institute of OBIGYN, Clinical Center of Serbia, Belgrade, Yugoslavia. Objectives: To estimate the accuracy and usefulness of the Biophysical profile score (BPS) in predicting adverse perinatal outcomes in hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, chronic hypertension, superimposed preeclampsia). Study Methods: One hundred and seventy-four fetuses jeopardized by maternal hypertension were monitored by BPS. Sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), efficacy (E) and ratio of LR+ to LR- (LR+/LR-) were estimated for BPS 5 6110 (positive test value). The adverse perinatal outcomes were: stillbirth, perinatal death (PD), 5 minute Apgar score less than 7, need for NICU admission, premature birth (PB) and intrauterine growth retardation (IUGR). Results
adm. PB
55.0
89.2
75.0
77.1
76.5
10.1
IUGR
52.1
92.3
84.1
71.2
74.7
13.1
Conclusions: Ability of BPS to distinguish between “true” positive from “true” negative results in prediction of perinatal mortality is excellent. Low sensitivity of BPS in prediction of perinatal morbidity (probably due to fetal adaptive responses to condition of chronic hypoxemia) reduces value of BPS as a screening test and LR+/LR- ratio. For this reason we consider that BPS is not suitable as a single fetal surveillance test in pregnancies complicated by hypertensive disorders.
FC1.28.08 HYPOCOILED CORD AS A MARKER FOR UMBILICAL CORD ENCIRCLEMENTS J. U. Pvrsikova, L. I. Titchenko, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russia Objectives: The aim of this study was to determine the relationship between hypocoiled umbilical cord and fetal outcome. Study Methods: Fifty pregnant women were examined in third term. The umbilical coiling index (UCI) of each cord was calculated using sonographia, by dividing number of helices by cord length from several segments antenatally. Doppler flow velocities were obtained from umbilical arteries and aorta in each fetus. The number of cord encirclements were noted. Fetal outcome was determined by using Apgar scores after 5 minutes. Results: The umbilical coiling index in this group was 0.2*0.08 coils/cm(p<0.05). Systolo-dyastolic ratio in umbilical arteries and aorta were increased in 68% of cases. Umbilical cord encirclements noted in 82% of cases, tight nuchal cord 34%, loose nuchal cord 66%, 61% of fetuses had asphyxia, Apgar scores<7 had 24% fetuses, operative deliver - 8 cases (16%), growth-restricted fetuses was determined in 12 cases (24%) and one fetus (2%) died during early postnatal period. Conclusions: Hypocoiled umbilical cord may be a marker for nuchal cord and bad outcomes of deliveries.
FC1.28.09 PERINATAL AUDIT IN SUDAN S. Elamin’,J. Langhoff-Roes’, B. Bodker’, S. Larsen’, S.A. Ibrahim”, A.L. Ashmeig”, G. Lindmark”‘. ‘Dept. Obstetrics, Rigshospitalet, University of Copenhagen, Denmark. “University of Khartoum, Sudan. *** Dept Women’s and Children’s Health, Uppsala University, Sweden. Objectives: To classify the perinatal deaths in Omdurman region, Sudan, compare with perinatal deaths in European countries, perform perinatal
audit and evaluate the procedure as a tool for quality improvement of perinatal care. Study Methods: Perinatal deaths were identified in two hospitals and a community based health area in the Omdurman region in 1999 giving an estimated perinatal mortality rate of 8 % All cases were classified and categorized by the Nordic-Baltic perinatal death classification, and the distribution was compared with that of Scandinavian and Eastern European countries, to identify categories that contributes most to the higher perinatal mortality rate of Sudan. Results: Intrapartum deaths of nonmalformed fetuses and neonatal death of infants week 34 + were more than 10 times higher than in European countries. At a Danish-Sudanese workshop the results were discussed and a perinatal audit on specific Danish and Sudanese cases was introduced. The experience and its impacts on perinatal care and future data collecting activities is presented. Conclusions: The application of a common classification of perinatal deaths may be a starting point for appropiate data collecting activities, perinatal audit, and improvement of perinatal care in Sudan.
FC1.29 ULTRASOUND
IN GYNECOLOGY
2
FC1.29.01 WHICH SONOGRAPHIC CRITERIA ARE IMPORTANT IN THE DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME (PCOS) ? W. U. Atiomo, Dept. OBIGYN, Royal Devon and Exeter Hospital, Exeter, UK A Prentice, Dept of Hematology, Derriford Hospital, Plymouth UK. P Dubbins, Dept. of Radiology, Derriford Hospital, Plymouth UK. Objectives: The aim of this study was to determine the value of individual ultrasound features of polycystic ovaries in detecting PCOS as not all women with polycystic ovaries on ultrasound will have the syndrome and clinical or biochemical features of PCOS may be present without ultrasound features Study methods: Thirty two women with PCOS and 40 controls were prospectively recruited into the study. Interested participants were invited to the hospital for the diagnosis or exclusion of PCOS by history and serum biochemical tests. Pelvic ultrasound scans were performed with the operator blind to the diagnosis. For this study, PCOS was defined as a combination of a history of chronic oligo- or amenorrhoea and a raised free androgen index or a raised LWFSH ratio in the absence of diseases of the adrenals or pituitary such as congenital adrenal hyperplasia or hyper-prolactinaemia. Results: The most sensitive ultrasound features were the presence of 10 or more follicles (82% and 69% in the left and right ovary) and a peripheral distribution of follicles (81.8% and 71.9% in the left and right ovary). Although ovarian enlargement and stromal brightness were not as sensitive as the previous criteria, stromal brightness was most specific. Combi ning all the criteria predicted a diagnosis of PCOS or control correctly in 86.4% of cases. Conclusion: This study shows that established sonographic criteria of polycystic ovaries remain of value in the diagnosis of PCOS however the discrepancy between the left and right ovaries is an interesting but unexplained finding.
FC1.29.02 DECREASED UTERINE PERFUSION IN POLYCYSTIC OVARY SYNDROME: IS IT ALWAYS PRESENT ? Aiossa S, Guerriero S, Paoletti AM, Floris S, Mannias M, Manno S, Lai MP, Melis GB, Department of Obstetrics and Gynecology- University of Cagliari- Italy Controversial results have been obtained evaluating uterine perfusion in patients affected by Polycystic ovary syndrome (PCOS)and this could be due to the differences in subgroups of PCOS-patients considered in the studies. The aims of this study were to verify whether it is possible to identify a subgroups of PCOS-patients with pathologic value of Pulsatility Index (PI)of uterine artery and to find factors affecting PI in PCOS-patients. Prospectively, 88 patients affected by PCOS were enrolled in the study and underwent transvaginal ultrasonography associated with color Doppler evaluation of uterine artery, serum hormone determination and Body Mass Index (BMI) analysis during early follicular phase. The PI values were considered pathologic when they were 2 3 in according to