- Email: [email protected]
Prenatal parameters to estimate outcome and respiratory morbidity in fetuses with isolated left-sided congenital diaphragmatic hernia
e110
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Patient safety
Surgical techniques in breast and gynaecological cancers
Poster Presentation
Poster Presentation
Third-degree obstetric perineal tear five years after primary repair: quality of life, clinical and functional results
Our experience with sentinel lymph nodes detection during surgical therapy of our patients with cervical and endometrial cancer
Akvile Statnickaite 1,∗ , Viktorija Taraseviciene 2 , Tomas Birzietis 2 , Saulius Svagzdys 3
1 , Katalin ˝ Ágnes Stefanovits 1,∗ , Péter Gocze 2 2 Zámbó , Erzsébet Schmidt , Krisztina Kovács 3 , Antal Arany 1 , Szilárd Papp 1 , József Bódis 1
1
Lithuanian University of Health Sciences, Lithuania Lithuanian University of Health Sciences Hospital Kaunas Clinics Department of Obs-Gyn, Lithuania 3 Lithuanian University of Health Sciences Hospital Kaunas Clinics Department of Surgery, Lithuania E-mail address: [email protected] (A. Statnickaite). 2
This prospective observational study was designed to establish the quality of life (QoL), long-term clinical and anorectal functional results after primary repair of a third-degree perineal rupture in a cohort of women who suffered a third degree tear (Group 1) and compare the results with a cohort of women who underwent an uncomplicated vaginal delivery (Group 2). Twenty nine consecutive women who had a primary repair of a third-degree perineal rupture in a period 2005–2011, and 58 who underwent an uncomplicated vaginal delivery, were contacted with a validated questionnaires (Wexner‘s and The Modified Faecal Incontinence Quality of life Score). Those who responded were invited to undergo anorectal function testing (anal manometry, anal endosonography) and gynecological examination. Of the total number contacted, sixty women (68.9%) returned the completed questionnaire: nineteen women out of 29 (65.5%) of the original study group and 41 out of 58 (70.6%) of the original control were examined. The incidence of worse bowel control was nearly 6 times higher in women with third-degree lacerations (57.8%) compared with women with no lacerations (9.7%, P < .001). Mean maximal anal squeeze pressures were 64 mmHg in the Group 2 and 42 mmHg in the group 1 (p = 0.028). First sensation to filling of the rectum was decreased in study group (p = 0.01). Group 1 women that pronounced faecal incontinence had lower anal resting pressures (21 mmHg) than those in group 2 (43 mmHg) (p = 0.04). During anal endosonography sphincter defect was found in 16 cases. Patients with severe perineal tears reported a greater impact of symptoms on their quality of life but the difference with the control group was not significant. Anal incontinence prevails in 57% of women 5 years after primary repair of a third-degree perineal rupture. These women are more likely to have bowel incontinence than women without anal sphincter lacerations so it is very important to prevent further sphincter damage and better quality of life. http://dx.doi.org/10.1016/j.ejogrb.2016.07.285
1 Department of Obstetrics and Gynecology of University of Pécs, Hungary 2 Department of Nuclear Medicine of University of Pécs, Hungary 3 Department of Pathology of University of Pécs, Hungary E-mail address: [email protected] (Á. Stefanovits).
In 2011 we started a new program on the University of Pécs, Hungary in collaboration between of the Department of Obstetrics and Gynaecology, and the Department of Nuclear Medicine and the Department of Pathology with the permission of Ethics Committee of University of Pécs. Objective was to install the procedure of the sentinel lymph node technique in our clinical practice during treatment of patients who suffering is gynecological cancers (cervix and endometrial cancer). I would like to present our results in two periods. In the first period (01.01.2011–12.31.2013) we use only singular injection with low molecular weight radioactive isotopes (Tc-99). In the second period we introduce two markers, the previous preoperative lymphoscintigraphy and singular photon emission CT (SPECT CT) supplemented with intraoperative patent blue injection. Summary we can draw the following conclusion: the singular marking is enough in case of cervical cancer, but the dual injection is more useful in patient with endometrial cancer. http://dx.doi.org/10.1016/j.ejogrb.2016.07.286 Imaging in obstetrics Oral Presentation Prenatal parameters to estimate outcome and respiratory morbidity in fetuses with isolated left-sided congenital diaphragmatic hernia Zbynek Stranak 1,∗ , Ladislav Krofta 2 , Lucia Anna Haak 2 , Jiˇrí Vojtˇech 2 , Luboˇs Haˇslík 2 , Jaroslav Feyereisl 2 1 Third Faculty of Medicine, Charles University, Prague, Czech Republic 2 Fetal Medicine Centre, Institute for the Care of Mother and Child, Prague, Czech Republic E-mail address: [email protected] (Z. Stranak).
Objectives: Respiratory morbidity in congenital diaphragmatic hernia (CDH) is associated with high mortality and adverse outcome. Accurate prenatal diagnosis is essential for prognosis and potential treatment in utero. The aim was to evaluate the prenatal ultrasound findings in assessing the respiratory prognosis in fetuses with isolated left-sided CDH. Methods: We retrospectively analyzed the medical records of 59 prenatally diagnosed left-sided CDH cases managed at a tertiary perinatal center. Results: Survival rate in the study group was 73% (43/59). We found no statistically significant relationship between survival
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
and the presence of polyhydramnios, gestational age at diagnosis, lung-to-head ratio (LHR) and observed/expected LHR (O/E LHR) values, gestational age at birth and birth weight. Intrathoracic liver herniation was a statistically significant parameter adversely affecting survival (37.2% in survivors, 68.8% in non-survivors, p = 0.031) and logistic regression confirmed this relationship. The presence of pneumothorax and severe pulmonary hypertension were significantly associated with mortality (82% non-survivors versus 15% in survivors, p = 0.0001). Conclusion: Intrathoracic liver herniation seems to be a reliable parameter in the prediction of survival and neonatal respiratory morbidity in fetuses with isolated left-sided CDH. In contrast, we found no significant correlation between perinatal outcome and LHR, O/E LHR values, birth weight and gestational age. This study was supported by the OPPK CZ.2.16/3.1.00/25015 project (Operational Program Prague, an EU funding mechanism).
e111
length and head circumference of their new-borns. This negative correlation was also observed in women with GDM. Conclusion: Pregnancy is usually accompanied by progressively increasing insulin resistance, which begins during the second trimester of pregnancy, and develops up to the level of Type Two Diabetes Mellitus in the third trimester. The orexigenic effect of ghrelin may contribute to weight gain in pregnant women, while the increased amount of adipose tissue may inversely affect ghrelin production. The multiple linear regression analysis raises the possibility that resistin is linked independently to pregnancy-induced insulin resistance. http://dx.doi.org/10.1016/j.ejogrb.2016.07.288 Assisted Reproduction No preference
http://dx.doi.org/10.1016/j.ejogrb.2016.07.287 Diabetes in pregnancy Poster Presentation Elevated serum acylated (biologically active) ghrelin and resistin levels associate with pregnancy-induced weight gain, insulin resistance and antropometric data in the fetus Dorina Supák ∗ , Zsolt Melczer, Károly Cseh 2nd Department of Obstetrics and Gynecology, Semmelweis University, Hungary E-mail address: [email protected] (D. Supák). Based on our previous studies and observations concerning the effects of acylated ghrelin and resistin on weight gain and insulin resistance, our current aim is to examine the association of these proteins with pregnancy-induced obesity and insulin resistance in a cross-sectional study carried out in patients with GDM, healthy pregnant women and non-pregnant controls of the same age. The diagnosis of GDM was done as specified by the WHO classification protocol using the 75 g oral glucose tolerance test (OGTT). The patients enrolled in our study according to the degree of dysfunction in their carbohydrate metabolism. Serum ghrelin and adiponectin levels were established using RIA kits, while serum resistin, soluble (s) TNF-receptor-1 and leptin levels were measured and published using the ELISA technique. The fasting serum levels of biologically active (acylated) ghrelin showed to be significantly lower in patients with GDM in comparison to those of non-pregnant healthy controls and healthy pregnant women in the 1st trimester. GDM values were significantly lower than those of healthy expectants in the 3rd trimester, as compared to the non-pregnant control group, the GDM patients, and the healthy pregnant women in the 1st and 3rd trimesters. Acylated ghrelin levels showed a negative correlation (p < 0.05) with body mass index (BMI), resistin, TNF-␣, sTNFR-2, leptin, C-peptide concentrations, C-peptide/blood glucose ratio and daily insulin dose required to maintain euglycemia, and in the GDM group, showed a positive correlation with adiponectin levels. Fasting serum resistin concentrations were significantly elevated in patients with GDM and in healthy pregnant women in the 3rd trimester in comparison to the non-pregnant control group. In the GDM group, serum resistin correlated positively with serum TNF-␣, sTNFR-1 and -2 and Cpeptide concentrations, C-peptide/blood glucose ratio and daily insulin dose. While analyzing antropometric data in the fetus, we found a negative correlation between fasting serum levels of biologically active ghrelin in healthy pregnant women, and the weight,
Correlation between oocyte morphology and the embryo aneuploidy rate in IVF cycles Anastasiya G. Syrkasheva ∗ , Nataliya V. Dolgushina, Nataliya P. Makarova, Evgeniya V. Kovalskaya, Elena A. Kalinina, Ekaterina L. Yarotskaya The Research Center for Obstetrics, Gynecology and Perinatology (RCOGP), The Ministry of Health of the Russian Federation, Moscow, Russia E-mail address: [email protected] (A.G. Syrkasheva). Aneuploidy is the main genetic cause of miscarriages and congenital birth defects following both natural conception and in vitro fertilization (IVF). The oocyte aneuploidy rate varies over a wide range, but there is a close correlation between advancing maternal age and the increasing aneuploidy rate. Controlled ovarian stimulation additionally complicates this problem because it leads to the maturation of oocytes that would naturally undergo apoptosis. A large proportion of oocytes recovered from exogenous gonadotropin-stimulated cycles exhibit different morphological abnormalities (dysmorphisms). The purpose of the study was to evaluate the aneuploidy rates of chromosomes 13, 18, 21, X and Y in embryos from patients with different oocyte morphotypes. Materials and methods: This prospective study included 84 patients treated with IVF at a single academic center. The patients were divided into the following groups: group 1 consisted of women with cytoplasmic dysmorphisms (n = 28), group 2 consisted of women with extracytoplasmic dysmorphisms (n = 28), and group 3 consisted of women with morphologically normal oocytes (n = 28). One blastomere from each embryo was analyzed for aneuploidies of chromosomes 13, 18, 21, X, and Y results. In total we sampled 368 embryos on day 3 (98 from group 1, 126 from group 2 and 144 from group 3). In group 1, there were 67 aneuploid embryos (68.4%); in group 2, there were 49 aneuploid embryos (38.9%); and in group 3, there were 45 (31.3%) (p < 0.0001). To identify the factors that influenced the appearance of aneuploidy in the embryo, we compared the groups with euploid (group A, n = 161) and aneuploid embryos (group B, n = 207). The aneuploidy rate was related to some of the female baseline characteristics, specifically, body mass index (BMI) and the basal AMH level. The women in group B were more likely to have histories of chlamydia infection. The summary dose of gonadotropins was higher in group B. Sperm quality (from the fertile or subfertile males) did not influence the embryo aneuploidy rate. The adjusted odds ratio (OR) for an aneuploid embryo in cases of cytoplasmic dysmorphisms was 3.6 (95% CI = 1.8; 7.2) after adjusting for the confounders. The adjusted OR for an aneuploid embryo in cases of extracytoplasmic dysmorphisms was
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Patient safety
Surgical techniques in breast and gynaecological cancers
Poster Presentation
Poster Presentation
Third-degree obstetric perineal tear five years after primary repair: quality of life, clinical and functional results
Our experience with sentinel lymph nodes detection during surgical therapy of our patients with cervical and endometrial cancer
Akvile Statnickaite 1,∗ , Viktorija Taraseviciene 2 , Tomas Birzietis 2 , Saulius Svagzdys 3
1 , Katalin ˝ Ágnes Stefanovits 1,∗ , Péter Gocze 2 2 Zámbó , Erzsébet Schmidt , Krisztina Kovács 3 , Antal Arany 1 , Szilárd Papp 1 , József Bódis 1
1
Lithuanian University of Health Sciences, Lithuania Lithuanian University of Health Sciences Hospital Kaunas Clinics Department of Obs-Gyn, Lithuania 3 Lithuanian University of Health Sciences Hospital Kaunas Clinics Department of Surgery, Lithuania E-mail address: [email protected] (A. Statnickaite). 2
This prospective observational study was designed to establish the quality of life (QoL), long-term clinical and anorectal functional results after primary repair of a third-degree perineal rupture in a cohort of women who suffered a third degree tear (Group 1) and compare the results with a cohort of women who underwent an uncomplicated vaginal delivery (Group 2). Twenty nine consecutive women who had a primary repair of a third-degree perineal rupture in a period 2005–2011, and 58 who underwent an uncomplicated vaginal delivery, were contacted with a validated questionnaires (Wexner‘s and The Modified Faecal Incontinence Quality of life Score). Those who responded were invited to undergo anorectal function testing (anal manometry, anal endosonography) and gynecological examination. Of the total number contacted, sixty women (68.9%) returned the completed questionnaire: nineteen women out of 29 (65.5%) of the original study group and 41 out of 58 (70.6%) of the original control were examined. The incidence of worse bowel control was nearly 6 times higher in women with third-degree lacerations (57.8%) compared with women with no lacerations (9.7%, P < .001). Mean maximal anal squeeze pressures were 64 mmHg in the Group 2 and 42 mmHg in the group 1 (p = 0.028). First sensation to filling of the rectum was decreased in study group (p = 0.01). Group 1 women that pronounced faecal incontinence had lower anal resting pressures (21 mmHg) than those in group 2 (43 mmHg) (p = 0.04). During anal endosonography sphincter defect was found in 16 cases. Patients with severe perineal tears reported a greater impact of symptoms on their quality of life but the difference with the control group was not significant. Anal incontinence prevails in 57% of women 5 years after primary repair of a third-degree perineal rupture. These women are more likely to have bowel incontinence than women without anal sphincter lacerations so it is very important to prevent further sphincter damage and better quality of life. http://dx.doi.org/10.1016/j.ejogrb.2016.07.285
1 Department of Obstetrics and Gynecology of University of Pécs, Hungary 2 Department of Nuclear Medicine of University of Pécs, Hungary 3 Department of Pathology of University of Pécs, Hungary E-mail address: [email protected] (Á. Stefanovits).
In 2011 we started a new program on the University of Pécs, Hungary in collaboration between of the Department of Obstetrics and Gynaecology, and the Department of Nuclear Medicine and the Department of Pathology with the permission of Ethics Committee of University of Pécs. Objective was to install the procedure of the sentinel lymph node technique in our clinical practice during treatment of patients who suffering is gynecological cancers (cervix and endometrial cancer). I would like to present our results in two periods. In the first period (01.01.2011–12.31.2013) we use only singular injection with low molecular weight radioactive isotopes (Tc-99). In the second period we introduce two markers, the previous preoperative lymphoscintigraphy and singular photon emission CT (SPECT CT) supplemented with intraoperative patent blue injection. Summary we can draw the following conclusion: the singular marking is enough in case of cervical cancer, but the dual injection is more useful in patient with endometrial cancer. http://dx.doi.org/10.1016/j.ejogrb.2016.07.286 Imaging in obstetrics Oral Presentation Prenatal parameters to estimate outcome and respiratory morbidity in fetuses with isolated left-sided congenital diaphragmatic hernia Zbynek Stranak 1,∗ , Ladislav Krofta 2 , Lucia Anna Haak 2 , Jiˇrí Vojtˇech 2 , Luboˇs Haˇslík 2 , Jaroslav Feyereisl 2 1 Third Faculty of Medicine, Charles University, Prague, Czech Republic 2 Fetal Medicine Centre, Institute for the Care of Mother and Child, Prague, Czech Republic E-mail address: [email protected] (Z. Stranak).
Objectives: Respiratory morbidity in congenital diaphragmatic hernia (CDH) is associated with high mortality and adverse outcome. Accurate prenatal diagnosis is essential for prognosis and potential treatment in utero. The aim was to evaluate the prenatal ultrasound findings in assessing the respiratory prognosis in fetuses with isolated left-sided CDH. Methods: We retrospectively analyzed the medical records of 59 prenatally diagnosed left-sided CDH cases managed at a tertiary perinatal center. Results: Survival rate in the study group was 73% (43/59). We found no statistically significant relationship between survival
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
and the presence of polyhydramnios, gestational age at diagnosis, lung-to-head ratio (LHR) and observed/expected LHR (O/E LHR) values, gestational age at birth and birth weight. Intrathoracic liver herniation was a statistically significant parameter adversely affecting survival (37.2% in survivors, 68.8% in non-survivors, p = 0.031) and logistic regression confirmed this relationship. The presence of pneumothorax and severe pulmonary hypertension were significantly associated with mortality (82% non-survivors versus 15% in survivors, p = 0.0001). Conclusion: Intrathoracic liver herniation seems to be a reliable parameter in the prediction of survival and neonatal respiratory morbidity in fetuses with isolated left-sided CDH. In contrast, we found no significant correlation between perinatal outcome and LHR, O/E LHR values, birth weight and gestational age. This study was supported by the OPPK CZ.2.16/3.1.00/25015 project (Operational Program Prague, an EU funding mechanism).
e111
length and head circumference of their new-borns. This negative correlation was also observed in women with GDM. Conclusion: Pregnancy is usually accompanied by progressively increasing insulin resistance, which begins during the second trimester of pregnancy, and develops up to the level of Type Two Diabetes Mellitus in the third trimester. The orexigenic effect of ghrelin may contribute to weight gain in pregnant women, while the increased amount of adipose tissue may inversely affect ghrelin production. The multiple linear regression analysis raises the possibility that resistin is linked independently to pregnancy-induced insulin resistance. http://dx.doi.org/10.1016/j.ejogrb.2016.07.288 Assisted Reproduction No preference
http://dx.doi.org/10.1016/j.ejogrb.2016.07.287 Diabetes in pregnancy Poster Presentation Elevated serum acylated (biologically active) ghrelin and resistin levels associate with pregnancy-induced weight gain, insulin resistance and antropometric data in the fetus Dorina Supák ∗ , Zsolt Melczer, Károly Cseh 2nd Department of Obstetrics and Gynecology, Semmelweis University, Hungary E-mail address: [email protected] (D. Supák). Based on our previous studies and observations concerning the effects of acylated ghrelin and resistin on weight gain and insulin resistance, our current aim is to examine the association of these proteins with pregnancy-induced obesity and insulin resistance in a cross-sectional study carried out in patients with GDM, healthy pregnant women and non-pregnant controls of the same age. The diagnosis of GDM was done as specified by the WHO classification protocol using the 75 g oral glucose tolerance test (OGTT). The patients enrolled in our study according to the degree of dysfunction in their carbohydrate metabolism. Serum ghrelin and adiponectin levels were established using RIA kits, while serum resistin, soluble (s) TNF-receptor-1 and leptin levels were measured and published using the ELISA technique. The fasting serum levels of biologically active (acylated) ghrelin showed to be significantly lower in patients with GDM in comparison to those of non-pregnant healthy controls and healthy pregnant women in the 1st trimester. GDM values were significantly lower than those of healthy expectants in the 3rd trimester, as compared to the non-pregnant control group, the GDM patients, and the healthy pregnant women in the 1st and 3rd trimesters. Acylated ghrelin levels showed a negative correlation (p < 0.05) with body mass index (BMI), resistin, TNF-␣, sTNFR-2, leptin, C-peptide concentrations, C-peptide/blood glucose ratio and daily insulin dose required to maintain euglycemia, and in the GDM group, showed a positive correlation with adiponectin levels. Fasting serum resistin concentrations were significantly elevated in patients with GDM and in healthy pregnant women in the 3rd trimester in comparison to the non-pregnant control group. In the GDM group, serum resistin correlated positively with serum TNF-␣, sTNFR-1 and -2 and Cpeptide concentrations, C-peptide/blood glucose ratio and daily insulin dose. While analyzing antropometric data in the fetus, we found a negative correlation between fasting serum levels of biologically active ghrelin in healthy pregnant women, and the weight,
Correlation between oocyte morphology and the embryo aneuploidy rate in IVF cycles Anastasiya G. Syrkasheva ∗ , Nataliya V. Dolgushina, Nataliya P. Makarova, Evgeniya V. Kovalskaya, Elena A. Kalinina, Ekaterina L. Yarotskaya The Research Center for Obstetrics, Gynecology and Perinatology (RCOGP), The Ministry of Health of the Russian Federation, Moscow, Russia E-mail address: [email protected] (A.G. Syrkasheva). Aneuploidy is the main genetic cause of miscarriages and congenital birth defects following both natural conception and in vitro fertilization (IVF). The oocyte aneuploidy rate varies over a wide range, but there is a close correlation between advancing maternal age and the increasing aneuploidy rate. Controlled ovarian stimulation additionally complicates this problem because it leads to the maturation of oocytes that would naturally undergo apoptosis. A large proportion of oocytes recovered from exogenous gonadotropin-stimulated cycles exhibit different morphological abnormalities (dysmorphisms). The purpose of the study was to evaluate the aneuploidy rates of chromosomes 13, 18, 21, X and Y in embryos from patients with different oocyte morphotypes. Materials and methods: This prospective study included 84 patients treated with IVF at a single academic center. The patients were divided into the following groups: group 1 consisted of women with cytoplasmic dysmorphisms (n = 28), group 2 consisted of women with extracytoplasmic dysmorphisms (n = 28), and group 3 consisted of women with morphologically normal oocytes (n = 28). One blastomere from each embryo was analyzed for aneuploidies of chromosomes 13, 18, 21, X, and Y results. In total we sampled 368 embryos on day 3 (98 from group 1, 126 from group 2 and 144 from group 3). In group 1, there were 67 aneuploid embryos (68.4%); in group 2, there were 49 aneuploid embryos (38.9%); and in group 3, there were 45 (31.3%) (p < 0.0001). To identify the factors that influenced the appearance of aneuploidy in the embryo, we compared the groups with euploid (group A, n = 161) and aneuploid embryos (group B, n = 207). The aneuploidy rate was related to some of the female baseline characteristics, specifically, body mass index (BMI) and the basal AMH level. The women in group B were more likely to have histories of chlamydia infection. The summary dose of gonadotropins was higher in group B. Sperm quality (from the fertile or subfertile males) did not influence the embryo aneuploidy rate. The adjusted odds ratio (OR) for an aneuploid embryo in cases of cytoplasmic dysmorphisms was 3.6 (95% CI = 1.8; 7.2) after adjusting for the confounders. The adjusted OR for an aneuploid embryo in cases of extracytoplasmic dysmorphisms was