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Third trimester intrauterine deaths — Unavoidable risk?
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gestational week is corrected accurately by ultrasonography in early stage of pregnancy. Present study was performed to elucidate whether it is possible to decrease the frequency of FD by the induction of labor after 41 weeks of gestation. Study Methods: 108 cases of primiparas delivered after 41 weeks of gestation were subjected. They were selected from 1486 of full term deliveries during recent ten years. They were divided into two groups; group A: naturally followed up till onset of labor, and the proper treatment was carried out if necessary, 46 cases, and group B: induction of labor was performed after 41 weeks of gestation, 62 cases. And parturition weeks, incidences of FD, rates of cesarean section (c/s) and Apgar scores were compared between these two groups. Results: Parturition weeks (A: 42.2e1.9 vs. B: 41.3 e1.5 weeks, p
P4.01.20 THIRD TRIMESTER INTRAUTERINE DEATHS - UNAVOIDABLE RISK? T. Maior, G. JuhBsz, .I. Aranyosi, A. Borsos, Dept. OBIGYN, University Medical School, Debrecen, Hungary. Objectives: The assessment of third trimester intrauterine deaths in a third level referral center. Study Methods: Analysis of 211 intrauterine deaths out of 32,126 deliveries. Results: As a causative factor, umbilical cork complication could be identified in 58 cases (35%), while abruption of the placenta in 22 (13%) cases, severe IUGR in 24 (15%), other reasons in 27 cases. In 32 cases (20%), even with the help of all available information, no definitive cause could be identified. Conclusions: Regularly performed careful analysis of intrauterine deaths, uniform data collection and routine autopsy would help us identify underlying pathology and possibly prevent third trimester intrauterine deaths and is strongly recommended to all departments.
P4.01.21 UTERINE BLOOD FLOW WAVEFORM ANALYSIS TO PREDICT SOME COMPLICATIONS OCCURRING IN THE LAST MONTHS OF PREGNANCY. L. Gargiulo, V. Guerriero, L. Caserta, A. Soriano, A. Magliole, E. Nesti, R. S. Panariello. Objectives: The aim of this study was to assess the performance of uterine blood flow waveform analysis to predict some complications occurring in the last months of pregnancy (gestosis, IUGR, preterlabor) in a non-selected population. Study Methods: 310 pregnant women were assisted during pregnancy until delivery and submitted to transabdominal ultrasound examination with uterine artery velocimetry waveform analysis, at about 20-24 weeks. Birth weight, gestational age at delivery and maternal blood pressure during pregnancy were aslo reported too. Results: The test, with regard to gestosis and IUGR, was found to have a sensibility of 43,2%, a positive predictive value of 27,8%, a specificity of 92,8% and a negative predictive value of 96,3%. No correlation was found between mean RI and gestation age at delivery. Conclusions: We retain that Doppler uterine artery waveform analysis can’t be used as screening test in unselected pregnant women, because of its low sensibility and positive predictive value. However, the high specificity and negative predictive value suggest that a normal test predict’s an uncomplicated pregnancy.
THURSDAY,
P4.02 CERVICAL
SEPTEMBER
CANCER
P4.02.01 ASSOCIATION OF RADIOSENSITIVITY WITH EXPRESSION OF THYMIDINE PHOSPHORYLASE (TdRPase) IN CERVICAL SQUAMOUS CELL CARCINOMA M. Sanezumi, H. Okada, T. Nakajima, T. Matsubara, K. Yasuda, H. Kanzaki. Dept. OBIGYN, Kansai Medical University, Osaka, Japan. Objectives: To clarify the association between expression of TdRPase and radiosensitivity in uterine cervical squamous cell carcinomas. Study Methods: The expression of TdRPase was evaluated by immunohistochemical staining of tissue specimens from 27 patients diagnosed as stage III cervical squamous cell carcinomas followed by radiotherapy. They included 14 radiosensitive patients and 13 nonradiosensitive ones. Results: In radiosensitive group, the expression of TdRPase was observed in every 14 cases examined: 7 strongly positive cases, 3 positive cases, and 4 weakly positive cases. In contrast, the expression of TdRPase was seen only 7 out of 13 cases in non-radiosensitive group: 3 strongly positive cases, 2 positive cases, 2 weakly positive cases, and 6 cases were negative for the staining. The localization of TdRPase was seen in both cytoplasm and nuclei, but the expression was not correlated with histological types of the cancers. Conclusions: In radiosensitive carcinomas, TdRPase expression was significantly higher and stronger than those in non-radiosensitive carcinomas. This result suggested that TdRPase was a useful marker for presuming the effect of radiotherapy in uterine cervical carcinomas.
P4.02.02 CD40 IN CIN AND CERVICAL CANCER: AN IMMUNOHISTOCHEMICAL ANALYSIS REVEALING AN INTRIGUING EXPRESSION PROFILE G R Teale, Y-L Hock, D M Luesley, L S Young, Birmingham Women’s Hospital, Birmingham, UK CD40 is a member of the tumour necrosis factor receptor superfamily. There is growing interest in the role of this antigen in carcinogenesis. CD40 positive carcinoma cell lines of ovarian, cervical, bladder and squamous epithelial origin all respond to CD40 ligation with an inhibition of cell growth. Objectives: To investigate the expression of CD40 in a premalignant condition, cervical intraepithelial neoplasia (GIN). Method Cervical specimens from 76 women were analysed by immunohistochemistry. Results: In normal epithelium CD40 expression is either absent or confined to basal cells. Expression in both low-grade and high-grade squamous intraepithelial lesions and in advanced invasive cancer is significantly increased above normal epithelium. Microinvasive lesions however show a consistently reduced expression despite the appearance of high level expression in areas of CIN 3 from which the microinvasive disease arose. HLA Class II expression is low in low-grade lesions and progressively increases from CIN 2 to CIN 3 and remains high in both micro and advanced invasive disease. Conclusions: The increase in CD40 expression between normal epithelium and squamous intraepithelial lesions raises the possibility of this antigen having a role in the progression of HPV induced lesions. The consistent reduction in areas of microinvasion as compared with more advanced cancer or high-grade CIN is a novel finding which does not appear to be the result of generalised immune upregulation as demonstrated by the HLA Class II results. It may reflect an alteration in HPV directed transcription events. The finding of an alteration in the expression of this antigen at the earliest stages of squamous cancer raises the possibility that this antigen has a pivotal role in carcinogenesis and may be amenable to therapeutic intervention.
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gestational week is corrected accurately by ultrasonography in early stage of pregnancy. Present study was performed to elucidate whether it is possible to decrease the frequency of FD by the induction of labor after 41 weeks of gestation. Study Methods: 108 cases of primiparas delivered after 41 weeks of gestation were subjected. They were selected from 1486 of full term deliveries during recent ten years. They were divided into two groups; group A: naturally followed up till onset of labor, and the proper treatment was carried out if necessary, 46 cases, and group B: induction of labor was performed after 41 weeks of gestation, 62 cases. And parturition weeks, incidences of FD, rates of cesarean section (c/s) and Apgar scores were compared between these two groups. Results: Parturition weeks (A: 42.2e1.9 vs. B: 41.3 e1.5 weeks, p
P4.01.20 THIRD TRIMESTER INTRAUTERINE DEATHS - UNAVOIDABLE RISK? T. Maior, G. JuhBsz, .I. Aranyosi, A. Borsos, Dept. OBIGYN, University Medical School, Debrecen, Hungary. Objectives: The assessment of third trimester intrauterine deaths in a third level referral center. Study Methods: Analysis of 211 intrauterine deaths out of 32,126 deliveries. Results: As a causative factor, umbilical cork complication could be identified in 58 cases (35%), while abruption of the placenta in 22 (13%) cases, severe IUGR in 24 (15%), other reasons in 27 cases. In 32 cases (20%), even with the help of all available information, no definitive cause could be identified. Conclusions: Regularly performed careful analysis of intrauterine deaths, uniform data collection and routine autopsy would help us identify underlying pathology and possibly prevent third trimester intrauterine deaths and is strongly recommended to all departments.
P4.01.21 UTERINE BLOOD FLOW WAVEFORM ANALYSIS TO PREDICT SOME COMPLICATIONS OCCURRING IN THE LAST MONTHS OF PREGNANCY. L. Gargiulo, V. Guerriero, L. Caserta, A. Soriano, A. Magliole, E. Nesti, R. S. Panariello. Objectives: The aim of this study was to assess the performance of uterine blood flow waveform analysis to predict some complications occurring in the last months of pregnancy (gestosis, IUGR, preterlabor) in a non-selected population. Study Methods: 310 pregnant women were assisted during pregnancy until delivery and submitted to transabdominal ultrasound examination with uterine artery velocimetry waveform analysis, at about 20-24 weeks. Birth weight, gestational age at delivery and maternal blood pressure during pregnancy were aslo reported too. Results: The test, with regard to gestosis and IUGR, was found to have a sensibility of 43,2%, a positive predictive value of 27,8%, a specificity of 92,8% and a negative predictive value of 96,3%. No correlation was found between mean RI and gestation age at delivery. Conclusions: We retain that Doppler uterine artery waveform analysis can’t be used as screening test in unselected pregnant women, because of its low sensibility and positive predictive value. However, the high specificity and negative predictive value suggest that a normal test predict’s an uncomplicated pregnancy.
THURSDAY,
P4.02 CERVICAL
SEPTEMBER
CANCER
P4.02.01 ASSOCIATION OF RADIOSENSITIVITY WITH EXPRESSION OF THYMIDINE PHOSPHORYLASE (TdRPase) IN CERVICAL SQUAMOUS CELL CARCINOMA M. Sanezumi, H. Okada, T. Nakajima, T. Matsubara, K. Yasuda, H. Kanzaki. Dept. OBIGYN, Kansai Medical University, Osaka, Japan. Objectives: To clarify the association between expression of TdRPase and radiosensitivity in uterine cervical squamous cell carcinomas. Study Methods: The expression of TdRPase was evaluated by immunohistochemical staining of tissue specimens from 27 patients diagnosed as stage III cervical squamous cell carcinomas followed by radiotherapy. They included 14 radiosensitive patients and 13 nonradiosensitive ones. Results: In radiosensitive group, the expression of TdRPase was observed in every 14 cases examined: 7 strongly positive cases, 3 positive cases, and 4 weakly positive cases. In contrast, the expression of TdRPase was seen only 7 out of 13 cases in non-radiosensitive group: 3 strongly positive cases, 2 positive cases, 2 weakly positive cases, and 6 cases were negative for the staining. The localization of TdRPase was seen in both cytoplasm and nuclei, but the expression was not correlated with histological types of the cancers. Conclusions: In radiosensitive carcinomas, TdRPase expression was significantly higher and stronger than those in non-radiosensitive carcinomas. This result suggested that TdRPase was a useful marker for presuming the effect of radiotherapy in uterine cervical carcinomas.
P4.02.02 CD40 IN CIN AND CERVICAL CANCER: AN IMMUNOHISTOCHEMICAL ANALYSIS REVEALING AN INTRIGUING EXPRESSION PROFILE G R Teale, Y-L Hock, D M Luesley, L S Young, Birmingham Women’s Hospital, Birmingham, UK CD40 is a member of the tumour necrosis factor receptor superfamily. There is growing interest in the role of this antigen in carcinogenesis. CD40 positive carcinoma cell lines of ovarian, cervical, bladder and squamous epithelial origin all respond to CD40 ligation with an inhibition of cell growth. Objectives: To investigate the expression of CD40 in a premalignant condition, cervical intraepithelial neoplasia (GIN). Method Cervical specimens from 76 women were analysed by immunohistochemistry. Results: In normal epithelium CD40 expression is either absent or confined to basal cells. Expression in both low-grade and high-grade squamous intraepithelial lesions and in advanced invasive cancer is significantly increased above normal epithelium. Microinvasive lesions however show a consistently reduced expression despite the appearance of high level expression in areas of CIN 3 from which the microinvasive disease arose. HLA Class II expression is low in low-grade lesions and progressively increases from CIN 2 to CIN 3 and remains high in both micro and advanced invasive disease. Conclusions: The increase in CD40 expression between normal epithelium and squamous intraepithelial lesions raises the possibility of this antigen having a role in the progression of HPV induced lesions. The consistent reduction in areas of microinvasion as compared with more advanced cancer or high-grade CIN is a novel finding which does not appear to be the result of generalised immune upregulation as demonstrated by the HLA Class II results. It may reflect an alteration in HPV directed transcription events. The finding of an alteration in the expression of this antigen at the earliest stages of squamous cancer raises the possibility that this antigen has a pivotal role in carcinogenesis and may be amenable to therapeutic intervention.
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