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W162 PLACENTA PREVIA: CLINICAL ANALYSIS OF 71 CASES
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
pregnancy at 28 to 34 weeks. 34.66% showed arrest of progression of preeclampsia with steady blood pressure (with or without anti-hypertensive), urine albumin trace to +2 and variable pedal edema with mild to moderate fetal growth retardation. They required termination at or near term. 18.66% started showing improvement, reduction in pedal edema, blood pressure and proteinuria and delivered spontaneously at or after 37 weeks, some required caesarean section for other obstetric indications. Group B: 66.66% did not show any improvement. 30.66% showed arrest in progression of preeclampsia. 2.66% showed improvement in signs of preeclampsia. Conclusions: If we compare outcomes of two groups, it suggests that providing a high dose of calcium in early preeclampsia helps to prolong duration of gestation and improves fetal survival rate. Table 1. Group
No improvement Termination before term
Arrest of progression Termination at/near term
Improvement Spontaneous delivery at/near term
A B
140 (46.66%) 200 (66.66%)
104 (34.66%) 92 (30.66%)
56 (18.66%) 8 (02.66%)
Table 2. Group
Maternal morbiditya
Maternal mortality
A B
5 APH, 2 HELLP syndrome 4 APH, 3 HELLP syndrome
0 0
a
In terms of APH, DIC (HELLP syndrome), & acute renal failure.
W160 EFFECTIVENESS OF AN ENOXAPARIN-BASED INTERVENTION ON PERINATAL OUTCOMES IN HIGH RISK PREGNANT WOMEN WITH HEREDITARY/ACQUIRED THROMBOPHILIAS E.A. Figueiro-Filho1 , V.M. Oliveira1 , L.R. Coelho1 , I. Breda1 . 1 Obstetrics and Gynecology, Faculty of Medicine – Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil Objectives: To assess whether an enoxaparin-based intervention was effective in reducing adverse obstetric events and to improve perinatal outcome in women with hereditary/acquired thrombophilia and poor obstetric background. Materials: This was a prospective, not randomized, uncontrolled study performed from October 2009 to October 2010. Methods: The women had obstetric and perinatal data for hereditary/acquired thrombophilia prior intervention compared with obstetric and perinatal outcomes following an enoxaparinbased intervention. Results: We included 84 pregnant women with 175 pregnancies before diagnosis, of which 20.0% resulted in fetal/perinatal death, 40.0% resulted in abortion, 10.3% premature births and 29.7% full-term births. In the 84 pregnancies after the diagnosis and therapeutic intervention for thrombophilia, 6.0% resulted in fetal/ perinatal death, 1.2% in abortion, 22.6% in premature birth and 70.2% in full-term birth. We observed a significant reduction in the rate of stillbirths/perinatal death (p < 0.05) and abortion (p < 0.0001) and a significant increase (p < 0.05) in the number of live births after intervention in this high-risk population. Conclusions: Use of enoxaparin as a therapeutic intervention in pregnant women with poor obstetric background with thrombophilia is effective in improving perinatal outcome in subsequent pregnancies, reducing the rate of abortions and stillbirths/perinatal deaths and increasing the number of live births.
S757
W161 AMNIOTIC FLUID INDEX AND FETAL-NEONATAL OUTCOME IN EXPECTANT MANAGEMENT OF PRETERM PREMATURE RUPTURE OF MEMBRANES S. Taghavi1 , M. Sayyahmelli1 , S. Barband1 . 1 Tabriz Medical Science University, Tabriz, East azerbayjan, Iran, Islamic Republic of Objectives: Preterm premature rupture of membranes (PPROM) mostly results in continuous leakage of amniotic fluid and consequently in reduced amniotic fluid index (AFI) or even oligohydramnios. The purpose of this study is to identify whether amniotic fluid index has any influence on fetal-neonatal outcome in expectant management of PPROM? Materials: 60 patients with gestational age of 26–32w and PPROM were hospitalized in Alzahra Teaching Hospital of Tabriz Medical Science University in Tabriz (capital city of north west of Iran). Methods: They were treated with same protocol (antibiotic and betamethasone with the same dose and duration). Their AFI were measured two times a week and we did NST every day. The cases were divided in group 1 with AFI above 5 cm and group 2 with AFI ≤5 cm (oligohydramnios). The daily NST results and fetal-neonatal mortality and morbidity were compared between two groups. Results: The last NST before delivery was more frequently nonreactive in group 2 than group 1 (0% of group 1 and 10% of group 2, P = 0.05). The mechanical ventilation necessity was higher in group2 (6.7% in group 1 and 26.7% in group 2, P = 0.04). Conclusions: There is no district answer about influence of oligohydramnios on expectant management of PPROM but this study shows that patients with PPROM and AFI≤5 cm should be seriously advised to be hospitalized and they need to be more closely watched with fetal well-being tests than cases with AFI above 5 cm. W162 PLACENTA PREVIA: CLINICAL ANALYSIS OF 71 CASES P.N. Oliveira1 , I. Rocha2 , F.K. Mak1 , S. Ferreira1 , A. Lanhoso1 . 1 Entre Douro e Vouga Hospital Center (CHEDV), Santa Maria da Feira, Portugal; 2 Vila Nova de Gaia/Espinho Hospital Center, Gaia, Portugal Objectives: To evaluate risk factors, complications and obstetric outcomes in pregnant women with the diagnosis of placenta previa (PP). Materials: 71 clinical cases of pregnancies complicated with PP where all the deliveries were performed in CHEDV. Methods: A retrospective study was conducted by reviewing the case records of all patients with the diagnosis of PP between 1st of January 2000 and 31st of December 2011. The variables evaluated were maternal age, parity, gestational age at diagnosis, types of previous deliveries, types of PP, complications during pregnancy, gestational age at delivery, birth weight of the newborn (NB), route of delivery and its complications. Statistical analysis was carried out using Statistical Package of Social Science (SPSS) version 16.0. Results: A total of 71 cases were studied of which 62% were multiparous women and 26.8% had a history of cesarean section. It was found that 86% of cases suffered from vaginal bleeding during pregnancy and premature rupture of membrane (PROM) was observed in 14.1% of the cases. The mean maternal age at delivery and the mean gestational age were 31.9 years and 28.8 weeks respectively. Neonates from pregnancies complicated with PP were presented with mean gestational age at birth of 35.9 weeks and the mean weight of 2684 g. It was observed that cesarean section was performed in 93% of the total cases of which 53.5% had complications at birth. Of the cases classified as complete PP (n = 22), there was a history of cesarean section in 3 cases and 12 were multiparous. Of the 22 cases with complete PP, cesarean section was performed in all. Among the women who had vaginal bleeding during pregnancy (n = 61), 38 had complications at birth (p < 0.05) and the mean gestational age at delivery was 34.71 weeks. Patients without
S758
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
complications at birth presented a mean gestational age at delivery of 37 weeks (p < 0.05). In patients with and without vaginal bleeding during pregnancy, the mean gestational age at delivery were 35.5 weeks and 37.9 weeks respectively (p < 0.05). Of the women who had bleeding episode during pregnancy, the mean weight of the newborns was lower (2640 g) as compared to those who had no bleeding 2958 g, but no statistical difference between the 2 groups was observed (p > 0.05). Conclusions: In this study, there appears to be no association between history of previous cesarean section and multiparity with the occurrence of complete PP. In most cases of PP, there is a higher risk of bleeding episodes during pregnancy and birth complications. W163 DOES MECHANICAL CERVICAL RIPENING BY LAMINARIA PROMOTE INTRAUTERINE INFECTION IN CASES WITH PREMATURE RUPTURE OF MEMBRANES AT TERM? K. Kurasawa1 , M. Yamamoto1 , M. Okuda1 , T. Takahashi1 , F. Hirahara2 . 1 Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan; 2 Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan Objectives: We retrospectively investigated adverse events in mothers and babies arising from cervical ripening by laminaria during delivery in cases with premature rupture of membranes (PROM). Materials: Background variables, complications, and perinatal outcomes were analyzed and compared between two groups: (1) non-laminaria group (23 women for whom labor-inducing drugs were used due to lack of spontaneous labor among 139 women hospitalized based on a diagnosis of PROM between October 2010 and June 2011) and (2) laminaria group (219 women for whom a laminaria tent was inserted followed by use of labor-inducing drugs between January 2001 and September 2010). All women received antimicrobial drugs as well. Methods: Retrospective examination was carried out of the data obtained from medical records. Results: Mean Bishop score before labor-inducing drug use was 7.4 in the laminaria group and 5.2 in the non-laminaria group (p < 0.01). Labor duration was 7.84 hours in the laminaria group and 9.71 hours in the non-laminaria group (p = 0.164). There were no significant inter-group differences in stillbirth rate, intrauterine infection incidence, the incidence of non-reassuring fetal status, percentage of women undergoing cesarean section, amniotic fluid turbidity rate, or incidence of pathological chorioamnionitis. In terms of neonate Apgar scores (1/5 min), UA pH level, or percentage of neonates requiring NICU care, there were no significant differences between the laminaria and non-lamnaria groups. Conclusions: Mechanical cervical ripening by laminaria did not worsen outcomes of babies delivered after PROM at term. Laminaria use did not promote infection in the present study. W164 A CASE OF PREGNANCY COMPLICATED BY ADENOMYOSIS RESULTING IN SEVERE FETAL GROWTH RETARDATION T. Yorifuji1 , S. Makino1 , J. Takeda1 , T. Inagaki1 , M. Sugimura1 , S. Takeda1 . 1 Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan Objectives: In pregnancy complicated by adenomyosis, fetal growth retardation (FGR) may occur. However, few actual case reports have been described, and the mechanisms are not well unknown. We report herein a case of pregnancy complicated by adenomyosis, resulting in severe FGR. Materials: The patient was a 34-year-old gravida 4, para 1 woman. Methods: In this case, we confirmed decreased placental blood flow which was attributed to FGR with the none-contrast-enhanced time-spatial labeling inversion pulse (Time-SLIP) MRA technique,
which provides high resolution angiograms with image equal to enhanced MRA. Results: The current pregnancy was a natural pregnancy. Transvaginal ultrasonography in early pregnancy showed a 7-cm adenomyosis in the posterior wall of the uterine body. At 19 wks, estimated fetal weight was 117 g and symmetrical FGR was identified. She was thus managed as an inpatient from 20wks. The mother had no underlying medical disease, no infections, and no obstetric complications other than FGR. After admission, fetal wellbeing was frequently evaluated by transabdominal ultrasonography. On admission, the umbilical diastolic blood flow was not already identified, but amniotic fluid volume was maintained. The placenta was located in the uterine fundus, away from the adenomyosis. The site of umbilical cord insertion appeared normal. At 23wks, MRI revealed the 11-cm adenomyosis in the lower posterior wall of the uterus. On Time-SLIP-MRA, blood flow in the left uterine artery, as the feeding artery, was toward the adenomyosis, and placental blood flow was poor (Fig 1). Starting from 25 wks, uterine artery diastolic blood flow was reversed. On day 4 of 27wks, fetal movements decreased and fetal pericardial effusion and oligohydramnios were detected. Emergency cesarean section was therefore performed. A baby girl was delivered, weighing only 292 g with an Apgar score of 1 at both 1 and 5 min. Pulmonary hemorrhage occurred at 9 days old, and the baby died. Chromosomal analysis of chorionic villi showed a normal karyotype. Histological examination of the placenta revealed no obvious cause of FGR. Conclusions: Time-SLIP MRA confirmed decreased placental blood flow. In this case, the cause of FGR was attributed to “vascular steal” by the uterine adenomyosis, decreasing placental blood flow.
Figure 1.
W165 ELEVATED PLASMA NITRIC OXIDE MAY INFLUENCE THE MANAGEMENT RESPONSE AND OUTCOME IN ATONIC POSTPARTUM HEMORRHAGE OF ANEMIC WOMEN DURING LABOR M.H. Soltan1 , I.Y. Khalil1 , M.H. Ebrahim1 , S.A.A. El Gelany1 , H.H. Kamel1 . 1 Obstetrics and Gynecology, Minia University, Minia, Egypt Objectives: Were to determine whether hemoglobin (Hb) and plasma nitrite (PN) concentrations in women during labor correlate with conservative management (CM) response of atonic postpartum hemorrhage (PPH), and the severity of complications.
pregnancy at 28 to 34 weeks. 34.66% showed arrest of progression of preeclampsia with steady blood pressure (with or without anti-hypertensive), urine albumin trace to +2 and variable pedal edema with mild to moderate fetal growth retardation. They required termination at or near term. 18.66% started showing improvement, reduction in pedal edema, blood pressure and proteinuria and delivered spontaneously at or after 37 weeks, some required caesarean section for other obstetric indications. Group B: 66.66% did not show any improvement. 30.66% showed arrest in progression of preeclampsia. 2.66% showed improvement in signs of preeclampsia. Conclusions: If we compare outcomes of two groups, it suggests that providing a high dose of calcium in early preeclampsia helps to prolong duration of gestation and improves fetal survival rate. Table 1. Group
No improvement Termination before term
Arrest of progression Termination at/near term
Improvement Spontaneous delivery at/near term
A B
140 (46.66%) 200 (66.66%)
104 (34.66%) 92 (30.66%)
56 (18.66%) 8 (02.66%)
Table 2. Group
Maternal morbiditya
Maternal mortality
A B
5 APH, 2 HELLP syndrome 4 APH, 3 HELLP syndrome
0 0
a
In terms of APH, DIC (HELLP syndrome), & acute renal failure.
W160 EFFECTIVENESS OF AN ENOXAPARIN-BASED INTERVENTION ON PERINATAL OUTCOMES IN HIGH RISK PREGNANT WOMEN WITH HEREDITARY/ACQUIRED THROMBOPHILIAS E.A. Figueiro-Filho1 , V.M. Oliveira1 , L.R. Coelho1 , I. Breda1 . 1 Obstetrics and Gynecology, Faculty of Medicine – Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil Objectives: To assess whether an enoxaparin-based intervention was effective in reducing adverse obstetric events and to improve perinatal outcome in women with hereditary/acquired thrombophilia and poor obstetric background. Materials: This was a prospective, not randomized, uncontrolled study performed from October 2009 to October 2010. Methods: The women had obstetric and perinatal data for hereditary/acquired thrombophilia prior intervention compared with obstetric and perinatal outcomes following an enoxaparinbased intervention. Results: We included 84 pregnant women with 175 pregnancies before diagnosis, of which 20.0% resulted in fetal/perinatal death, 40.0% resulted in abortion, 10.3% premature births and 29.7% full-term births. In the 84 pregnancies after the diagnosis and therapeutic intervention for thrombophilia, 6.0% resulted in fetal/ perinatal death, 1.2% in abortion, 22.6% in premature birth and 70.2% in full-term birth. We observed a significant reduction in the rate of stillbirths/perinatal death (p < 0.05) and abortion (p < 0.0001) and a significant increase (p < 0.05) in the number of live births after intervention in this high-risk population. Conclusions: Use of enoxaparin as a therapeutic intervention in pregnant women with poor obstetric background with thrombophilia is effective in improving perinatal outcome in subsequent pregnancies, reducing the rate of abortions and stillbirths/perinatal deaths and increasing the number of live births.
S757
W161 AMNIOTIC FLUID INDEX AND FETAL-NEONATAL OUTCOME IN EXPECTANT MANAGEMENT OF PRETERM PREMATURE RUPTURE OF MEMBRANES S. Taghavi1 , M. Sayyahmelli1 , S. Barband1 . 1 Tabriz Medical Science University, Tabriz, East azerbayjan, Iran, Islamic Republic of Objectives: Preterm premature rupture of membranes (PPROM) mostly results in continuous leakage of amniotic fluid and consequently in reduced amniotic fluid index (AFI) or even oligohydramnios. The purpose of this study is to identify whether amniotic fluid index has any influence on fetal-neonatal outcome in expectant management of PPROM? Materials: 60 patients with gestational age of 26–32w and PPROM were hospitalized in Alzahra Teaching Hospital of Tabriz Medical Science University in Tabriz (capital city of north west of Iran). Methods: They were treated with same protocol (antibiotic and betamethasone with the same dose and duration). Their AFI were measured two times a week and we did NST every day. The cases were divided in group 1 with AFI above 5 cm and group 2 with AFI ≤5 cm (oligohydramnios). The daily NST results and fetal-neonatal mortality and morbidity were compared between two groups. Results: The last NST before delivery was more frequently nonreactive in group 2 than group 1 (0% of group 1 and 10% of group 2, P = 0.05). The mechanical ventilation necessity was higher in group2 (6.7% in group 1 and 26.7% in group 2, P = 0.04). Conclusions: There is no district answer about influence of oligohydramnios on expectant management of PPROM but this study shows that patients with PPROM and AFI≤5 cm should be seriously advised to be hospitalized and they need to be more closely watched with fetal well-being tests than cases with AFI above 5 cm. W162 PLACENTA PREVIA: CLINICAL ANALYSIS OF 71 CASES P.N. Oliveira1 , I. Rocha2 , F.K. Mak1 , S. Ferreira1 , A. Lanhoso1 . 1 Entre Douro e Vouga Hospital Center (CHEDV), Santa Maria da Feira, Portugal; 2 Vila Nova de Gaia/Espinho Hospital Center, Gaia, Portugal Objectives: To evaluate risk factors, complications and obstetric outcomes in pregnant women with the diagnosis of placenta previa (PP). Materials: 71 clinical cases of pregnancies complicated with PP where all the deliveries were performed in CHEDV. Methods: A retrospective study was conducted by reviewing the case records of all patients with the diagnosis of PP between 1st of January 2000 and 31st of December 2011. The variables evaluated were maternal age, parity, gestational age at diagnosis, types of previous deliveries, types of PP, complications during pregnancy, gestational age at delivery, birth weight of the newborn (NB), route of delivery and its complications. Statistical analysis was carried out using Statistical Package of Social Science (SPSS) version 16.0. Results: A total of 71 cases were studied of which 62% were multiparous women and 26.8% had a history of cesarean section. It was found that 86% of cases suffered from vaginal bleeding during pregnancy and premature rupture of membrane (PROM) was observed in 14.1% of the cases. The mean maternal age at delivery and the mean gestational age were 31.9 years and 28.8 weeks respectively. Neonates from pregnancies complicated with PP were presented with mean gestational age at birth of 35.9 weeks and the mean weight of 2684 g. It was observed that cesarean section was performed in 93% of the total cases of which 53.5% had complications at birth. Of the cases classified as complete PP (n = 22), there was a history of cesarean section in 3 cases and 12 were multiparous. Of the 22 cases with complete PP, cesarean section was performed in all. Among the women who had vaginal bleeding during pregnancy (n = 61), 38 had complications at birth (p < 0.05) and the mean gestational age at delivery was 34.71 weeks. Patients without
S758
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
complications at birth presented a mean gestational age at delivery of 37 weeks (p < 0.05). In patients with and without vaginal bleeding during pregnancy, the mean gestational age at delivery were 35.5 weeks and 37.9 weeks respectively (p < 0.05). Of the women who had bleeding episode during pregnancy, the mean weight of the newborns was lower (2640 g) as compared to those who had no bleeding 2958 g, but no statistical difference between the 2 groups was observed (p > 0.05). Conclusions: In this study, there appears to be no association between history of previous cesarean section and multiparity with the occurrence of complete PP. In most cases of PP, there is a higher risk of bleeding episodes during pregnancy and birth complications. W163 DOES MECHANICAL CERVICAL RIPENING BY LAMINARIA PROMOTE INTRAUTERINE INFECTION IN CASES WITH PREMATURE RUPTURE OF MEMBRANES AT TERM? K. Kurasawa1 , M. Yamamoto1 , M. Okuda1 , T. Takahashi1 , F. Hirahara2 . 1 Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan; 2 Obstetrics and Gynecology, Yokohama City University, Yokohama, Japan Objectives: We retrospectively investigated adverse events in mothers and babies arising from cervical ripening by laminaria during delivery in cases with premature rupture of membranes (PROM). Materials: Background variables, complications, and perinatal outcomes were analyzed and compared between two groups: (1) non-laminaria group (23 women for whom labor-inducing drugs were used due to lack of spontaneous labor among 139 women hospitalized based on a diagnosis of PROM between October 2010 and June 2011) and (2) laminaria group (219 women for whom a laminaria tent was inserted followed by use of labor-inducing drugs between January 2001 and September 2010). All women received antimicrobial drugs as well. Methods: Retrospective examination was carried out of the data obtained from medical records. Results: Mean Bishop score before labor-inducing drug use was 7.4 in the laminaria group and 5.2 in the non-laminaria group (p < 0.01). Labor duration was 7.84 hours in the laminaria group and 9.71 hours in the non-laminaria group (p = 0.164). There were no significant inter-group differences in stillbirth rate, intrauterine infection incidence, the incidence of non-reassuring fetal status, percentage of women undergoing cesarean section, amniotic fluid turbidity rate, or incidence of pathological chorioamnionitis. In terms of neonate Apgar scores (1/5 min), UA pH level, or percentage of neonates requiring NICU care, there were no significant differences between the laminaria and non-lamnaria groups. Conclusions: Mechanical cervical ripening by laminaria did not worsen outcomes of babies delivered after PROM at term. Laminaria use did not promote infection in the present study. W164 A CASE OF PREGNANCY COMPLICATED BY ADENOMYOSIS RESULTING IN SEVERE FETAL GROWTH RETARDATION T. Yorifuji1 , S. Makino1 , J. Takeda1 , T. Inagaki1 , M. Sugimura1 , S. Takeda1 . 1 Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan Objectives: In pregnancy complicated by adenomyosis, fetal growth retardation (FGR) may occur. However, few actual case reports have been described, and the mechanisms are not well unknown. We report herein a case of pregnancy complicated by adenomyosis, resulting in severe FGR. Materials: The patient was a 34-year-old gravida 4, para 1 woman. Methods: In this case, we confirmed decreased placental blood flow which was attributed to FGR with the none-contrast-enhanced time-spatial labeling inversion pulse (Time-SLIP) MRA technique,
which provides high resolution angiograms with image equal to enhanced MRA. Results: The current pregnancy was a natural pregnancy. Transvaginal ultrasonography in early pregnancy showed a 7-cm adenomyosis in the posterior wall of the uterine body. At 19 wks, estimated fetal weight was 117 g and symmetrical FGR was identified. She was thus managed as an inpatient from 20wks. The mother had no underlying medical disease, no infections, and no obstetric complications other than FGR. After admission, fetal wellbeing was frequently evaluated by transabdominal ultrasonography. On admission, the umbilical diastolic blood flow was not already identified, but amniotic fluid volume was maintained. The placenta was located in the uterine fundus, away from the adenomyosis. The site of umbilical cord insertion appeared normal. At 23wks, MRI revealed the 11-cm adenomyosis in the lower posterior wall of the uterus. On Time-SLIP-MRA, blood flow in the left uterine artery, as the feeding artery, was toward the adenomyosis, and placental blood flow was poor (Fig 1). Starting from 25 wks, uterine artery diastolic blood flow was reversed. On day 4 of 27wks, fetal movements decreased and fetal pericardial effusion and oligohydramnios were detected. Emergency cesarean section was therefore performed. A baby girl was delivered, weighing only 292 g with an Apgar score of 1 at both 1 and 5 min. Pulmonary hemorrhage occurred at 9 days old, and the baby died. Chromosomal analysis of chorionic villi showed a normal karyotype. Histological examination of the placenta revealed no obvious cause of FGR. Conclusions: Time-SLIP MRA confirmed decreased placental blood flow. In this case, the cause of FGR was attributed to “vascular steal” by the uterine adenomyosis, decreasing placental blood flow.
Figure 1.
W165 ELEVATED PLASMA NITRIC OXIDE MAY INFLUENCE THE MANAGEMENT RESPONSE AND OUTCOME IN ATONIC POSTPARTUM HEMORRHAGE OF ANEMIC WOMEN DURING LABOR M.H. Soltan1 , I.Y. Khalil1 , M.H. Ebrahim1 , S.A.A. El Gelany1 , H.H. Kamel1 . 1 Obstetrics and Gynecology, Minia University, Minia, Egypt Objectives: Were to determine whether hemoglobin (Hb) and plasma nitrite (PN) concentrations in women during labor correlate with conservative management (CM) response of atonic postpartum hemorrhage (PPH), and the severity of complications.