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W170 PREGNANT IN YOUR FORTIES – BETTER LATE THAN NEVER!
S760
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
carcinoma is increasing. This increasing has raised concerns about the high preterm birth rate as an effect of the procedure on subsequent pregnancies. This study aimed to elucidate the risk factors for preterm birth after cervical conization, by examination of the course and perinatal outcomes of pregnancy in patients undergoing cervical conization. Materials: The study involved 101 cases of pregnancy developing after conization that were managed for pregnancy and delivery at our hospital (including cases of maternal transport) between 2000 and 2011. Methods: Retrospective examination was carried out of the data obtained from medical records and the results of histopathological examination. Results: Of the total of 101 cases of pregnancy after conization, 38 developed preterm birth, 61 had term deliveries, and 2 had mid-term abortions. The mean cervical length measured in the second trimester (17 to 20 weeks of gestation) was 3.28 cm in the cases developing preterm birth and 4.55 cm in the cases with term deliveries, showing significant shortening of the cervical length in the second trimester in the cases developing preterm birth (P < 0.05). Preterm premature rupture of membranes occurred in 21 of the 25 preterm birth before 34 weeks of gestation, and the placental pathological findings revealed chorioamnionitis in all 21 cases. In the examination of the 23 conization specimens from the 19 patients who underwent conization at our hospital, the mean depth of conization was 1.21 cm in the cases with term deliveries and 1.5 cm in the cases that developed preterm birth, the size of the excisions being significantly larger in the preterm birth cases (P < 0.05). The mean cone volume of the conization specimens was 2.69 cm3 in the cases with term delivery and 4.68 cm3 in the cases that developed preterm birth, indicating a significantly larger volume of resection in the cases of premature labor (P < 0.01). Conclusions: In pregnancies developing after conization, cases with shorter cervical length in the second trimester and with larger depth and volume of the conization specimens tended to have preterm birth. Since chorioamnionitis was more common in the cases that developed preterm birth, one of the possible causes of premature labor was considered to be attenuation of the defense mechanisms against infection in the cervical canal during pregnancy after conization. W170 PREGNANT IN YOUR FORTIES – BETTER LATE THAN NEVER! V. Nair1 , D. Vinayagam2 , A. Anantharachagan2 . 1 Kingston Hospital NHS Trust, London, United Kingdom; 2 St George’s Hospital NHS Trust, London, United Kingdom Objectives: With the ever changing roles of modern women, more and more women are delaying their pregnancies. It is not unusual to see women in their forties having their first birthing experience. This brings upon a huge responsibility on us obstetricians to make this experience as satisfying and risk-free as possible to these women. Materials and Methods: A retrospective analysis of 50 women aged 40 or more who delivered during a three-month period from August to October 2011. The women were chosen by random selection. Data was analysed using Microsoft Excel. Results: The women were aged between 40 and 47 with the average age being 41.4 years. There were 2 women who were 47 years of age, of whom one was a primiparous. 24% of the women were primiparous and 76% multiparous. 40% of the women had spontaneous labour, 22% requested elective Caesarean section and 38% needed induction of labour. 74% had vaginal births, of which 56% of women had spontaneous delivery, 12% needed forceps and 6% needed ventouse delivery. The Caesarean section rate was 26% of which elective was 22%. The average gestational age for delivery was 39 weeks with only 2 women delivering after 41 weeks. 18% of the women had intrapartum complications. 10% had postpartum
haemorrhage, 6% had 3rd degree perineal tear and 1 woman had shoulder dystocia. 2 of the babies needed admission to neonatal unit for careful monitoring. Conclusions: As evidenced by this study, majority of the women who are 40 years and above give birth to healthy babies without any major complications. However, it must be borne in mind that there is an increased request for elective Caesarean sections and those women who have not been delivered by term are generally induced before they are 41 weeks of gestation. The intrapartum complications risks are also noted to be slightly higher in women who are 40 and above. W171 DOES PLANNED PREGNANCY FOR WOMEN WITH EPILEPSY IMPROVE SEIZURE CONTROL DURING PREGNANCY AND REDUCE ADVERSE MATERNAL AND NEONATAL OUTCOMES? K. Abe1 , H. Hamada1 , T. Yamada2 , H. Minakami3 , H. Yoshikawa1 . 1 Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Ibaraki, Japan; 2 Hokkaido University Hospital, Sapporo, Hokkaido, Japan; 3 Hokkaido University, Sapporo, Hokkaido, Japan Objectives: To investigate whether planned pregnancy for women with epilepsy contributes to good seizure control and reduced adverse maternal and neonatal outcomes. Materials: We reviewed the medical records of 153 pregnant women with epilepsy who were treated at Tsukuba University Hospital and Hokkaido University Hospital from 2003 to 2011. Methods: This study was a retrospective cohort study. We excluded 21 pregnant patients because we were uncertain whether pregnancy planning was considered during their neurological management. The study population included patients who had been followed by neurologists with special reference to their planned pregnancies (planned pregnancy group, n = 51) and patients who were referred to neurologists after conception (unplanned pregnancy group, n = 81). We statistically compared the treatment profile for epilepsy, seizure control, and maternal and neonatal outcomes between the 2 groups. Data were analyzed using Fisher’s exact test and the Mann-Whitney U test. Results: Compared to the unplanned pregnancy group, the planned pregnancy group had a significantly larger proportion of patients who had undergone monotherapy with antiepileptic drugs (AEDs) (61% vs 46%, p = 0.049) and who had avoided valproic acid (79% vs 57%, p = 0.046) during pregnancy. In the planned pregnancy group, which showed good compliance with the AED regimen (95% vs 75% in the unplanned group, p = 0.014), a significantly smaller proportion of patients experienced epileptic seizure attacks (16% vs 35%, p = 0.018) or needed AED adjustment (24% vs 40%, p = 0.042) during pregnancy. Further, the planned pregnancy group had a higher rate of live births (96% vs 88%, p = 0.13) and a lower rate of neonatal withdrawal syndrome (0% vs 3%, p = 0.52) and NICU/GCU admission (16% vs 22%, p = 0.45) than the unplanned pregnancy group. The 2 groups did not show any significant difference with regard to obstetric complications and congenital malformations. Conclusions: In women with epilepsy, planned pregnancy improves seizure control and reduces fetal exposure to AEDs during pregnancy. Planned pregnancy may also improve neonatal outcomes, but this study could not confirm this possibility. W172 WHAT IS THE ROLE OF GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY IN PREECLAMPSIA? A. Rasekh Jahromi1 . 1 Ob & Gyn, Jahrom university of Medical Science, Jahrom, fars, Iran, Islamic Republic of Objectives: Glucose-6-phosphate dehydrogenase deficiency (G6 PD.D) is a common enzyme deficiency in the world and X-linked recessive hereditary disease featuring non immune hemolytic anemia in response to a number of causes. Its prevalence in our country, Iran is 12% in male & 2% in famle. Preeclampsia
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
carcinoma is increasing. This increasing has raised concerns about the high preterm birth rate as an effect of the procedure on subsequent pregnancies. This study aimed to elucidate the risk factors for preterm birth after cervical conization, by examination of the course and perinatal outcomes of pregnancy in patients undergoing cervical conization. Materials: The study involved 101 cases of pregnancy developing after conization that were managed for pregnancy and delivery at our hospital (including cases of maternal transport) between 2000 and 2011. Methods: Retrospective examination was carried out of the data obtained from medical records and the results of histopathological examination. Results: Of the total of 101 cases of pregnancy after conization, 38 developed preterm birth, 61 had term deliveries, and 2 had mid-term abortions. The mean cervical length measured in the second trimester (17 to 20 weeks of gestation) was 3.28 cm in the cases developing preterm birth and 4.55 cm in the cases with term deliveries, showing significant shortening of the cervical length in the second trimester in the cases developing preterm birth (P < 0.05). Preterm premature rupture of membranes occurred in 21 of the 25 preterm birth before 34 weeks of gestation, and the placental pathological findings revealed chorioamnionitis in all 21 cases. In the examination of the 23 conization specimens from the 19 patients who underwent conization at our hospital, the mean depth of conization was 1.21 cm in the cases with term deliveries and 1.5 cm in the cases that developed preterm birth, the size of the excisions being significantly larger in the preterm birth cases (P < 0.05). The mean cone volume of the conization specimens was 2.69 cm3 in the cases with term delivery and 4.68 cm3 in the cases that developed preterm birth, indicating a significantly larger volume of resection in the cases of premature labor (P < 0.01). Conclusions: In pregnancies developing after conization, cases with shorter cervical length in the second trimester and with larger depth and volume of the conization specimens tended to have preterm birth. Since chorioamnionitis was more common in the cases that developed preterm birth, one of the possible causes of premature labor was considered to be attenuation of the defense mechanisms against infection in the cervical canal during pregnancy after conization. W170 PREGNANT IN YOUR FORTIES – BETTER LATE THAN NEVER! V. Nair1 , D. Vinayagam2 , A. Anantharachagan2 . 1 Kingston Hospital NHS Trust, London, United Kingdom; 2 St George’s Hospital NHS Trust, London, United Kingdom Objectives: With the ever changing roles of modern women, more and more women are delaying their pregnancies. It is not unusual to see women in their forties having their first birthing experience. This brings upon a huge responsibility on us obstetricians to make this experience as satisfying and risk-free as possible to these women. Materials and Methods: A retrospective analysis of 50 women aged 40 or more who delivered during a three-month period from August to October 2011. The women were chosen by random selection. Data was analysed using Microsoft Excel. Results: The women were aged between 40 and 47 with the average age being 41.4 years. There were 2 women who were 47 years of age, of whom one was a primiparous. 24% of the women were primiparous and 76% multiparous. 40% of the women had spontaneous labour, 22% requested elective Caesarean section and 38% needed induction of labour. 74% had vaginal births, of which 56% of women had spontaneous delivery, 12% needed forceps and 6% needed ventouse delivery. The Caesarean section rate was 26% of which elective was 22%. The average gestational age for delivery was 39 weeks with only 2 women delivering after 41 weeks. 18% of the women had intrapartum complications. 10% had postpartum
haemorrhage, 6% had 3rd degree perineal tear and 1 woman had shoulder dystocia. 2 of the babies needed admission to neonatal unit for careful monitoring. Conclusions: As evidenced by this study, majority of the women who are 40 years and above give birth to healthy babies without any major complications. However, it must be borne in mind that there is an increased request for elective Caesarean sections and those women who have not been delivered by term are generally induced before they are 41 weeks of gestation. The intrapartum complications risks are also noted to be slightly higher in women who are 40 and above. W171 DOES PLANNED PREGNANCY FOR WOMEN WITH EPILEPSY IMPROVE SEIZURE CONTROL DURING PREGNANCY AND REDUCE ADVERSE MATERNAL AND NEONATAL OUTCOMES? K. Abe1 , H. Hamada1 , T. Yamada2 , H. Minakami3 , H. Yoshikawa1 . 1 Obstetrics and Gynecology, University of Tsukuba, Tsukuba, Ibaraki, Japan; 2 Hokkaido University Hospital, Sapporo, Hokkaido, Japan; 3 Hokkaido University, Sapporo, Hokkaido, Japan Objectives: To investigate whether planned pregnancy for women with epilepsy contributes to good seizure control and reduced adverse maternal and neonatal outcomes. Materials: We reviewed the medical records of 153 pregnant women with epilepsy who were treated at Tsukuba University Hospital and Hokkaido University Hospital from 2003 to 2011. Methods: This study was a retrospective cohort study. We excluded 21 pregnant patients because we were uncertain whether pregnancy planning was considered during their neurological management. The study population included patients who had been followed by neurologists with special reference to their planned pregnancies (planned pregnancy group, n = 51) and patients who were referred to neurologists after conception (unplanned pregnancy group, n = 81). We statistically compared the treatment profile for epilepsy, seizure control, and maternal and neonatal outcomes between the 2 groups. Data were analyzed using Fisher’s exact test and the Mann-Whitney U test. Results: Compared to the unplanned pregnancy group, the planned pregnancy group had a significantly larger proportion of patients who had undergone monotherapy with antiepileptic drugs (AEDs) (61% vs 46%, p = 0.049) and who had avoided valproic acid (79% vs 57%, p = 0.046) during pregnancy. In the planned pregnancy group, which showed good compliance with the AED regimen (95% vs 75% in the unplanned group, p = 0.014), a significantly smaller proportion of patients experienced epileptic seizure attacks (16% vs 35%, p = 0.018) or needed AED adjustment (24% vs 40%, p = 0.042) during pregnancy. Further, the planned pregnancy group had a higher rate of live births (96% vs 88%, p = 0.13) and a lower rate of neonatal withdrawal syndrome (0% vs 3%, p = 0.52) and NICU/GCU admission (16% vs 22%, p = 0.45) than the unplanned pregnancy group. The 2 groups did not show any significant difference with regard to obstetric complications and congenital malformations. Conclusions: In women with epilepsy, planned pregnancy improves seizure control and reduces fetal exposure to AEDs during pregnancy. Planned pregnancy may also improve neonatal outcomes, but this study could not confirm this possibility. W172 WHAT IS THE ROLE OF GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY IN PREECLAMPSIA? A. Rasekh Jahromi1 . 1 Ob & Gyn, Jahrom university of Medical Science, Jahrom, fars, Iran, Islamic Republic of Objectives: Glucose-6-phosphate dehydrogenase deficiency (G6 PD.D) is a common enzyme deficiency in the world and X-linked recessive hereditary disease featuring non immune hemolytic anemia in response to a number of causes. Its prevalence in our country, Iran is 12% in male & 2% in famle. Preeclampsia