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W188 CERVICAL CERCLAGE: A 5 YEAR EXPERIENCE IN A DISTRICT GENERAL HOSPITAL IN THE UNITED KINGDOM
S766
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
W187 MATERNAL AND FOETAL OUTCOME OF TEENAGE PREGNANCY F. Sultana1 , N. Hossain1 . 1 Rangpur Medical College, Rangpur, Bangladesh Objectives: • To evaluate the compelling factors that lead to teenage marriage and pregnancy. • To evaluate the outcome of teenage pregnancy. • To evaluate the outcome of teenage labour. • To findout the perinatal outcome. Materials: It was descriptive type of cross sectional study inDepartment of Obstetric and Gynaecology (indoor), Rangpur Medical College Hospital from February 2008 to February 2009. Study was done among the admitted patient’s in between age 10–19 years having viable pregnancy (28 completed weeks or more). One hundred cases of pregnancy between age 10–19 years were selected randomly after taking their informed written consent. Data were recorded on a pre-designed data collection sheet. Methods: After formulation of aim and objectives of the study a data sheet was made for recording all relevant parameters. Careful history and through clinical examination was performed. Antenatal complication like anaemia, hypertention, oedema jaundice, premature rupture of membrane, pre-eclampsia, eclampsia, antepartum haemorrhage, IUGR were recorded. Intrapartum complications like eclampsia, prolonged labour, obstructed labour, or immediate postpartum complication which occurred within 24 hours of delivery in a hospital were also recorded. Data was compiled on a master sheet and processed by a computer. Data was analyzed as frequency percentage in tables using computer based software Microsoft Excel Statistical program. Results: Overall distribution of teenage pregnancy was 5.52%. 36% were 19 years and 54% were 18 years old. 54% of teenage mother had come from rural areas. 94% of them had come from low socioeconomic class and 93% were housewives. 41% teenage mother were illiterate. 93% of teenager mothers were non contraceptive users and 17% pregnancy were unplanned. Anaemia (35%) was the major complication during pregnancy. The incidence of vaginal delivery among teenage mothers was about 65%. 35% of teenage mother had undergone caesarean section and 60% section were due to CPD. There was about 7% perinatal mortality and maternal mortality was nil. Conclusions: As the study has taken place in a developing country like Bangladesh, it will help to reduce maternal & perinatal mortality by identification of compelling factor of teenage pregnancy, major complication during pregnancy & labour. W188 CERVICAL CERCLAGE: A 5 YEAR EXPERIENCE IN A DISTRICT GENERAL HOSPITAL IN THE UNITED KINGDOM S. Basak1 , S. Basak1 , H. Nosib1 . 1 Obstetrics and Gynaecology, Bedford Hospital NHS Trust, Bedford, United Kingdom Objectives: To assess the efficacy of cervical cerclage in prolonging high risk pregnancies in cases performed based on history, ultrasound and emergency rescue cerclage. To review local practice of pre-operative swabs, intra-operative antibiotics, post-operative Indomethacin and Progesterone and post-cerclage ultrasound surveillance. Materials: We compared the outcome of three groups of women who had cerclage based on history, cervical length less than or equal to 25 mm on ultrasound and rescue cerclage. We analysed the indications for cerclage, gestation of stitch insertion and removal and the mode and gestation of delivery. Methods: Retrospective analysis of 30 cases performed in a District General Hospital between 2006–2011. Results: 12 women (40%) had cerclage entirely based on history of one or more mid-trimester losses or preterm delivery, previous successful cervical cerclage or previous cervical cone biopsy. 7 of
these women (58.3%) delivered after 36 weeks with good neonatal outcome. 15 women (50%) with similar history had cerclage following ultrasound surveillance and cervical length <25 mm with or without funnelling. 10 of these women (66.7%) delivered after 36 weeks. 3 women (10%) had rescue cerclage at 19–22 week and all miscarried 1–10 days later. 4 patients had in-utero transfer at <32 weeks following preterm premature rupture of membranes and preterm labour for tertiary neonatal care. The local practice for pre-operative high vaginal swabs, intraoperative antibiotics, post-operative Indomethacin and Progesterone and post-cerclage ultrasound surveillance were inconsistent within our unit. This is possibly a reflection of their limited evidence of benefit. Conclusions: Cervical cerclage appears to prolong pregnancy in high risk women selected on the basis of history or ultrasound however our study is limited by low numbers. Effect on perinatal morbidity and mortality remains unknown from our data. Rescue cerclage in contrast was unsuccessful in all cases. Clinicians should consider whether it is justifiable to offer cerclage to such women with maternal morbidity implications. We have identified a lack of consistency in pre and post operative care for women in our unit and will be establishing a protocol in our unit to facilitate this process. Our results are consistent with the recently published RCOG guidelines for suture insertion based on ultrasound findings and history. W189 PLACENTAL VASCULARIZATION IN DIABETIC AND MILD HYPERGLYCEMIC PREGNANCIES L. De Rosa1,2 , A.M.C. Ruocco1 , J. Moreli1 , S. Corrˆea-Silva1,2 , E. Bevilacqua2 , M.V.C. Rudge1 , I. Calderon1 . 1 Medical School, UNESP, Botucatu, Sao Paulo, Brazil; 2 University of S˜ ao Paulo, USP, Sao Paulo, Sao Paulo, Brazil Objectives: To assess central and peripheral placental villous vessels in diabetic and mild hyperglycemic pregnancies. Materials: Central (CVV) and peripheral villous vessels (PVV) were evaluated in placentas of pregnant women with (i) mild gestational hyperglycemia [MGH; normal 100g-GTT and abnormal glycemic profile (GP); n = 10]; (ii) gestational diabetes mellitus [GDM; abnormal 100g-GTT and GP; n = 10] and (iii) diabetes mellitus type 2 [DM2; previous abnormal 100g-GTT; n = 10]. The control group consisted of non-diabetic pregnant women [ND; n = 10]. Methods: Placental samples were randomly selected for blind morphometric assessment with an image analyzer system. The vessels of five fields/slide were counted and classified (400X) as either PVV (≤10 mm from the margin villous) or CVV (>10 mm). Vessel number, area (mm2 ), and perimeter (mm) were measured, as well as vessel area/total villous area ratio (vascularization ratio; %). Placental morphometric variables were adjusted by the generalized linear model (GLM), assuming gamma distribution, and compared by GENMOD test for statistical analysis (p < 0.05). Results: In DM2 (117.43±28.48 mg/dL) and GDM (110.58±7.01 mg/dL), maternal glycemic mean (MGM) value was higher than in ND (82.21±12.02 mg/dL), whereas in MGH (97.05±7.94 mg/dL) it was intermediate between those in the diabetic groups and controls (p = 0.0001). There was no statistical difference in CVV morphometric parameters. However, except for vascular area, PVV morphometric results were different among groups. PVV perimeter tended to be higher (p = 0.0676) in the DM2 (2268.64±3914.59 mm). PVV number was higher in ND (13.58±6.28) and MGH (13.00±5.55), intermediate in GDM (11.62±5.44) and lower in DM2 (10.31±5.64) (p = 0.0432). Vascularization ratio was lower in DM2 (4.38±2.98%) (p = 0.0113) compared with ND (6.18±2.75%), MGH (5.18±2.49%) and GDM (5.42±2.61%). Conclusions: Placental PVV number and vascularization ratio were similar in the MGH and ND groups, and inversely associated
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
W187 MATERNAL AND FOETAL OUTCOME OF TEENAGE PREGNANCY F. Sultana1 , N. Hossain1 . 1 Rangpur Medical College, Rangpur, Bangladesh Objectives: • To evaluate the compelling factors that lead to teenage marriage and pregnancy. • To evaluate the outcome of teenage pregnancy. • To evaluate the outcome of teenage labour. • To findout the perinatal outcome. Materials: It was descriptive type of cross sectional study inDepartment of Obstetric and Gynaecology (indoor), Rangpur Medical College Hospital from February 2008 to February 2009. Study was done among the admitted patient’s in between age 10–19 years having viable pregnancy (28 completed weeks or more). One hundred cases of pregnancy between age 10–19 years were selected randomly after taking their informed written consent. Data were recorded on a pre-designed data collection sheet. Methods: After formulation of aim and objectives of the study a data sheet was made for recording all relevant parameters. Careful history and through clinical examination was performed. Antenatal complication like anaemia, hypertention, oedema jaundice, premature rupture of membrane, pre-eclampsia, eclampsia, antepartum haemorrhage, IUGR were recorded. Intrapartum complications like eclampsia, prolonged labour, obstructed labour, or immediate postpartum complication which occurred within 24 hours of delivery in a hospital were also recorded. Data was compiled on a master sheet and processed by a computer. Data was analyzed as frequency percentage in tables using computer based software Microsoft Excel Statistical program. Results: Overall distribution of teenage pregnancy was 5.52%. 36% were 19 years and 54% were 18 years old. 54% of teenage mother had come from rural areas. 94% of them had come from low socioeconomic class and 93% were housewives. 41% teenage mother were illiterate. 93% of teenager mothers were non contraceptive users and 17% pregnancy were unplanned. Anaemia (35%) was the major complication during pregnancy. The incidence of vaginal delivery among teenage mothers was about 65%. 35% of teenage mother had undergone caesarean section and 60% section were due to CPD. There was about 7% perinatal mortality and maternal mortality was nil. Conclusions: As the study has taken place in a developing country like Bangladesh, it will help to reduce maternal & perinatal mortality by identification of compelling factor of teenage pregnancy, major complication during pregnancy & labour. W188 CERVICAL CERCLAGE: A 5 YEAR EXPERIENCE IN A DISTRICT GENERAL HOSPITAL IN THE UNITED KINGDOM S. Basak1 , S. Basak1 , H. Nosib1 . 1 Obstetrics and Gynaecology, Bedford Hospital NHS Trust, Bedford, United Kingdom Objectives: To assess the efficacy of cervical cerclage in prolonging high risk pregnancies in cases performed based on history, ultrasound and emergency rescue cerclage. To review local practice of pre-operative swabs, intra-operative antibiotics, post-operative Indomethacin and Progesterone and post-cerclage ultrasound surveillance. Materials: We compared the outcome of three groups of women who had cerclage based on history, cervical length less than or equal to 25 mm on ultrasound and rescue cerclage. We analysed the indications for cerclage, gestation of stitch insertion and removal and the mode and gestation of delivery. Methods: Retrospective analysis of 30 cases performed in a District General Hospital between 2006–2011. Results: 12 women (40%) had cerclage entirely based on history of one or more mid-trimester losses or preterm delivery, previous successful cervical cerclage or previous cervical cone biopsy. 7 of
these women (58.3%) delivered after 36 weeks with good neonatal outcome. 15 women (50%) with similar history had cerclage following ultrasound surveillance and cervical length <25 mm with or without funnelling. 10 of these women (66.7%) delivered after 36 weeks. 3 women (10%) had rescue cerclage at 19–22 week and all miscarried 1–10 days later. 4 patients had in-utero transfer at <32 weeks following preterm premature rupture of membranes and preterm labour for tertiary neonatal care. The local practice for pre-operative high vaginal swabs, intraoperative antibiotics, post-operative Indomethacin and Progesterone and post-cerclage ultrasound surveillance were inconsistent within our unit. This is possibly a reflection of their limited evidence of benefit. Conclusions: Cervical cerclage appears to prolong pregnancy in high risk women selected on the basis of history or ultrasound however our study is limited by low numbers. Effect on perinatal morbidity and mortality remains unknown from our data. Rescue cerclage in contrast was unsuccessful in all cases. Clinicians should consider whether it is justifiable to offer cerclage to such women with maternal morbidity implications. We have identified a lack of consistency in pre and post operative care for women in our unit and will be establishing a protocol in our unit to facilitate this process. Our results are consistent with the recently published RCOG guidelines for suture insertion based on ultrasound findings and history. W189 PLACENTAL VASCULARIZATION IN DIABETIC AND MILD HYPERGLYCEMIC PREGNANCIES L. De Rosa1,2 , A.M.C. Ruocco1 , J. Moreli1 , S. Corrˆea-Silva1,2 , E. Bevilacqua2 , M.V.C. Rudge1 , I. Calderon1 . 1 Medical School, UNESP, Botucatu, Sao Paulo, Brazil; 2 University of S˜ ao Paulo, USP, Sao Paulo, Sao Paulo, Brazil Objectives: To assess central and peripheral placental villous vessels in diabetic and mild hyperglycemic pregnancies. Materials: Central (CVV) and peripheral villous vessels (PVV) were evaluated in placentas of pregnant women with (i) mild gestational hyperglycemia [MGH; normal 100g-GTT and abnormal glycemic profile (GP); n = 10]; (ii) gestational diabetes mellitus [GDM; abnormal 100g-GTT and GP; n = 10] and (iii) diabetes mellitus type 2 [DM2; previous abnormal 100g-GTT; n = 10]. The control group consisted of non-diabetic pregnant women [ND; n = 10]. Methods: Placental samples were randomly selected for blind morphometric assessment with an image analyzer system. The vessels of five fields/slide were counted and classified (400X) as either PVV (≤10 mm from the margin villous) or CVV (>10 mm). Vessel number, area (mm2 ), and perimeter (mm) were measured, as well as vessel area/total villous area ratio (vascularization ratio; %). Placental morphometric variables were adjusted by the generalized linear model (GLM), assuming gamma distribution, and compared by GENMOD test for statistical analysis (p < 0.05). Results: In DM2 (117.43±28.48 mg/dL) and GDM (110.58±7.01 mg/dL), maternal glycemic mean (MGM) value was higher than in ND (82.21±12.02 mg/dL), whereas in MGH (97.05±7.94 mg/dL) it was intermediate between those in the diabetic groups and controls (p = 0.0001). There was no statistical difference in CVV morphometric parameters. However, except for vascular area, PVV morphometric results were different among groups. PVV perimeter tended to be higher (p = 0.0676) in the DM2 (2268.64±3914.59 mm). PVV number was higher in ND (13.58±6.28) and MGH (13.00±5.55), intermediate in GDM (11.62±5.44) and lower in DM2 (10.31±5.64) (p = 0.0432). Vascularization ratio was lower in DM2 (4.38±2.98%) (p = 0.0113) compared with ND (6.18±2.75%), MGH (5.18±2.49%) and GDM (5.42±2.61%). Conclusions: Placental PVV number and vascularization ratio were similar in the MGH and ND groups, and inversely associated