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W200 DOES BARIATRIC SURGERY AFFECT FERTILITY AND SUBSEQUENT PREGNANCY OUTCOME?
S770
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
W199 OBSTETRIC OUTCOME IN IDIOPATHIC NECROTISING MYOPATHY WITH ANTI SIGNAL RECOGNITION PARTICLE (SRP) ANTIBODIES: A CASE REPORT S. Basak1 . 1 Obstetrics and Gynaecology, Peterborough City Hospital, Cambridge, United Kingdom Objectives: Necrotising Myopathy associated with anti-SRP antibodies has an increased risk for fetal loss, IUGR and prematurity. Unfortunately, little data on pregnancy outcome in such patients is available. Here we share our experience of such a pregnancy management by multidisciplinary team approach including obstetricians, rheumatologists, intensivists and neonatalogists. Materials: This is a case report on eventual outcome of second pregnancy in a 35-year-old with anti-SRP antibody positive myopathy, who had a previous stillbirth at 26 weeks due to earlyonset severe pre-eclampsia, IUGR and massive abruption. Methods: At the onset of present (second) pregnancy, her condition was well controlled with steroids and azathioprine She had normal scans. At 25+2 weeks gestation she was admitted with acute chest pain, episodic abdominal pain, dyspnea, haematuria and marked jaundice. Her blood showed features of haemolytic jaundice and thrombocytosis. This was diagnosed as hepatotoxicity due to Azathioprine, which was promptly discontinued. She was also commenced on enoxaparin for raised platelets. Echocardiography showed mild pulmonary hypertension. She recovered within 2 weeks. Growth scans done at 30 & 34 weeks showed static growth with oligohydramnios. She had PROM at 36 weeks and was induced. Labour was uneventful and she had a spontaneous vaginal delivery of a healthy male child weighing 2400 grams. Discussion: Anti-SRP, a myositis-specific antibody, is prevalent in only 4% cases of myopathy and is associated with a more aggressive form of polymyositis with poor prognosis. Clinical pattern is characterised by rapidly progressive proximal muscle weakness with very high muscle enzyme levels (CPK) at presentation, severe myalgia and arthralgia, cardiac involvement and rarely interstitial lung disease. They often respond poorly to corticosteroids. The physiological changes to the immune system in pregnancy can affect the course of this autoimmune diseases, conversely the autoimmune processes characteristic of these conditions may compromise the fetal outcome. Conclusions: Pregnancy should be planned when anti-SRP myositis is in remission as this maximises the probability of a successful feto-maternal outcome. Regular monitoring by a multidisciplinary team including rheumatologist, obstetrician, and neonatologist is necessary and any relapse/complication should be treated aggressively. W200 DOES BARIATRIC SURGERY AFFECT FERTILITY AND SUBSEQUENT PREGNANCY OUTCOME? A. Deliveliotou1 , D. Hassiakos1 , G. Creatsas1 . 1 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens Medical School, Athens, Greece, Athens, Greece Objectives: Provided that the prevalence of obesity among women at reproductive age has increased dramatically over the last two decades, more and more morbidly obese patients undergo bariatric surgery, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future fertility. The purpose of this study was to assess fertility and subsequent pregnancy outcomes, in women after bariatric surgery. Materials: Forty women with a history of previous bariatric surgery (BS) who delivered in our Hospital during a 10-year period, included in the study. Twenty six of them had undergone
laparoscopically adjustable gastric band (LABG), while fourteen women had undergone Roux-en-Y gastric bypass (RYGB). Methods: Conception and live-births rates, as well as obstetric and neonatal outcomes were compared before and after BS. Results: Overall 44 pregnancies following spontaneous conceptions occurred in women with previous BS, that ended to 40 livebirths and 4 spontaneous 1st trimester abortions, compared to 20 pregnancies that occurred before the BS (P < 0.05) which ended to 8 live-births only and 12 spontaneous abortions (P < 0.05, respectively). The mean weight gain during pregnancy was significantly lower after the BS than before (10.3 kg vs. 25.9 kg; P < 0.05). Gestational diabetes mellitus, well controlled with diet, was diagnosed in 10 women. IUGR was identified in 8 cases. No cases of pre-eclampsia, fetal macrosomia, intrauterine fetal demise, placental abruption, placenta previa, labor dystocia, or perinatal complications were noted in women after BS. Two cases, that had undergone RYGB, developed illeus postoperatively; the first case developed obstructive illeus and surgical repair of intestinal hernia was performed, while the second one developed paralytic illeus which was conservatively managed. Women with LABG and RYGB had similar obstetric characteristics, pregnancy outcome and neonatal birth weights. Conclusions: BS significantly improved subsequent fertility and live birth rates. Rates of many adverse maternal and neonatal outcomes in women who become pregnant after having had bariatric surgery remain low as long as adequate maternal nutrition and vitamin supplementation are maintained. Close supervision before, during and after pregnancy following bariatric surgery can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population. W201 NEWBORN SMALL FOR GESTATIONAL AGE: DIAGNOSTIC SENSITIVITY AND NEONATAL OUTCOME 1 L. Diaz1 , P. Quinones ˜ , D. Vargas1 , F. Coppola1 . 1 Montevideo, Pereira Rossell, montevideo, Uruguay Objectives: To determine the sensitivity of clinical–ultrasound diagnosis of Small for Gestational Age Infants (SGA). To assess the impact of prenatal diagnosis in cesarean section rate and neonatal outcome. Materials: Retrospective descriptive and analytical trial, of the Latin American Center of Perinatology database Perinatal Information System (SIP). Methods: From March through September 2010 of a total of 4548 newborn child at the Centro Hospitalario Pereira Rossell, 379 were SGA Infants (defined as growth below p10 for gestational age). Of the target population, it was studied whether they had prenatal clinic and ultrasonographic diagnosis, number of prenatal visits, route of delivery and neonatal outcome (Apgar score, blood gases).
≥5 controls <5 controls Uncontrolled Vaginal delivery Cesarean section Neonatal depression (Apgar <7) Acidosis (pH < 7.2 BE < −10)
Previous diagnosis of IUGR
Without previous diagnosis
88 (89%) 9 (9%) 2 (2%) 44 (44%) 55 (56%) 4 (4%) 5 (5%)
190 (68%) 33 (12%) 57 (20%) 221 (89%) 59 (21%) 19 (7%) 8 (3%)
Results: Of diagnosed cases, 88 had more than 5 prenatal visits in comparison with the group without previous diagnosis; in which group 190 cases were well-controlled pregnancies. However a larger number of controls showed higher RR 2.91 prenatal diagnosis (95% CI 1.62 to 5.91) p < 0.001. Neonatal outcomes of acidosis and low Apgar score were not different in the IUGR group compared to the undiagnosed. Instead cesareans were 56% in the diagnosis group versus 21% in the undiagnosed group (table). In population
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
W199 OBSTETRIC OUTCOME IN IDIOPATHIC NECROTISING MYOPATHY WITH ANTI SIGNAL RECOGNITION PARTICLE (SRP) ANTIBODIES: A CASE REPORT S. Basak1 . 1 Obstetrics and Gynaecology, Peterborough City Hospital, Cambridge, United Kingdom Objectives: Necrotising Myopathy associated with anti-SRP antibodies has an increased risk for fetal loss, IUGR and prematurity. Unfortunately, little data on pregnancy outcome in such patients is available. Here we share our experience of such a pregnancy management by multidisciplinary team approach including obstetricians, rheumatologists, intensivists and neonatalogists. Materials: This is a case report on eventual outcome of second pregnancy in a 35-year-old with anti-SRP antibody positive myopathy, who had a previous stillbirth at 26 weeks due to earlyonset severe pre-eclampsia, IUGR and massive abruption. Methods: At the onset of present (second) pregnancy, her condition was well controlled with steroids and azathioprine She had normal scans. At 25+2 weeks gestation she was admitted with acute chest pain, episodic abdominal pain, dyspnea, haematuria and marked jaundice. Her blood showed features of haemolytic jaundice and thrombocytosis. This was diagnosed as hepatotoxicity due to Azathioprine, which was promptly discontinued. She was also commenced on enoxaparin for raised platelets. Echocardiography showed mild pulmonary hypertension. She recovered within 2 weeks. Growth scans done at 30 & 34 weeks showed static growth with oligohydramnios. She had PROM at 36 weeks and was induced. Labour was uneventful and she had a spontaneous vaginal delivery of a healthy male child weighing 2400 grams. Discussion: Anti-SRP, a myositis-specific antibody, is prevalent in only 4% cases of myopathy and is associated with a more aggressive form of polymyositis with poor prognosis. Clinical pattern is characterised by rapidly progressive proximal muscle weakness with very high muscle enzyme levels (CPK) at presentation, severe myalgia and arthralgia, cardiac involvement and rarely interstitial lung disease. They often respond poorly to corticosteroids. The physiological changes to the immune system in pregnancy can affect the course of this autoimmune diseases, conversely the autoimmune processes characteristic of these conditions may compromise the fetal outcome. Conclusions: Pregnancy should be planned when anti-SRP myositis is in remission as this maximises the probability of a successful feto-maternal outcome. Regular monitoring by a multidisciplinary team including rheumatologist, obstetrician, and neonatologist is necessary and any relapse/complication should be treated aggressively. W200 DOES BARIATRIC SURGERY AFFECT FERTILITY AND SUBSEQUENT PREGNANCY OUTCOME? A. Deliveliotou1 , D. Hassiakos1 , G. Creatsas1 . 1 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens Medical School, Athens, Greece, Athens, Greece Objectives: Provided that the prevalence of obesity among women at reproductive age has increased dramatically over the last two decades, more and more morbidly obese patients undergo bariatric surgery, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future fertility. The purpose of this study was to assess fertility and subsequent pregnancy outcomes, in women after bariatric surgery. Materials: Forty women with a history of previous bariatric surgery (BS) who delivered in our Hospital during a 10-year period, included in the study. Twenty six of them had undergone
laparoscopically adjustable gastric band (LABG), while fourteen women had undergone Roux-en-Y gastric bypass (RYGB). Methods: Conception and live-births rates, as well as obstetric and neonatal outcomes were compared before and after BS. Results: Overall 44 pregnancies following spontaneous conceptions occurred in women with previous BS, that ended to 40 livebirths and 4 spontaneous 1st trimester abortions, compared to 20 pregnancies that occurred before the BS (P < 0.05) which ended to 8 live-births only and 12 spontaneous abortions (P < 0.05, respectively). The mean weight gain during pregnancy was significantly lower after the BS than before (10.3 kg vs. 25.9 kg; P < 0.05). Gestational diabetes mellitus, well controlled with diet, was diagnosed in 10 women. IUGR was identified in 8 cases. No cases of pre-eclampsia, fetal macrosomia, intrauterine fetal demise, placental abruption, placenta previa, labor dystocia, or perinatal complications were noted in women after BS. Two cases, that had undergone RYGB, developed illeus postoperatively; the first case developed obstructive illeus and surgical repair of intestinal hernia was performed, while the second one developed paralytic illeus which was conservatively managed. Women with LABG and RYGB had similar obstetric characteristics, pregnancy outcome and neonatal birth weights. Conclusions: BS significantly improved subsequent fertility and live birth rates. Rates of many adverse maternal and neonatal outcomes in women who become pregnant after having had bariatric surgery remain low as long as adequate maternal nutrition and vitamin supplementation are maintained. Close supervision before, during and after pregnancy following bariatric surgery can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population. W201 NEWBORN SMALL FOR GESTATIONAL AGE: DIAGNOSTIC SENSITIVITY AND NEONATAL OUTCOME 1 L. Diaz1 , P. Quinones ˜ , D. Vargas1 , F. Coppola1 . 1 Montevideo, Pereira Rossell, montevideo, Uruguay Objectives: To determine the sensitivity of clinical–ultrasound diagnosis of Small for Gestational Age Infants (SGA). To assess the impact of prenatal diagnosis in cesarean section rate and neonatal outcome. Materials: Retrospective descriptive and analytical trial, of the Latin American Center of Perinatology database Perinatal Information System (SIP). Methods: From March through September 2010 of a total of 4548 newborn child at the Centro Hospitalario Pereira Rossell, 379 were SGA Infants (defined as growth below p10 for gestational age). Of the target population, it was studied whether they had prenatal clinic and ultrasonographic diagnosis, number of prenatal visits, route of delivery and neonatal outcome (Apgar score, blood gases).
≥5 controls <5 controls Uncontrolled Vaginal delivery Cesarean section Neonatal depression (Apgar <7) Acidosis (pH < 7.2 BE < −10)
Previous diagnosis of IUGR
Without previous diagnosis
88 (89%) 9 (9%) 2 (2%) 44 (44%) 55 (56%) 4 (4%) 5 (5%)
190 (68%) 33 (12%) 57 (20%) 221 (89%) 59 (21%) 19 (7%) 8 (3%)
Results: Of diagnosed cases, 88 had more than 5 prenatal visits in comparison with the group without previous diagnosis; in which group 190 cases were well-controlled pregnancies. However a larger number of controls showed higher RR 2.91 prenatal diagnosis (95% CI 1.62 to 5.91) p < 0.001. Neonatal outcomes of acidosis and low Apgar score were not different in the IUGR group compared to the undiagnosed. Instead cesareans were 56% in the diagnosis group versus 21% in the undiagnosed group (table). In population