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W209 THE PLACENTA PRAEVIA
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
W208 THE PLACENTA ACRETA S. Jeridi1 , D. Zeghal1 , O. Khelifi1 , R. Ben hmid1 , F. Zouari1 , S. Mahjoub1 . 1 C, Maternity Center of Tunis, Tunis, Tunisia Objectives: The aim of our study is: – To estimate the frequency of placenta acreta in the last 10 years. – To study the risk factors, clinical presentations of the placenta acreta. – To study the contribution of echography and IRM in the prenatal diagnosis of placenta acreta. – To study the different therapies and there results. Materials: It’s a retrospective study in department C of the maternity center of Tunis. Methods: We compiled 23 patients with placenta acreta consulting in our department between January 2001 and December 2011. Results: The frequency of the placenta acreta is 0.04% of all delivery. The average age is 37.3 years old. There’s association with placenta praevia in 15 cases. History of one or many caesarian sections was found in 83% and uterine curettage in 13 cases. The second and third trimester bleeding was the revealing symptom in 14 cases. The diagnosis of placenta acreta was suspected by ultrasound in 16 cases and confirmed by IRM in 10 cases. 2 cases of uterine rupture were observed. The mean term of delivery is 35.7 weeks and in all cases it was by caesarian section except 2 cases of endo uterine curettage. We carried out hemostatic hysterectomy in 19 cases and conservative management in 4 cases. There’s no case of maternal death in this study. Conclusions: The placenta acreta is a serious problem of the pregnancy and the delivery; it’s a major factor of maternal mortality. A good knowledge of the main risk factors, the diagnosis and therapeutic ways will allow us a better management of the patients. W209 THE PLACENTA PRAEVIA O. Khelifi1 , D. Zeghal1 , S. Jeridi1 , R. Ben hmid1 , F. Zouari1 , S. Mahjoub1 . 1 C, Maternity Center of Tunis, Tunis, Tunisia Objectives: The placenta praevia is among the most dangerous situation in obstetric because of the risk of unpredictable and massive hemorrhage and its maternal and fetal morbidity. Materials: Our study is about is about 76 patients with placenta praevia who were consulting in our department between January 2008 and December 2011. Methods: Its a retrospective study in the department C of the maternity center of Tunis. Results: The frequency of placenta praevia is 0.8%, the delivery was by caesarian section in 89.5%. The most important risk factors were: advanced maternal age (>35 years old), multiparity (69.7%), history of abortion (35.5%) and uterine scar (27.6%). The principal reason for consultation was a hemorrhage (47.3%). The maternal morbidity contains: anemia (41.6%), massive transfusion (26;3%), hemostatic hysterectomies (5.9%), association of placenta praevia and placenta acreta (3.9%), post-partum infections (5.2%) and thromboembolic complications (2.6%). There’s no case of maternal death. The fetal prognostic is related to perinatal morbidity (7.7%): high prematurity (51.25%), materno-fetal infection (4%), respiratory distress syndrome (15%) and neonatal anemia. Conclusions: Management of placenta praevia requires preventive strategy and efficient therapeutic means by the cooperation between obstetrician, anesthesiologist and neonatologist.
S773
W210 EFFECT OF HYPERINSULINEMIC THERAPY IN PREGNANT WOMEN WITH PREGESTATIONAL DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME ON THE PLACENTAL FUNCTION EVALUATED BY 2- AND 3-D ULTRASOUND AT 11–14 WEEKS OF PREGNANCY S. Triunfo1 , P. Rosati1 , M. Busacca1 , C. Di Florio1 , G. Scambia1 , A. Lanzone1 . 1 Obstetrics and gynecology, Catholic University of Sacred Heart, Rome, Italy Objectives: Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorder in women of childbearing age and is the leading cause of anovulatory infertility in women. Studies reported many complications in pregnant women with PCOS (miscarriage, diabetes, hypertension, fetal growth restriction). Hyperinsulinemic therapy appears improve obstetric outcome. The new diagnostic ultrasound can increase knowledge related to placental volume and vascularization in early stage of pregnancy. Indices well established in the literature, as the pulsatility index (PI) of uterine arteries, are currently associated with flow index (velocity index, VI; flow index, FI; velocity flow index, VFI) calculated using 3-D software (VOCAL). Aim of the study is to evaluate the effect of metformin treatment on placental volume and vascularization using an integrated approach 2 and 3-D ultrasound between 11–14 weeks of gestation, correlating these data with neonatal outcomes. Materials: Pregnant women with pregestational diagnosis of PCOS in metformin treatment were enrolled in early pregnancy. Informed consent was signed. The study included a integrated approach 2and 3D ultrasound evaluation with acquisition of placental volume by specific setting, calculation of indices of vascularization in early pregnancy (11–14 weeks). We collected neonatal dates. Methods: Two groups were recognized: PCOS and control group defined as normal pregnancies. Age, parity, body mass index (BMI), PI in uterine arteries, placental volume, VI, FI, VFI and neonatal outcomes were reported. Statistical analysis was performed by Student t-test, with significance for a P value <0.05. Results: The study group included 9 patients with PCOS and the control group 7 patients, respectively. No differences were described between the two groups in uterine artery indexes, placental volume and VI, FI and VFI of the placenta, obtained by 2 and 3-D power Doppler. Neonatal outcomes, defined as gestational age at birth, weight, Apgar score and pH did not appear different between the two groups considered. Conclusions: Our preliminary data, even if in a sample still rather limited, show a positive effect on placental function in the treatment of PCOS during pregnancy, allowing normal fetal growth and good neonatal outcome. W211 OVARIAN TUMOR AND PREGNANCY: TWISTED GIANT CYST N. Behar1 , M.A. Calil2 , A.T. Silva3 , W.G.M. Pereira3 , P.R. Bretz3 , F.A. Mameri3 . 1 Centro Universitario S˜ ao Camilo, Sao Paulo, Brazil; 2 Instituto Brasileiro de Controle do Cˆ ancer, Sao Paulo, Sao Paulo, Brazil; 3 Hospital Geral de Carapicuiba, Carapicuiba, Sao Paulo, Brazil Objectives: The association between ovarian cancer and pregnancy is a rare and severe disorder, whose outcome is uncertain as it may interfere with the course of gestation. The incidence of adnexal masses in pregnancy varies from 1:81 to 1:8000 pregnancies, being most cases benign tumors, while the malignancy is from 1:10000 to 1:100000 pregnancies (2–5% of cases). In case of torsion, the patient presents with acute abdominal pain, requiring surgical intervention. We present a case of a giant ovarian tumor, diagnosed in a pregnant woman in the early third quarter, with surgical resolution due to a torsion. Materials and Methods: Case report and literature review with review of medical records, imaging tests and perioperative images. Results: Patient CKA, 20 years, caucasian, primigravida with 28 weeks of gestation. She was admited into the emergency room
W208 THE PLACENTA ACRETA S. Jeridi1 , D. Zeghal1 , O. Khelifi1 , R. Ben hmid1 , F. Zouari1 , S. Mahjoub1 . 1 C, Maternity Center of Tunis, Tunis, Tunisia Objectives: The aim of our study is: – To estimate the frequency of placenta acreta in the last 10 years. – To study the risk factors, clinical presentations of the placenta acreta. – To study the contribution of echography and IRM in the prenatal diagnosis of placenta acreta. – To study the different therapies and there results. Materials: It’s a retrospective study in department C of the maternity center of Tunis. Methods: We compiled 23 patients with placenta acreta consulting in our department between January 2001 and December 2011. Results: The frequency of the placenta acreta is 0.04% of all delivery. The average age is 37.3 years old. There’s association with placenta praevia in 15 cases. History of one or many caesarian sections was found in 83% and uterine curettage in 13 cases. The second and third trimester bleeding was the revealing symptom in 14 cases. The diagnosis of placenta acreta was suspected by ultrasound in 16 cases and confirmed by IRM in 10 cases. 2 cases of uterine rupture were observed. The mean term of delivery is 35.7 weeks and in all cases it was by caesarian section except 2 cases of endo uterine curettage. We carried out hemostatic hysterectomy in 19 cases and conservative management in 4 cases. There’s no case of maternal death in this study. Conclusions: The placenta acreta is a serious problem of the pregnancy and the delivery; it’s a major factor of maternal mortality. A good knowledge of the main risk factors, the diagnosis and therapeutic ways will allow us a better management of the patients. W209 THE PLACENTA PRAEVIA O. Khelifi1 , D. Zeghal1 , S. Jeridi1 , R. Ben hmid1 , F. Zouari1 , S. Mahjoub1 . 1 C, Maternity Center of Tunis, Tunis, Tunisia Objectives: The placenta praevia is among the most dangerous situation in obstetric because of the risk of unpredictable and massive hemorrhage and its maternal and fetal morbidity. Materials: Our study is about is about 76 patients with placenta praevia who were consulting in our department between January 2008 and December 2011. Methods: Its a retrospective study in the department C of the maternity center of Tunis. Results: The frequency of placenta praevia is 0.8%, the delivery was by caesarian section in 89.5%. The most important risk factors were: advanced maternal age (>35 years old), multiparity (69.7%), history of abortion (35.5%) and uterine scar (27.6%). The principal reason for consultation was a hemorrhage (47.3%). The maternal morbidity contains: anemia (41.6%), massive transfusion (26;3%), hemostatic hysterectomies (5.9%), association of placenta praevia and placenta acreta (3.9%), post-partum infections (5.2%) and thromboembolic complications (2.6%). There’s no case of maternal death. The fetal prognostic is related to perinatal morbidity (7.7%): high prematurity (51.25%), materno-fetal infection (4%), respiratory distress syndrome (15%) and neonatal anemia. Conclusions: Management of placenta praevia requires preventive strategy and efficient therapeutic means by the cooperation between obstetrician, anesthesiologist and neonatologist.
S773
W210 EFFECT OF HYPERINSULINEMIC THERAPY IN PREGNANT WOMEN WITH PREGESTATIONAL DIAGNOSIS OF POLYCYSTIC OVARY SYNDROME ON THE PLACENTAL FUNCTION EVALUATED BY 2- AND 3-D ULTRASOUND AT 11–14 WEEKS OF PREGNANCY S. Triunfo1 , P. Rosati1 , M. Busacca1 , C. Di Florio1 , G. Scambia1 , A. Lanzone1 . 1 Obstetrics and gynecology, Catholic University of Sacred Heart, Rome, Italy Objectives: Polycystic ovary syndrome (PCOS) is one of the most frequent endocrine disorder in women of childbearing age and is the leading cause of anovulatory infertility in women. Studies reported many complications in pregnant women with PCOS (miscarriage, diabetes, hypertension, fetal growth restriction). Hyperinsulinemic therapy appears improve obstetric outcome. The new diagnostic ultrasound can increase knowledge related to placental volume and vascularization in early stage of pregnancy. Indices well established in the literature, as the pulsatility index (PI) of uterine arteries, are currently associated with flow index (velocity index, VI; flow index, FI; velocity flow index, VFI) calculated using 3-D software (VOCAL). Aim of the study is to evaluate the effect of metformin treatment on placental volume and vascularization using an integrated approach 2 and 3-D ultrasound between 11–14 weeks of gestation, correlating these data with neonatal outcomes. Materials: Pregnant women with pregestational diagnosis of PCOS in metformin treatment were enrolled in early pregnancy. Informed consent was signed. The study included a integrated approach 2and 3D ultrasound evaluation with acquisition of placental volume by specific setting, calculation of indices of vascularization in early pregnancy (11–14 weeks). We collected neonatal dates. Methods: Two groups were recognized: PCOS and control group defined as normal pregnancies. Age, parity, body mass index (BMI), PI in uterine arteries, placental volume, VI, FI, VFI and neonatal outcomes were reported. Statistical analysis was performed by Student t-test, with significance for a P value <0.05. Results: The study group included 9 patients with PCOS and the control group 7 patients, respectively. No differences were described between the two groups in uterine artery indexes, placental volume and VI, FI and VFI of the placenta, obtained by 2 and 3-D power Doppler. Neonatal outcomes, defined as gestational age at birth, weight, Apgar score and pH did not appear different between the two groups considered. Conclusions: Our preliminary data, even if in a sample still rather limited, show a positive effect on placental function in the treatment of PCOS during pregnancy, allowing normal fetal growth and good neonatal outcome. W211 OVARIAN TUMOR AND PREGNANCY: TWISTED GIANT CYST N. Behar1 , M.A. Calil2 , A.T. Silva3 , W.G.M. Pereira3 , P.R. Bretz3 , F.A. Mameri3 . 1 Centro Universitario S˜ ao Camilo, Sao Paulo, Brazil; 2 Instituto Brasileiro de Controle do Cˆ ancer, Sao Paulo, Sao Paulo, Brazil; 3 Hospital Geral de Carapicuiba, Carapicuiba, Sao Paulo, Brazil Objectives: The association between ovarian cancer and pregnancy is a rare and severe disorder, whose outcome is uncertain as it may interfere with the course of gestation. The incidence of adnexal masses in pregnancy varies from 1:81 to 1:8000 pregnancies, being most cases benign tumors, while the malignancy is from 1:10000 to 1:100000 pregnancies (2–5% of cases). In case of torsion, the patient presents with acute abdominal pain, requiring surgical intervention. We present a case of a giant ovarian tumor, diagnosed in a pregnant woman in the early third quarter, with surgical resolution due to a torsion. Materials and Methods: Case report and literature review with review of medical records, imaging tests and perioperative images. Results: Patient CKA, 20 years, caucasian, primigravida with 28 weeks of gestation. She was admited into the emergency room