- Email: [email protected]
W259 PRETERM PRELABOUR RUPTURE OF MEMBRANES: IS HOMECARE A SAFE MANAGEMENT?
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
been commenced on Prednisolone 60 mg. She had an uneventful pregnancy since then until 38+ weeks of gestation when she had a still birth. Her platelet count was shown to be normal. Conclusions: Both cases illustrate the complexity of ITP. Early diagnosis is necessary in order to optimise anaesthetic options for delivery and reduce the risk of post-partum haemorrhage. Management of ITP in pregnancy is therefore challenging, requiring a multidisciplinary collaboration. W258 FISTULA AFTER ATTENDED DELIVERY: THE CHALLENGE OF OBSTETRICAL CARE CAPACITY IN EASTERN DEMOCRATIC REPUBLIC OF CONGO C. Kimona3 , R.M. Kisindja3 , L.M. Kalisya3 , N. Young-Lin2 , N. Benfield1 . 1 Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, United States; 2 University of California, San Francisco, San Francisco, CA, United States; 3 Heal Africa Hospital, Goma, North Kivu, Congo, The Democratic Republic of the Objectives: This analysis of a prospective database of women with fistula in eastern Democratic Republic of Congo aims to describe their labor and birth history to determine factors contributing to fistula development. Materials: The study was conducted at Heal Africa (HA) in Goma, North Kivu, a Congolese NGO and tertiary care hospital with an established fistula care program that has performed over 2000 fistula repairs since 2004 averaging 150–200 per year at the central and local hospitals. Methods: A prospective survey of all women who underwent surgery for fistula at HA in 2011 was conducted. This comprehensive survey focused on fistula etiology, classification, surgical treatment, and post fistula recovery. Surveys were conducted and recorded by health care providers and no patients refused participation. For this analysis all women with fistula secondary to obstetric causes were included. Results: Ninety-five women with fistula were included, mean age 31.9 years [range 15–69]. The median parity was 3.0 [range 1–11] but 39% had only one delivery. The mean length of time with fistula was 53 months. 94 women had fistula secondary to obstructed labor, 1 was determined to be secondary to cesarean section. 87.3% had vesicovaginal fistula, 6.3% rectovaginal and the remainder had both. 48.4% of women planned to, and began their active labor at a health center, 23.2% at a hospital, while 28.5% began active labor at home. In accordance with place of delivery, 47.4% began active labor attended by a nurse, 13.7% by a doctor, and 10.5% by both. Only 8.4% were attended by a traditional birth attendant. The majority of women 52.6% had their delivery at a hospital, 31.6% at a health center, and 15.8% at home. Only 29.4% were transferred from home or health center to hospital. Conclusions: Facility-based and attended delivery is often cited as a primary way to prevent the development of obstetric fistula. In this study 71.6% of those who presented for fistula repair actually started intra-partum care under the supervision of a nurse or doctor in a health care facility. In this population, transport of patients to a health care facility and encouragement of attended birth appears to be less critical than actually improving the capacity of the existing facilities and staff to diagnose labor abnormalities and intervene in a timely fashion. W259 PRETERM PRELABOUR RUPTURE OF MEMBRANES: IS HOMECARE A SAFE MANAGEMENT? C. Garabedian1 , C. Boquet1 , P. Deruelle1 . 1 Jeanne de Flandre, Lille, France Objectives: Premature prelabour rupture of membrane (PPROM) is associated with an increased risk for both the mother and the fetus. Expectant management is usually advised under hospital supervision. Home care is associated with reduced cost. However, its safety in PPROM management has not yet been established.
S789
Our objective was to assess neonatal and maternal outcome in pregnancies complicated by PPROM comparing home care to inhospital management. Materials: Retrospective study in two tertiary centers over a two-year period between January 2009 and December 2010. We included all singleton pregnancies with a history of PPROM which occured between 24 and 35 weeks of gestation. Methods: We compared women with PPROM and in-hospital management in Center 1 (Group 1; n = 42) to women with PPROM and a home care after a short period of observation in Center 2 (Group 2; n = 32). We studied gestational age at delivery, pregnancy complications, mode of delivery and neonatal outcome. Results: Demographic characteristics were similar at onset of PPROM between the two groups. Women in group 2 delivered later than in group 1 (234.8±19.54 days vs 224.6±22.02 days; p = 0.04). There was no difference between the groups in pregnancy complications including chorioamnionitis, delivery issue and neonatal outcome. The length of stay in neonatal intensive care unit was higher in group 1 compared to group 2 (n = 43.51±2.67 days for group 1 vs. n = 24.21±2.72 days for group 2; p = 0.0003). Conclusions: Home care appears to be a safe option for women with PPROM between 24 and 35 weeks with stable condition. These preliminary findings suggest performing a randomized control trial with a higher number of women, including further data such as assessment of maternal satisfaction and cost analysis. W260 IL-1b AND IL-6 PLASMA LEVELS IN PREGNANCIES COMPLICATED BY DIABETES OR MILD GESTATIONAL HYPERGLYCEMIA I. Calderon1 , J. Moreli1 , D. Damasceno1 , G. Morceli1 , S. Corrˆea-Silva2 , L. De Rosa1 , E. Bevilacqua2 , M.V.C. Rudge1 . 1 Botucatu Medical School, Botucatu, Brazil; 2 Laboratory of Cytophysiology of Trophoblast, Institute of Biomedical Sciences, USP, S˜ ao Paulo, S˜ ao Paulo, Brazil Objectives: This study was conducted to evaluate maternal IL-1b and IL-6 levels in pregnant women with gestational diabetes mellitus (GDM), type-2 diabetes mellitus (DM2) or mild gestational hyperglycemia (MGH). Materials: This cross-sectional study included 183 pregnant women who underwent the 100g glucose tolerance test (GTT-100g) and glycemic profile (GP) between the 24th and 28th gestational weeks. According to the results of the two tests, the pregnant women were classified in the following groups: non diabetic [ND; normal GTT-100g and GP; n = 65], MGH [normal GTT-100g and altered GP; n = 44], GDM [altered GTT-100g and GP in pregnancy; n = 56] and DM2 [altered GTT-100g previously to pregnancy; n = 18]. Methods: Maternal glycemic control was evaluated by the HbA1c levels (chromatography-HPLC) and the glycemia mean (GM) performed in GP. Anthropometric evaluation was performed by BMI in the first (BMI1) and third (BMI2) pregnancy trimesters. Maternal blood was collected prior to labor. Such samples were randomized (10 pregnant women from each study group) for IL-1b and IL-6 analysis (ELISA-MILLIPLE® ). The generalized linear model and LSMeans Test (p < 0.05) were used for statistical analysis. Results: Glycemic control was less strict in pregnant women with MGH, GDM and DM2. These groups showed a higher HbA1c percent and higher GM levels (respectively, MGH = 5.69±0.77%; 96.72±7.30 mg/dL; GDM = 6.10±0.70%; 107.20±13.26 mg/dL and DM2 = 6.49±0.77%; 113.72±19.61 mg/dL; p < 0.0001), thus confirming the presence of hyperglycemia. The BMI1 was higher in GDM (34.75±7.49 kg/m2; p = 0.0122). However, the pregnant women in groups MGH, GDM and DM2 began their pregnancies with BMI1 >30 kg/m2 and, at the end of pregnancy, all the evaluated women showed BMI2 >30 kg/m2. In this scenario, IL-1b levels were higher in DM2 (4.67±11.72 pg/mL) as compared with those in the other groups (ND = 0.30±0.16; MGH = 2.50±5.67; GDM = 3.42±7.79 pg/mL) while IL-6 levels were higher in GDM (3.60±4.66 pg/mL) and DM2 (2.96±3.93 pg/mL) as
been commenced on Prednisolone 60 mg. She had an uneventful pregnancy since then until 38+ weeks of gestation when she had a still birth. Her platelet count was shown to be normal. Conclusions: Both cases illustrate the complexity of ITP. Early diagnosis is necessary in order to optimise anaesthetic options for delivery and reduce the risk of post-partum haemorrhage. Management of ITP in pregnancy is therefore challenging, requiring a multidisciplinary collaboration. W258 FISTULA AFTER ATTENDED DELIVERY: THE CHALLENGE OF OBSTETRICAL CARE CAPACITY IN EASTERN DEMOCRATIC REPUBLIC OF CONGO C. Kimona3 , R.M. Kisindja3 , L.M. Kalisya3 , N. Young-Lin2 , N. Benfield1 . 1 Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY, United States; 2 University of California, San Francisco, San Francisco, CA, United States; 3 Heal Africa Hospital, Goma, North Kivu, Congo, The Democratic Republic of the Objectives: This analysis of a prospective database of women with fistula in eastern Democratic Republic of Congo aims to describe their labor and birth history to determine factors contributing to fistula development. Materials: The study was conducted at Heal Africa (HA) in Goma, North Kivu, a Congolese NGO and tertiary care hospital with an established fistula care program that has performed over 2000 fistula repairs since 2004 averaging 150–200 per year at the central and local hospitals. Methods: A prospective survey of all women who underwent surgery for fistula at HA in 2011 was conducted. This comprehensive survey focused on fistula etiology, classification, surgical treatment, and post fistula recovery. Surveys were conducted and recorded by health care providers and no patients refused participation. For this analysis all women with fistula secondary to obstetric causes were included. Results: Ninety-five women with fistula were included, mean age 31.9 years [range 15–69]. The median parity was 3.0 [range 1–11] but 39% had only one delivery. The mean length of time with fistula was 53 months. 94 women had fistula secondary to obstructed labor, 1 was determined to be secondary to cesarean section. 87.3% had vesicovaginal fistula, 6.3% rectovaginal and the remainder had both. 48.4% of women planned to, and began their active labor at a health center, 23.2% at a hospital, while 28.5% began active labor at home. In accordance with place of delivery, 47.4% began active labor attended by a nurse, 13.7% by a doctor, and 10.5% by both. Only 8.4% were attended by a traditional birth attendant. The majority of women 52.6% had their delivery at a hospital, 31.6% at a health center, and 15.8% at home. Only 29.4% were transferred from home or health center to hospital. Conclusions: Facility-based and attended delivery is often cited as a primary way to prevent the development of obstetric fistula. In this study 71.6% of those who presented for fistula repair actually started intra-partum care under the supervision of a nurse or doctor in a health care facility. In this population, transport of patients to a health care facility and encouragement of attended birth appears to be less critical than actually improving the capacity of the existing facilities and staff to diagnose labor abnormalities and intervene in a timely fashion. W259 PRETERM PRELABOUR RUPTURE OF MEMBRANES: IS HOMECARE A SAFE MANAGEMENT? C. Garabedian1 , C. Boquet1 , P. Deruelle1 . 1 Jeanne de Flandre, Lille, France Objectives: Premature prelabour rupture of membrane (PPROM) is associated with an increased risk for both the mother and the fetus. Expectant management is usually advised under hospital supervision. Home care is associated with reduced cost. However, its safety in PPROM management has not yet been established.
S789
Our objective was to assess neonatal and maternal outcome in pregnancies complicated by PPROM comparing home care to inhospital management. Materials: Retrospective study in two tertiary centers over a two-year period between January 2009 and December 2010. We included all singleton pregnancies with a history of PPROM which occured between 24 and 35 weeks of gestation. Methods: We compared women with PPROM and in-hospital management in Center 1 (Group 1; n = 42) to women with PPROM and a home care after a short period of observation in Center 2 (Group 2; n = 32). We studied gestational age at delivery, pregnancy complications, mode of delivery and neonatal outcome. Results: Demographic characteristics were similar at onset of PPROM between the two groups. Women in group 2 delivered later than in group 1 (234.8±19.54 days vs 224.6±22.02 days; p = 0.04). There was no difference between the groups in pregnancy complications including chorioamnionitis, delivery issue and neonatal outcome. The length of stay in neonatal intensive care unit was higher in group 1 compared to group 2 (n = 43.51±2.67 days for group 1 vs. n = 24.21±2.72 days for group 2; p = 0.0003). Conclusions: Home care appears to be a safe option for women with PPROM between 24 and 35 weeks with stable condition. These preliminary findings suggest performing a randomized control trial with a higher number of women, including further data such as assessment of maternal satisfaction and cost analysis. W260 IL-1b AND IL-6 PLASMA LEVELS IN PREGNANCIES COMPLICATED BY DIABETES OR MILD GESTATIONAL HYPERGLYCEMIA I. Calderon1 , J. Moreli1 , D. Damasceno1 , G. Morceli1 , S. Corrˆea-Silva2 , L. De Rosa1 , E. Bevilacqua2 , M.V.C. Rudge1 . 1 Botucatu Medical School, Botucatu, Brazil; 2 Laboratory of Cytophysiology of Trophoblast, Institute of Biomedical Sciences, USP, S˜ ao Paulo, S˜ ao Paulo, Brazil Objectives: This study was conducted to evaluate maternal IL-1b and IL-6 levels in pregnant women with gestational diabetes mellitus (GDM), type-2 diabetes mellitus (DM2) or mild gestational hyperglycemia (MGH). Materials: This cross-sectional study included 183 pregnant women who underwent the 100g glucose tolerance test (GTT-100g) and glycemic profile (GP) between the 24th and 28th gestational weeks. According to the results of the two tests, the pregnant women were classified in the following groups: non diabetic [ND; normal GTT-100g and GP; n = 65], MGH [normal GTT-100g and altered GP; n = 44], GDM [altered GTT-100g and GP in pregnancy; n = 56] and DM2 [altered GTT-100g previously to pregnancy; n = 18]. Methods: Maternal glycemic control was evaluated by the HbA1c levels (chromatography-HPLC) and the glycemia mean (GM) performed in GP. Anthropometric evaluation was performed by BMI in the first (BMI1) and third (BMI2) pregnancy trimesters. Maternal blood was collected prior to labor. Such samples were randomized (10 pregnant women from each study group) for IL-1b and IL-6 analysis (ELISA-MILLIPLE® ). The generalized linear model and LSMeans Test (p < 0.05) were used for statistical analysis. Results: Glycemic control was less strict in pregnant women with MGH, GDM and DM2. These groups showed a higher HbA1c percent and higher GM levels (respectively, MGH = 5.69±0.77%; 96.72±7.30 mg/dL; GDM = 6.10±0.70%; 107.20±13.26 mg/dL and DM2 = 6.49±0.77%; 113.72±19.61 mg/dL; p < 0.0001), thus confirming the presence of hyperglycemia. The BMI1 was higher in GDM (34.75±7.49 kg/m2; p = 0.0122). However, the pregnant women in groups MGH, GDM and DM2 began their pregnancies with BMI1 >30 kg/m2 and, at the end of pregnancy, all the evaluated women showed BMI2 >30 kg/m2. In this scenario, IL-1b levels were higher in DM2 (4.67±11.72 pg/mL) as compared with those in the other groups (ND = 0.30±0.16; MGH = 2.50±5.67; GDM = 3.42±7.79 pg/mL) while IL-6 levels were higher in GDM (3.60±4.66 pg/mL) and DM2 (2.96±3.93 pg/mL) as