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ABSTRACT BOOK 2016
ORAL PRESENTATIONS page 2 POSTERS page 73
 http://informahealthcare.com/jmf
ISSN: 1476-7058 (print), 1476-4954 (electronic)

J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

! Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/14767058.2016.1191212

ORAL
Some placentation abnormalities detected by ultrasound, can draw
attention to the need for invasive prenatal diagnosis.
ABNORMAL PLACENTATION - 042
Ultrasonographic and Keywords: Histological, abnormalities, maternal-fetal outcome.

pathological diagnostic
correlations in abnormal
placentation 453
C. Berceanu1, E. Brătilă2, S. Vlădăreanu3, M. M. Cı̂rstoiu2, Prevalence of placental
C. Simionescu4, V. Gheorman5, R. Ciortea6, insufficiency complications on
C. Mehedint¸u2, and S. Berceanu1
1
oocyte donation pregnancies
Department of Obstetrics-Gynaecology, University of Medicine and
Pharmacy of Craiova, Romania, 2Department of Obstetrics-
C. Villalaı́n, L. Álvaro, R. Bermejo, O. Villar, I. Herráiz,
Gynaecology, ‘‘Carol Davila’’ University of Medicine and Pharmacy,
E. Gómez-Montes, and I. Mejı́a
Bucharest, Romania, 3Department of Neonatology, ‘‘Carol Davila’’
University of Medicine and Pharmacy, Bucharest, Romania, Obstetrics and Gynecology Dept, Hospital Universitario 12de octubre,
4
Department of Pathology, University of Medicine and Pharmacy of Madrid, Spain
Craiova, Romania, 5Department of Psychiatry, University of Medicine
and Pharmacy of Craiova, Romania, and 6Department of Obstetrics- Introduction: Normal placentation requires development of maternal-
Gynaecology, ‘‘Iuliu Hat¸ieganu’’ University of Medicine and fetal inmunotolerance. Placental insufficiency complications of
Pharmacy, Cluj-Napoca, Romania, pregnancy, as preeclampsia (PE) and intrauterine growth restriction
(IUGR) might be caused by an abnormal maternal immune response
Introduction: Routine obstetrical and maternal-fetal clinical practice to paternally-derived antigens. Pregnancies conceived by oocyte
involves the ultrasonographic (US) assessment of the placental donation (IVF-DO) have to cope with a higher degree of antigenic
structure throughout gestation by standard 2D examination, but dissimilarity, which has been linked to an increased rate of placental
also through advanced 3D and Doppler techniques. The aim of the insufficiency complications. To evaluate such association in our
study is to achieve systematic correlations between abnormal setting, we present a description of our perinatal results in IVF-DO
placentation evaluated by ultrasonography and pathological diag- pregnancies.
nosis of this gestational structure. Materials and methods: The study group included 136 women who
Materials and Methods: Tertiary multicentric research including 727 conceived through IVF-DO within 2011-2015 and were followed up at
unselected pregnancies diagnosed by ultrasonography with placental our center. Medical files were reviewed to make a description of the
or fetal membranes abnormalities, in the 4 years range 2012-2016. basal characteristics, looking for perinatal complications including
Ultrasound scanning was followed by morphological study of these PIH, PE, IUGR, neonatal intensive care unit (NICU) admission and
structures. US examination interval ranged from 11(þ4) - 38(þ5) perinatal mortality. We searched for differences in obstetric outcomes
gestational weeks. The study includes 716 singletons and 11 multiple between singleton and multiple pregnancies.
pregnancies. US diagnostic evaluation included transabdominal, Clinical cases and summary results: We studied 136 pregnancies, 94
transvaginal or mixed assessment. singletons and 42 multiples (41 twins and one triplet). Maternal age
Clinical cases and summary results: Ultrasound and histological distribution was bimodal with two peaks at 30 and 40 years. Mean
correlations were observed in: placental infarctions 73 cases body mass index (kg/m2) was 24.2(SD3.6). In singleton pregnancies,
(10.04%), placental echolucencies 16 (2.2%), placenta circummargi- prevalence (%) of PE and IUGR was 7.5 and 8.5 respectively, while in
nata 42 (5.77%). placental tumors 7 (0.96%). placenta praevia 23 multiple pregnancies reached 17.1 and 7.5. These differences were
(3.16%). retroplacental bleeding 49 (6.74%). amniotic bands not statistically significant. There were 11 cases of IUGR, 8 (7.3%) as
29 (3.98%). morbidly adherent placenta (accreta. increta. percreta) - percentile 53rd with no doppler anomalies, one (1.2%) with an
28 (3.85%). molar placenta 27 (3.71%). succenturiate lobes 42 (5.77%). elevated doppler resistive index on umbilical artery and two with
placental abruption 9 (1.23%). absent telediastolic umbilical flow. Four of them were early onset
Conclusion: A significant number of placental abnormalities can be (diagnosed before 34 weeks) and seven of late onset. There were 14
detected by ultrasonography from the first trimester of pregnancy. (10.4%) cases of preeclampsia, all of late onset except for one which
Standard 2D US examination is essential for diagnosis, but 3D and delivered at 27 weeks due to setting of HELLP syndrome. Mean
Doppler advanced ultrasound techniques complement and support gestational age at delivery (weeks) was 38.9 (SD7.5) in singletons and
the evaluation. Some placental macroscopic anatomical structures 35.7 (SD3.6) in multiples. Mean neonatal weight was 2795 (SD784)
have obvious and well defined ultrasound expression, bringing details grams. There were 3 cases of Apgar 57 at 5 minutes (2.2%), 13 (9.6%)
for the maternal-fetal outcome. There are a significant number of infants who required NICU admission, two postnatal deaths, (one on a
structural or functional fetal anomalies, some with syndromic singleton, one on a twin pregnancy), and one stillbirth.
involvement, whose identification by ultrasound examination Conclusion: Given that in spontaneously conceived pregnancies in
should lead to pathological assessment of the placental structure. Spain, prevalence of PE in singletons is 2.5-3% and 8-9% in multiples,
we have observed a higher rate in both subgroups of IVF-DO. These
data are consistent with previous studies suggesting that IVF-DO
2 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

gestations have a higher prevalence of placental insufficiency factors that are usually associated with MC pregnancies on locomotor,
complications. personal and social, language, eye and hand coordination and
performance development.
Materials and methods: It was a retrospective observational study.
Between 2008-2015 were studied 82 children at V. Buzzi Children’s
Hospital born between 2007-2012 from 48 MC pregnancies (mean GA
327 = 31.3  2.61, range = 27.30-35.5, mean BW = 1452  448g, range =
620-2870g). Initially were enrolled 91 children: the 10,1% had a motor
Impact of risk factors in specific impairment and they were excluded, while the 89,9% were healthy. In
areas of behavioral development the present study neurobehavioral outcomes of healthy MC twins
were evaluated using the Griffiths Mental Development Scale (GMDS,
in monochorionic healthy twins Griffiths, 1984). The GMDS was utilized to gain a measure of 5 areas of
child development: locomotor, personal and social, language, eye and
investigated with Griffiths’ scale hand coordination and performance.
Clinical cases and summary results: Data were analyzed with SPSS 20.0.
Pearson’s and Kendall’s correlations and linear regressions were
M. Balestriero1, B. Scelsa1, C. Colombo2, V. Brazzoduro2, performed to investigate the impact of risk factors associated with MC
P. Introvini2, A. La Verde2, E. Mascheroni3, C. Ionio3, pregnancies (GA, TTTS, Apgar, level of Hb at birth, BPD) on children’s
M. Rustico4, M. Mastrangelo1, and G. Lista2 neurobehavioral development. Lower GA predicts worst scores in
1
personal and social Griffiths’subscale (=0.241, sig.=0.029). TTTS
Neurology, V.Buzzi Children’s Hospital-ASST, Milano, Italy, 2NICU, during pregnancies is related to worst scores in eye and hand
V.Buzzi Children’s Hospital-ASST, Milano, Italy, 3Psychology, CRIdee- coordination Griffiths’subscale (T=0.201, sig.=0.035). No relations
Università Cattolica del Sacro Cuore, Milano, Italy, and 4Fetal were found between TTTS, considering different treatment, and
Therapy Unit, Department of Obstetrics and Gynaecology, V. Buzzi scores obtained in Griffiths’subscale. Lower Apgar at minute 1 predict
Children’s Hospital ASST, Milano, Italy worst scores in personal and social Griffiths’subscale (=0.273,
sig.=.016) and worst scores in language Griffiths’subscale (=0.319,
Introduction: Different studies had widely demonstrated that compli- sig.=0.005). Higher level of Hb at birth predicts worst scores in motor
cations of monochorionic (MC) pregnancies increase mortality and Griffiths’subscale (=0.294, sig.=0.011). BPD predicts worst scores in
morbidity of newborn twins. The follow-up of these children assesses language Griffiths’subscale (=0.350, sig.=.001).
their neurological outcome, trying to identify the associated risk Conclusion: MC pregnancies have an impact on neurobehavioral
factors. The aim of the present study was to evaluate the impact of development of healthy MC twins. MC twins with lower GA, lower
risk factors associated with MC pregnancies (GA, TTTS, Apgar, level of Apgar at minute 1 and higher level of Hb at birth are at risk to
Hb at birth, BPD) on specific areas of neurobehavioral development in develop difficulties in personal and social areas. MC twins suffering
a population of healthy MC twins at 1 (64.1%) 2 (28.2%) and 3 (7.7%) from TTTS independently from the treatment are at risk to develop
years of age. In particular we wanted to investigate the impact of risk difficulties in eye and hand coordination. Lower Apgar at minute 1
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 3
and BPD could impair the language development. Further large 235
cohort studies are needed to confirm these data.
The role of decidual natural killer
Keywords: Monochorionic, twins, healthy, Griffiths mental develop-
ment scale cells in recurrent missed
abortions
D. Radovic Janosevic1,2, D. Krtinic1, A. Tubic Pavlovic1,
J. Milosevic Stevanovic1,2, M. Tasic1, and
S. Pop-Trajkovic Dinic1,2
104
1
Clinic of Gynecology and Obstetrics, Clinical center Nis, Nis, Serbia
Placenta-associated pregnancy and 2Faculty of Medicine, University of Nis, Nis, Serbia
complications in pregnancies
Introduction: Recurrent or habitual missed abortions (RMA) are
complicated with placenta previa defined as three or more consecutive abortions. In the first trimester
of pregnancy habitual missed abortions occur in about 1% of
population. The aim of this immuno-histochemical study of decidua
Baumfeld Y.1,2, Herkovitz R.1,2, Bar Niv Z.1,2, and
in RMA of unknown etiology was to identify subpopulations of
Weintraub A. Y.1,2 decidual lymphocytes in recurrent miscarriages and compare the
1
Department of Obstetrics and Gynecology, Soroka University distribution of immunocompetent cells in artificial abortions
and RMA.
Medical Center, Faculty of Health Sciences, Ben-Gurion University of
Materials and methods: The study included 30 women with at least 2
the Negev, Israel and 2Clinical research center, Soroka University
consecutive miscarriages in the first trimester of pregnancy.
Medical Center, Faculty of Health Sciences, Ben-Gurion University of Curettements of the third missed abortion were immunohistochemi-
the Negev, Israel, cally analyzed. The control group consisted of 20 women without
loaded reproductive anamnesis, with the abortion for social reasons.
Introduction: Defective placentation is associated with many preg- Criteria for exclusion from the study were diagnosed uterine
nancy complications, including preeclampsia, IUGR, PROM, preterm anomalies, positive screening for thrombophilia and women who
birth, late miscarriage and placental abruption. We believe that an suffered from diabetes mellitus and disorders in the function of the
abnormal placental location, such as in of placenta previa, may cause thyroid gland. Immunophenotyping was performed by immuno-
faulty placentation and increase the risk of placental insufficiency alkaline phosphatase (APAAP) using monoclonal antibodies: CD 56
associated pregnancy complications. Indeed, placenta previa has and CD 57.
been associated with the development of pregnancy complications Clinical cases and summary results: The number of missed abortions
related to placental insufficiency. With advancing maternal age, (1,223) was on the average 9.7% of all deliveriies during the test
fertility treatments and cesarean deliveries the prevalence of placenta period. Among them RMA were registered in 52 (4.2%) patients and in
previa is rising. We aim to examine the hypothesis that pregnancies 30 (57%) the exact etiology of abortions was not determined. RMA
complicated with placenta previa have an increased risk of placental was most common in the 25-34 years of age group. The largest
insufficiency associated pregnancy complications. number of RMA showed the ultrasound characteristics of missed
Materials and methods: Our study included all deliveries that took at abortion in 60% of cases and was in nulliparous patients (76.7%). The
Soroka University Medical Center (Beer Sheva, Israel) between January number of NK CD56 positive cells did not differ significantly between
1998 and December 2013. Of them 1249 were complicated by the types of abortion. In the decidual tissue, a number of NK CD57
placenta previa and represented our study group. A composite positive cells was significantly higher in missed abortions compared
outcome was created to include conditions associated with placental to artificial interruptions (p 5 0.01).
insufficiency. It included hypertensive disorders (i.e. gestational Conclusion: The number and phenotypic structure of NK cells are
hypertension, mild and severe preeclampsia, HELLP and eclampsia), significantly different in normal pregnancy decidua and in RMA. The
small for gestational age neonates and placental abruption. NK cell dominance is present in the RMA group, in favor of CD56þ
Clinical cases and summary results: Patients with pregnancy compli- and CD 57 of subpopulations.
cated by placenta previa had significantly different obstetrical
characteristics including bad obstetric history (8% versus 4%, Keywords: Decidual natural killer cells, recurrent missed abortions
p50.001), recurrent abortions (11% versus 5%, p50.001). Patients
with placenta previa had higher rates of vaginal bleeding in the
second half of pregnancy (3% versus 0%, p50.001), gestational
diabetes (8% versus 5.5%, p50.001), placental abruption (10% versus
1%, p50.001), adherent placenta (4% versus 0.5%, p50.001), preterm
delivery (52% versus 8%, p50.001), with a median gestational age of
36 versus 39 weeks, p50.001. The composite outcome was
significantly more prevalent in the placenta previa group (21%
versus 13%, p50.001).
Conclusion: Our study demonstrated an increased rate of placental
insufficiency associated complications in women with placenta previa.
This is of clinical relevance and suggests that a careful surveillance for
women with placenta previa may help in minimizing maternal, fetal
and neonatal complications.

Keywords: Placental pathology, preeclampsia, fetal growth

assessment
4 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

CESAREAN SECTION - 287 Materials and methods: Included were all elective (gentle) CSs at term
gestation in the Bronovo hospital between January 2013 and July
2014, compared with the conventional CSs from 2010 to 2013.
Maternal and neonatal outcomes Excluded were women with diabetes mellitus, connective tissue
of the gentle caesarean delivery: disease, immunocompromitation, fever or active infectious diseases,
altering a possible infection risk. The operative technique of the
a clinical report of one and a half gentle CS is unaltered. However, the ambient temperature will be
heightened and the patient will be covered by a Bair Hugger
years experience in a Dutch preventing the newborn from cooling down. Parents get the
opportunity to see their baby been born through a transparant
hospital window in our operation blanket and mother and child will be
reunited, if both in good health, by SSC. This will not be interrupted
V. Wolters and and K. Boers during the stay at the operation complex.
Clinical cases and summary results: The introduction of the gentle CS
Gynaecology Dept, Bronovo Hospital, The Hague, The Netherlands did not increase the incidence of the surgical site infections (SSIs) or
other postoperative infections. Moreover, the incidence of SSI in our
Introduction: As the global caesarean section (CS) rate raises to cohort was comparable to the national numbers reported by the
alarming levels, a British research group introduces the ‘natural RIVM. Since the introduction of the gentle CS, mainly positive
caesarean’, giving the parents the opportunity to watch the birth and feedback was given. Therefore the need for patient information
provide an early and uninterrupted skin-to-skincontact (SSC), result- concerning the safety of mother and child became more apparent.
ing in higher breastfeeding success rates and an easier bonding The application of measures (e.g. warmed mattress, bair hugger and
process. An enhancement of maternal satisfaction and reduction of higher ambience temperature) to prevent mother and child from
pain experience is assumed. Alterations in ambience temperature in cooling down is successful, an important procedure as the newborn
the operation room to keep the newborn warm and an extended lacks the ability to regulate his/her core body temperature and
amount of people present may influence the infection risk post hypothermia of the mother causes higher rates of SSIs. The
partum. Goal of this research was to prove equal risks compared to introduction of the gentle CS seemed to result in a shortening of
the conventional CS, alongside an improvement of maternal operating time, less door movements, less blood loss and a higher
satisfaction to support the decision to continue offering the gentle post-operative body temperature. This may be a representation of a
caesarean in our hospital. general improvement and awareness, possibly boosted by the gentle
CS, of restraining potential risk factors to a minimum, presumably
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 5
leading to less SSIs. The results showed that the gentle CS was at least MoM) in our routinely screened population in the Helsinki University
as safe as the conventional CS concerning direct neonatal outcomes District area.
and a positive trend concerning breastfeeding rates. Although the Materials and methods: A cohort of 961 pregnant women with low
gentle CS group was small, we could not find an increase of PAPP-A levels (50.3 MoM) and 961 age-matched women with normal
postoperative infection rate, justifying continuation of this relatively PAPP-A levels (0.9-1.1 MoM) were followed over a four year period
recent introduced family centred care. (2009-2012).The reference group selection was based on the
Conclusion: We showed a comparability in maternal infection rate and assumption that the exposure related to decreased PAPP-A produc-
immediate neonatal outcomes between the gentle CS (n=287) and tion would be absent in women with PAPP-A level close to 1.0 MoM
the conventional CS (n=875), indicating that the gentle CS is a safe (0.9 - 1.1 MoM). The FTS was performed according to the guidelines of
alternative. With the introduction of the gentle CS the amount of the Finnish Ministry of Social Affairs and Health and the NT
door movements, length of surgery and total perioperative blood loss measurement was performed according to the Fetal Medicine
declined significantly, which might lead to a lower risk of surgical site Foundation protocol. Patients were considered screen positive with
infection. NT 3 mm or a FTS risk 1/250, and genetic counseling with
chromosomal analysis was offered in these pregnancies. Pregnancy-
Keywords: Gentle caesarean section induced hypertension (PIH) was identified as a normal blood pressure
in the early pregnancy and a measurement 145/90 mmHg at least
twice during pregnancy. Increased blood pressure with proteinuria
4300 mg/ 24 h was identified as preeclampsia. A spontaneous
abortion was identified as a loss of the pregnancy or fetal viability
236 before completed 22 pregnancy weeks, and preterm delivery as any
delivery before completed 37 pregnancy weeks. Fetal death before
Low versus normal first-trimester delivery and after completed 22 pregnancy weeks was identified as
stillbirth (SB), and small for gestational age (SGA) was identified as a
maternal papp-a levels and gender-specific birth weight less than 2 SD. The prevalence of
pregnancy outcome adverse pregnancy outcomes was determined. This included aneu-
ploidies, fetal structural abnormalities, hypertensive disorders of
pregnancy, spontaneous abortion, PTD, SB and SGA births.
M. Kaijomaa, L. Rahkonen, V.-M. Ulander, E. Hämäläinen, Clinical cases and summary results: Compared to the reference, the
H. Alfthan, H. Markkanen, S. Heinonen, V. Stefanovic, and overall incidence of pregnancy failure (OR 17.8, p 50.001) was
Marja Kaijomaa increased in the group with low PAPP-A. In the study group, the risk
of aneuploidies (OR 116.1) and spontaneous abortion (OR7.7) was
Department of Obstetrics and Gynecology, University of Helsinki, significantly higher (p 50.001), but no difference was detected in the
Helsinki University Hospital incidence of major structural abnormalities (p=0.738). The incidences
of preterm delivery (OR 2.5), PIH (OR 1.9), preeclampsia (OR 10.9) and
Introduction: Pregnancy-associated placental protein A (PAPP-A) is small for gestational age births (OR 4.9) were all significantly higher in
a glycoprotein produced by the placental syncytiotrophoblasts, and the group with low PAPP-A. Nine cases (0.9 %) of stillbirth occurred in
it is detectable in the maternal circulation from early pregnancy. pregnancies with low PAPP-A whereas there were none in the
PAPP-A is responsible for the cleavage of insulin-like growth factor reference group.
binding protein-4 (IGFBP-4) from insulin-like growth factor (IGF), Conclusion: Low PAPP-A and the associated adverse outcomes reflect
and thus it contributes to the regulation of fetal growth. PAPP-A is poor placental function. However, due to controversial data, a low
used as part of the first-trimester combined screening (FTS) for positive predictive value and a lack of follow-up consensus, PAPP-A
Down’s syndrome but has also been studied as an independent can not be considered suitable for routine screening of adverse
marker for adverse pregnancy outcome. The risks of aneuploidy, pregnancy outcome. Still, low PAPP-A is clearly a warning sign and
hypertensive disorders,spontaneous abortion,small for gestational risks should to be considered in planning the follow-up scheme of
age births,prematurity and stillbirths have been shown to increase pregnancies with low PAPP-A. On the contrary, normal PAPP-A
with decreasing PAPP-A levels. Still, the value of PAPP-A as an appeared to be reassuring with a very low risk of adverse outcome.
individual marker is debatable, and different cut-off values for low
PAPP-A have been used in previous studies. The objective of our Keywords: PAPP-A, aneuploidy, spontaneous abortion, preeclamp-
study was to estimate the clinical significance of low PAPP-A (50.3 sia, preterm delivery, stillbirth
6 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

(based on their high frequency of occurrence and low performance

358
scores) were: (1) women with suspected fetal compromise (frequency
Adherence to guideline based of occurrence 19%, adherence 29%), (2) women with failure to
progress (frequency of occurrence 19%, adherence 85%), (3) women
quality indicators for caesarean with breech presentation at term (frequency of occurrence 6%,
unable to calculate performance scores because of limited docu-
sections in South Australia mentation) and (4) women with a previous CS (frequency of
occurrence 38.7%, adherence 52%).
S. C. J. van Alphen1, N. F. M Anthonissen1, G. Matthews2, Conclusion: In women undergoing CS, we identified four groups with
relatively poor adherence to the guidelines with indications for CS.
S. Kuah2, G. A. Dekker3,7, S. Kane3, S. Melman4,
Future efforts can be made in those categories for improvement of
H. C. J. Scheepers4, M. Woiski5, R. P. M. G. Hermens6, and care.
B. W. Mol2,3,7
1
Radboud University, Faculty of Medical Sciences, Nijmegen, The Keywords: Caesarean section, quality indicators, clinical guidelines,
practice guidelines
Netherlands, 2Women’s and Children’s Hospital, Department of
Obstetrics and Gynaecology, Adelaide, Australia, 3Lyell McEwin
Hospital, Department of Obstetrics and Gynaecology, Adelaide,
Australia, 4Maastricht University, GROW - School for Oncology and
Developmental Biology, Maastricht, The Netherlands, 5Radboud 458
University Medical Centre, Department of Obstetrics and Patient decision aid with
Gynaecology, Nijmegen, The Netherlands, 6Radboud University,
Scientific Institute for Quality of Healthcare (IQ healthcare), individual risk estimation: an
Nijmegen, The Netherlands, and 7University of Adelaide, Discipline of
Obstetrics and Gynaecology, Adelaide, Australia
effective tool in choosing the
mode of delivery after cesarean
Introduction: The incidence of caesarean sections (CS) in Australia has
shown an upward trend to 34% in 2013.1 A CS is associated with an section
increased risk of maternal morbidity and mortality.2,3,4 Beside that it
has significant cost implications for the health care system in
E. Vankan1, E. Schoorel1, S. van Kuijk2, B. Mol MD3,
Australia.5,6 Therefore it’s important to determine factors which
may explain this incidence. International guidelines are developed to J. Nijhuis1, R. Aardenburg4, F. Delemarre 5, C. Dirksen2,
assist healthcare professionals, such as gynaecologists and obste- I. van Dooren6, S. Kuppens7, A. Kwee 8, J. Langenveld9,
tricians, for the decision to perform a caesarean section. Current care L. Smits10, R. Hermens11, and H. Scheepers1
will be evaluated according to guideline-based quality indicators, 1
recently developed by Dutch researchers and thereby identify target Department of Obstetrics and Gynecology, GROW-School for
groups for future improvements.7,8 Oncology and Developmental Biology, Maastricht University Medical
Materials and methods: Design & setting: A retrospective medical chart Centerþ, Maastricht, The Netherlands, 2Department of Clinical
review in two hospitals in South-Australia. Epidemiology and Medical Technology Assessment, Maastricht
Methods: We studied women undergoing a CS between May 1st to University Medical Center, Maastricht, The Netherlands, 3The
July 31st 2015. Women were classified according the Robson Robinson Research Institute, School of Pediatrics and Reproductive
classification and we determined adherence to guideline based
Health, Department of Obstetrics and Gynecology, University of
quality indicators, that were derived from literature. We quantified
Adelaide and The South Australian Health and Medical Research
adherence by calculating performance scores, defined as the number
of women in which the indicator was applied to and consistent with, Institute. Adelaide, Australia, 4Department of Obstetrics and
in both elective and emergency CS care. Gynecology, Zuyderland Medical Center, Sittard, The Netherlands,
5
Clinical cases and summary results: We studied 470 women that had a Department of Obstetrics and Gynecology, Elkerliek Hospital,
CS. The main groups of women were nulliparous women having a Helmond, The Netherlands, 6Department of Obstetrics and
primary emergency CS (29%) and multiparous women having an Gynecology, Sint Jans Gasthuis, Weert, The Netherlands,
elective repeat CS (28%). Four groups with relatively poor adherence, 7
Department of Obstetrics and Gynecology, Catharina Hospital,
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 7

Eindhoven, The Netherlands, 8Department of Obstetrics and 399

Gynecology, University Medical Center Utrecht, Utrecht, The
Netherlands, 9Department of Obstetrics and Gynecology, Zuyderland
Niche ratio after single- or
Medical Center, Heerlen, The Netherlands, 10Caphri School for Public double-layer interrupted closure:
Health and Primary Care, Maastricht University, Maastricht, The
Netherlands, and 11Scientific Institute for Quality of Healthcare (IQ a prospective assessment of
healthcare), Radboud Institute for Health Sciences (RIHS), Radboud
University Medical Center Nijmegen Medical Center, Nijmegen, The
primary cesarean hysterotomy
Netherlands scar using saline contrast
Introduction: International guidelines indicate that when no contra-
sonohysterography
indication for vaginal birth after cesarean (VBAC) exists, women
pregnant after a previous cesarean section (CS) should be able to S. Kataoka, K. Tanaka, T. Fujii, K. Iwaki, Y. Iwaki, and
choose between an intended VBAC or an elective repeat cesarean F. Tanuma
section (ERCS). Although in the Netherlands the majority of women
opt for intended vaginal delivery, previous studies showed that in Department of Obstetrics and Gynecology, Hakodate Central General
many cases women were not adequately informed about their Hospital, Hakodate, Japan
options. We developed a patient decision aid (DA) aiming to increase
guideline adherence in counseling women pregnant after CS and to Introduction: The formation of uterine niches at the site of cesarean
enhance patient involvement in decision making while not leading to section (CS) is a complication of CS. Numerous studies have
an increase in CS rate. suggested the potential involvement of a niche in uterine rupture,
Materials and methods: Women pregnant after one previous CS placenta accrete, cesarean scar pregnancy (CSP) in a future
without a contra-indication for an intended VBAC were enrolled in six pregnancy, and postmenstrual spotting. Whether suture techniques
matched pairs of hospitals. Women in the intervention hospitals can affect niche development is not yet fully established, partly due
received a DA, including both information on benefits and risks of to the complexities in diagnosing a uterine niche and the scarcity of
intended VBAC or ERCS and a prediction model to calculate the prospective studies on this topic. We analyzed the incidence and
individual VBAC probability. Counseling in the control hospitals was severity of niches formed at the site of the cesarean scar in
performed according to usual care. The hypothesis was that the use interrupted single- and double-layer sutures for primary CS by
of a DA did not lead to a decrease in VBAC rate. The VBAC rate in the saline contrast sonohysterography (SCSH), which has been reported
period before the study started was 48%. A difference of 410 % was to have a higher diagnostic efficacy for identifying niches than
considered ‘inferior’ care. The sample size needed was 400 per study transvaginal sonography.
arm. Materials and methods: An interventional prospective cohort study of
Clinical cases and summary results: We included 924 women of whom women undergoing their first CS with a transverse lower uterine
483 were enrolled in the intervention group and 441 in the control segment incision was performed between June 2011 and July 2014.
group. In total 256 women filled in a questionnaire on decision SCSH was performed 3-4 months after CS, and in the case of a niche,
making: in the intervention group 133 of 137 women (98%) stated the depth and residual myometrium were recorded. The severity of
they were involved in the choice for the mode of delivery, as the niche was expressed as niche ratio, a ratio of the niche depth to
compared to 78 of 119 women (68%) in the control group (p50.001). the sum of the niche depth and residual myometrium thickness. The
The total VBAC rate was comparable (217 (45%) versus 203(46%)). In predictors of a niche included in the univariate analysis were the
the intervention group more women chose an ERCS (201 (42%) versus maternal age, gestational week, plural fetal pregnancy, primipara,
137 (31%), adjusted odds ratio (OR) 1.59 (95% BI 1.17-2.15). In the preeclampsia, cervix dilatation 5 cm, retroflexion of the uterus, and
intervention group, 217/282 women attempting VBAC delivered blood loss, and these were extracted using logistic regression
vaginally (77%), compared to 203/304 women in the control group analysis.
(67%) (Adjusted OR 1.44 (0.97-2.14)). Consequently, 10% more Clinical cases and summary results: 267 women undergoing primary
emergency CS were performed in the control group. After correcting CS were included. Single-layer interrupted sutures were used in 58
for confounders, the odds ratio for an emergency CS in the women, and double-layer interrupted sutures were used in 209.
intervention group compared to the control group was 0.57 (95% Niches were identified in 14/58 (24.1%) patients with single-layer
BI 0.39-0.81). interrupted sutures and in 55/209 (26.3%) with double-layer inter-
Conclusion: Implementing a decision aid for mode of delivery after CS rupted sutures (p= 0.74). The frequency of patients with niche ratio
results in improved patient involvement, an unchanged VBAC rate 0.4 was significantly higher in the single-layer interrupted sutures
but better risk selection with a 43% reduction in the emergency CS group than in the double-layer interrupted sutures group (7/58
rate. [12.1%] versus 6/209 [2.9%], p= 0.004). Single-layer closure was
associated with more than a five-fold increase in the odds of a larger
Keywords: Vaginal birth after cesarean, repeat cesarean section, niche (niche ratio 0.4) (odds ratio, 5.59, 95% confidence interval [CI],
decision aid 1.71-18.28), regardless of the maternal age, gestational wk, plural fetal
pregnancy, primipara, preeclampsia, cervix dilatation 5 cm, and
retroflexion of the uterus. Blood loss per 100 mL was also associated
with an increased odds of a larger niche (odds ratio, 1.11, 95% CI,
1.03-1.19).
Conclusion: The incidence of large niche formation(niche ratio 0.4)
was significantly lower with double-layer closure, although it may not
increase the overall frequency of niche formation. The odds of a larger
niche were more than five-fold higher with single-layer closure. Our
study provided critical results that can be used for better CS planning,
patient counseling, and designing larger multicenter studies.

Keywords: Cesarean section, hysterotomy, suture techniques

8 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

002 CORD ACID-BASE BALANCE - 158

Adverse obstetric outcomes with Early outcome of neonates with
endometriosis: meta-analyses umbilical cord blood acidemia
Y. S. Kim (PH57.1)
Obstetrics and Gynecology Department, University Hospital of
T. Smolkin1, S. Ravid2, I. Ulanovsky1, A. Ilivitzki3,
Soochunhyang of Cheonan, Chungnam, Korea
T. Mashiach4, and I. Makhoul1
1
Introduction: Women with endometriosis at pregnancy have known Neonatology, Ruth Rappaport Children’s Hospital, Haifa, Israel,
an increased risks of impaired obstetric outcomes. The objective of 2
Pediatric Neurology, Ruth Rappaport Children’s Hospital, Haifa,
this study was to assess the association between women with Israel, 3Pediatric Clinical Imaging, Ruth Rappaport Children’s
endometriosis and adverse obstetric outcomes. Hospital, Haifa, Israel, and 4Epidemiology, Ruth Rappaport Children’s
Materials and methods: Two reviewers independently determined all
Hospital, Haifa, Israel
prospective cohort study, retrospective cohort study, multicentric,
observational and cohort study, population-based prospective
cohort study, and retrospective secondary analysis published Introduction: During 2014-2015, we observed an increase in cases of
using PubMed MEDLINE database, KERIS (Korea education and umbilical cord blood (UCB) acidemia (pH57.1). Hence, we investi-
research information service), Scopus, Google Scholar, and the gated the impact of this finding on early neonatal outcome (ENO) up
Cochrane Central Register of comparing obstetric outcomes women to 72 hours of age.
with endometriosis and women without endometriosis. Meta- Materials and methods:We routinely obtain UCB for gas analysis at all
analyses were estimated with Odds ratios (OR) and 95% confidence Cesarean deliveries (CD), vacuum extraction deliveries (VED) and
intervals (95% CI) using random effect analysis according to vaginal deliveries (VD) with fetal distress. Starting 2014, our
heterogeneity of studies. obstetricians aimed for reduction of CD rate. All 5519 neonates
Clinical cases and summary results: Data from eight effect sizes from born between 1/1/2011 and 10/7/2015 with available UCB gas results
five studies involving 47 003 patients were enrolled. These meta- were studied. Favorable ENO was defined as a 5-minute Apgar
analyses showed women with endometriosis have an increased risks score7, no resuscitation at birth, no mechanical ventilation, no
of preterm birth (adjusted OR 1.38; 95% CI, 1.10, 1.73), cesarean intracranial or severe subgaleal hemorrhages, no convulsions, no
section (adjusted OR 1.47; 95% CI, 1.40, 1.54). No significant difference hypoxic ischemic encephalopathy, no therapeutic hypothermia,
were observed in the incidence of small for gestational age(SGA) and normal neurological examination and cranial ultrasound.
placental complication such as placenta previa and placental Clinical cases and summary results: UCB pH was as follows: pH7.1
abruption between the two groups. (n=5308, 96.2%). Three variables were significantly associated with
Conclusion: These meta-analyses demonstrate women with endome- risk of UCB pH57.0 (multivariate logistic regression): birth at 2014-
triosis at pregnancy have an increased risks of impaired obstetric 2015 versus 2012-2013 [p=0.005, OR 4.5, 95% CI: 1.57-12.9], 5-min
outcomes. Therefore, it is worthy for obstetrics to increase the careful Apgar Score 7 [p50.001,8.77, 3.08-24.98], VD [p50.001, OR 9.1, 95%
inspection in women with endometriosis during pregnancy. CI,3.61-22.96] and VED [p=0.003, 3.57, 95% CI: 1.52-8.37). Five
variables were significantly associated with unfavourable ENO (1):
VD [p=0.001, OR 2.1, 95%CI: 1.36-3.25], VED [p=0.001, OR 1.74, 95%CI:
Keywords: Endometriosis, adverse obstetric outcomes, meta-
1.24-2.45], GA 535 weeks [p=0.016,OR 1.59, 95%CI: 1.09-2.32], GA of
analyses
35-37.6 weeks [p50.001, OR 7.58, 95%CI: 4.47-12.84], intrapartum
fever [p=0.026, OR 1.79, 95%CI: 1.07-2.98], cord around neck [p=0.004,
OR 5.85, 95%CI: 1.74-19.6], UCB pH 7.0-7.1 [p=0.026,OR 1.99, 95%CI:
1.09-3.65] and pH 57.0 [p50.001, OR 13.2, 95%CI: 6.36-26.8]. Of 40
neonates with UCB pH57.0, 16 (40%) had unfavorable ENO, as
compared to 12 of 171 (7%) with UCB 7.0pH57.1.
Conclusion: The risk for unfavorable ENO increased significantly with
UCB pH 57.0, none-Cesarean birth, GA538 weeks, maternal intra-
partum fever and cord around neck. UCB pH57.0 inferred favorable
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 9
ENO of 81.9% and 51.7% after CD and VD, respectively. With UCB pH
of 7.0-7.1, ENO was favorable in 96.9% (CD) and in 90.6% (VD). The 233
change in local policy regarding mode of delivery could have
contributed to the year-of-birth dependent changes of UCB acidemia
Umbilical arterial PH 7.00 and
and neonatal outcome. base excess 4 12. Is it an
acceptable definition of
pathological fetal acidemia?
430
Umbilical cord blood base deficit Martı́ Gamboa S., Pascual Mancho J., Lapresta Moros M.,
Redrado Giménez O., Ruiz Sada J., Rodrigo Rodrı́guez M.,
predicts the development of Rodrı́guez Lázaro L. and Castán Mateo S.
significant hyperbilirubinemia in Miguel Servet University Hospital, Zaragoza, Spain. Obstetrics Dept.
healthy term and near-term (all the authors)

newborns Introduction: The classical definition of pathological fetal acidemia

includes an umbilical arterial pH  7.00 and a base excess (BE) 4
-12 mmol/L. Both values are considered necessary to attribute a poor
K. A. Simbi
neonatal outcome to an intrapartum event. A recent analysis of 4
Division of Perinatology, Policlinico Abano Terme, Abano Terme, Italy 50,000 consecutive cord samples suggested that the risk for
encephalopathy, an accepted precursor to cerebral palsy of
intrapartum origin, begins to rise at 7.10. The objective of this
Introduction: In the era of early discharge of newborns from hospital
study is to determine the sensitivity of this definition (pH  7.00 and a
the recognition, follow-up, and early treatment of neonatal jaundice
BE 4 -12 mmol/L) for predicting morbidity at term neonates.
has become more difficult. We tested the predictivity of umbilical
Materials and methods: We conducted a four year retrospective case-
blood gas parameters at birth for developing pre-discharge
control study of all nonanomalous, singleton, vertex, term births with
hyperbilirubinemia.
severe neonatal acidemia (umbilical arterial cord gas pH  7.00).
Materials and methods: A total of 537 consecutive healthy term and
Neonates in the control group were matched to each neonate in the
near-term newborns, admitted to maternity ward of Policlinico Abano
case group in a one-to-one fashion using subsequent delivery,
Terme (Italy), underwent to umbilical cord hemogasanalysis at birth
matched by gestational age and an umbilical cord gas pH 4 7.00 and
and capillary heel total serum bilirubin (TSB) at 36 hour of life, to test
 7.10. The primary outcomes were a composite neurological
predictivity hyperbilurubinemia risk, of 49 mg/dL bilirubin level,
morbidity including those with  1 of: neonatal death, encephalo-
corresponding to  75% on TSB nomogram of Bhutani et al.
pathy, seizures abnormal tone or imaging and a composite systemic
(Pediatrics 1999,103:6-14). The relationship between umbilical cord
morbidity including those with  1 of: intubation, ventilation 4 24h,
pH, pO2, pCO2, bicarbonate, base deficit and neonatal hyperbilir-
hepatic or renal impairment. Arterial blood BE was determined in all
ubinemia were determined with statistical analysis.
the sample.
Clinical cases and summary results: It was found that 133 (24.8%)
Clinical cases and summary results: A total of 14523 term, singleton,
screened newborns had TSB levels of 49 mg/dL at 36 hours of life.
nonanomalous neonates were identified who had paired and
When the cord blood gas analysis components were compared, their
validated cord blood gas analysis. Of those, 94 were severely acidemic
academia levels were significantly higher: HCO3- (20.71 þ 2.37 versus
(pH  7.00) and were compared with 99 mild acidemic neonates (pH
21.29 þ 2.25 mEq/L, p 50.010), base deficit (3.52 þ 3.188 vs,
47.00 and  7.10) (Figure 1). Among all the acidemic neonates (pH 
2.68 þ 3.266 mEq/L, p 50.010), and lactacidemia (3.84 þ1.864 vs,
7.10) both pH and BE were significantly related to each adverse
3.39 þ 1.737 mEq/L, p9 mg% (OR=0.593, p=0.005), and the hyperbilir-
outcome and lower on average among those affected compared to
ubinemia risk increases by 40% with the increase of 1 mEq/l of base
those who were not (Table 1). A 16% of the sample showed any kind
deficit.
of neonatal morbidity, a 10.8% showed neurological morbidity and a
Conclusion: Umbilical cord blood gas analysis is a reliable diagnostic
13.4% systemic morbidity. The definition of pathological fetal
test for intrapartum hypoxic stress, with base deficit significant
acidemia (pH  7.00 and BE 4 -12 mmol/L) had a sensitivity of
predictive estimate regarding neonatal significant bilirubin risk zone
80.6% for predicting any kind of neonatal morbidity, 85.7% for
on an hour specific bilirubin nomogram generating risk stratification
neurological morbidity and 84.6% for systemic morbidity.
score in healthy term and near term neonates.
Conclusion: The current definition of pathological fetal acidemia had a
high sensitivity for predicting a poor neonatal outcome. However, the
Keywords: Early discharge, predictivity hyperbilirubinemia, cord 15-20% of neonates with morbidity will not present an umbilical
blood gas analysis arterial cord gas within this range.

Keywords: Metabolic acidemia, morbidity, prediction, sensitivity

10 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 11

465 the ability of lactate for predicting morbidity at term. The objective of
this study is to determine which parameter of the cord gas analysis,
Vasomotor effects of hydrogen pH, base excess (BE) and lactate has a bigger predictive ability for
neonatal morbidity at term.
sulfide in human umbilical Materials and methods: We conducted a four year retrospective case-
control study of all nonanomalous, singleton, vertex, term births with
vessels severe neonatal acidemia, defined as an umbilical cord gas pH  7.00.
Neonates in the control group were matched to each neonate in the
R. Mohammed1, L. Provitera2, G. Cavallaro2, F. Mosca2, case group in a one-to-one fashion using subsequent delivery,
and E. Villamor1 matched by gestational age and an umbilical cord gas pH 4 7.00 and
7.10. The primary outcomes were a composite neurological
1
Department of Pediatrics, Maastricht University Medical Center morbidity including those with 1of: neonatal death, encephalo-
(MUMCþ), Research Institute Growth and Development (GROW), pathy, seizures or abnormal tone and a composite systemic morbidity
University of Maastricht, Maastricht, the Netherlands, 2Neonatal including: intubation, ventilation for 424 hours, hepatic or renal
Intensive Care Unit, Department of Clinical Sciences and Community impairment. The predictive ability of lactate, BE and pH were
Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, compared using ROC curves. Optimal cut-off values of lactate, base
excess and pH were estimated.
Università degli Studi di Milano, Milan, Italy
Clinical cases and summary results: A total of 14523 term, singleton,
nonanomalous neonates were identified who had paired and
Introduction: Hydrogen sulfide (H2S) has recently emerged as a validated cord blood gas analysis. Of those, 94 were severely acidemic
biologically active gas with multiple effects on the cardiovascular (pH 7.00) and were compared with 99 mild acidemic neonates (pH
system. However, the information on the vascular effects of H2S in 47.00 and 7.10) (Figure 1). The ROC curve analysis revealed that pH,
human vessels is scarce. We aimed to investigate the vasomotor BE and lactate had a similar predictive ability for global neonatal
actions of Na2S, which forms H2S and HS in solution, in human morbidity (AUC: 0.75, 0.77, 0.78 respectively), neurological morbidity
umbilical artery (HUA) and vein (HUV) rings. (AUC: 0.81, 0.79, 0.80 respectively) and systemic morbidity (AUC: 0.75,
Materials and methods: HUA and HUV rings from 20 healthy term 0.78, 0.77 respectively). The optimal cut-off value of each parameter,
newborns were mounted in organ baths (5 mL) containing Krebs- and its sensitivity and specificity for predicting global, neurological
Ringer bicarbonate buffer bubbled with 95% O2/5% CO2 (hyperoxia), and systemic neonatal morbidity is described in Table 1.
21% O2/5% CO2/74% N2 (normoxia) or 95% N2/5% CO2 (hypoxia) Conclusion: pH, BE and lactate showed a similar predictive ability for
and maintained at 37  C. Concentration-response curves to Na2S were global, neurological and systemic neonatal morbidity. The optimal
performed in vessels under resting tone or following pre-contraction cut-off values obtained had a high sensitivity and specificity for pH
with KCl (62.5 mM), or serotonin (5-HT, 1 mM). and BE. Further studies are needed to find an optimal cut-off value for
Clinical cases and summary results: HUA rings did not respond to lactate with higher sensitivity.
Na2S (1mM-1mM) either at resting tone or during contraction evoked
by serotonin (5-HT, 1mM) or KCl (62.5mM). In contrast, Na2S induced a
Keywords: Ph, base excess, lactate, morbidity, prediction
concentration-dependent contraction in HUV rings under resting tone
and a concentration-dependent relaxation when the HUV rings were
contracted with 5-HT (42  5% relaxation) or KCl (12  5% relaxation).
Na2S-induced contraction of HUV was impaired following removal of
extracellular Ca2þ, endothelial denudation, NO synthase inhibition (L-
NAME), or soluble guanylate cyclase (sGC) inhibition (ODQ). Na2S-
induced relaxation of HUV was impaired by the KATP channel
inhibitor glibenclamide.
Conclusion: In conclusion, our results show that exogenous H2S does
not have vasomotor effects on HUA but induced contraction
(mediated through inactivation of the NO/sGC axis) and relaxation
(mediated through KATP channels) in HUV. Our data suggest a role
for H2S in the venous side of human umbilical circulation.

Keywords: Hydrogen sulfide, umbilical artery, umbilical vein

218
PH, base excess or lactate. Which
is better for predicting neonatal
morbidity?
Martı́ Gamboa S., Pascual Mancho J., Lapresta Moros M.,
Rodrı́guez Lázaro L., Ruiz Sada J., Redrado Giménez O.,
Rodrigo Rodrı́guez M. and Castán Mateo S.
Miguel Servet University Hospital, Zaragoza, Spain. Obstetrics Dept.

Introduction: Umbilical cord blood acid-base analysis provides an

objective assessment of newborn metabolic status. Recent studies are
questioning the significance of base excess in acidemic neonates or
12 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

CULTURE AND CHALLENGES - 180 year after delivery. Unintended pregnancy is a serious cause of
adolescent morbidity, and use of effective contraception is one of the
Breaking the cultural and social pillars preventing adolescent pregnancy. An opportune time to
introduce contraceptive methods with adolescents is the postpartum
taboos associated with women period. Effective postpartum contraception is a unique opportunity to
sexuality in Pakistan lengthen inter-pregnancy intervals. The aim of this study was to
determine which methods of contraception are used before and after
pregnancy among adolescents who have had children.
S. Sohail and and A. Samuel Materials and methods: A cross-sectional study was performed and
data was obtained from medical records of all adolescents who
Chanan Development Association underwent childbirth review consultation at the University of
Campinas Women’s Hospital, between July 2011 and Sept. 2013.
Introduction: In Pakistani society women sexuality and HIV/AIDS both Inclusion criteria were adolescents aged between 10 and 19 years
considered as taboo and a big stigma which creates an environment who were attended in puerperal medical consultation. Exclusion
of frustration and repression among women and girls to internalized criterion was a first consultation after 90 days postpartum. All data
the sex, sexual and their sexual rights as a big cultural, social and were routinely transcribed into a specific form and inserted into a
religious sin to talk about all these topics which is hindering them spreadsheet created in Epi Info 7. Statistical analyses were performed
from accessing the available information and healthcare services using averages, standard deviation, percentage correlations, and
regarding sexual and reproductive health information, Lack of Fisher’s exact test. The statistical software used was Statistical Analysis
information and services increase the vulnerability of community System (SAS) version 9.4 for Windows. The study was approved by the
women, high risk sexual behaviors, unintended pregnancies, teenage Research Ethics Committee.
pregnancies, unsafe abortions, family planning methods and HIV and Clinical cases and summary results: All 196 postpartum adolescents
AIDs including STIs, STDs. were included. The average first postpartum follow-up consultation
Materials and methods: The project aims at empowering community happened 44 days after birth. The average age of patients was 16.18
women give them accurate information through interactive theater years (þ1.43), more than half had menarche at age 12 years or
and capacity building. younger (65%), the first sexual intercourse occurred between 13 and
The activities of the projects are 14 years in 49% of them, and 76% had a vaginal delivery.
1. Conducting research in District Lahore to find out the knowledge, Contraception before pregnancy was used by 74% of these
Attitude, and Perception of women about Gender, Sexuality and HIV/ adolescents. The most frequent method used was combined oral
AIDS contraceptives (56.85%) followed by condoms (34.4%). Among the
2. Educating 1000 community women of District Lahore about primiparas, 57% used combined oral contraceptives (COCs) before
Gender, Sexuality rights, family planning including STIs, STDs and pregnancy, and 37% reported the use of condoms. Among
HIV/AIDS, mode of Transmission and Prevention adolescents with two or more deliveries, 57% reported the use of
3. Enabling community women to establish ‘‘Sexuality Education COCs and 22% used DMPA. Comparing primiparas and adolescents
Clubs’’ in their areas for replicating the information among other with two or more births, the type of contraceptive used prior to
women of their communities and to enable them to fight the stigma pregnancy is statistically different (p= 0.0086 in Fisher’s exact test).
and discrimination related to sexuality and HIV/AIDS in Islamic The main reason for abandoning the use of contraception was to
society. become unintended pregnant (41%), followed by reports of side
Clinical cases and summary results: 1. 5000 community women of effects (22%), behavior issues (18%), desire for pregnancy (16%), and
‘‘Lahore’’ got accurate education about gender, sexuality rights and difficult access to contraception (3%). After the births, DMPA was the
HIV/AIDS contraception method mostly frequently used (71%), followed by oral
2. 25 Sexuality Education Clubs established and start functioning contraceptives (11.8%) and IUDs (11.2%). Table 1 shows a comparison
efficiently, 1700 young women volunteered to be part of these Clubs between the desired contraceptive method and the prescribed
Conclusion: Need to give Sexuality education to community women method in postpartum follow-up consultations among 134 girls who
as they have no source to get accurate information about their manifested a preferred contraceptive method.
gender, sexuality health and rights which creates their vulnerabilities Conclusion: The most popular used contraceptive method before
to HIV/AIDs and creating space for them to internalized the sex, pregnancy was combined oral contraceptive, and the main justifica-
sexual and sexual rights as cultural, social and religious taboo to keep tion to stop contraception was unintended pregnancy. After delivery,
them away on getting information about such sensitive issues. the method more desired and prescribed was DMPA in accordance
with the choice of the adolescent. Nevertheless, it is important to
Keywords: Women sexuality, family planing, birth spacing promote the use of long-acting, reversible contraceptive (LARCs) to
avoid unintended pregnancy among teenagers.

Keywords: Adolescents contraception, pregnancy

363
Adolescent contraception before
and after childbirth - choices and
challenges for the future
A. Pinheiro, F. G. Surita, A. D. Annibale, R. C. Pacagnella,
and J. L. Pinto e Silva
Obstetrics Dept., University of Campinas Women’s Hospital,
Campinas, Brazil

Introduction: About 16 million girls aged 15 to 19, and around

1 million girls under 15, give birth every year in the world.
Adolescents are at high risk for rapid repeat pregnancy: approxi-
mately 12-49% of adolescent mothers are pregnant again in the first
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 13
187 669
Obstetrical and perinatal Outcomes from birth to hospital
outcome of oldest pregnant discharge of infants with tracheo-
women oesphaegal fistula/oesophageal
atresia from a UK - based tertiary
S. Garcı́a, M. Urtasun, M. Donazar, A. Safont, N. Abian, neonatal surgical centre over 8
B. Pérez, and C. Larrañaga
Servicio de Ginecologı́a y Obstetricia, Complejo Hospitalario de
years
Navarra, Navarra, España
S.-L. Chuang1,2, C. Heppolette2, A. Tang2, R. Cotton2,
Introduction: Pregnancy in women aged 440 years old is becoming H. Gbinigie1, and E. Ogundipe1,2
more commom. In the last years there is a trend to delay childbearing 1
Department of Neonatology, Chelsea and Westminster Hospital,
and this trend is stronger in developed countries. In Spain during the
London, United Kingdom 2Imperial College London, London, United
last years the prevalence of pregnancy over 40 years has doubled. A
Kingdom
lot of complications have been associated with increasing maternal
age. There is an increase in the risk of: Gestational Diabetes, Obesity,
Hipertension, and preterm labour. Intrapartum complications like: Presenter: S-L. Chuang
increased use of Oxitocyn, caesarian sections, instrumental delivery Introduction: Background: Limited published outcome data exists
and haemorrhage are more frequent in older women. Also perinatal on infants with tracheo-oesophageal fistula/oesophageal atresia
outcomes are worse in older women. We present obstetrical and (TOF/OA).
perinatal outcomes in women over 40 who gave birth in our hospital, Aim: To determine outcomes from a tertiary neonatal surgical centre
Complejo Hospitalario de Navarra, Spain, between 2006 and 2012. of infants born with TOF/OA over 8 years.
Materials and methods: This is a retrospective study with a total of Materials and methods: Clinical and demographic data were collated
32368 patients who gave birth in our hospital between 2006 and retrospectively on all babies admitted to the NICU with a diagnosis
2012.1557 (4.8%) of all patients were aged 40 or more years old. The of TOF/oesophageal atresia (OA) from 1st January 2006 to 31st
aim of the study is to investigate if there are significant differences in December 2014 using clinical notes and the Standard Electronic
obstetric outcome, complications in childbirth and perinatal outcome Neonatal Database. Ethical approval was not required as the study
among women younger and older than 40 years. We analyzed this was regarded as health outcomes surveillance.
obstetric variables: Rate of pregnancy-induced hypertension, gesta- Clinical cases and summary results: Of 79 infants; 22.8% were inborn.
tional diabetes, premature rupture of membranes, placenta previa, Majority, 73 (92.4%) had TOF and 6 (7.6%) isolated OA. Mean
placental abruption and preterm labor. Regarding the delivery, the birthweight and gestation was 2423g and 37.1 weeks respectively.
following variables were compared: type of delivery, and rate of Most common associations were cardiac (69.6%), 8.9% chromosomal
inductions. To compare perinatal outcome, the following variables anomalies and 17.7% had at least 3 features of VACTERL. Most TOF/
were analyzed: Rate of prematurity, birth weight, Apgar and cord OA was repaired by day 4, 1/3 were ventilated pre-operatively and
blood pH. 15.2% required 2 or more operations. Ventilation was averagely for 15
Clinical cases and summary results: Between 2006 and 2012 the days; commonest post-operative complications were pneumothorax
prevalence of pregnancy in women over 40 years in our hospital rose or lung collapse (32.9%), pleural effusion (15.2%) and chylothorax
from 3.4% in 2006 to 6.5% in 2012. Regarding obstetric complications (7.6%). Nearly half (46.8%) had gastro-oesophageal reflux disease
the following results were obtained. Old pregnant equal or greater (GORD), 10.1% had trachea/broncho-malacia, 11.4% had mild chronic
than 40 years had a higher rate of pregnancy-induced hypertension lung disease i.e, oxygen therapy at 28 days of life but only 3.8% were
(4%) compared to those under 40 years (2%) with significant on oxygen at 36 weeks corrected age. Most common discharge
differences. Gestational diabetes rate was also higher in women of complication was feed-related with 16.5% on nasogastric or jejunal
equal or more than 40 years, with a rate of gestational diabetes 11.3% feeds. Overall mortality was 10.1%
versus 4.7% in those under 40 years. The premature rupture of Conclusion: Survival to discharge was 90%. Significant ongoing co-
membranes was more frequent in older women, with a rate of 2.2% morbidities post-discharge mainly related gastrointestinal tract
compared to 1.2% in younger women, there are also significant interventions. TOF-OA babies’ in-hospital feeding progress should
differences. On the other hand also the older women had a higher be monitored closely and aggressively managed.
rate of placenta previa (1.2% versus 0.5%). However there was no
statistically significant difference in the rate of abruption. We also Keywords: Outcomes, tracheo-oesophageal fistula, oesophageal
found no differences in the rate of preterm labor. Women equal or atresia
over age 40 have a higher rate of caesarean sections (23% versus
14%), with statistically significant differences. The rate of labor
inductions, is also higher in patients 40 years of age or older (39%
versus 34%). There are no significant differences in weight. In both DOCTORS AND MIDWIVES: CARE OR CURE -
groups. We found a similar rate of macrosomas fetuses and less than 452
2500 grams fetuses. In relation to Apgar in the first minute, there are
no significant differences. Finally, no differences in the rate of
The effect of attending a prenatal
pathological arterial pH in the umbilical cord were found.
Conclusion: Complications in pregnancy and childbirth increases with
childbirth preparation course on
age. Age is a risk factor in pregnancy. The increasing age of pregnant labor duration and outcomes
women is becoming more common, especially in developed
countries. We must inform patients in the preconception period of
the risks of maternal age and make proper control of pregnancy in A. Y. Weintraub, D. Elharar, B. Aricha-Tamir, R. Cohen,
these women, to achieve similar results to younger patients. Z. Kalatian-Meloul, and D. Yohay
Department of Obstetrics and Gynecology, Soroka University Medical
Keywords: Pregnancy outcome, maternal age
center, Faculty of Health Sciences, Ben-Gurion University of the
Negev, Beer Sheva, Israel
14 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Introduction: The Dutch maternity care system – with its strong

midwifery profession and the option for a home birth – is under
Introduction: Due to the stressful and painful nature of childbirth and pressure nowadays. There is an on-going debate regarding the safety
its potential for maternal and neonatal complications, woman from all of home birth and the way maternity care is organized in the
cultures need support in this life-changing stage of their life. It has Netherlands. In addition, the home birth rate is rapidly decreasing. In
been postulated that increased knowledge and skills during 2000, nearly 30% gave birth at home, compared to 16% in 2013.
pregnancy prepares pregnant mothers for labor and leads to Recent studies on place of birth or birth setting has mainly focused on
promoted health. The purpose of the current study was to evaluate birth outcomes and issues of safety. Despite the fact that women-
the effect of attending a prenatal childbirth preparation course on centred care is given as an important point by all professionals
labor duration and outcomes. involved in maternity care, women’s views on place of birth are
Materials and methods: In this cross sectional study, 53 primiparous relatively unknown. The aim of this study was to explore women’s
women were compared with 54 primiparous women that did and did decisions related to place of birth – at home or in a hospital.
not attend a prenatal childbirth preparation course, respectively. Materials and methods: A qualitative study with an explorative
Women delivered between April and July 2014. The State-Trait descriptive design using semi-structured interviews. A sample of 23
Anxiety Inventory (STAI) was used to diagnose anxiety before delivery. healthy nulliparous women in the third trimester of their pregnancy
Data regarding demographic and clinical characteristics, obstetrical with a preference for a home birth, a midwife-led hospital birth or an
risk factors, pregnancy complications and adverse perinatal outcomes obstetrician-led hospital birth. We used thematic analysis to identify
were collected from the perinatal database of our center. In addition, and examine themes in the data.
through post-partum interviews, coping strategies learned in the Clinical cases and summary results: We examined key motivating
prenatal course were assessed, patients graded their childbirth factors for place of birth as well as how women conceptualize
experience and breastfeeding was evaluated. Data were analyzed childbirth and how this affects their birth place choices. While being
using description analyses and a p value 50.05 was considered in their own home was the most important aspect for women who
statistically significant. choose a home birth, women’s choice for a hospital birth was driven
Clinical cases and summary results: Most women who attended the by aspects of safety. However, women’s choice for one place did not
prenatal course (87.2%) felt it helped decrease their anxiety of labor. necessarily exclude the other one. Most women had primarily a
Over 90% of women thought that attending the course greatly preference for a place of birth instead of a highly motivated choice,
(63.8%) or moderately (27.7%) facilitated their positive coping with especially women who prefer a home birth. They were often careful
the delivery. Almost all women (97.9%) in the study group were with their decisions and they did not have explicit expectations about
satisfied with the course and would recommend it to a friend. The childbirth to avoid disappointments. Although most women saw
STAI score was significantly lower in the study group compared with childbirth mainly as a natural process, the language they spoke about
controls (p=0.025). The first stage and the entire duration of labor childbirth was in certain extent, the language of risk.The caregivers’
were significantly shorter (p=0.036 and p=0.026, respectively) in attitude also seems to have an influence: midwives seem to act more
women who attended the prenatal course. No significant differences and more from the medical paradigm instead of the social-
were found with regard to mode of delivery, rate of episiotomy and physiological paradigm when they provide information to women
perineal tears, use of analgesics and perinatal outcomes between the about childbirth and place of birth.
groups. Women in the study group rated their labor experience Conclusion: Caregivers should go more deeply into women’s
significantly higher (7.02.9 versus 5.63.0, p=0.016) and exhibited expectations and internal motivations of women regarding childbirth
significantly higher rates of breastfeeding (86.8% versus 54.7%, and place of birth, in order to create more awareness of women’s
p 50.001) than controls. decisions. Thereby should caregivers be aware of the effect of the
Conclusion: The knowledge acquired in the prenatal childbirth language they speak about childbirth.
preparation course aids in reducing anxiety of labor, is associated
with a significantly shorter first stage and entire duration of labor and
with an improved labor experience. Moreover, attending the prenatal Keywords: Place of birth, home birth, preferences, qualitative study
course, increases women’s awareness to the importance of breast-
feeding and results in significantly higher rates of breastfeeding. 416
Keywords: Prenatal childbirth preparation course, The State-Trait Does a POP-team contribute to
Anxiety Inventory (STAI), labor duration, labor experience,
breastfeeding
the prevention of child abuse
I. van Wanrooij1, J. H. A. M. Tuerlings2, K. de Boer3
208 A. Plaisier1, J. de Waal2, and J. C. Smal1
Why home or hospital birth? 1
Department of Pediatrics, Rijnstate Hospital, Arnhem, the
Netherlands, 2Department of Psychiatry, Rijnstate Hospital, Arnhem,
A qualitative study exploring the Netherlands, and 3Department of Gynaecologie/Obstetrics,
women’s motives and prefer- Rijnstate Hospital, Arnhem, the Netherlands

ences about place of birth in the Introduction: Maternal psychopathology, drug abuse, social problems
during pregnancy are risk factors for child abuse. Adequate selection
Netherlands of pregnant women at risk provides the opportunity to prevention of
future child abuse. For this reason a multidisciplinary collaboration
T. van Haaren - ten Haken1, M. Hendrix1, between psychiatrist, obstetricians, pediatricians and social workers
(POP-team) was established in 2007 in the Rijnstate Hospital, Arnhem,
M. Nieuwenhuijze1, J. Nijhuis2, and R. de Vries1,3 the Netherlands. During weekly meetings women at risk are reviewed.
1
Research Center for Midwifery Science Maastricht, Zuyd University, The POP-team assesses the presence of psychiatric or psychosocial
Maastricht, The Netherlands, 2Maastricht University Medical Center, problems, suggests policy social help and medical treatment. In
severe cases Child Protective Services (CPS) are consulted. In this
Dept. Obstetrics & Gynecology, Maastricht, The Netherlands, and
3 study we investigated the psychiatric and psychosocial problems
Maastricht University Medical Center, CAPRHI School for Public
were directive in consulting the CPS and their decision
Health and Primary Care, Maastricht, The Netherlands Materials and methods: Retrospectively we included all women and
their children who were reviewed by the POP-team from 1 January
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 15
2010 until 31 December 2013. Data were collected from the medical choices of place and mode of birth. We will present some tips and
records of mother and child. They comprised maternal demographic pointers for a suggested way to find common ground in the discourse
and psychosocial characteristics, medication, substance abuse, with these patients, so that the common goal, a healthy mother and a
obstetrical details and psychiatric diagnosis. Neonatal characteristics, healthy infant, can be achieved.
problems and hospital admissions in the first year of life were
evaluated. Outcome was the consultation of the CPS and their Keywords: Unassisted child birth, home birth, midwives, obstetri-
decision. A multivariate regression analysis was performed to identify cians, high risk, against medical advice
risk factors for consultation of the CPS.
Clinical cases and summary results: 649 women were identified of which
103 women were excluded because of delivery at home, termination of
pregnancy, preconceptional advice or loss to follow-up. 546 women
with 557 children were analyzed. The CPS was consulted in 99 (15%)
cases, (92 prenatal and 7 neonatal). Main factors for consultation CPS
were: maternal psychiatric disorder(n=6), mental retardation (n=9),
psychosocial problems (n=26), substance abuse (n=4), teenage
pregnancy (n=3), combination of several of these factors (n=50). All
CPS consultations were receptive, 21 children (3%) were placed in
foster families, the other parents got intensive accompaniment.
Conclusion: Having a POP-team to review socially vulnerable pregnant
women is advisable. Severe psychiatric disorders , mental retardation,
domestic violence and accommodation problems are the most
important factors for consulting the CPS. By consulting the CPS
extra support can be arranged. In case of serious problems children
can be protected by placement in a foster home. The data in our
study indicate that our POP-team contributes to prevention of child
abuse in a hospital setting.

Keywords: Psychiatric and psychosocials problems, vulnerable preg- 224

nant women, child abuse
Assesment of attitudes and
152 satisfaction among women
Why women want other or no who undergone cesarean
delivery care (wonder study) section without medical
indication
M. Hollander1, L. Holten2, J. van Dillen3, and
E. de Miranda3 A. Bashiri, T. Eshkoli, A.Y. Weintraub, B. Aricha-Tamir,
1
Obstetrics and Gynaecology Dept., Radboud University Medical Z. Yohay, and D. Yohay
Centre, Nijmegen, the Netherlands, 2Midwife, PhD, teacher, Midwifery Soroka Medical Center, Beer-Sheva, Israel
Academy (AVAG), Amsterdam, the Netherlands, and 3Midwife, PhD,
researcher, Academic Medical Centre, Amsterdam, the Netherlands Introduction: To identify attitudes and satisfaction among women
who undergone cesarean section without medical indication, to
Introduction: In the Netherlands, it appears that an increasing number examine the reasons why women choose cesarean section without
of women choose to go against medical advice and opt for a high risk medical indication and whether these reasons can be reduced.
home birth or even an unattended birth (unassisted childbirth, UC). In Materials and methods: A retrospective study was conducted
a system where low risk pregnancies are the domain of midwives, and including 48 women who gave birth by cesarean section without
high risk pregnancies are supervised by obstetricians, there are clear medical indication (study group), compared to 48 women, randomly
guidelines to demarcate the boundaries between these two groups of selected, who gave birth vaginally (control gtoup). Deliveries occurred
professionals. However, some women opt to go against recommen- in a tertiary medical center. Using a questionnaire and medical
dations and deliver at home with twins, a breech or a vaginal birth records, maternal attitudes about cesarean section without medical
after previous caesarean section. There are even approximately 200 indication and satisfaction were compared between the two groups.
women each year who choose to have a UC. This study attempts to Clinical cases and summary results: The main reasons to choose
elucidate the reasons why some women make these choices. cesarean section without medical indication were: past traumatic birth
Materials and methods: Twenty-eight women and their partners were experience (68.8%), avoidance of prolonged vaginal delivery (66.7%)
interviewed in depth by three of the authors. These audio files were and avoidance of pain during labor (64.6%). There was disagreement
transcribed and thematically analysed using the MaxQDA pro- between the women of the two groups regarding the following
gramme. Main themes and subthemes were indentified through assumptions: the improving effect a regular birth has on born babies
coding by two of the authors. (50% versus 25%), babies born surgically will be spending more time in
Clinical cases and summary results: We will present the main themes the hospital (25.5% versus 52.2%), anesthetic drugs can pass the
and some of the sub themes, including some citations from the newborn and cause him to be apathetic (30.2% versus 71.7%) and
women themselves. Themes that have emerged are, among others, a surgery have a greater risk than normal delivery (51.1% versus 85.4%).
mismatch between the medical professionals’ biophysical model, and Conclusion: There is lack of knowledge among all women regardless
the more nature- and body knowledge oriented discourse used by of selection through birth, the risks and complications for operative
the subjects, influence of social media and networks, differences in delivery compared with vaginal delivery.
risk perception, the cascade of interventions, and fear.
Conclusion: There appears to be a mismatch in risk perception and Keywords: Cesarean section without medical indication, vaginal
frame of reference between medical professionals and some pregnant delivery, maternal attitudes, maternal satisfaction
women. This may cause patients to go against medical advice in their
16 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

338
FETAL GROWTH RESTRICTION - 226
Association of mid-trimester Antithrombotic medication in
doppler parameters with pregnant women with previous
abdominal circumference intrauterine growth restriction
percentile in low-risk pregnant K. Neykova1, V. Dimitrova1,2, R. Dimitrov1,2, and
L. Vakrilova1
women 1
Medical University of Sofia, Medical Faculty, State University
T. Yuce, E. Kalafat, A. Gokce, and A. Koc Hospital of Obstetrics and Gynecology - Maichin Dom and
2
Femina Medical Center, Sofia, Bulgaria
Department of Obstetrics and Gynecology, Faculty of Medicine,
Ankara University Introduction: The aim of this prospective study is to analyze the
pregnancy outcome in patients who were on antithrombotic
Introduction: Purpose of this study was to investigate association medication (AM) because of previous pregnancy with fetal intrauter-
between Doppler parameters of umbilical artery pulsatility index (PI), ine growth restriction (IUGR).
uterine artery PI and middle cerebral artery PI with abdominal Materials and methods: The study included three groups: 1) studied
circumference (AC) percentiles. Rationale behind the study question group (SG) - 21 women on low dose aspirin (LDA) and/or low
was to find an appropriate mid-trimester Doppler parameter to molecular weight heparin (LMWH) because of previous pregnancy
identify pregnancies at risk for fetal growth restriction(FGR). with IUGR, 2) primary group (PG) - 15 previous pregnancies with IUGR
Materials and methods: Data from previously performed mid-trimester of the same women, 3) control group (CG) - 45 pregnancies matched
scans between 20 and 24 weeks of gestation was used in this study. AC for parity with the SG, without previous IUGR and no medication. The
percentiles were calculated using data from INTERGROWTH-21 study. three groups were compared for mean gestational age (GA) at
After normalising the PI value of each Doppler parameter, linear delivery, birth weight (BW), incidence of early preeclampsia (PE), IUGR,
regression plots were used to test for possible association between intrauterine fetal death (IUFD), neonatal death (NND), admission to
Doppler parameters and AC percentile. When a possible association NICU, cesarean section (CS) for chronic or acute fetal distress (FD).
was observed, the correlation of AC percentiles predicted by the model Student’s t-test was applied to assess differences between the groups.
and the actual values were tested with correlation coefficient analysis. p 50.05 was considered statistically significant.
Clinical cases and summary results: Results of 122 pregnant women Clinical cases and summary results: The SG and the PG were not
were included in the analysis. Linear regression analysis have shown significantly different regarding mean GA at delivery (33.7 versus 29.8
no significant association between Doppler parameters of uterine w.g.), proportion of CS for FD (53.3% versus 57.1%) and of babies
artery PI (R2=0.037, Cohen’s f=0.19, p=0.06) and middle cerebral admitted to NICU (66.7 vs.71.4%). The mean BW in the SG was
artery PI (R2=0.013, Cohen’s f=0.11, p=0.25) and AC percentile. significantly higher than in the PG (2115 vs.1091 g) while there were
However there was a significant association between umbilical artery significantly less cases of IUFD (14.3 versus 53.3%), early PE (9.5 versus
PI (R2=0.07, Cohen’s f=0.27, p=0.009) and AC percentile. The equation 46.7%) moderate and severe IUGR (10.5%/36.8% versus 41.7%/58.3%).
of linear regression model was AC%= -38.38*(UA PI)þ103.0 indicating Neonatal mortality in the SG (5.6%) was significantly lower than in the
a 0.1 point increase in PI predicts a 3.8% drop in AC percentile. PG (57.1%). In the SG compared to the CG mean GA age at birth was
Predictive power of model was tested on a separate group of significantly lower (33.7 versus 38 w.g.). So was BW (2114 versus
pregnant women and the correlation between predicted and actual 3094 g.). There were significantly more cases with IUGR in the SG -
AC percentiles were weak to moderate (r=0.26, p=0.009, n=86). moderate/severe (10.5%/36.8% versus 6.7%/2.2% in CG) and more
Conclusion: Although the final predictive power of the model was NICU admissions (66.7 versus 4.4% in the CG). There were no cases
weak, there was a significant relation between umbilical artery PI and with severe PE, IUFD, and CS for FD in the CG group while in the SG
AC percentiles whereas other Doppler parameters failed to show they were 9.5%, 14.3% and 53.3% respectively.
significant association. Since AC percentile is a strong determinant of Conclusion: The outcome of pregnancies with AM because of
birth weight, predictive power of umbilical artery PI during mid- previous fetal IUGR is improved compared to the index ones.
trimester for identifying fetuses at risk for FGR should be investigated However, it is less favorable compared to the outcome in matched
further. cases with no history of IUGR in previous pregnancies.

Keywords: Growth restriction, Doppler, mid-trimester, regression Keywords: Antithrombotic medication during pregnancy, low mole-
cular-weight heparin, low dose aspirin, intrauterine growth
restriction
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 17
589 2014 and June 2015 in which an EFW<10th centile was identified
32þ0 weeks ?gestation. Following the same methodology
Validation of a predictive risk described by Figueras et al (Ultrasound Obstet Gynecol 2015),
cerebroplacental ratio (CPR), mean uterine artery pulsatility index
model for adverse perinatal (mUtA-PI) and EFW were obtained from the last scan. Fetuses with
congenital anomalies were excluded. Cases were classified as high risk
outcome in late-onset small for for adverse outcome if they had any of the three parameters of the
gestational age fetuses model: CPR95th centile and EFW 3rd centile. As defined in the original
model, we considered adverse perinatal outcome as cesarean delivery
(CD) for non reassuring fetal status (NRFS) or umbilical artery pH<7.15.
A. Vázquez-Sarandeses, E. Gómez-Montes, I. Herraiz, Clinical cases & summary results: 133/202 (65.8%) SGA cases were
P. I. Gómez-Arriaga, M. S. Quezada, and A. Galindo. classified as high risk. 62/202 (30.7%) cases had an adverse perinatal
outcome, including non-exclusively 51 cases of CD for NRFS and 17
Fetal Medicine Unit - RED SAMID. Department of Obstetrics and cases of pH<7.15. There was one case of stillbirth in the low risk
Gynaecology. Hospital Universitario 12 de Octubre. Universidad group. Figure 1 shows the prognostic model according to the
Complutense de Madrid. Madrid, SPAIN perinatal outcome. The predictive performance of this algorithm in
our validation cohort compared to the original one showed a
Presenter: A. Vázquez Sarandeses sensitivity (%) of 82.3 (95% CI 70.9-89.8) vs. 82.8, a specificity (%) of
Introduction: Small for gestational age fetuses (SGA) are those with an 41.4 (95% CI 36.6-41.7) vs. 47.7, a positive predicted value (%) of 38.3
estimated fetal weight (EFW) below the 10th centile. A high (95% CI 30.5-46.8) vs. 36.2, and a negative predicted value (%) of 84.1
proportion of them also suffer from fetal growth restriction (FGR), (95% CI 73.7-90.9) vs. 88.6. Positive and negative likelihood ratios
with poorer perinatal outcomes including stillbirths, intrapartum fetal were 1.4 (95% CI 1.1-1.5) and 0.4 (95% CI 0.8-0.2), respectively.
distress and neonatal acidosis. Hence, it is essential to distinguish Additionally, the high risk group had lower birth weights (g) than the
between them to adequate monitoring and time to delivery. low risk group (2180 vs. 2588, p<0.001) and lower gestational age
Umbilical artery Doppler (UA) is the best validated parameter to (weeks) at delivery (36.7 vs. 38.2, p<0.001).
define FGR, but as the pregnancy is approaching its due date, UA is Conclusion: In our population, the predictive risk model for adverse
more usually normal in FGR. Recently, a risk model has been perinatal outcomes in late-onset SGA showed a predictive capability
proposed to identificate late-onset FGR, based on alternative similar to that observed by the original study. According to this
ultrasound parameters. Our aim was to validate this model in our algorithm, the measurement of CPR, mUtA-PI and EFW in the
population. evaluation of late-onset SGA is of moderate usefulness for predicting
Materials and methods: We performed a retrospective cohort study of adverse perinatal outcome.
202 singleton pregnancies evaluated in our center between January
18 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

653
523
Early markers of endocrino-meta-
Proteomic technologies in
bolic disease in growth restricted
prenatal diagnosis
fetuses
T. N. Pogorelova, V. O. Gunko, V. A. Linde, I. I. Krukier,
I. Alonso Larruscain, J. L. Ruibal Francisco, and A. A. Nikashina, N. V. Palieva, V. V. Avrutskaya, and
C. Notario Muñoz Zh. A. Elzhorukaeva
Paediatric Dept., University Infanta Cristina Hospital, Parla (Madrid), Rostov Scientific-Research Institute of Obstetrics and Pediatrics,
Spain Rostov-on-Don, Russia

I. Alonso Larruscain Presenter: V. A. Linde

Introduction: The adjustments to malnutrition in the growth restricted Introduction: Normal prenatal development depends on the balanced
fetus (GRF) that lead to obesity, insulin resistance, diabetes and functioning of the fetoplacental system, which is largely determined
cardiovascular disease in adulthood are not well known. The most by the dynamics of protein composition placenta. Modification of the
feasible explanation for this association is the hypothesis of catch up. proteins spectrum, performing essential functions in placenta, can
In utero, fetal metabolism is constantly readjusting to slow growth. serve as a trigger mechanism for the development of subsequent
When this adaptation is inconsistent with postnatal nutrition, it may metabolic disorders at fetus. The use of post-genomic technologies
be associated with rapid weight gain in infancy. This can lead to an makes it possible to evaluate the sum total of proteins of a biological
adaptation that predisposes a set of metabolic syndrome related object and creates qualitatively new opportunities for system
signs, increasing the risk of comorbidities (obesity, diabetes, searches of molecular markers of a pathology. Among the leading
dyslipidemia, coronary heart disease and hypertension). Some studies complications of pregnancy, resulting in prenatal morbidity and
postulate a greater influence of catch up growth than the low birth mortality, is fetal growth restriction (FGR)
weight itself in developing metabolic disease. Objective: Study of the protein spectrum of placenta in physiological
Materials and methods: This is a prospective cohort study of GRF pregnancy and FGR.
children born in the Hospital Infanta Cristina (Parla) during 2012 and Materials and methods: The study involved women with physiological
2013. Variables of anthropometric data, perinatal history, as well as pregnancy (n=27) and FGR (n=21). The material of the study was full-
blood pressure, analytical data (fat, sugar and hormone profile) were term placentas obtained after the delivery (weeks 38-40). The
collected during follow-up the first year of life in consultations of proteomic analysis was carried out using the two-dimensional
Pediatric Endocrinology. 126 GRF children were born in the time electrophoresis and matrix-assisted laser desorption/ionisation time-
period established, 125 accepted the inclusion in the study; 67 of of-flight mass spectrometry of peptides. Proteins were identified
these completed the full monitoring for a year. Two main using the Mascot program, Swiss-Prot and NCBI database.
comparative groups were established: those GRF who made a catch Clinical cases & summary results: In placentas of women with FGR
up growth (increase in Z score of weight of more than 0,67) during there are 18 proteins down-regulated as compared with physiological
the follow-up (47) and those who did not get it (20). pregnancy: actin cytoplasmatic, proteasome subunit a type 6,
Clinical cases & summary results: No direct correlation was found in the prohibitin, a-centractin, tropomyosin-a1, annexin A4, actin-related
GRF population between the presence of complications during protein, neutral a-glucosidase AB, protein ERp29, 4-trimethylamino-
pregnancy, maternal anthropometry, maternal smoking and the butyraldehyde dehydrogenase, 14-3-3 protein epsilon. The increased
presence or absence of a recovery growth. The analyzed character- expression was determined for endoplasmin, vimentin, actin, a1-
istics of the children in terms of sex, race and prematurity did not antitripsin, tropomyosin-. The increase in the production of certain
influence the presence of a recovery growth. Triglycerides at 12 proteins, in particular vimentin and tropomyosin- that are respon-
months was the only analytic variable in which statistically significant sible for the safety of the structure of a cytoskeleton, may have a
differences were found in the GRF group who made catch up growth compensatory value aimed at maintaining cell integrity under
during follow-up. This parameter could be proposed as early marker conditions of the complicated gestation.
of future endocrine-metabolic pathology in GRF population. There Conclusion: Changes in the production of proteins that regulate pro-
were no differences in other laboratory markers analyzed (insulin, and antioxidative balance, processes of cell differentiation, prolifera-
cholesterol, glucose, HOMA, IGF-1 and IGF-BP3). tion, trophic of a fetus, intercellular transport, apoptosis and
Conclusion: Those GRF with catch up growth during the first year of angiogenesis play a pathogenetic role in the development of FGR
life may have early changes in the triglycerides at the end of that and can be used for its diagnosis.
period.
Keywords: Proteomic analysis, placenta, fetal growth retardation
Keywords: Growth restricted fetus, endocrinometabolic disease,
early markers
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 19

520
FETAL ULTRASOUND - 505
Impact of prenatal evaluation of Ultrasound evaluation of foetal
congenital malformations in fetus spine position and success rate of
on postoperative mortality the manual rotation of foetus in
occiput posterior position: a pilot
I. Y. Gordienko, O. M. Tarapurova, G. O. Grebinichenko, study
O. K. Slepov, and A. V. Velichko
SI ‘‘Institute of Pediatrics, Obstetrics & Gynecology of National L. Attamante1, B. Masturzo1, A. Farina2, A. Piazzese1, and
Academy of Medical Sciences of Ukraine’’, Kyiv T. Todros1
1
Presenter: I. Y. Gordienko Department of Surgical Sciences, Sant’Anna Hospital; University of
Turin, Turin, Italy, and 2Department of Medicine and Surgery
Introduction: Appropriate prenatal diagnosis of congenital pathology (DIMEC), Division of Prenatal Medicine, Sant’Orsola Malpighi
that requires urgent surgical correction is the global problem of Hospital; University of Bologna, Bologna, Italy
perinatal medicine. Management of patients in specialized clinic
allows to start necessary interventions right after birth. Prenatal
evaluation of pathology is important for establishing complete Presenter: L. Attamante
preoperative diagnosis. The most important factors, which influence Introduction: Persistent Occiput Posterior Position (OPP) is the most
survival in patients with congenital diaphragmatic hernia (CDH), are common malpresentation in labour, causing about 18% of caesarean
associated pathology, liver invasion, degree of pulmonary hypoplasia sections and increasing the operative delivery rate (about 70%).
and time of diagnosis. Mortality rates in live-born with CDH range Manual rotation of the foetal occiput (MRFO) is considered a
from 10 to 50%, depending on country, clinic etc. In case of reasonably safe technique that can allow spontaneous delivery in
omphalocele infant mortality varies from 6 to 43%, for gastroschisis to OAP reducing the risk of operative and caesarean delivery, but it has a
11% and is mostly caused by associated bowel pathology. failure rate from 10 to 26%. The main aim of this pilot study was to
Materials and methods: Prenatal dispensary system which considers evaluate if the ultrasound diagnosis of both position of the occiput
the fetus as the patient has been established in Department of Fetal and of the foetal spine can increase the success rate of the manual
Medicine since 1985. Prenatal diagnosis was made in 151 fetuses with rotation of the foetal occiput in second stage arrest in persistent
CDH, 97 with gastroschisis and 79 with omphalocele. Detailed occiput posterior position.
ultrasound (US) examination and karyotyping were performed. Materials and methods: At Sant’Anna Hospital of Turin from January
Associated malformations (AM) were found in 27.8% and chromoso- 2014 to September 2015 we prospectively enrolled in a pilot study 35
mal anomalies (CA) in 2.7% of fetuses with CDH. Among fetuses with primiparous women who presented arrest of the second stage of
gastroschisis, AM were present in 6.2%. In cases of omphalocele, AM labour (diagnosed as lack of foetal head descent after two hours of
and CA were found in 26.6% and in 8.7%, respectively. During the adequate maternal expulsive efforts) with foetus in cephalic
pregnancy postnatal prognosis was specified, with assessment of presentation and occiput posterior position diagnosed by ultrasound.
established indices and new US indices from our clinic. Strategy for These women were randomized to group A where the foetal spine
delivery and management for the newborn was defined in each case position was not known by the operator and to group B where the
by interdisciplinary council. operator knew the spine position. The main outcome of the study
Clinical cases and summary results: From 1988 to 2015, 88 neonates was the rate of success of the MRFO with or without the ‘‘a priori’’
with CDH, 70 with gastroschisis and 29 with omphalocele were knowledge of foetal spine position by the operator. Secondary
diagnosed in our clinic. Comparison of postoperative mortality in outcomes were perineal injuries, blood loss, duration of the expulsive
groups of patients with mentioned pathology during the 1st period period and neonatal APGAR at 5’.
from 1988 to 2005 and 2nd period from 2006 to 2015 showed a Clinical cases & summary results: The two groups were found to be
significant decrease of postoperative mortality (p<0.01). In operated homogeneous for rate of posterior spine (respectively 7 and 6 cases),
newborns with CHD (27 from 40 and 37 from 48 during the 1st and maternal age, maternal BMI, use of epidural analgesia and foetal
2nd period, respectively), postoperative mortality decreased from weight at birth. The manual rotation was successful in 47.4% of
44.4% to 10.8%. All newborns with gastroschisis and omphalocele patients of group A and in 87.5% of women of group B (p-
were operated. Postoperative mortality in patients with gastroschisis value=0.030), significantly improving the percentage of spontaneous
during the 1st and 2nd period was 62.9%, and 20.9%, respectively. deliveries (21.1% vs. 68.8%, p-value=0.0043) and the maternal
Common causes of death were associated malformations, mostly outcome. Blood loss was significantly lower for Group 2, probably
intestinal atresia of various levels, infections and necrosis of due to the lower percentage of perineal damages and to a shorter
abdominal wall in 1 case. For the patients with omphalocele, second stage of labour after MRFO. Even if the series of data is
postoperative mortality during the 1st and 2nd period was 57.1%, relatively small, the comparison reached a significant p-value. No
and 10%, respectively. differences were found on the neonatal side.
Conclusion: The prenatal dispensary system with implementation of Conclusion: Manual rotation of the foetal occiput is a safe and useful
effective strategy of perinatal help, development of local protocols of procedure that should possibly be performed in second stage arrest
operations and interdisciplinary collaboration of specialists in prenatal of labour in occiput posterior position. Despite the low power of our
diagnostics, obstetricians and surgeons, enabled to decrease post- study, we think that these preliminary results are encouraging and
operative mortality considerably during last 10 years in newborns in allow us to speculate on the usefulness of the a priori knowledge of
cases of CDH, gastroschisis and omphalocele. The work of the team the position of the foetal spine to improve the success rate of the
was optimized because of increased level of specific knowledge in manoeuvre. Wider series of data are however needed to yield more
each of involved specialists. robust results and conclusions.
Keywords: Manual rotation of foetal occiput, second stage of labour,
Keywords: Prenatal diagnosis, congenital malformations, postopera- ultrasound evaluation of foetal spine position, occiput posterior
tive mortality position
20 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

199 TCD can be used for accurate dating of pregnancies when first day of
LMP or first trimester CRL measurement is not available.
Accuracy of mid-trimester
transcerebellar diameter Keywords: Dating, transcerebellar diameter, crown-rump length,
accuracy
measurements for pregnancy
dating 730
E. Kalafat, T. Yuce, O. Ulusoy K. Baydemir, and Fetal cardiac tumor
F. Soylemez
A. Safont, M. Donázar, B. Gastón, J. Barrenetxea,
Faculty of Medicine, Department of Obstetrics and Gynecology, M. Urtasun, S. Garcia, and N. Abián
Ankara University, Ankara, Turkey
Obstetrics and gynecology Dept., Complejo Hospitalario de Navarra,
Introduction: Accurate dating of a pregnancy is perhaps the most Pamplona, Navarra, Spain
important part of antenatal care as all future management strategies
will rely on gestational age. The gold standard of pregnancy dating is Presenter: Andrea Safont
crow-lump length (CRL) measurement between 9th to 13th gesta- Introduction: Cardiac tumors are rare, with an incidence varying from
tional age. Purpose of this study was to compare pregnancy dating 0.17/10.000 to 28/10.000. Rhabdomyomas are the most common
via mid-trimester transcerebellar diameter(TCD) measurements with tumors in intrauterine life, followed by teratomas and fibromas.
dating via CRL measurements. Although fetal cardiac tumors are extremely rare, poor prognostic
Materials and methods: This was a retrospective cohort study indicators include development of intracardiac flow obstruction,
conducted between July 2015 and February 2016 in Ankara alteration of the atrioventricular valve function with consequent
University Department of Obstetrics and Gynecology. First day of regurgitation, arrhythmia, cardiac dysfunction and hydrops. Early
last menstrual period (LMP) was calculated for each pregnancy by detection of congenital tumor is critical to improving outcome. Many
using both first trimester CRL measurements and mid-trimester TCD studies have demonstrated the frequent association of fetal cardiac
measurements. A mean of three measurements was used for each rhabdomyoma with tuberous sclerosis and the incidence may be as
variable. First day of LMP was expressed in days calculated as [Day of high as 50%.
USG þ Month of USG*30] minus [Gestational age in days] according Clinical cases & summary results: We present a case of fetal cardiac tumor
to either CRL or TCD measurements. First day of LMPs were compared ultrasound diagnose at 21 þ 1 weeks of gestation. An intracardiac solid
with Wilxocon matched-pairs rank test. Correlation between two homogeneous and isoecogenic mass of 33 mm was observed
methods was analysed with interclass correlation coefficient and between tricuspid valve and lateral myocardium wall. Normal cardiac
Bland-Altman plot. function was observed. Genetic study was performed. Maternal
Clinical cases and summary results: A total of 89 pregnancies between karyotype was normal. Fetal karyotype was normal. Specific genetic
17 and 26 weeks of gestational age at the time of mid-trimester scan tuberous sclerosis study did not detect any alteration. At 34 þ 2 weeks
were included in the analysis. Median CRL of study population was of pregnancy the tumor had decreased and was difficult to detect on
59 mm (IQR 54 to 65.5 mm) and median of TCD measurements was ultrasound. At 36 þ 2 weeks of pregnancy no tumor was visualized. At
22.56 mm (IQR 18.2 to 23.31 mm). Median gestational age at CRL birth echocardiographyc study did not show any alteration.
measurements was 87 days (IQR 84 to 90 days) and median gestational Conclusion: Fetal cardiac tumors can be detected by echocardiogra-
age at TCD measurements was days 158 days (IQR 127 to 163 days). phy. However, differential diagnosis is important as this will affect
Median difference between LMPs calculated with CRL or TCD prognosis and subsequent management. In this case rhabdomyoma
measurements was 2 days (IQR -2 to 6 days) and correlation between was suspected so genetic study was conducted but did not show any
two methods had a correlation coefficients of 0.98 (95% CI 0.97 to 0.98). alteration.
Bland Altman plot of two methods can be seen in Image 1. Spontaneous regression of the tumor was observed and confirmed at
Conclusion: By using mid-trimester TCD measurements, an accurate birth with favorable neonatal outcome.
dating of most pregnancies were achieved with an error margin of -2
to þ6 days when CRL measurements were used as gold-standard. Keywords: Fetal cardiac tumor, rhabdomyoma, tuberous sclerosis,
echocardiography
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 21

FIRST TRIMESTER SCREENING AND

469 (CASE REPORT) PREVENTION STRATEGIE - 461 (CASE REPORT)
Fetal intraabdominal umbilical Detection of 15q (Prader Willi/
vein varix: antenatal diagnosis Angelman) deletion in maternal
and management cell-free fetal dna test, a case
report
M. A. Ozek, P. Calis, M. Bayram, and D. Karcaaltincaba
Department of Perinatology, Gazi University Hospital, Ankara, Turkey C. Batukan1, O. Takmaz2, C. Yakicier3, Y. Alanay4,
E. Ozbasli 1, and O. Tosun 5
Introduction: Fetal intraabdominal umbilical vein varix (FIUVV) is a very 1
Obstetrics and Gynecology Department, Maslak Hospital, Faculty of
rare clinical finding. It is defined as a focal dilatation of the umbilical
vein. The prevalence of FIUVV is reported to be between 1.1 to 2.8 per Medicine, Acibadem University, Istanbul, Turkey, 2Obstetrics and
1000 pregnancies. Although controversial, finding of FIUVV has Gynecology Departmet, Maslak Hospital, Acibadem University,
usually been associated with poor obstetric outcomes. Because of this Istanbul, Turkey, 3Department of Moleculer Biology and Genetics,
ambiguity, antenatal management and timing of delivery are also not Faculty of Arts and Sciences, Acibadem University, Istanbul, Turkey,
4
determined clearly. Here we present a case with FIUVV complicated Department of Pediatrics, Maslak Hospital, School of Medicine,
with intrauterine growth restriction, managed successfully in our Acibadem University ,Istanbul, Turkey, and 5Gumussuyu Military
department. Hospital, Balmumcu Polikliniği, Istanbul, Turkey
Clinical cases & summary results: A 24-year-old, gravida 1 para 0
woman was referred to our department with the suspicion of fetal
Introduction: The number of invasive diagnostic procedures has been
pelviectasis at 29 weeks. Combined test and fetal anatomy survey
significantly decreased since non-invasive prenatal screening (NIPS
were reported to be normal. An intraabdominal umbilical vein varix
test) was introduced into prenatal screening work-up. NIPS is
with diameter of 11 mm and highly turbulent flow were revealed on
considered to be an effective test in the diagnosis of some of
sonogram and Color Doppler (Figure 1). Fetal biometry was normal
known microdeletion syndromes. The evidence for using this test for
(estimated fetal weight was 13p). Umbilical artery Doppler indices
screening these syndromes is limited. due to the low prevalence rate
were normal and there were no other fetal anomaly. The patient was
of microdeletion syndromes, NIPS test’s positive predictive value
followed up weekly till 34 weeks of gestation. At 34 weeks of
might not be high enough to screen population, and most of the
gestation, estimated fetal wieght was 1900 gr (4p), (AC 2,3 p). Doppler
positive test results, therefore, might be false-positive for patient
studies were normal. Daimeter of the umbilical vein varix was
population with an average risk. We presented the first 15q (Prader-
13 mm.Then, the patient was followed up on twice-weekly basis. At
Willi/Angelman syndrome) deletion detected by nips in a patient with
37 weeks,patient was admitted for induction of vaginal delivery.
a twin pregnancy who had undergone in vitro fertilization.
However c-section was performed due to arrest of labor. A 2100 gr
Clinical cases and summary results: A 29-year-old woman with
baby with APGAR scores of 9 and 10, respectively was delivered. The
dichorionic diamniotic twin pregnancy applied to our clinic for nips
baby was discharged without any complications.
test on her own choice at about 12 weeks gestational age. massively
Conclusion: We are in the opinion that, detection of FIUVV should
parallel sequencing technology was used for detection of chromo-
warrant a detailed sonogram and fetal echocardiography.
somal aneuploidies and microdeletion syndromes, resulting in
Karyotyping should be reserved only for those with accompanying
positive for 15q microdeletion (figure1). She was counseled for
other fetal anomalies. Then, the patient should be followed up on
prenatal ultrasound and underwent amniocentesis procedure in order
weekly basis till term in the absence of any complications. The
to be able to confirm the test result. It was confirmed with fish
reasons for this close surveillance are possibility of thrombus
technique that one of the fetuses has a15q deletion (figure2). A
formation, monitorization of fetal well-being and growth. Delivery
selective fetocites procedure was succesfully done for the fetus with
should be planned after 38 weeks of gestation.
15q deletion. The other baby was vaginally delivered at term. the
postnatal evaluation of the baby was unremarkable.
Keywords: Fetal, umbilical vein varix, antenatal diagnosis, Conclusion: As a consequence, theoretically NIPS tests may have a
management lower chance in the detection of micro deletion syndromes, but it
should be assessed with wider studies to be able to reveal its role as a
screening tool in the evaluation of these diseases in a population with
an average risk. Additionally, NIPS testing shows that commercial
22 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

marketing of medical tests directly to the patients can cause overuse of combined screening did not reveal high risk of trisomy in all the
of some medical tools before exact evidence emerges. patients except for one. In one patient due to calculated high risk of
trisomy 21 in the first trimester (with no wish for invasive procedure at
Keywords: Non-invazive prenatal testing, prenatal detection of 15q that time) and premature rupture of membranes in 20 week of
deletion, prenatal diagnose of Angelman/Prader-Willi syndrome , gestation cordocentesis was performed which revealed normal male
prenatal diagnose of micro deletion syndromes karyotype. The pregnancy resulted in preterm delivery in the 25th
week of pregnancy and the baby died. The median MoM for PAPP-A
in the liver recipients was 1.679 and for free beta-hCG 2.186. In the
536 kidney recipients median MoM for PAPP-A was 1.139 and for free
beta-hCG was 2.107. Second trimester ultrasound examination
First trimester biochemical revealed no congenital anomalies in the fetuses. All the pregnant
graft recipients were followed up in our center until delivery and no
screening in female kidney and cases of trisomy 21, 13 or 18 as well as no other congenital
liver graft recipients abnormalities were detected.
Conclusion: Our preliminary results may indicate that the serum
biochemistry might be changed in graft recipients. The main
N. Mazanowska, B. Pietrzak P. Kosinski, and M. Wielgos limitation of the study, which is a small number of participants
enrolled, emerges from an alarming fact that only 29% of pregnant
First Department of Obstetrics and Gynecology, Medical University of post-transplant patients were referred to our center before 14 weeks.
Warsaw, Poland The performance of the first trimester combined screening in the
post-transplant population remains to be established and the
Presenter: N. Mazanowska optimization of perinatal care is essential.
Introduction: Frist trimester combined screening is based on taking into
account maternal age, results of an ultrasound examination performed Keywords: First trimester screening, PAPP-A, free beta-hCG, graft
between 11 and 13 þ 6 weeks of pregnancy and serum biochemistry, recipient, posttransplan pregnancy
assessing concentrations of placental products such as free beta-hCG
and PAPP-A in maternal blood sample. It is well known that factors
such as maternal weight, smoking or method of conception influence 331
the concentration of free beta-hCG and PAPP-A and in calculation of
patient specific risk the measured level is converted into multiples of Fetal aneuploidy screening
the expected median (MoM). There are no data available on the levels
of free beta-hCG and PAPP-A in post-transplant pregnancies. The aim results in maternal plasma
of the study was to evaluate the first trimester biochemical serum
markers in pregnant kidney and liver graft recipients.
samples redrawn due to
Materials and methods: Sixty-two post-transplant women that
delivered in our Department in years 2010-2014 were identified.
insufficient fetal cfDNA in the
Among them there were thirty-three liver and twenty-nine kidney initial sample
recipients. Eighteen patients underwent combined first trimester
screening based on the maternal age, ultrasound markers (nuchal Schmid M., Musci T., Song K., Wang E., and Fergus K.
translucency, nasal bone, ductus venosus flow and tricuspid flow) as
well as serum biochemistry performed by the holders of FMF Ariosa Diagnostics, Inc and Roche Sequencing, San Jose, CA, USA
certificate of competence. The blood samples were analyzed by
means of the Delfia and Roche Cobas analyzer. The calculations were Introduction: To determine the redraw success rate of samples initially
performed by means of software approved by the FMF and the receiving no cfDNA result due to low fetal fraction (FF) and to
measured levels of free-bhCG and PAPP-A were exhibited as multiples characterize the results of redrawn samples.
of median (adjusted to gestational age, maternal weight, smoking Materials and methods: A review of initial cfDNA results of 229,454
status, ethnicity and method of conception). consecutive samples submitted to Ariosa Diagnostics for the
Clinical cases & summary results: The eighteen patient that underwent HarmonyTM Prenatal Test was conducted. cfDNA samples were
combined screening were 10 liver and 8 kidney recipients. The results reviewed and categorized as having an increased probability for
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 23
trisomy 21 (T21), trisomy 18 (T18) and trisomy 13 (T13), decreased presence of positive thyroglobulin antibodies (anti-TG) and anti-thyroid
probability for trisomy and no reportable results due to low FF. peroxidase/antimicrosomal antibodies (anti-TPO).
Samples that received no reportable results due to low FF (54%) were Materials and methods: The inclusion criteria for this study were
identified, tracked and matched to repeat cfDNA samples. The results pregnant women between 6-12 weeks of gestation. The exclusion
of redrawn samples were also categorized and compared to the criteria were pre-pregnancy thyroid disease, other medical history of
results of initial samples. The overall and redraw success rates were Diabetes or Hypertension, or abnormal levels of free T4 at the
evaluated (Table 1). Pregnancy outcome data was not obtained. moment of the study. Covariates: the following data were collected
Clinical cases and summary results: Of the 229,454 samples submitted, from each patient: gestational age at the time of the serum
97.4% (223,649) received a result on their initial cfDNA sample, with determination, TSH determination in serum, free T4, anti-TG and
1.49% (3287) receiving results indicating an increased probability for anti-TPO antibodies. In the first visit, TSH, free T4, anti-TG and anti-
trisomy 21, 18 or 13. Non-reportable results due to low fetal fraction TPO antibodies, were determined. Statistics: In order to determine the
were seen in 1.8% (4100) of the initial samples. Of this group, 74.2 % correct cut-off of TSH we calculate TSH centiles and, to evaluate the
(3041) elected to have a repeat cfDNA sample collected, with 68% capacity of TSH to predict the detection of anti-TG autoantibodies we
(2058) receiving a reportable result on their second sample. While the performed a ROC (Receiver Operating Characteristic curve).
mean fetal fraction was lower in the redrawn samples (6.58% compared Clinical cases & summary results: 107 pregnant women were included
to 11.49% in the initial samples), results indicating a low probability for in our study. Seven presented abnormal levels of free T4 and were
trisomy 21, 18 and 13 were generated for 98% (2017) of these samples. excluded. Range, median and standard deviation of free T4, anti-TG
Conclusion: Of cfDNA samples redrawn after an initial sample failure and anti-TPO antibodies was obtained. The group selected was
due to low FF, 68% received a result with 98% indicating a low resampled to a 5000 participants sample (by the technic of
probability for the autosomal trisomies. Recommendations that bootstrap).Based on this, we calculated TSH percentiles (Table 1). 11
women receiving ‘no call’ cfDNA screen results be referred for patients present high levels of anti-TG antibodies, (4115UI/ml). Figure
diagnostic testing due to an increased aneuploidy risk result in 1 showed ROC curve, in order to determine the best cut-off point of
increased number of invasive prenatal diagnostic tests. This study TSH associated with positive anti-TG antibodies.
shows submitting a second cFDNA sample yields a reportable result This point corresponds with TSH level of 2.47 mUI/ml; which present a
for most women and is a viable pathway in clinical care. sensitivity of 81,8% and the specificity of 68,5% (AUC = 0.801).
9 participants showed high levels of anti-TPO antibodies (434UI/ml).
Keywords: NIPT, redraws, low-risk results We performed ROC curve to determine the best cut-off point of TSH
levels that will predict the presence of positive anti-TPO.
The calculated AUC 0.563; conclude that TSH levels are not valid to
predict the presence or absence of positive anti-TPO.
666 Conclusion: In our area, the limits of normal level for TSH in the first
Hipothyroidism screening during trimester of pregnancy are between 0,066mUI/ml and 4.721mUI/ml.
In the first trimester, the cut-off of TSH that best predicts the presence
pregnancy of anti-TG antibodies is 2.47mUI/ml.
TSH is not a valid parameter to predict the presence of positive
antiTPO antibodies in the first trimester.
M. Castillo Lara, E. Soto Pazos, C. González Macı́as,
J. J. Fernández Alba, L. J. Moreno Corral and y R. Torrejón Keywords: Subclinic gestational hypothyroidism, free tetraiodothyr-
Cardoso onine, thyroglobulin antibodies, anti-thyroid peroxidase/antimi-
crosomal antibodies
Marı́a Castillo Lara, Medical Intern Residence II-Obstetrics and
GynecologyHospital Universitario de Puerto Real (Cádiz) -Spain,
Carretera Nacional IV Km. 665, 11510 Puerto Real, Cádiz. Phone: 956
00 50 00, [email protected]/Phone: þ34 699847240
393
Accuracy and reproducibility of
Presenter: Marı́a Castillo Lara
Introduction: Hypothyroidism may have adverse effects on pregnancy, fetal fraction measurement using
depending upon the severity of biochemical abnormalities. It has been
associated with preeclampsia, preterm delivery, neuropsychological quantitation at polymorphic loci
and cognitive impairment. Subclinical hypothyroidism is defined by
tyroid stimulating hormone (TSH) elevated levels with normal free
with microarray
tetraiodothyronine (T4), with no clinical manifestations of hypothyroid-
ism. There is controversial regarding the cut-off value of TSH level used M. Schmid, D. Miller, K. White, T. Musci, and E. Wang
in pregnant women. The aim of this study was to determine the correct
cut-off of TSH in order to diagnose subclinic gestational hypothyroid- Roche Sequencing Unit
ism. Secondary, we determine the TSH level which predicts better the
24 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Introduction: Measurement of the proportion of cell-free DNA (cfDNA) GENERAL OBSTETRICS - 241
in maternal plasma that originates from the pregnancy, commonly
known as fetal fraction (FF), is widely considered to be a critical Cervical biomarkers as predictors
quality control metric in the application of cfDNA screening for fetal
aneuploidy. Different methodologies have been employed for FF of successful labor induction by
estimation with varying demonstrations of accuracy when compared
to a standard measure of Y sequence quantitation in pregnancies
foley catheter
with a male fetus. We have previously demonstrated that FF
measurement is reproducible using single nucleotide polymorphisms H. Kruit1, O. Heikinheimo1, T. Sorsa2,3, J. Juhila4,
(SNPs) across different quantitation methods (microarray and J. Paavonen1, and L. Rahkonen1
sequencing). In this study we evaluate the accuracy and reproduci-
1
bility of FF measurement with SNPs compared to Y sequences using Department of Obstetrics and Gynecology, University of Helsinki and
microarray quantitation. Helsinki University Hospital, Helsinki, Finland, 2Department of Oral
Materials and methods: Maternal plasma samples were assayed on and Maxillofacial Diseases, University of Helsinki and Helsinki
custom arrays designed to quantify non-polymorphic targets on University Hospital, Helsinki, Finland, 3Division of Periodontology,
chromosomes of interest for aneuploidy assessment (21, 18, 13, X, and Department of Dental Medicine, Karolinska Institutet, Huddinge,
Y) and polymorphic targets (for fetal fraction assessment) as
Sweden, 4Medix Biochemica, Espoo, Finland
previously described. The coefficients of determination were calcu-
lated for the measurement of fetal fraction between SNPs and Y
sequences as well as for fetal fraction measurements between the first Introduction: Prediction of successful labor induction is difficult,
and second tubes for the same patient sample. indicating a need for a biochemical test. The levels of insulin-like
Clinical cases and summary results: Comparison of the SNP to Y growth factor binding protein-1 (IGFBP-1) and phosphorylated IGFBP-
sequence quantitation showed a strong correlation (r2 ¼ 0.99). Fetal 1 (pGFBP-1) in the cervical fluid reflect cervical ripeness. Matrix
fraction measurement between the first and second tubes was highly metalloproteinases (MMPs) and their endogenous tissue inhibitors
reproducible (r2 0.99). (TIMPs) are mediators in preterm labor but also appear to play a role
Conclusion: Microarray quantitation of SNPs is an accurate and in the initiation of labor at term. The mechanism of Foley catheter is a
reproducible method for fetal fraction estimation. This study provides direct mechanical stretching of the cervix and lower uterine segment,
a useful benchmark for ensuring reliability and accuracy of fetal combined with local secretion of endogenous prostaglandins. Little is
fraction measurement. known of the effect of Foley catheter induction on biochemical
mediators in the cervix.
Materials and methods: We included 35 nulliparous women with
Keywords: NIPT, Fetal fraction, cfDNA, prenatal testing
uncomplicated singleton pregnancy, intact amniotic membranes,
cephalic presentation, and an unripe cervix (Bishop score 56)  37
weeks of gestation scheduled for induction of labor by Foley catheter
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 25
Table 1 Cervical biomarker levels.

At start of IOL At balloon expulsion

mg/L Mean SD Median Range Mean SD Median Range p-value
IGFBP 25.2 55.3 1.8 0.07–261 64.5 132.4 23.5 1.1–718 0.008
pHIGFBP 71.6 176.4 5.5 0.3–976 143.7 270 75.5 3.4–1530 0.001
MMP-8 683.6 582.6 446 28–1998 241.6 151.1 230 23–661 0.000
TIMP-1 25.6 31.3 16.2 1.1–161.9 39 34.4 32 7.2–172.4 0.45
TIMP-2 11.4 8.2 9.3 1.2–38.5 48.6 93.3 18.9 1.0–539.0 0.018
MMP-9 697.7 748.4 431.5 11–3019 159.6 160 178.4 13.5–666.7 0.000
MMP-2 29.1 25.8 25.5 0.7–110.9 7.9 5.8 5.6 2.0–29.5 0.77
MMP-8/TIMP-1 molar ratio 36.8 55.3 14.2 0.4–245.9 4.5 6.6 3.9 0.1–39.5 0.000

between September 2014 and June 2015. Serial cervical swab is a reduction in platelet count. Some other studies showed that
samples were collected at Foley catheter insertion and expulsion. hypertensive disorders cannot be predicted based on platelet count
The concentrations of IGFBP-1, pIGFBP-1, MMP-2, MMP-8, MMP-9, during early stages of pregnancy. Nevertheless, an increased mean
TIMP-1, and TIMP-2 were analyzed. Concentrations of cervical IGFBP-1, platelet volume (MPV) reflects enhanced platelet activation which
pIGFBP-1, and MMP-8 were measured by immunoenzymometric may be caused by impairment in uteroplacental circulation.
assays using monoclonal antibodies (Medix Biochemica, Espoo, Materials and methods: A retrospective population-based study was
Finland). MMP-2, MMP-9, TIMP-1 and TIMP-2 analyses were carried conducted between 2013 and 2015 to examine whether platelet
out by using commercial ELISA kits (Biotrak ELISA Systems,GE levels and MPV in the first trimester of pregnancy, 8-14 weeks of
Healthcare Life Sciences and Quantikine ELISA Kit,R&D Systems). gestation, are associated with obstetric complications. The second
Clinical cases and summary results: The median time from Foley aim is to rule out variables that may have a significant contribution on
catheter insertion to expulsion was 255169 minutes. Table 1 shows platelet levels during first trimester. Robust linear multiple regression
the concentrations of the cervical biomarkers at the start of labor model was constructed to rule out variables that were significantly
induction and after Foley catheter expulsion. The median IGFBP-1 and related to platelet count levels during first trimester of pregnancy.
pIGFBP-1 levels increased (from 1.8 to 23.5 and from 5.5 to 75.5 mg/l, ROC curves analysis were performed to test MPV alone and in
p=0.008, p=0.001, respectively) in relation to the time the Foley combination with PAPPA levels to find out whether these markers are
catheter was retained. MMP-8 and MMP-9 levels decreased (from 446 good predictors of PE and IUGR.
to 230 and from 431.5 to 178.4 mg/l, p=0.00, p=0.00, respectively) Clinical cases & summary results Platelet count was measured in 6097
during Foley catheter induced cervical ripening. On the contrary, the patients at first trimester of pregnancy assuming that the distribution
TIMP-2 concentrations increased (from 9.3 to 18.9 mg/l, p=0.02). The did not follow an exact normal pattern in our sample. Results from
levels of MMP-2 and TIMP-1 did not significantly change. The cesarean the linear multiple regression including 2124 observations with a R-
delivery rate was 44 % (n=15). There were no significant differences in squared of 0,022 showed that there was a significant contribution on
the biomarker levels according to the mode of delivery. platelets count at first trimester from: maternal ethnicity, presence of
Conclusion: IGFBP-1, pIGFBP-1 and TIMP-2 levels increase, and MMP-8 rheumatologic disease and maternal weight (p<0,05). There was not
and MMP-9 levels significantly decrease in the cervix during Foley significant association between platelet count at first trimester and
catheter induced ripening in nulliparous women and seemed to be any adverse perinatal outcome. The area under ROC curve for PE and
biochemical mediators of this event. However, these cervical biomar- IUGR including MPV alone and in combination with PAPPA levels at
kers are not suitable for predicting the outcome of labor induction. first trimester of pregnancy showed the following results: 0.609 for PE
by MPV + PAPPA, 0.596 for IUGR by MPV + PAPPA, 0.534 for PE by
Keywords: Induction of labor, Foley catheter, Cervical biomarker, MPV.
Insulin-like growth factor binding protein-1 (IGFBP-1), Matrix Conclusion: The major finding of our study is that platelet count
metalloproteinases during first trimester of pregnancy is not associated with PE, IUGR,
preterm delivery, gestational diabetes or any adverse perinatal
outcome at birth. High MPV alone and in combination with low
PAPPA levels at first trimester appears not to be a good predictor of
PE or IUGR either.
518
Platelets in first trimester as a Keywords: Platelets, perinatal outcome, preeclampsia, intrauterine
growth restriction
predictor of perinatal outcome: a
based population study
G. Nozaleda Pastor A. Garcia Carreras S. Garcia-Tizon
Larroca and S. Lizárraga Bonelli
Servicio de Ginecologı́a y Obstetricia, Hospital General Universitario
Gregorio Marañon de Madrid, Madrid, Spain

Presenter: G. Nozaleda Pastor

Introduction: Prediction of perinatal outcome from early stages in
pregnancy has become a health priority as a way to improve both
maternal and neonatal healthcare. Normal pregnancy is characterized
by an increase in platelet aggregation and slightly lower mean
platelets counts than in healthy non-pregnant women. Longitudinal
studies showed that in women with adverse perinatal outcome such
as Preeclampsia (PE) and intrauterine growth restriction (IUGR) there
26 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

190 heart rate involvement were 23.6 and 14.2% respectively. Tocolysis
was given in 14.2% of the cases. Meconium-stained liquor was seen in
Observational study of misopros- 16.0%. Two neonates had a low 5-minute APGAR-score and six
neonates were diagnosed with metabolic acidosis (umbilical artery pH
tol 200 mG vaginal delivery 5 7.05 and base deficit 4 12 mmol/l). Experience of the treating
system (MISODELÕ ) in Dutch physician with MisodelÕ regarding efficacy, safety, single dose for
24 h, controlled release, ease of insertion, possibility of retrieval and
obstetric practice reduction in vaginal examinations scored on average 4 out of 5.
Conclusion: Use of MisodelÕ in Dutch obstetric practice resulted in a
relatively high vaginal delivery rate and a short time to vaginal
T. Hasaart1, N. van Gemund2, R. Pal3, G. Muijsers4, delivery. In the majority of multiparous patients, oxytocin augmenta-
M. Verbeek5, J. van Eyck6, J. Baalman7, R. Olivier8, tion was not needed. Foetal and neonatal safety warrant the cautious
J. Lenglet9, H. Versendaal10, H. Mous11, H. Feitsma12, use of MisodelÕ . Dutch doctors were satisfied with the use of
MisodelÕ .
D. Schippers13, and E Creutzberg14
1
Departements of Gynaecology, the Netherlands:, 1Catharina Keywords: Induction of labour, misoprostol vaginal delivery system,
Hospital, Eindhoven, 2St. Franciscus Gasthuis, Rotterdam, 3St. Misodel
Franciscus Hospital, Roosendaal, 4Hospital Rivierenland, Tiel, 5St.
Antonius Hospital, Nieuwegein, 6Isala Clinics, Zwolle, 7University
Medical Cente, Utrecht, 8Medical Centre Zuiderzee, Lelystad, 9Flevo
Hospital, Almere, 10Maasstad Hospital, Rotterdam, 11Nij Smellinghe
Hospital, Drachten, 12Haga Hospital, Den Haag, 13Canisius 344
Wilhelmina Hospital, Nijmegen, 14Ferring B.V., Hoofddorp
Minor alterations of glucose
Introduction: Patient population as well as obstetric practice in the
Netherlands may deviate from those in the USA, where the phase III
metabolism: the flat OGTT and its
study on MisodelÕ was performed. Aim of this prospective,
observational, multi-centre, open-label study was to retrieve ‘real
effects on fetal growth
world evidence’ about the effectiveness and safety of misoprostol 200
micrograms misoprostol vaginal delivery system (MisodelÕ ) in Dutch Rambaldi MP1, Paoli D2, Cecconi L3, Simeone S1,
obstetric practice. Serena C1, Ottanelli S1, Mello G1, and Mecacci F1
Materials and methods: MisodelÕ was applied in accordance with 1
clinical routines after obtaining informed consent for (coded) use of Women and children health department, High Risk Pregnancy Unit,
medical chart information. Primary endpoint was the time to vaginal Careggi University Hospital, Florence, Italy, 2School of Science of the
delivery after insertion of MisodelÕ . Key secondary endpoints were Human Health, Dietetics Department, University of Florenc,
3
time to any delivery, Caesarean section rate, need for oxytocin after Department of Statistics, Computing, Applications ’Giuseppe
priming, maternal/foetal/neonatal safety and experience of the Parenti’, University of Florence
treating physician.
Clinical cases and summary results: Thirteen centres enrolled 106 Introduction: It has been hypothesized that an enhanced insulin
patients, of whom 55% were nulliparous, from December 2014 till response can influence fetal growth. This altered response would
August 2015. Total vaginal delivery rate was 78%. Median time to result in a reduction of physiological post prandial glycemic peak and
vaginal delivery was 14.0 h, 19.1 h for nulliparous and 12.6 h for thus, reducing the transplacental passage of nutrients, could lead to
multiparous women. Incidences of a. vaginal delivery and b. vaginal compromise the optimal fetal growth. The presence of such alteration
delivery and Caesarean section combined within 24 h were 60.4% and can be detected during the oral glucose tolerance test in the form of
71.7% respectively. The proportion of women needing oxytocin for an inadequate increase in blood sugar after the load called ‘‘flat
augmentation was 58.9% for nulliparous and 25.0% for multiparous curve’’. In the literature are reported few studies which confirm this
women. The incidences of tachysystole and tachysystole with foetal
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 27
hypothesis (1-4) . However, the threshold value that could represent a 644
risk factor is not uniquely defined.
Materials and methods: We performed a retrospective study over the Fatty acid profiles at antenatal
past five years (2010-2015) on 18376 women who delivered at
Careggi University Hospital. Of these 1294 (7%) were excluded booking are a predictor of
because had a multiple gestation and 114 (0.7%) for pregestational
diabetes. 6517 (38.1%) were not screened for gestational diabetes,
gestational diabetes mellitus
1933 (11.3%) had a positive screening and 8518 (49.9%) were
screened negative and constitute our study group. We analyzed this S. Samuelson, M. R., Johnson M. A., Crawford Y. Wang2,
population in order to find a useful cut-off value for defining the ‘‘flat and E. Ogundipe3
OGTT’’, than we verify the effect of the ‘‘flat OGTT’’ on pregnancy
1
outcome. Department of Academic Obstetrics, Imperial College London,
Clinical cases and summary results: It has been defined as a flat curve Chelsea & Westminster Hospital Campus, London, UK, 2Department
an OGTT whose delta between fasting glucose and blood glucose one of Medicine, Imperial College London, Chelsea & Westminster
hour after administration of 75 g glucose was less than 5 mg/dl. In the Hospital Campus, London, UK, and 3Neonatal Unit, Chelsea &
OGTT negative group we had 494 women with flat curve and 8024 Westminster Hos
women with delta45 who constitute our control group. We found an
increased risk of small for gestational age (SGA) 510 centile (11.8%
Presenter: Saidee Samuelson
versus 9.0% p= 0.033 OR 1.36 95% CI 1.03, 1.81) and severe SGA 53
Introduction: Gestational Diabetes Mellitus (GDM) is a condition
centile (4.7% versus 2.8% p=0.019 OR 1.69 95%CI 1.09, 2.62) in the flat
resulting from insulin insensitivity, it currently affects around 16% of
curve group respect to controls. In the study group we had a parallel
pregnant women in the UK. The pathogenesis of insulin insensitivity is
decrease in the incidence of macrosomia (3.6% versus 6.2% p=0.023
complex, however the contribution of the innate immune and
95% CI 0.57 0.36, 0.93). In a multivariate analysis we saw that being
inflammatory response is clear. Fatty acids are known independently
underweight, gain insufficient weight at term and having a flat OGTT
to influence causative factors associated with GDM risk.
are all independent risk factors associated with SGA. Finally, we went
Materials and methods: 300 pregnant women were recruited to a
to analyze the correlation between flat OGTT and other obstetric
double blind placebo controlled study, to examine the effect of fish
outcome. The complications considered were caesarean section,
oil supplementation on the lipid profile and infant outcomes of high
preterm delivery (537 weeks), operative delivery and intrauterine fetal
risk pregnant women. At recruitment participants booking bloods
death. None of these outcomes were statistically significant
were taken in early pregnancy prior to supplementation. Their fatty
associated.
acid composition were analysed and compared to normal healthy
Conclusion: Our study confirm the results already present in the
controls. The lipid profile were analysed by sub group based on
literature that pregnant women with flat OGTT in pregnancy are at
current known risk factors, in this case to GDM.
increased risk of SGA. Based on these data it is desirable that dietary
Clinical cases & summary results: The n-3 and n-6 polyunsaturated fatty
intervention studies in pregnancy are conducted in order to
acids (PUFA’s) were analysed. Compared to normal health control
determine whether this risk can be reduced.
(NHC) pregnancies the fatty acid (FA) profiles of women who went on
to develop GDM showed:
Keywords: Flat curve, small for gestational age, gestational diabetes
 Sub-optimal n-6 PUFA
 Elevated n-3 PUFA
 Elevated LA/AA ratio
 Elevated LA/DHA ratio
LA= linoleic acid; AA = arachidonic acid; DHA = docoshexaenoic acid;
Conclusion: There are significant, defined differences in lipid profiles of
pregnant women at risk of GDM compared to NHC pregnancies. This
suggest significant differences in either periconceptual dietary status,
periconceptual gut nutrient interactions or of periconceptual FA
metabolism/regulation in women at high risk of GDM when
compared to NHC women. This outlines a predictive value to baseline
FA profile that may identify women who would benefit from peri-
conceptual supplementation of targeted FAs.

Keywords: Predicting GDM, PUFAs, DHA, Fish oil, omega-3, omega-6

28 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

540 428
Birth at 37 weeks gestation and Expected financial and health
associated perinatal risks versus impact of advising pregnant
term delivery - case-control study women to use calcium
M. L. Ognean1, O. Boantă1, C. Zgârcea1, R. Dumitra1,
supplements: a decision analysis
S. A. Kovacs2, and R. Chicea3
L. J. E. Meertens1, H. C. J. Scheepers2, J. P. M. M.
1
Neonatology Dpt., Clinical County Hospital Sibiu, 2Preterm Infant Willemse3, M. E. A. Spaanderman2, and L. J. M. Smits1
Dpt., Clinical County Hospital Sibiu, and 3Faculty of Medicine Sibiu,
1
Obstetrics & Gynecology Dpt., Clinical County Hospital Sibiu Department of Epidemiology, Maastricht University, Maastricht, The
Netherlands, 2Department of Obstetrics and Gynaecology, Maastricht
Presenter: M. L. Ognean University Medical Centre, Maastricht, The Netherlands, 3Maastricht
Introduction: Early term delivery rate is increased worldwide and in University, Maastricht, The Netherlands
Romania in the latest years due to multiple factors including
increased maternal age and more complicated pregnancies, increased Introduction: Calcium supplementation is an efficacious intervention
number of multiple pregnancies, improved pregnancy management, for the prevention of pre-eclampsia. Despite its documented
and increased number of deliveries induced for maternal and fetal protective effect, relative cheapness, and safety, calcium supplemen-
medical complications, gestational age estimation errors, demo- tation is still not routinely advised to pregnant women in most
graphic changes, etc. Early term birth - compared to term delivery - is countries. We aimed to predict the impact of advising pregnant
associated with increased rate of perinatal complications as revealed women to use calcium supplements (1000 mg/day) on the number of
by data published in the literature. The authors aimed to evaluate the cases of pre-eclampsia prevented and related health care costs.
short term prognosis of infants delivered at 37 weeks gestation Materials and methods: By use of a decision-analytic model, we
compared to infants delivered at term. assessed the expected impact of advising calcium supplementation
Materials and methods: In order to evaluate the short term prognosis during pregnancy, to either (1) all pregnant women, (2) women at
of infants delivered at 37 weeks gestation versus infants delivered at high risk of developing pre-eclampsia, or (3) women with a low
term for each infant born at 37 weeks a pair case having a birth dietary calcium intake compared with current care. Calculations were
weight˘ 100g was identified in the database of the Maternity Hospital performed for a hypothetical cohort of 100 000 pregnant women
Sibiu during the study period (1 January 2013 - 31 December 2015). living in a high-income country. Difference in number of cases of pre-
Epidemiological data - birth weight (BW), gestational age (GA), eclampsia between the new scenarios and current care was
gender, residence, maternal characteristics -, labor and delivery, and calculated in terms of absolute reduction, relative reduction, and
perinatal complications - birth resuscitation, Apgar score, respiratory number needed to advise. Net financial impact was expressed as the
distress, pulmonary hypertension, jaundice, anemia, neonatal inten- difference between health care expenses and savings. Sensitivity
sive care unit (NICU) admission, etc. - were extracted from the analyses were performed to assess the impact of variations in input
database and compared using SPSS 10.0 for Windows; p was values on model outcomes.
considered statistically significant if < 0.05 (confidence interval 95%). Clinical cases and summary results: Advising calcium supplementation
Clinical cases & summary results: The study included 686 infants: 343 to all pregnant women, women at high risk of pre-eclampsia, or
born at 37 weeks gestation (mean BW 2953.7415.6 g) and 343 women with a low dietary calcium intake would reduce the incidence
delivered at term (mean BW 2957.4406.2 g). No difference was of pre-eclampsia by 25%, 8%, or 13%, respectively. Expected net
found between the groups as regards the gender (51% male in both financial benefits of the three scenarios were of E4 621 465,
groups) but more twins (8.2 vs 3.2%, p=0.009) and more infants E2 059 165, or E2 822 115 per 100 000 pregnant women, respectively.
conceived using assisted reproductive techniques (5.2 vs 0.3%, Sensitivity analyses showed a clinical and financial net benefit of
p=0.000), and more C-section deliveries (39.7 vs 27.1%, p=0.000) advising calcium supplementation during pregnancy compared with
were found at 37 weeks gestation. Apgar score was lower at 1 and current care for all scenarios under all plausible parameter variations.
5 minutes (p=0.000, p=0.006), but no difference was found as regards Conclusion: Advising pregnant women to use calcium supplements
the need for resuscitation at birth. Respiratory distress was identified can be expected to cause substantial reductions in the incidence of
more often at 37 weeks gestation (9.9 vs 0%, OR 2.11[CI 1.94-2.39]), as pre-eclampsia as well as related health care costs. Largest impact is
well as peristent pulmonary hypertension (23.7 vs 4%, p=0.003, OR expected from calcium supplementation advice to all pregnant
7.45[CI1.64-23.72]), jaundice needing phototherapy (47.5 vs 22.2%, women, not subgroups only.
p=0.000, OR 3.18[CI2.28-4.43]), anemia at birth (30.7 vs 15.9%,
p=0.014, OR 2.34[CI1.17-4.70]), and need for NICU admission (10.5 Keywords: Calcium supplementation, pre-eclampsia, prevention,
vs 1.2%, p=0.000, OR 9.94[CI3.49-28.24]). decision analysis, impact
Conclusion: Delivery at 37 weeks gestation increases the risks for
perinatal complications, mostly those related to immaturity - cardiac
and respiratory difficulties, hyperbilirubinemia, anemia -. These
complications are partially explained also by the increased number
of multiple pregnancies and C-section deliveries in the group of 37
weeks gestation infants. A specific analysis of the epidemiology of
early term birth is mandatory in order to decrease their number and
improve the neonatal prognosis.

Keywords: Early term, neonatal prognosis, perinatal complications

DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 29
179 186
Oxidative stress: their role in Polyhydramnios in pregnant
pregnancy and miscarriage women undergoing long-term
Z. Grujic1, I. Grujic2, M. Bogavac1, A. Nikolic1, and
hemodialysis: a treatable
M. Milosevic Tosic1 pathology, a hemodialysis dose
1
Clinical Centre of Vojvodina, Department of obstetrics and adequacy tool and an outcome
gynecology, University of Novi Sad, Medical faculty, Novi Sad, Serbia,
2
University of Novi Sad, Medical faculty, Novi Sad, Serbia, and
predictor
3
Clinical Centre of Vojvodina, Emergency Center, Urgent Laboratory
at Department of Obstetrics and Gynecology, University of Novi Sad C. Luders1, I. Noronha1, S. Kahhale2, S. M. Titan1,
Medical Faculty, Novi Sad, Serbia R. Francisco2, and M. Zugaib2
1
Nephrology Dept. and 2Obstetric Dept., University of São Paulo
Introduction: The pregnancy is defined as a condition of increased
oxidative stress. Some studies show that the systemic and placental Medical School, São Paulo, Brazil
oxidative stress have a role in pathophysiological mechanism of
spontaneous and recurrent miscarriage occurence. The goal of this Introduction: Although still uncommon, pregnancy occurs in women
research was to determine the intensity of pro-oxidative processes on chronic hemodialysis (HD) with a frequency that is probably
(LPx and GSH), antioxidative enzymes (SOD, CAT, GSH, GSH-Px) and increasing. In this population, polyhydramnios (PH) is a common
TAS in patients with spontaneous abortions. complication with prevalence ranging from 20 to 60%. Increased fetal
Materials and methods: A total of 85 patients in the first trimester of urine production secondary to urea osmotic diuresis probably is the
pregnancy, were involved in the research: 35 patients with missed cause of the excessive amniotic fluid volume. Different reports
abortion (group M) and control group of 50 healthy pregnancies suggested that polyhydramnios in HD patients could be treated by
(group N). The intensity of lipid peroxidation (Lx) was determined increasing HD dose and, therefore, decreasing maternal and fetal
with a modified thyobarbituric acid method. The GSH content in the blood urea levels and osmotic diuresis. In the past 15 years we have
homogenate was determined based on the amount of non-protein followed up 87 pregnancies in patients requiring HD. The objectives
sulfhydryl residues using the Ellman reagens. Antioxidative para- of the study are to demonstrate that PH could be treated adjusting
meters were measured with: SOD method with xanthine oxidase- HD dose and to confirm the association between amniotic fluid
using commercial RANSOD sets, CAT method by Aebi, the enzyme volume and fetal outcome.
activity was measured by monitoring the decomposition of H2O2 at Materials and methods: In this retrospective cohort study, prospec-
240 nm, the activity of GSH-Px was determined using hydrogen tively collected data from all 87 pregnancies in women undergoing
peroxide as a substrate. The total antioxidative status (TAS) was dialysis at the University of São Paulo Medical School, between
determined using the FRAP method. January 2000 and December 2015, were analyzed. Forty four
Clinical cases and summary results: The average value of Lx in group M pregnant women on HD developed PH or excess of amniotic fluid
was 44.57 pmol/mg Hgb and in group N was 26.06 pmol/mg Hgb (PH, amniotic fluid index (AFI) 4 25cm, excess of amniotic fluid AFI 4
(p 50.001). Alsow, there is a statistically highly significant difference 18 cm), thirty eight of them were treated increasing the dialysis time
(p 50.001) in CAT and in TAS content between patients with missed in half an hour. All patients treated normalized the amniotic fluid
abortion and the control group: (CAT, M-21.46 and N 30.94 nmol/mg volume, within 30 days. Six patients were not treated because they
Hgb), (TAS, M-277.66 and N-452.12 mmol/L). A statistically significant refuse increasing hemodialysis time or they developed PH late in
(p 50.05, r=0.37) positive correlation between LPx and CAT in the pregnancy.
group of patients with missed abortion was also noted. The other Clinical cases and summary results: The mean AFISD before and after
results were: (GSH, M-3.10 and N-3.07 mmol/ml Er), (SOD, M-1211.66 the change in HD dose were, 27.17.4 versus 17.363.3 cm,
and N-1116.36 IU/g Hgb), (GSH-Px, M-1091.57 and N-1291.38 nmol/ respectively (p 50.0001, Wilcoxon test). The mean serum urea level
mg Hgb). By ANOVA testing, there is a statistically significant before and after the change in HD dose were, 91.821.8 versus
difference (p 50.05) in SOD and GSH-Px between patients of 64.814.4 mg/dL, respectively (p 50.0001, t test). The gestational age
exemined group. and fetal weight of the patients with excess of amniotic fluid were
Conclusion: Determination of the value of pro-oxidative and significantly higher than the remaining 43 patients (352 versus
antioxidative parameters in patients with spontaneous abortion can 324 weeks, p 50.001 and 2081537 versus 1347677g, p 50.0001,
indicated the condition of fetoplacental unit and these analyses can respectively). Using a multivariate linear regression model, with birth
be included in protocol of rutine perinatal diagnosis. weight as the dependent variable, we observed that PH was positively
related to birth weight, even after adjusting to predialysis serum urea,
Keywords: Oxidative stress, spontaneous abortions, perinatal hemodialysis dose and to the presence of preeclampsia.(=329, 95%
diagnosis CI 83 to 576, p=0.01). At multivariate logistic regression analysis, the
presence of PH was positively related to a better fetal outcome
(p=0.03). We also observed a normal umbilical Doppler velocimetry at
the time of the PH diagnose in all patients with elevated AFI.
Conclusion: We conclude that PH in pregnant women undergoing
hemodialysis is a treatable pathology, can be used as an HD dose
adequacy tool and is related to a better fetal outcome. We also
speculate that the presence of PH is probably an indirect evidence of
an adequate placental blood flow and this may be the reason for the
better fetal outcome.

Keywords: Polyhydramnios, hemodialysis

30 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

289 INFECTION & SURROUNDINGS - 303

Fetal speech movements in Prevention and treatment of fetal
response to intravaginal emission cytomegalovirus infection with
of music are due to audition, not cmv-hyperimmune globulin: a
to vibration multicentre study in Madrid
(GECITMA Group)
A. Garcia-Faura, V. Moens, E. Valladares, A. Gràcia, and
M. Lopez-Teijon M. De la Calle2, D. Blázquez-Gamero1, A. Galindo
Institut Marques, Barcelona Izquierdo3, F. Baquero-Artigao4 , N. Izquierdo Méndez5,
M. Soriano-Ramos1, P. Rojo Conejo1, M. I. González-
Introduction: The main aim of this study was to analyze fetal speech Tomé1, T. Rosal4, A. Garcı́a-Burguillo6, N. Pérez Pérez5,
response to an acoustic stimulus emitted by a vaginal device, and and V. Sánchez1.
compare it with vibration applied with the same device.
1
Materials and methods: This study compared fetal response to Pediatric Infectious Disease Unit, Hospital Universitario 12 de
musical stimuli applied intravaginally (IVM) with intravaginal emission Octubre, 2Fetal Medicine Unit, Hospital Universitario La Paz, 3Fetal
of vibration (IVV). Responses were quantified by recording fetal Medicine Unit, Hospital Universitario 12 de Octubre, 4Pediatric
speech movements identified on 3D/4D ultrasound. Fifty-six normal Infectious Disease Unit, Hospital Universitario La Paz, 5Department of
pregnancies between 16 and 39 weeks of gestation were randomized Obstetrics, Hospital Universitario Clı́nico San Carlos, 6Department of
to 3D/4D ultrasound with: IVM with a specially designed device Obstetrics, Hospital Universitario 12 de Octubre
emitting a flute monody at 53.7 dB, and IVV with the same device at
68 dB. Fetal speech movements were quantified at baseline, during
Introduction: Congenital cytomegalovirus (CMV) infection is the most
stimulation, and for 5 minutes after stimulation was discontinued.
common cause of congenital viral infection in the Western world and
Clinical cases and summary results: IVM elicited mouthing (MT) and
can lead to severe neurological sequelae. The aim of this study is to
tongue expulsion (TE) in 86.7% and 46.6% of fetuses, respectively,
investigate the use of cytomegalovirus (CMV) hyperimmune globulin
with significant differences when compared with IVV (p= 0.004). There
(HIG) in prevention and treatment of CMV fetal infection in Madrid
were no changes from baseline in IVV. TE occurred 5 times in
(Spain).
5 minutes in 13.3% with IVM. IVM was related with higher occurrence
Materials and methods: A retrospective observational study compris-
of MT (odds ratio = 10.980, 95% confidence interval = 3.105-47.546)
ing all pregnancies treated with CMV-HIG (2009-2015) in three tertiary
and TE (odds ratio = 10.943, 95% confidence interval = 2.568-77.037).
hospitals in Madrid was conducted. Investigators offered HIG
The frequency of TE with IVM increased significantly with gestational
treatment (200 UI/kg) in pregnancies with a CMV primary infection
age (p= 0.024).
(prevention group, HIG before amniocentesis) or with fetal infection
Conclusion: Our findings suggest that neural pathways participating in
(treatment group: positive PCR in amniocentesis/cordocentesis).
the auditory-motor system are developed as early as gestational week
Symptomatic congenital CMV infection at birth was defined as the
16, and that fetuses at 16 39 weeks of gestation respond to
presence of at least one: abnormal physical exam (petechiae,
intravaginally emitted music with repetitive MT and TE movements,
jaundice, hepatoesplenomegaly, neurologic abnormalities), hearing
that are not observed when we apply intravaginal vibration.
loss, laboratory abnormalities, or abnormal ultrasound or MRI.
Clinical cases and summary results: During the study period 36
Keywords: Fetal hearing, fetal behaviour, intravaginal music, mothers received at least one dose of HIG. Median gestational age
ultrasound (g.a) at primary infection was 20w [IQR=10-25], and at amniocentesis
was 21 weeks [20-26]. No severe adverse events of HIG were observed
and median g.a at birth was 38.3 weeks [38-40]. Prevention group
included 17 pregnancies, all with a primary CMV infection. One
pregnancy of this group was interrupted due to abnormal
cordocentesis and fetal symptoms on follow-up (the necropsy also
showed congenital CMV findings Fetal infection was confirmed in 7/
17 (38.5%) patients, and 1/16 (5.9%) was symptomatic at birth
(abnormal ultrasound, mild unilateral hearing loss (50 dB), but with
good neurodevelopmental outcome at 12 months of age). No other
children presented long term sequelae at 12 month of age in the
prevention group. Treatment group included 19 pregnancies with
positive PCR either in amniotic fluid or fetal blood. Hearing loss at
birth was present in 4/19 (21%), motor impairment in 3/19 (16%) and
9/19 (47%) were symptomatic at birth. At 12 months of age, three
children (3/16, 18.8%) in the treatment group presented motor
impairment and 4 children (4/16, 25%) presented hearing loss.
Children with CNS fetal US abnormalities before HIG treatment,
presented a high risk of long term sequelae (3/3, 100%) compared
with children without fetal CNS abnormalities (2/29, 6.7%,
p=0.009,OR=77, 95% CI: 3-1954).
Conclusion: In our population CMV-HIG treatment was not associated
to relevant adverse events. A high rate of infected fetuses were found
in the prevention group. Almost half of the children in the treatment
group had any symptoms at birth. Fetuses without CNS abnormalities
in US before HIG treatment presented low risk of long term sequelae.
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 31
HIG seems not to be useful in fetuses with previous brain Clinical cases and summary results: In total, 47 patients receiving
abnormalities in US. Randomized controlled trials are needed. gentamicin during controlled hypothermia were included. An
allometric two-compartment model with GA as a covariate on
clearance (Cl) best described the PK. During hypothermia the Cl of
Keywords: Congenital cytomegalovirus infection, pregnancy, hyper-
a typical patient (3 kg, GA 40 weeks, 2 days PNA) was 1.9 L/h/70kg
immune globulin
(inter-individual variability (IIV) 27%) and volume of distribution of the
central compartment (Vc) was 33 L/70kg (IIV 41%). Cl was constant
during hypothermia and increased with 29% after reaching
normothermia.
162 Conclusion: The PK of gentamicin in neonates undergoing controlled
hypothermia is described. The 29% higher Cl in the normothermic
Altered gentamicin phase suggests a delay in normalization of Cl after hypothermia has
ended and rewarming has occurred. We recommend an empiric dose
pharmacokinetics in neonates of 5 mg kg-1 every 36 hours or every 24 hours for patients with GA 36-
40 weeks and GA 42 weeks, respectively. The PK properties of
undergoing controlled analgesic-, antiepileptic- and sedative drugs in this patient population
hypothermia will also be analysed and reported in future.

Keywords: Gentamicin, neonates, population pharmacokinetics,

Y. Bijleveld1, T. de Haan2, J. van der Lee3, controlled hypothermia
F. Groenendaal4, P. Dijk5, A. van Heijst6, R. de Jonge7,
K. Dijkman8, H. van Straaten9, M. Rijken10,
I. Zonnenberg11, F. Cools12, A. Zecic13, D. Nuytemans14,
A. van Kaam2, and R. Mathot1 499
1
Department of Pharmacy, Academic Medical Center, Amsterdam, Group B streptococcus
the Netherlands, 2Department of Neonatology, Emma Children’s
Hospital, Academic Medical Center, Amsterdam, the Netherlands, colonization in obese and
3
Pediatric Clinical Research Office, Division Woman-Child, Academic
Medical Center, University of Amsterdam, Amsterdam, the
diabetic pregnant women
Netherlands, 4Department of Neonatology, Wilhelmina Children’s
Hospital, University Medical Center Utrecht, Utrecht, the Netherlands, G. Moreno Coca, M. J. Canto Rivera, S. Palmero Aliste,
5
Department of Neonatology, University Medical Center Groningen, M. Esteve Martinez, M. Pérez de Puig, and
Groningen, the Netherlands, 6Department of Neonatology, Radboud F. Ojeda Pérez
University Medical Center, Nijmegen, the Netherlands, 7Department
Obstetrics and Gynecology Dept, Fundació Privada Hospital Assil de
of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children’s
Granollers. Barcelona, Spain
Hospital, Rotterdam, the Netherlands, 8Department of Neonatology,
Máxima Medical Center Veldhoven, Veldhoven, the Netherlands,
9 Presenter: GEMMA MORENO COCA
Department of Neonatology, Isala Clinics, Zwolle, the Netherlands,
10 Introduction: Group B streptococcus (GBS) is a common gastrointest-
Department of Neonatology, Leiden University Medical Center,
inal and lower reproductive tracts commensal. It is a known perinatal
Leiden, the Netherlands, 11Department of Neonatology, VU University pathogen involved in neonatal meningitis, pneumonia, septic
Medical Center, Amsterdam, The Netherlands, 12Department of abortions and chorioamnionitis. Maternal obesity and gestational
Neonatology, Vrije Universiteit Brussel, Brussels, the Netherlands, diabetes have been suggested as risk factors for rectovaginal Group B
13
Department of Neonatology, Academic Medical Center, Gent, streptococcus colonization. Many studies have linked obesity to GBS
Belgium, and 14Clinical Research Coordinator PharmaCool Study colonization in both pregnant and nonpregnant women. Besides,
pregnant diabetic women appear to have higher group B strepto-
Introduction: In the Netherlands, approximately 170 term infants are coccus colonization rates when compared to pregnant women
admitted annually to a Neonatal Intensive Care Unit for controlled without diabetes. The objective of this study was to investigate the
hypothermia suffering from hypoxic-ischemic encephalopathy due to association between obesity and maternal diabetes with GBS
perinatal asphyxia.[1] In these patients analgesic-, antiepileptic-, colonization in a term cohort of a non-tertiary community hospital.
sedative- and antibiotic drugs are frequently prescribed. The effect Materials and methods: We conducted a retrospective cohort study on
of hypothermia on their pharmacokinetic (PK) properties is however 413 women with singleton term pregnancies who gave birth
largely unknown. In the ‘‘PharmaCool Study’’[2] the population PK consecutively between January and March 2015. Maternal body
properties of these drugs were assessed in neonates undergoing mass index was calculated from the patients’ weight and height at
controlled hypothermia. The results of the antibiotic gentamicin are the beginning of the pregnancy. Obesity was defined as BMI ? 30kg/
reported here. m2. The diabetic group included both pregestational and gestational
Materials and methods:Data of patients included in a multicenter diabetes mellitus. Culture specimens for GSB were obtained with a
prospective observational cohort study conducted in ten Dutch and sterile swab from the lower vaginal walls and rectum at 34-36 weeks
two Belgian NICUs between November 2010 and October 2014 (the of gestation. Student T-test and Chi-square or Fisher’s exact tests were
‘‘PharmaCool Study’’[2]) were collected. Term newborns (437 weeks used for continuous or categorical variables respectively. Their
gestational age (GA)) fulfilling the criteria of perinatal asphyxia were association with GBS colonization was assessed using odds ratios
cooled within 6 hours after birth to a core body temperature of 33.5 C with 95% confidence intervals. PASW-18 software was used for data
for 72 hours. Thereafter the infants were rewarmed to normothermia analysis.
(36.5 C). Blood samples were drawn during the cooling-, rewarming- Clinical cases & summary results: Of the 413 women admitted in labor
and normothermic phase for gentamicin concentration analysis. A at term during the study period, 27 had an unknown GBS status and
non-linear mixed-effects regression analysis (NONMEMÕ ) was per- were excluded from the study. The prevalence of GBS colonization in
formed to describe the population PK of gentamicin. The most the entire cohort of 386 women was 23.3%. Regarding body mass
optimal dosing regimen was evaluated based on Monte Carlo index, we found 321 non-obese women and 65 obese women. 36 of
simulations of the final model. 231 (11.2%) non-obese women were identified carriers of group B
32 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

streptococcus; compared to 54 of 65 (83.1%) obese women (OR 38.86, non-exposed groups were significantly correlated with the effect size
95% CI 18.63 - 81.067). Regarding gestational and pregestational of the association between PDA and CA. Adjusted ORs were reported
diabetes, we identified 355 non-diabetic women and 31 diabetic in 11 studies (19577 infants). Meta-analysis of these 11 studies
women. 73 of 355 (20.6%) non-diabetic women were colonized by showed a significant negative association between CA and PDA (OR
BGS, compared to 17 of 31 (54.8%) diabetic women (OR 4.69, 95% CI 0.802, 95% CI 0.751 to 0.959). This association remained significant for
2.21 - 9.958). clinical (OR 0.849, 95% CI 0.703 to 0.916) but not for histological CA
Conclusion: Our cohort study showed a significantly increased risk of (OR 1.214, 95% CI 0.781 to 1.692).
Group B streptococcus colonization in obese and diabetic pregnant Conclusion: Differences in GA and BW between infants exposed and
women at term. We found a higher GBS colonization rate in the unexposed to CA may account for the higher risk of PDA observed
pregnant obese and diabetic population. Our findings suggest that when unadjusted data were pooled. The present study confirms that
maternal obesity and gestational diabetes are factors that need to be confounders need to be taken into account in meta-analyses
considered in strategies for reducing group B streptococcus disease in assessing the association between CA and clinical outcomes in
neonates. preterm infants.

Keywords: GSB, Group B streptococcus, obesity, gestational Keywords: Patent ductus arteriosus, chorioamnionitis, meta-analysis,
diabetes. meta-regression

547 590
Is chorioamnionitis a risk or a Hand hygiene in reducing
protective factor for patent bloodstream infection rate in
ductus arteriosus in preterm neonatal unit of cipto
infants? a systematic review and mangunkusumo hospital
meta-analysis indonesia
E. Villamor, E. Behbodi, E. Villamor-Martı́nez, and T. N. Paramita1 and R. Rohsiswatmo2
P. L. J. Degraeuwe Neonatology Division, Department of Child Health, Faculty of
Department of Pediatrics, Maastricht University Medical Center Medicine University of Indonesia, Cipto Mangunkusumo Hospital,
(MUMC+), School for Oncology and Developmental Biology (GROW), Jakarta, Indonesia
Maastricht, the Netherlands
Presenter: Tiara Nien Paramita
Presenter: E. Villamor Introduction: Healthcare-associated infections (HAI) - bloodstream
Introduction: There is a substantial body of evidence supporting that infections (BSI) is one of the major problem in neonatal unit especially
chorioamnionitis (CA) is a major risk factor for spontaneous preterm in developing countries. One of the most effective and inexpensive
birth but the independent contribution of CA to prematurity- strategy recommended by WHO to reduce HAI-BSI rate is good hand
associated mortality and morbidity is much more difficult to assess hygiene. However, hospital staff hand hygiene compliance varies
because observational studies comparing the outcomes of infants considerably among health centers. Cipto Mangunkusumo Hospital
with and without CA are, in general, comparing the effects of (CMH) is the main referral and teaching hospital in Indonesia with
placental infection with vascular placental pathology. This may result high rate of daily Neonatal Intensive Care Unit (NICU) admission. An
in significant differences between the CA and the ‘‘control’’ group in infection control bundle has been implemented since 2013, with
terms of, for example, GA, birth weight (BW), or use of antenatal proper hand hygiene as one of the main focus. In this study, we
corticosteroids. These differences may exert an important influence in would like to analyse the effectiveness of hand hygiene as the
outcomes such as patent ductus arteriosus (PDA). possible low-cost solution to the bloodstream infection rate in
Materials and methods: In an attempt to perform a thorough neonatal unit in CMH.
assessment of the possible association between CA and PDA in Materials and methods: The study used cross sectional design. Hand
preterm infants, we conducted a systematic review and meta-analysis hygiene was defined as any hand washing using soap and tap water,
in which adjusted odds ratios (ORs), whenever available, were pooled. or handrub using alcohol-based solution. Solution used for handrub is
In addition, we analyzed the magnitude of the differences in potential self-produced by CMH pharmacy with 95% of ethanol and 3% of
confounders, such as GA or BW, between the infants of the CA and H2O2. BSI was defined as clinical signs of sepsis, abnormal laboratory
the control group. Finally, we performed a meta-regression in order to septic marker and positive blood culture. Hand hygiene compliance
investigate the effect of confounders on the association between CA data was collected from monthly audit, while BSI data was collected
and PDA. retrospectively over 60 months of time from hospital database.
Clinical cases & summary results: We identified 1188 potentially Bacterial culture on hands of 25 members of NICU staff and tap water
relevant studies from which 45 (27186 patients, 7742 CA cases, 8033 was conducted in November 2014 as part of infection control review.
PDA cases) met the inclusion criteria. Random effects meta-analysis Spearman correlation test was performed to assess correlation
based on the unadjusted ORs from the 45 studies showed a between hand hygiene compliance and BSI rate.
significant positive association between CA exposure and PDA (OR Clinical cases & summary results: During 2011-2015 period, average
1.352, 95% CI 1.172 to 1.560). The association remained significant for hand hygiene compliance is 73.13% (SD 14.47) and BSI rate is 10.63
histological CA (OR 1.442, 95% CI 1.205 to 1.726) but not for clinical per 1000 catheter days (SD 6.35). This study showed highest hand
CA (OR 1.208, 95% CI 0.953 to 1.531). Meta-regression showed hygiene compliance from nurses (r=0.880; p<0.05) and doctors
that the differences in GA or BW between the CA-exposed and (r=0.772; p<0.05) among other professions, while hand hygiene
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 33
practice was performed most often before touching the patient Conclusion: In our cohort, symptomatic cCMV newborns were at high
(r=0.876) risk of sequelae at 1 year of age, which also affected one fourth of
Conclusion: The lack of correlation between hand hygiene compliance asymptomatic patients at birth. Hearing loss at birth was associated
and blood stream infection case does not represent the unimpor- with both hearing loss and neurologic impairment at 1 year of age;
tance of hand hygiene in infection control practice. Many factors neonatal hepatitis was also a risk factor for neurologic sequelae at 12
could possibly affect this result, such as the tap water bacterial months of age.
contamination and improper hand hygiene technique. This study
suggests that the result of infection control practice depend on many Keywords: Congenital cytomegalovirus infection, hearing loss, neu-
factors and cannot rely on a single intervention. rologic impairment

Keywords: Hand hygiene compliance; blood stream infection;

neonatal unit; infection control

661
Histological chorioamnionitis:
616 does it prevent late-onset sepsis
Risk factors associated with in preterm infants?
hearing loss and neurologic
M. van Doorn1, J. van der Voorn2, M. van Weissenbruch3,
impairment in the spanish net- and D. Visser4
work of infants with congenital 1
VU University, Amsterdam, the Netherlands, 2Division of Pathology,
cytomegalovirus infection VU medical center, Amsterdam, the Netherlands, 3Division of
Neonatology, VU medical center, Amsterdam, the Netherlands, and
(REDICCMV) 4
Department of Paediatrics, OLVG West Medical Center, Amsterdam,
The Netherlands.
L. Castells Vilella1, R. Dı́ez2, J. Vilas3, I. Olabarrieta4,
A. Medina5, P. Galán6, A. M. Grande7, O. Calavia8, Presenter: M. van Doorn
Introduction: Premature infants are highly susceptible to late-onset
J. Beceiro9, A. Filgueira1, I. Llana1,1, E. Colino1,2, B. sepsis (LOS). Although the mechanisms underlying this vulnerability
Agúndez1,3, J. Barja1,4, M. Llorente1,5, P. Terol1,6, and are not yet fully understood, the importance of the innate immune
D. Blázquez-Gamero1,7 system is increasingly acknowledged. Fetal exposure to histological
1
chorioamnionitis (HCA), a common risk factor for preterm birth, is
Neonatal Unit, Pediatrics Dept., Hospital Universitario General de suggested to enhance epigenetic changes in innate immune cells.
Catalunya, Sant Cugat del Vallés, Barcelona, Spain, 2Hospital de This enhancement may have a protective influence on LOS in
Mataró, Barcelona, Spain, 3Hospital de Pontevedra, Spain, 4Hospital premature infants. However, results from previous studies on this
Severo Ochoa, Madrid, Spain, and 5Hospital de la Axar subject are conflicting. Therefore, this study aims to investigate the
association between HCA and LOS in preterm infants.
Presenter: Laura Castells Vilella Materials and methods: All infants admitted from January 1st 2005
Introduction: We aimed to study risk factors associated with hearing until December 31st 2011 to a level III Neonatal intensive care unit
loss and neurologic abnormalities at 12 months of age in the Spanish (NICU) in the Netherlands, with a gestational age (GA) between 25
cohort of children with congenital cytomegalovirus infection (cCMV; and 32 weeks, or with a birth weight of ?1500 grams were eligible for
REDICCMV). study participation. Infants with major congenital anomalies, without
Materials and methods: A prospective multicentric study was placental histologic exam, or who suffered from clinical LOS or
performed from January-2011 to May-2015 in Spain. All children necrotizing enterocolitis (NEC) before or during a LOS episode were
with confirmed cCMV were included. Hearing loss (>25dB in ABR) and excluded. Demographic and clinical data were obtained from the
neurologic abnormalities (motor impairment, microcephaly, epilepsy patient folder and electronic health record. Histological assessment of
and neurodevelopmental delay evaluated by a pediatric neurologist) placenta, extraplacental membranes and umbilical cord was per-
were studied at birth and at 12 months of age. The collection of data formed according to a standardized diagnostic framework. Incidence
was made with the parents consent and in accordance with the of LOS and LOS severity were compared between infants with and
clinical research ethics committee norms. without HCA.
Clinical cases & summary results: 297 children with cCMV from 34 Clinical cases & summary results: Seven hundred five premature infants
hospitals were included. 229 (82.7%) children were diagnosed during were included in this study of whom 35% developed LOS. LOS
the fetal or newborn period, and 111/225 (49.3%) were symptomatic incidence was inversely related to GA. Mean birth weight was 1270 
at birth. Among asymptomatic infants at birth (n=61), 23.0% and 7.8% 350 gram with a mean GA of 29.2  2.1 weeks. Signs of inflammation
presented hearing loss and neurologic abnormalities at 12 months, were seen in two hundred seven (29%) placenta’s. LOS incidence was
respectively. Symptomatic children at birth presented higher risk of significant lower in infants born at a GA of ?29 with HCA in
hearing loss and neurologic sequelae at 12 months of age (OR:3.2 comparison to infants without HCA (OR:0.484 [CI:0.238-0.984],
[CI95%: 1.5-7.2] and OR:9.0 [CI95%:2.9-27.9] respectively). Blood viral p=0.045). This effect was not seen in infants born at <29 weeks GA
load at birth was not associated with sequelae. Children with severe (OR:1.590 [CI:0.909-2.783], p=0.104). A possible positive effect in this
disease were given a longer course of antiviral treatment. In a age group may have been overshadowed by the high rate of LOS in
multivariate logistic regression analysis, only hearing loss at birth was this group (50-60%) in comparison to the literature. After adjustment
associated with hearing loss at 12 months (OR:33.2 [IC95%9.8?112.4]; for confounding factors there was no difference in LOS disease
p=0.0001). GPT>80 IU/L and hearing loss at birth were associated with severity between infants with or without HCA exposure (OR:1.328
neurologic abnormalities at 12 months (OR:7.5 [IC95%:1.0-57.0]; [CI:0.644-2.740], p=0.442).
p=0.05 and OR:6.9 [IC95%:2.1-22.2], p=0.001 in both).
34 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Conclusion: LOS incidence is reduced in infants born at ?29 weeks of 689

gestational age with signs of HCA. Priming of the fetal innate
immunity by inflammatory stimuli could possibly explain this effect. Pathogen to keep in mind:
Understanding the underlying mechanisms may direct future
strategies to improve neonatal innate immune response in order to ureaplasma species induce
prevent LOS and improve neonatal outcome. Further research should
provide the evidence necessary to draw firm conclusions.
pro-inflammatory immune
responses in human neonatal and
Keywords: Histological chorioamnionitis; late-onset sepsis
adult monocytes
K. Glaser1, M. Fehrholz1, B. Henrich2, H. Claus3, and
C. P. Speer1
1
University Children’s Hospital, University of Würzburg, Würzburg,
174 Germany, 2Institute of Medical Microbiology and Hospital Hygiene,
Anti-inflammatory effects of University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf,
Germany, and 3Institute for Hygiene and Microbiology, University of
budesonide in human fetal lung Würzburg, Würzburg, Germany

P. Ballard1, A. Barrette1, J. Roberts2, and and E. Egan3 Presenter: Kirsten Glaser

Introduction: Colonization with Ureaplasma species (spp.) has been
1
Department of Pediatrics, University of California, San Francisco, associated with adverse pregnancy outcome, and perinatal transmis-
San Francisco CA, USA, 2Department of Pediatrics, University of Utah, sion has been implicated in the development of fetal systemic
Salt Lake City UT, USA, 3Department of Pediatrics, University of inflammatory response syndrome. Being mostly opportunistic com-
Buffalo, Buffalo NY, USA mensals, pathogenicity of Ureaplasma spp. has been generally
considered low in children and adults. Controversy remains concern-
ing the clinical relevance of Ureaplasma infection in neonates and its
Introduction: Lung inflammation in premature infants contributes to
implication in the pathogenesis of inflammatory disorders.
development of bronchopulmonary dysplasia (BPD), a chronic lung
Ureaplasma infection has been associated with diseases of prema-
disease with long-term sequelae. Pilot clinical trials administering the
turity, such as lung and brain injury in very immature preterm infants.
corticosteroid budesonide suspended in surfactant have found
The present study addressed pro-inflammatory features of
reduced BPD without apparent adverse effects as occur with systemic
Ureaplasma isolates in human neonatal and adult monocytes.
dexamethasone therapy. The objective of this study was to determine
Materials and methods: Purified neonatal and adult CD14+ cells were
potency, stability and anti-inflammatory effects of budesonide in vitro
stimulated either with Ureaplasma urealyticum (U. urealyticum) and
to inform design of an appropriate dosing regimen of lung-targeted
U. parvum alone or simultaneously with Ureaplasma isolate and E. coli
corticosteroid therapy for future clinical trials.
LPS. Monocyte TNF-a, IL-1 and IL-8, cytokine response as well as
Materials and methods: We used cultured explants of second trimester
TLR2 and TLR4 expression were analyzed by means of real-time
human fetal lung treated with either budesonide or dexamethasone
quantitative PCR and flow cytometry.
and examined responses by microscopy, immunoassays, RNAseq,
Clinical cases & summary results: U. urealyticum and U. parvum
liquid chromatography/tandem mass spectrometry and pulsating
induced significant mRNA and protein expression of TNF-a, IL-1 and
bubble surfactometry.
IL-8 in both neonatal and adult monocytes (p<0.05, p<0.01, p<0.001
Clinical cases and summary results: Treatment of lung explants with
and p<0.0001; vs. unstimulated controls). In contrast to LPS,
budesonide suppressed secreted chemokines IL-8 and CCL2 (MCP-1)
Ureaplasma infection led to a significantly increased expression of
within 4 h reaching 90% decrease at 12 h, which was fully reversed
TLR2 mRNA in both cells (p<0.01 and p<0.001 in neonatal monocytes,
72 h after removal of steroid. Half-maximal effects occurred at 0.04-
p<0.01 and p<0.0001 in adult monocytes). TLR4 mRNA was
0.05 nM, representing a 5-fold greater potency than for dexametha-
significantly suppressed in adult CD14+ cells exposed to U.
sone. Budesonide significantly induced 3.6% and repressed 2.8% of 14
urealyticum or U. parvum (both p<0.001), but was unaffected in
500 sequenced mRNAs by 1.6- to 95-fold, including 119 genes that
Ureaplasma-stimulated neonatal monocytes. Simultaneous infection
contribute to the glucocorticoid inflammatory transcriptome, 29 of
of monocytes with LPS and Ureaplasma isolates significantly
these genes are known targets of NF-kB. By global proteomics, 22
enhanced IL-1 mRNA expression in adult monocytes (p<0.05 and
secreted inflammatory proteins were hormonally regulated.
p<0.01; vs. LPS alone), but significantly suppressed IL-8 mRNA
Budesonide retained activity in the presence of surfactant and did
expression (p<0.05; vs. LPS alone) as well as intracellular TNF-a, IL-
not alter the in vitro surface properties or stability of surfactant. There
1 and IL-8 protein synthesis in human adult monocytes (p<0.05 and
was some formation of palmitate-budesonide in lung tissue, which
p<0.01 respectively; vs. LPS alone).
serves as a tissue reservoir of steroid, but no detectable metabolism
Conclusion: Our data confirm a pro-inflammatory capacity of
to inactive 16a-hydroxy prednisolone.
Ureaplasma spp. in both neonatal and adult monocytes. Moreover,
Conclusion: We conclude that budesonide is a potent and stable anti-
results in neonatal and adult monocytes might point to relevant
inflammatory glucocorticoid in human fetal lung in vitro. The study
immunomodulatory effects of ureaplasmas comprising induction of
provides new findings for molecular effects of budesonide that define
TLR2 and suppression of TLR4 mRNA expression and modulation of
the glucocorticoid inflammatory transcriptome, identify new potential
LPS-induced cytokine responses.
biomarkers for both budesonide action in lung cells and the
pathogenesis of BPD, and inform design of the optimal budesonide:-
surfactant treatment regimen for clinical trials to prevent lung disease Keywords: Ureaplasma species, preterm infants, infection, inflamma-
in premature infants. tion, cytokine response, monocytes

Keywords: Inflammatory, chemokines, surfactant, RNAseq,

proteomics
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 35

766 411
Time to positivity (TTP) of Predictive value of amniotic
neonatal blood cultures: analysis interleukin - 6 for intraamniotic
over a decade from an irish inflammation in women with
regional neonatal unit PPROM and for early-onset sepsis
in their neonates
D. Huggard1, J. Powell2, C. Kirkham3, N. O’Connell2,
L. Power2, and R. Philip1 V. Korecko1, A. Mockova2, M. Kozerovsky1, J. Dort2, and
1
Neonatal unit, University Maternity Hospital Limerick, Ireland, M. Kapoun1
2
Department of Clinical Microbiology, University Hospital Limerick, 1
Ob/Gyn Dept., University Hospital of Pilsen, Pilsen, Czech Republic,
Ireland, and 3Research Office, Rotunda Maternity Hospital, Dublin, 2
Dept. of Neonatology, University Hospital of Pilsen, Pilsen, Czech
Ireland Republic

Introduction: A positive blood culture is considered as the gold Introduction: Chorioamnionitis can cause as well as result from
standard for the diagnosis of neonatal sepsis. In general, the more preterm premature rupture of membranes and could be associated
pathogenic the bacteria is the faster it will grow and flag positive with maternal and neonatal complications with long-term adverse
sooner than a commensal or contaminant. Isolated flora seems to be outcome. Intraamnionic inflammation is accompanied with elevated
changing over time as well with Escherichia coli (E. coli) becoming a concentration of quantity of proinflammatory substances in amniotic
more prevalent significant growth overtaking the group B strepto- fluid, mainly interleukin - 6 (AFIL - 6). The purpose of the study was to
coccus (GBS) after the introduction of widespread screening and evaluate the accuracy of the AFIL - 6 concentrations as a marker of
intrapartum antibiotic use in many maternity units. Predicting the intramniotic infection in women with a preterm premature rupture of
pathogenicity of the isolated bacteria depending on the time to membranes (PPROM). Secondly, in women with PPROM and low
positivity (TTP) would be beneficial in the antimicrobial management levels of AFIL-6 simuntaneously the average time of expectant
(including the selection of antiobiotcs and deciding the duration of management was evaluated. The tertiary outcome was to identify the
treatment) in neonatal units. correlation between the concentrations of AFIL-6 and early-onset
Materials and methods: We conducted a retrospective laboratory sepsis in neonates.
review of the computerised database of blood culture results over a Materials and methods: Thirty one pregnant non-laboring women534
14 year period (2001 -2014) from an Irish Regional stand-alone weeks of gestation (range: 24 þ 0-33 þ 6) with PPROM and subse-
Maternity Hospital. Specimens from all newborn infants were quently their thirty one neonates were enrolled in our study. The
included and TTP was defined as the time from when the sample study group of women underwent t amniocentesis for determination
was placed in the automated blood culture analyser to when the of the AFIL - 6 and microbial invasion of the amniotic cavity
machine flagged a positive result. An automated blood culture (MIAC) together with histological examination of placenta, amniotic
PedsBacT alert system was utilised during the study period. A single membranes and umbilical cord. AFIL-6 concentrations were deter-
medical scientist has overseen the data transfer over this period (JP). mined using a quantitative immunoassay. The infection indicating
Demographic details of newborn infants were obtained from level of AFIL-6 was defined as concentration 41000 pg /ml. After
maternity hospital and neonatal databases as well as healthcare delivery, the study group of neonates was followed for clinical
records. Audit committte of the University Maternity Hospital Limerick symptoms very closely of early-onset sepsis and concurently the
approved the study. laboratory analysis of blood account, CRP and microbial testing were
Clinical cases & summary results: Over a 14 year period there were performed.
11,432 neonatal blood cultures were taken with 605 (5.3%) becoming Clinical cases and summary results: The concentration of AFIL-6
positive. The range of positivity varied - low of 9/670 (1.3%) in 2013, 41000 pg/ml was found in 35.4% women with PPROM (11/31), in
high of 64/710 (9.0%) in 2002. Time to positivity (TTP) of our cohort 72.7% (8/11) of them was the histologically proven chorioamnionitis
was as follows: 0-11 hours - 46 (7.6%), 12-24 hours - 273 (45.1%), 25- present. An AFIL- 6 concentration 41000 pg/ml had 73% sensitivity,
36 hours - 123 (20.3%), 37-48 hours - 103 (17.0%) and >48 hours - 60 95.7 % specificity and positive likelihood ratio of 6.7 to determinate
(9.9%). Overall 442 (73.1%) were positive within 36 hours, and 545 the intraamniotic infection. The positive and negative predictive value
(90.1%) within 48 hours. All Klebsiella species and other Coliform of the test was 85.7% and 74.2%, respectively (p50.01). The
isolates were detected within 24 hours; 95% E.coli, GBS, Enterococci, & correlation between AFIL-6 41000 pg /ml and MIAC in women with
S.aureus bacame positive within 24 hours. There were no cases of PPROM had 57% sensitivity and 92% specificity (p50.01). In the entire
culture positive Listeria. All cultures positive with S. aureus, GBS, neonatal study group early-onset sepsis in 32.2% neonates (10/31)
Klebsiella sp. and other Coliforms were detected within 36h and we was detected. The positive microbial specimens were cultured in 6
observed that 96.1% of cultures were positive in <24h & 98.1% in affected neonates (2 Escherichia coli, 1 Serratia marcescens, 3
<36h. Predominant pathogenic microorganisms were- S. aureus 23 Ureoplasma urealyticum). In neonates born to the mothers with AFIL-
(3.8%), Enterococcus 22 (3.6%), E. coli 21 (3.5%), & GBS 18 (3%). 6 41000 pg /ml the occurrence of early-onset sepsis was 54.5 % (6/
Pathogenic bacteria have significantly shorter mean TTP, with Gram 11). In women with PPROM and expectant management the time of
negatives flagging sooner than Gram positives (OR of 1.55) delayed delivery averaged 13.2 days. Neonates born to mother in this
Conclusion: We observed a 5.3% rate of overall neonatal blood culture subgroup revealed early-onset sepsis in 19.04% (4/21) cases. One
positivity. Vast majority of the most pathogenic organisms in blood child developed recurrent meningitis caused by Escherichia coli. The
cultures turned positive within the first 24 hours (96%). Our evaluation of AFIL-6 at above mentioned threshold had 60%
obervations support the discontinuation of empirical antibiotics sensitivity, 76.2% specificity, 54.5% positive predictive value and 80
after 36 hours (versus the traditional 48hours) in the absence of % negative predictive value in detection of early- onset neonatal
ongoing clinical evidence or other compelling laboratory results for sepsis (p=0.4).
neonatal infection. Conclusion: AFIL-6 41000 pg/ml was found in 35.4 % women with
PPROM (11/31), in 72.7% (8/11) of them was the histologically
Keywords: Time to positivity (TTP); Blood culture: neonatal sepsis; comfirmed chorioamnionitis. An AFIL- 6 concentration 41000 pg/ml
Antibiotics had 73% sensitivity, 95.7% specificity and positive likelihood ratio of
6.7 to determinate the intraamniotic infection. The positive and
36 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

negative predictive value of the test was 85.7% and 74.2%. In

neonates born to the mothers with AFIL-6 41000 pg/ml the
occurrence of early-onset sepsis was 54.5% (6/11).

Keywords: Chorioamniitis, neonatal sepsis, IL-6, intraamniotic

infection

INTRAPARTUM SURVEILLANCE - 294

Computerised antepartum fetal
monitoring updated: the new
Dawes-Redman 2016 system
C. W. G. Redman, P. Szafranski, and A. Georgieva
Nuffield Department of Obstetrics and Gynaecology, University of
Oxford, The John Radcliffe Hospital, Oxford, UK 217

Introduction: The Dawes-Redman system of computerised antepartum

Fetal lactate sensor
cardiotocography (AN CTG) has been used in many countries for 25
years. It applies 14 criteria of normality, developed from the Oxford P. P. van den Berg1 and T. Cremers2,3
database (now 470 000 AN CTG with detailed outcome data). When 1
criteria are met, at a variable time after 10 mins, the record can be Department of Obstetrics and Gynecology, University Medical
stopped. Otherwise it is stopped at 60 mins with ‘Criteria not met’ Centre Groningen, Groningen, the Netherlands, 2University of
when a summary of the reasons is given. The new system, Dawes- Groningen, and 3Brains On-Line, Groningen, The Netherlands
Redman 2016, grades the reasons why criteria are not met with a
score of 3-10. 3 is the worst outcome (fast sinusoidal rhythm) and 10 Introduction: In the developed world, it can be estimated that 80% of
is ‘Criteria met’. Intermediate scores display a spectrum of risk to labors are continuously monitored with electronic fetal monitoring
inform clinical staff of the urgency of the problem. The scores are (EFM). Since the beginning of EFM there has been an escalation of
derived from Oxford data. The performance of the system is reported operative deliveries - in USA now every third pregnancy ends in a
here. caesarean delivery. Increased C-section rates are not associated with a
Materials and methods: All AN CTGs from singleton pregnancies at lower incidence of birth asphyxia [1], and lead to a 100% increase in
Oxford (Jan 1991-Nov 2011) were analysed. 71 235 from 27 197 healthcare costs for obstetrics [2]. We developed a micro dialysis
pregnancies were valid traces: lasting either 60 min or less, only if probe integrated into the fetal scalp electrode allowing continuous
Dawes-Redman criteria were met. The lowest score per pregnancy measurement of lactate, giving instant information about the
was considered. Three exclusive compromise groups were defined: oxygenation status of the fetus.
1. The Cochrane Database of Systematic Reviews 2006 Issue 3
– Mild: low Apgar (54 at 1min or 57 at 5min) or acidaemia (cord 2. New York Times 30 June 2013
arterial pH10mmol if delivered by elective Caesarean, or pH14mmol Materials and methods: 4 Adult male wistar rats were anaesthetized
otherwise). using isoflurane. After shaving, micro dialysis probes were inserted in
– Severe: stillbirth, neonatal death (528 days) or birth asphyxia (a low the back of the animal and fixated with a suture. A pulse oximeter was
Apgar AND either metabolic acidaemia or a clinical diagnosis of BA clamped on the tail to monitor oxygenation and heart rate. A jugular
with admission to Special Care). vena cannula was inserted to draw blood samples (100 microl each),
– Birthweight 53rd Yudkin centile but no mild or severe compromise. for analysis of lactate and saturation. Dialysis was performed using
We define adverse outcome to be a composite of any of the above. sterile saline solution at 1.5 microl/min. Samples were collected in 300
Clinical cases and summary results: The 27 197 women with valid microl polypropylene vials, for lactate analysis. After stabilization of
antepartum CTG traces represent 22% of all deliveries in Oxford for 15 min, sampling was started. Lactate, pH and saturation in blood
that period and are characterised with significantly higher rates of samples was analyzed using a handheld Abbott analyzer. Lactate
adverse labour outcome when compared to deliveries with no from dialysis samples was quantified with an enzymatic assay in a 96
antepartum monitoring (7.91% versus 4.43%, p50.001). The perfor- well plate.
mance of Dawes-Redman 2016, on the entire archive, is shown in Clinical cases and summary results: Upon decreasing of oxygenation
Table 1. The risk for mild and severe compromise consistently (t=0 min), increasing nitrogen (0.8 l/min) and decreasing oxygen
increases as scored fall from 10 to 4. Score 3 is reserved for a fast (0.05l/min), saturation dropped below 40% for an hour. Blood lactate
sinusoidal pattern, which carries 60% risk for low Apgar (due to fetal levels increased 2.5 fold (image).Upon restoration of saturation (0.8 l/
anaemia). The system was not designed to detect the risk for min oxygen), lactate levels returned to baseline levels rapidly. The
intrauterine growth restriction but low scores clearly relate to this lactate levels are depicted as measured in dialyze and blood. With a
problem. recovery of the dialysis membrane for lactate of about 20%, levels
Conclusion: The Dawes-Redman 2016 CTG system enhances the corrected for recovery match blood lactate levels. Dialysis lactate
functionality of the original system. It grades the estimated risk of levels increased at the same time as blood lactate levels increased,
adverse outcome when criteria of normality are ‘‘not met’’. The figures indicating that micro dialysis can be used as alternative for blood
are based on a large clinical archive. Dawes-Redman 2016 replaces lactate analysis.
the binary conclusion of ‘Criteria Met’ or ‘Not met’ with a measured Conclusion:
spectrum of risk to guide clinical management at the bedside. The Lactate can be quantified in subcutaneous tissue of the Rat
new system will be marketed in 2016/2017 (Huntleigh- Lactate increases upon transient deprivation of of oxygen
diagnostics.com). Microdialysis can be used to monitor [Lactate] subcutaneously in vivo
Monitoring lactate may be useful as an adjunct to EFM, preventing
unnecessary interventions.
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 37
pH 12 mmol/l, we found 6 cases of metabolic acidosis (0.8%). Area
Keywords: Monitoring fetal hypoxia, lactate, microdialysis under the ROC curve was 0.87 (95%CI 0.79 - 0.94) and we found
sensitivity of 0.83 and specificity of 0.83 at the point closest to (0,1).
Conclusion: Relative ST analysis is a promising method to detect fetal
acidosis. We may improve diagnostic accuracy of ST analysis when we
adjust the current definition of ST events. This may provide a
promising and objective method in fetal monitoring independent of
cardiotocography. Relative ST analysis needs external validation.

Keywords: ST analysis, fetal surveillance, fetal electrocardiography

305
Reduced incidence of cord
metabolic acidosis using
ST-analysis of the fetal
electrocardiogram for
intrapartum surveillance
242
ST events redefined: cut off for A. Landman1, S. Immink-Duijker1, E. Mulder1, W. Koster1,
S. Xodo2, G. Visser1, F. Groenendaal 3, and A. Kwee1
relative ST Analysis 1
Department of Obstetrics, Wilhelmina Children’s Hospital, University
1 1,2 Medical Center Utrecht, Utrecht, The Netherlands, 2Division of
D. J. Hulsenboom , M. B. van der Hout-van der Jagt ,
Perinatal Medicine, Policlinico Abano Terme, Abano Terme, Padua,
R. Vullings2, A. Kwee3, J. O. E. H. van Laar1, and Italy, and 3Department of Neonatology, Wilhelmina Children’s
S. G. Oei1,2 Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
1
Department of Obstetrics and Gynaecology, Máxima Medical
Center, Veldhoven, the Netherlands, 2Faculty of Electrical Introduction: Due to the limited specificity of cardiotocography there is
Engineering, Eindhoven University of Technology, Eindhoven, the a demand for an additional test that enables more accurate
identification of fetuses at risk for intrapartum asphyxia. For several
Netherlands, and 3Department of Obsetrics and Gynaecology,
years intrapartum ST-analysis of the fetal electrocardiogram with STAN
University Medical Center Utrecht, Utrecht, the Netherlands
is being considered for this purpose. However, studies regarding its
benefits are conflicting. Several cohort studies have shown a
Introduction: Fetal ST analysis failed to decrease perinatal asphyxia continuing improvement of perinatal outcomes following the intro-
and cesarean section rates. False positive ST events may explain this duction of the STAN-methodology. It has, therefore, been suggested
result. We observed that fetuses are more prone to ST events when many other factors influence the results. The objective of the present
the orientation of the fetal electrical heart axis is aligned with the study is to evaluate perinatal outcomes over a long period of time,
orientation of the scalp electrode. We may improve diagnostic fourteen years, with increasing STAN-usage in a high-risk population.
accuracy of ST analysis when we correct for this effect. We propose a Materials and methods: This retrospective cohort study was performed
new method ‘‘relative ST analysis’’ with redefined ST events. ST events between in a tertiary referral center, which participated in the Dutch
will be based on relative rather than absolute rises from the STAN-trial during 2006-2008. Inclusion criteria were: high-risk
individual’s T/QRS baseline. This study aims to determine the optimal singleton pregnancies with fetuses in cephalic presentation, a
cut off for relative ST events in fetal electrocardiography (fECG) to gestational age of 36 weeks and the intention to deliver vaginally
detect fetal metabolic acidosis. in the period between 2000 and 2013. STAN-usage increased from
Materials and methods: Post hoc analysis on women from the Dutch using one monitor in 2000 to nine in 2010. Data was collected on the
STAN trial (STþCTG branch). Exclusion criteria: fetal cardiac mal- following perinatal outcomes: the number of fetal blood samples,
formation, fever, tocolysis, no fECG tracing/signal quality 50% in last vaginal instrumental deliveries or cesarean sections, cord metabolic
hour and no cord blood sample. We automatically extracted all T/QRS acidosis (pH 47.05 and BDecf 512 mmol/L), cord acidosis (pH 57.00),
values and determined their medians in shifting windows of 5, 10, 15, Apgar scores, moderate and severe neonatal encephalopathy, and
20 and 25 minutes. T/QRS baseline was the lowest value of these perinatal death. Trend analysis was used to detect changes over time.
continuously shifting windows. We calculated relative T/QRS rises for Clinical cases and summary results: A total of 19.664 high-risk
each minute with the formula: (recent T/QRS median - T/QRS pregnancies were included. Since the implementation of the STAN-
baseline)/(T/QRS baseline). Metabolic acidosis was set as cord artery method, the cord metabolic acidosis rate declined from 2.5% to 0.4%
pH12 mmol/l (pH12 mmol/l in cases with one blood sample). We set (p50.001). This decrease largely occurred during the STAN-trial, when
the cut off at the point closest to (0,1) in the receiver operating only two to three delivery rooms were equipped with a STAN-
characteristic (ROC) curve. monitor. Furthermore, there were significant reductions in fetal blood
Clinical cases and summary results: We included 762 women, 12 of sampling rate from 11.8% to 8.8% (p 50.001), and the total number
which had metabolic acidosis (1.6%) and determined the optimal instrumental vaginal deliveries from 13.8% to 10.3% (p 50.001). There
diagnostic accuracy for events defined as the median T/QRS over were no changes in Apgar scores and neonatal encephalopathy.
5 minutes compared to the lowest T/QRS baseline over 15 minutes. When the study population was dichotomized, the incidence of
Relative ST analysis showed an area under the ROC curve of 0.84 moderate and severe NE was 1.56 per 1000 births in the years 2000-
(95%CI 0.76 - 0.91) for metabolic acidosis. The optimal cut off was set 2007 and 0.86 in 2008-2013 with an OR of 0.39 (2, 95%-CI 0.17-0.89,
at a 103% rise from T/QRS baseline, with sensitivity of 0.75 and p=0.035).
specificity of 0.80. When metabolic acidosis was defined as cord artery
38 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Conclusion: Since the use of the STAN-method, there has been a (Georgieva et al, BJOG 128,2014) exceeded a threshold, adjusted for
significant decrease in fetal blood sampling, and the number of preeclampsia or thick meconium.
cesarean sections and vaginal instrumental deliveries. Most striking is Clinical cases and summary results: Table 1 shows that, when
the 84% reduction of the incidence of metabolic acidosis, especially the compared to the rate of emergency deliveries due to presumed
rapid decline at the time of the STAN-trial. The pattern of the decline fetal compromise as recorded in the patients’ notes at birth, OxSys 1.5
suggests that, in addition to STAN-technology itself, intensified had significantly lower alert rates in the Healthy group (i.e. lower false
training of personnel also greatly contributes to the observed effect. positive rate, 14.46% versus 16.40%, p 50.001) and slightly higher
alert rates in the compromise groups (i.e. higher sensitivity). We
Keywords: CTG, fetal blood sampling, intrapartum fetal surveillance, demonstrate that the false positive rate was high and the sensitivity
metabolic acidosis, ST analysis, fetal ECG, STAN was low for both clinical practice and OxSys 1.5.
Conclusion: The Oxford prototype computerised intrapartum system
OxSys 1.5 compares favourably to assessment in clinical practice.
More work is needed to achieve better performance. Our approach to
evaluating diagnostic accuracy, presented here, allows methods for
296 CTG interpretation to be compared and improved. We can include
A data-driven system for any new knowledge in the system and test its contribution by
measuring changes in sensitivity and/or the false positive rate.
continuous fetal moniotring in
labour: the oxford prototype 023
A. Georgieva, A. Papageorghiou, and C. W. G. Redman Does subacute hypoxic pattern
Nuffield Department of Obstetrics and Gynaecology, University of on the ctg trace during active
Oxford, The John Radcliffe Hospital, Oxford, UK
second stage of labour result in
Introduction: Intrapartum cardiotocography (CTG) is widely used.
Maternal and fetal risk factors confound the relation of CTG patterns
poor neonatal outcomes?
to fetal health, visual interpretation is unscientific, without reliable
estimates of the risk for the fetus. Unnecessary operative deliveries A. Albertson1, E. Chandraharan2, V. Lowe2, A. Archer2,
are performed whilst some babies at risk are not delivered in a timely and I. Amer-Wåhlin3
fashion. 1
Commercial computerised systems are not widely adopted. They aid Medical School, Uppsala University, Uppsala, Sweden, 2Women’s
visual assessment of standard features (baseline rate, decelerations Direcotrate, St George;s University Hosptials NHS Foundation Trust,
etc.) but do not quantify the associated fetal risks or incorporate other London, UK, and 3Department of Learning, Informatics, Management
risk factors. Our prototype data-driven system (OxSys) objectively and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
quantifies the intrapartum CTG. It takes account of clinical risk factors
and relates to the perinatal outcome in a large cohort. We report how Introduction: Subacute hypoxia occurs mainly during second stage of
an early OxSys prototype performs. labour when a fetus is exposed to a rapidly evolving hypoxic stress
Materials and methods: Considered were all normally formed babies, within 30-60 minutes and is characterised by deep and wide
born Mar’00-Dec’11 at Oxford, who had intrapartum CTG, paired cord decelerations with progressively reduced time spent on the baseline
gas analyses, and gestation 435 weeks (n=23,903). We studied four (typically a 1:3 baseline to deceleration ratio). This may result in a
exclusive groups: drop of fetal pH at the rate of 0.01/every 2-3 minutes. The objective of
 Severe compromise (composite of stillbirth, neonatal death (528 our study was to determine the effect of the subacute hypoxic
days), neonatal encephalopathy, seizures, and resuscitation at pattern on the CTG trace on perinatal outcomes.
birth followed by intensive care), Materials and methods: 1800 CTGs were analysed to determine the
 Moderate compromise (umbilical cord arterial blood pH at birth occurrence of subacute hypoxic pattern over a 30 minute period after
57.05), obtaining permission from the Research and Audit Office. Effect
 Mild compromise (7.05pH57.15), subacute pattern on the CTG trace on the Apgar score and umbilical
 Healthy (all remaining). cord arterial pH was determined.
Clinical cases and summary results: Approximately 10% fetuses
The prototype, OxSys 1.5 analysed each CTG with a moving 15min developed a subacute hypoxic pattern on the CTG during the
window, updated every 5 minutes. OxSys 1.5 alerted if the first hour of second stage of labour, after 30 minutes of active maternal pushing.
the trace was unreactive or, at any time, the Decelerative Capacity The use of prostaglandins or oxytocin to induce or augment labour
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 39
was associated with 42% of all cases of subacute hypoxia. 12.1% of both maternal and fetal heart rate by abdominal ECG and uterine
fetuses with a subacute hypoxic pattern had an umbilical cord arterial activity by electrohysterography (EHG). This new tool presents
pH 57.0 compared to 7.7% without the subacute hypoxic pattern. superiority in distinguishing fetal and maternal heart rate and it
Conclusion: 30% of fetuses demonstrated features of subacute appears more efficacy in obese pregnant. The aim of our study is to
hypoxia on the CTG trace during active maternal pushing. The use compare lecture and clinicians interpretation of fetal heart tracing
of oxytocin or prostaglandins appear to increase the likelihood of obtained by these different tools.
subacute hypoxic pattern. Subacute hypoxia which occurs secondary Materials and methods: A total of twenty eight simultaneous CTG and
to a combination of repetitive and prolonged compressions of the abfECG have been evaluated. One expert senior observer calculated
umbilical cord and reduction in utero-placental oxygenation, which the percentage of success of each recording; total amount of small
results in a progressively less time spent at the normal baseline fetal and large accelerations, small and large decelerations and uterine
heart rate appears to increase the likelihood of lower umbilical cord contractions have been counted. Ninety-two traces lasting 30 minutes
arterial pH at birth. This may be secondary to reduced time available each have assigned to four clinicians (2 senior and 2 junior) to be
to expel carbon dioxide and metabolic acid as well as to obtain fresh classified according to ACOG classification.
oxygenated blood from the placental venous sinuses. Clinical cases & summary results: Overall perceived signal quality was
significantly superior for abfECG than CTG Doppler (94.19% vs.
Keywords: Cardiotocograph, subacute hypoxic pattern, rate of fall 88.23%, p<0.01). The number of small accelerations, small decelera-
in pH tions and uterine contractions detected were greater in the trace
obtained using abfECG, while big decelerations were counted fewer
times. During second stage of labour, signal quality decreased using
both recording methods (85.00% vs. 84.60%, p = 0.638). Given 46 CTG
tracks of 30 minutes each and the corresponding abfECG tracks (total:
733 92 tracks), percentage of agreement (Pa) among 4 observers in
interpreting the FHR patterns according to ACOG criteria was
Electronic fetal monitoring calculated. Overall Pa was superior for abfECG than Doppler CTG
(47.8% vs. 39.1%), although this difference was not significant. All
during labor: comparison of observers choose the same ACOG category (namely ACOG 1, 2 or 3) in
abdominal fetal 47.8% of abfECG tracks, and only in 39.1% of Doppler CTG tracks. A
bad signal quality hindering the interpretation of the track was
electrocardiography and doppler reported on average in 8.7% abfECG recording and in 35.9% Doppler
recording (p<0.05). On average, in 0.5% of abfECG tracks no ACOG
cardiotocography category was attributed due to a bad signal quality, while this
happened in 3.8% of Doppler CTG recordings (p<0.05).
Conclusion: Monica AN24, through a better acquisition of the fetal
E. Grossi, P. Antonazzo, V. M. Savasi, and I. Cetin heart rates signal, could provide clearer information about fetal well
Unit of Obstetrics and Gynaecology, Hospital Luigi Sacco, via Gb being and uterine contractions improving the skills of interpretation
Grassi 74, Milan, Centre for fetal research Giorgio Pardi, of the CTG pattern and decreasing variability between clinicians.

Introduction: Electronic fetal monitoring is a method of fetal well Keywords: Electronic fetal monitoring, abdominal CTG, fetal well
being monitoring during labur. It is the most utilized worldwide. being, sensitivity.
Nerveless it presents a poor sensitivity and limits regarding variability
inter- and intra-observer, frequently due to record of undetermined
tracks. Recently a non-invasive electronic feta monitoring has been
introduced. It is called Monica AN24 (abfECG) and is able to monitor
40 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

238 in the control group were matched to each neonate in the case group in
a one-to-one fashion using the subsequent delivery matched by
The FIGO 3-tier system of gestational age. The primary exposure was 30 minutes of EFM
immediately prior to delivery, interpreted by two obstetricians, blind
assessing fetal heart rate tracings to clinical and outcome data. Both reviewers categorized EFM patterns
into FIGO and NICHD categories systems. Relative risks, 95% confidence
is superior to the NICHD 3-tier intervals and test characteristics for acidemia were calculated.
Clinical cases and summary results: During the period of study 3490
system in detecting neonatal women met inclusion criteria, of these, 102 delivered an acidemic
fetus (Figure 1). There were no meaningful differences in maternal
acidemia demographics between the neonates in the case group and those in
the control group (Table 1). According to the NICHD system, 94.2% of
Marti Gamboa S., Redrado Gimenez O., Ruiz Sada J., Category I tracings were normal. Category II included normal (30.9%),
Pascual Mancho J., Rodrigo Rodriguez M., Rodriguez suspicious (34.3%) and pathological (34.6%) tracings. All category III
tracings were pathological, although 95.2% of pathological tracings
Lazaro L., Lapresta Moros M., and Castan Mateo S. belonged to category II. When analyzing the validity of both systems,
Obstetrics Dept, Miguel Servet University Hospital, Zaragoza, Spain we found that NICHD system presented 2.9% sensitivity and 100%
specificity for detecting mil acidemia (pH  7.10) whereas FIGO
system showed 43.1% sensitivity and 81.5% specificity. For the
Introduction: Despite the ubiquity of electronic fetal monitoring (EFM),
detection of severe acidemia (pH  7.00), the FIGO system presented
the validity of the relationship between various fetal heart rate (FHR)
a higher validity (Sensitivity: 69.0%, Specificity: 73.4%) than the NICHD
patterns and fetal acidemia has not yet been established, although
system (Sensitivity: 7.1%, Specificity: 99.1%).
several classification systems have been developed in the last forty
Conclusion: The FIGO 3-tier system had a better sensitivity and
years. In 2008, a three categories system was accepted unanimously by
specificity than the NICHD 3-tier system for identifying mild and
obstetric community in the NICHD workshop. Seven years later, a three
severe fetal acidemia.
categories system was proposed by the FIGO Intrapartum Fetal
Monitoring Expert Consensus Panel. The objective of this study is to
determine which system presents more validity for fetal acidemia Keywords: Fetal acidemia, classification systems, sensitivity,
detection. specificity
Materials and methods: We conducted a one year retrospective case-
control study of all singleton, non-anomalous gestations delivered at 
37 week with neonatal acidemia, defined as an umbilical cord gas
pH7,10 and base excess (BE) 58 mmol/L. A sub-analysis was
performed in those fetus with pH7 and BE 5 -12mmol/L. Neonates
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 41

295 (Georgieva et al, BJOG 128,2014) and no accelerations during the

first hour. Severe compromise was a composite outcome of
Significance of the first hour of stillbirth, neonatal death (48hrs of intensive care.
the fetal heart rate monitoring: Clinical cases and summary results: In total 51 000 cases were included,
185 (0.36%) were identified as nonreactive (34% before established
nonreactive versus reactive initial labour, 57% in the first stage of labour, 4% in the second stage and
5% with unknown dilatation). Their characteristics were compared
trace with the remaining 50,815 births (Table 1). Those with nonreactive
patterns were nearly five times more likely to have severe
compromise, twice as likely to have thick meconium and three
A. Georgieva, A. Ugwumadu, A. Papageorghiou, and times more likely to be growth restricted (all significant). There were
C. W. G. Redman seven cases of severe compromise in the nonreactive group and 430
in the remaining cases. Thus, the sensitivity of the test was only
Nuffield Department of Obstetrics and Gynaecology, University of
1.39%, but because a nonreactive FHR is so rare (0.36%) the false
Oxford, John Radcliffe Hospital, Oxford, UK positive rate was also very low (about 3 in 1000). The risk for severe
compromise was 1 in 118 for the entire dataset, but increased to 1 in
Introduction: Fetal heart rate (FHR) ‘cyclicity’ is defined as 26 in the nonreactive cases, and to 1 in 5 in the nonreactive cases
alternating episodes of low variability (quiet sleep) and reactivity with thick meconium.
(increased variability and/or accelerations, i.e. active sleep), Fig. 1. Conclusion: Persistently nonreactive FHR in the first hour of
Antepartum, the Dawes-Redman normality criteria require at least intrapartum monitoring is rare. Computerised FHR monitoring can
one episode of FHR reactivity in an hour. During early labour, reliably alert clinicians if such a pattern is present. The nonreactive
identification of the nonreactive FHR may also be informative, initial FHR detects over 1% of severe compromises early with minimal
because of its association with pre-existing fetal compromise such over-intervention. Moreover, nonreactive initial FHR in the presence
as neurological injury, infection or inflammation (Phelan & Kim, of thick meconium presents a 1 in 5 risk for severe compromise,
Seminar Perinatol 24,2000) but this has only been subject to indicating the need for prompt intervention.
limited research (Spencer & Johnson, BJOG 93,1986). We used
computerised methods to detect nonreactive FHR patterns in
labour at the onset of FHR monitoring and report their incidence
and association with perinatal outcome.
Materials and methods: All singleton births at Oxford in Jan 1993-
Dec 2011, of gestation 435 weeks with intrapartum FHR monitor-
ing of 1 hour duration were included, excluded were breech
presentations or congenital abnormalities. The first hour of the FHR
was analysed regardless of what point in labour the FHR
monitoring began. Cases in which FHR monitoring commenced
during the latent phase of labour (cervical dilatation 53cm) were
included provided they were delivered within 24 hours. Nonreactive
FHR was defined automatically as Decelerative Capacity 51
42 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Introduction: A sinusoidal heart rate (SHR) pattern is a rare and still not
091 completely understood fetal heart rate (FHR) pattern which was first
described in 1972 as fixed, uniform fluctuations of the fetal heart rate.
A true SHR pattern is rarely seen and considered as a sign of severe
Remifentanil elicits a sinusoidal fetal jeopardy, being associated with increased perinatal morbidity
and mortality and poor perinatal outcome. The pattern is best known
heart rate pattern in the human for its association with fetal conditions causing severe acute or
chronic fetal anemia, but has also been seen during severe fetal
fetus intrapartum asphyxia/hypoxia. Besides the presence of a true SHR
pattern during fetal jeopardy, other conditions with SHR patterns
D. Boterenbrood1, M. M. Wassen1, G. H. A. Visser2, and have been reported. These SHR patterns are mostly transient,
resolving spontaneously and are associated with a good fetal
J. G. Nijhuis3 outcome. They have been related to different causes, such as fetal
1
Department of Obstetrics and Gynaecology, Zuyderland Medical sucking movements and regular mouthing. Earlier, narcotic analgesics
Center, Sittard, the Netherlands, 2Department of Obstetrics and (butorphanol, alphaprodine, meperidine and nalbuphine), given to
Gynaecology, Utrecht Medical Center, Utrecht, The Netherlands, and the mother during labour, also have been reported as a possible
3 cause of this SHR pattern. Remifentanil is a more recent narcotic
Department of Obstetrics and Gynaecology, GROW-School for
analgesic used as pain relief during labour. In a short period of time
Oncology and Developmental Biology, Maastricht University Medical we observed several cases with a SHR pattern after administration of
Centerþ, Maastricht, The Netherlands remifentanil. Based on these cases we aimed to investigate the
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 43

possible relation between remifentanil and the appearance of a SHR of a SHR pattern related to the use of remifentanil. Several
pattern. components of the SHR pattern were described: delay until onset
Materials and methods: We conducted a retrospective cohort study of the SHR pattern after start remifentanil, total duration of SHR
and analyzed FHR patterns during the period of June 1st 2015 to pattern in relation to total duration of remifentanil use, the presence
August 30th 2015. The study population included nulliparous and of a intermittent or continuous pattern and the amplitude of
multiparous women during labor with a singleton or multiple oscillations. Secondary outcome was the neonatal condition at
pregnancy, gestational age exceeding 32 weeks and at least birth, assessed by the Apgar score (AS) after five minutes and the
60 minutes of interpretable cardiotocography (CTG). Women in the umbilical artery pH.
intervention group were using remifentanil, while women in the Clinical cases and summary results: One hundred twenty-eight tracings
control group were either having no pain relief or receiving epidural from fetuses during labour were reviewed, 64 from women receiving
analgesia (EA). Groups were matched for spontaneous or induced remifentanil en 64 from women without remifentanil. In the
labour and for the type of delivery. All FHR patterns were assessed by intervention group, 22/64 tracings (34%) showed a SHR pattern after
two independent investigators, who were blinded for the use of the administration of remifentanil, compared to 6/64 tracings (9%) in
remifentanil. Tracings were reviewed during labour, starting from the the control group (p = 0.001). Time of onset after remifentanil
beginning of first stage. A SHR pattern was identified using criteria of administration varied from zero till 45 minutes (mean 12 min  13 min).
Modanlou et al. and a minimum period of ten minutes of this pattern Amplitude of oscillations in both groups were all525 bpm, with only
was set as an inclusion criterium. Primary outcome was the presence two SHR patterns in each group having an amplitude between 15 and
44 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

25 bpm. Total duration of available CTG did not differ significantly decreased (5.5%, 95%CI 5.0–6.0 VERSUS 4.9%, 95%CI 4.7–5.2).
between the intervention and the control group (mean 465 min  232 However, it did not reach estatistic significance. more importantly,
versus 362 min  229). There were no significant differences in five there was a significant decrease in the number of HIE cases per 1000
minute AS and umbilical artery pH between intervention group and births (5.3, 95%CI 4.0–7.0 VERSUS 2.2, 95%CI 1.7–2.8).
control group, with none of the neonates having a five minute AS57 Conclusion: Introduction of central fetal monitoring with computer
and only two neonates in the intervention group versus three neonates analysis of cardiotocographic signals and real-time alerts was
in the control group with an umbilical artery pH57.10, with normal AS. associated with a significant reduction in cesarean section rates and
There were no cases of severe fetal anemia that could explain the SHR in the incidence of hypoxic-ischemic encephalopathy.
patterns. Also no serious side effects of remifentanil on maternal vital
functions were reported. Keywords: Central monitoring, real-time alerts, cardiotocography,
Conclusion: Remifentanil use during labour frequently elicits a SHR heart rate, fetal, cesarean section
pattern in the human fetus. The high incidence of this pattern (34%) in
this study and the short interval between the administration of
remifentanil and its appearance strongly suggests a causal relation-
ship. No adverse neonatal outcomes were reported, which indicates NEONATAL 1 - 339
that the presence of a SHR pattern after the administration of
remifentanil does not seem to indicate fetal distress. Following these Neoclot-study: neonatal
results, this study indicates that a SHR pattern observed after start of
remifentanil, without other FHR signs suggestive of fetal distress, does central-venous line observational
not warrant further fetal investigation. For clinicians this knowledge is
of crucial importance as the recording of a SHR pattern may otherwise study on thrombosis
lead to unnecessary interventions and also to unnecessary maternal
anxiety. The underlying mechanism is unknown and additional studies J. J. Sol1,2, M. van de Loo3, M. Boerma4, and
are still necessary to further clarify this unusual pattern. C. H. van Ommen3
1
Keywords: Neonatal outcome, remifentanil, sinusoidal heart rate Department of Pediatrics, Groene Hart Hospital, Gouda, the
pattern Netherlands, 2Department of Neonatal Intensive Care Unit, Sophia
Children’s Hospital / Erasmus MC, Rotterdam, the Netherlands,
3
Neonatal Intensive Care Unit, Emma Children’s Hospital / AMC,
Amsterdam, the Netherlands, and 4Department of Pediatric
Hematology, Erasmus MC Sophia Children’s Hospital, Rotterdam, the
089
Netherlands
Impact on obstetric indicators
Introduction: In critically ill (premature) neonates, central venous
of central fetal monitoring catheters (CVCs) are increasingly used for monitoring and adminis-
with computer analysis of tration of medication or parenteral nutrition. A serious complication,
however, is the development of catheter-related thrombosis (CVC-
cardiotocographic signals thrombosis), which may resolve by itself or cause severe complica-
tions such as stroke. Due to lack of evidence, management of
and real-time alerts neonatal CVC-thrombosis varies among neonatal intensive care units
(NICUs). In the Netherlands a partly consensus based national
management guideline has been developed which is implemented
J. Pereira1, A. Costa1,2,5, C. Costa-Santos3, in all 10 neonatal intensive care units (NICUs).
D. Ayres-de-Campos1,2,5, and J. Bernardes2,4 Materials and methods: The NEOCLOT study is a multicentre
1 prospective observational cohort study, including 150 preterm and
Centro Hospitalar Sao João, Porto, Portugal, 2Department of
term infants (0-6 months) admitted to one of the 10 NICUs, developing
Obstetrics and Gynecology, Medical School – University of Porto, CVC-thrombosis. Patient characteristics, thrombosis characteristics, risk
Portugal, 3Department of Biostatistics and Medical Informatics, factors, treatment strategies and outcome measures will be collected
Medical School – University of Porto, Portugal, 4Unidade Local de in a web-based database. Management of CVC-thrombosis will occur
Saúde de Matosinhos, Portugal, 5Institute for Research and as recommended in the protocol. Violations of the protocol will be
Innovation in Health (I3S) and Institute of Biomedical Engineering noted. Primary outcome measures are a composite efficacy outcome
(INEB), University of Porto, Portugal, consisting of death due to CVC-thrombosis and recurrent thrombosis
(CVC-thrombosis or pulmonary embolism), and a safety outcome
Introduction: Avoidance of fetal hypoxia/acidosis and unnecessary consisting of the incidence of major bleedings during therapy.
obstetric intervention remains a high priority for intrapartum care. Secondary outcomes include individual components of primary
The objective of this study was to evaluate the impact of introducing efficacy outcome, all-cause mortality, clinically relevant non-major
a central fetal monitoring system with computer analysis of and minor bleedings and the frequency of risk factors, protocol
cardiotocographic signals and real-time alerts (Omniview-SisportoÕ ), variations, residual thrombosis and post thrombotic syndrome.
on the cesarean section and adverse neonatal outcome rates of a Clinical cases and summary results: At the moment about 50 neonates
tertiary care hospital. are included in this study. A total of 150 infants are needed.
Materials and methods: The clinical database of a tertiary care university Conclusion: The NEOCLOT study will evaluate the safety, efficacy and
hospital was searched for the period between january 2001 and feasibility of the new, national, neonatal CVC-thrombosis guideline.
december 2014, to determine yearly rates of cesarean section (CS), cs Furthermore, risk factors as well as long-term consequences of CVC-
for non-reassuring fetal state (NRFS), and newborn hypoxic-ischemic thrombosis will be analysed.
encephalopathy (HIE). the periods before and after the introduction of Keywords: Central venous catheters, thrombosis, neonate, national
central fetal monitoring system in december 2003 were compared. guideline
results were calculated with 95% confidence intervals (95% CI).
Clinical cases and summary results: After introduction of the system,
there was a significant reduction in overall CS rates (29.2%, 95% CI
28.9–30.8 VERSUS 28.3%, 95%CI 27.8–28.8), CS for nrfs rates have also
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 45

700 340
The predictive value of amniotic A microscopic evidence for the
fluid ph and electrolytes on thrombogenicity of umbilical
neonatal respiratory disorders catheters
S. Y. Semerci1, B. Yucel2, I.M. Erbas3, O. S. Gunkaya2, A. Sobczak1, P. Kruczek1, M. Homa2, and P. K. Winta1
M. Talmac2, A. Babayigit1, B. Cebeci1, G. Buyukkale1, and 1
Neonatal Intensive Care Unit, Department of Pediatrics, Jagiellonian
M. Cetinkaya1 University Medical College, Kraków, Poland, and 2Centre for High
1 Temperature Studies, Foundry Research Institute, Kraków, Poland
Neonatology Dept., Kanuni Sultan Süleyman Training and Research
Hospital, Istanbul, Turkey, 2Obstetrics and Gynecology Dept., Kanuni
Introduction: Umbilical catheterization is a routine procedure
Sultan Süleyman Training and Research Hospital, Istanbul, Turkey,
performed in the neonates to obtain a central vascular access. It is
and 3Pediatrics Dept., Kanuni Sultan Süleyman Training and painless for the child and easy for the operator as after birth the
Research Hospital, Istanbul, Turkey vessels are opened in the umbilical stump. The major complication
that limits the usage time of umbilical catheters is thrombosis, leading
Presenter: M. Cetinkaya to embolic events and infection. Among children, neonates are most
Introduction: Amniotic fluid (AF) pH can be affected by both maternal prone to thromboembolic disease. This is due to their immature
and fetal conditions. Fetal AF may have effect on fetal lung hemostasis, small vessel diameter and hemodynamics altered by
maturation. Down-regulation of epithelial Na channels and an congenital defects and persistent fetal circulation. However, almost
increase of pulmonary compliance accompany to pulmonary adapta- 90% of thrombi in neonates are associated with arterial or venous
tion developing at the first hours of life. Lower genomic expression of access devices.
Na channels in airways were found to be associated with respiratory Materials and methods: New and used polyurethane umbilical
distress syndrome (RDS) in preterms. Although pH and electrolyte catheters were examined using Computed Tomography (Phoenix
value of AF may be relevant to fetal and maternal conditions, there is NanotomÕ ) and Scanning Electron Microscopy (Hitachi TM3000). The
no study about this topic in the literature. The aim of this study is to project was performed in frame of the collaboration agreement, with
determine the possible role/s of amniotic fluid pH and electrolytes to a permission from the Bioethics Committee.
predict neonatal respiratory morbidities. Clinical cases and summary results: /Multiple images here - please
Materials and methods: From all infants, 1 ml of AF was aspirated notice: I am sending a pdf file with my results seen as actual images.
during C-section before incision of membranes. pH value and Figure 2. Linear transducer ultrasound image of a catheter-related
electrolytes of AFs were analyzed by the blood gas machine thrombus in abdominal aorta: a) on day 3 of UAC presence, b) day 4,
(Siemens RAPIDLabÕ 1200 Systems). Maternal and neonatal demo- just after UAC removal.
graphic features and clinical outcomes, presence of morbidities such Figure 3. CT and SEM imaging of a new umbilical catheter, 75% of the
as respiratory distress syndrome (RDS), transient tachypnea of the device consist of radiopaque polymer (barium sulfate, 2) dedicated to
newborn (TTN) were all recorded. assess the catheter’ position on an X-ray. We suggest it is mostly
Clinical cases & summary results: AF of 184 infants were evaluated. A responsible for the roughness of catheter’s surface.
total of 26 infants developed RDS and 35 had a diagnosis of TTN. Figure 4. Graduation numbers on a new catheter show a fractured
Receiver operating characteristic analysis showed a statistically structure. A simulation of a traumatic tweezers use was performed,
significant difference of AF Na and K values between the group resulting in paint peeling and catheter crumbling.
with respiratory morbidity and the healthy group (p50.001, p50.04). Figure 5. Comparison of a groove at a tip of the new catheter (left)
Besides AF Na value was statistically significantly different between and a groove filled with inclusions removed from the patient (right).
the preterm neonates with RDS and healthy preterm neonates Figure 6. SEM images of an umbilical catheter from a patient indicate
(p50.015). AF pH did not show any statistically significant value for that the clot formation has begun.
TTN in term and RDS in preterm infants. Figure 7. An illustration of what can happen if we do not react to the
Conclusion: To our best of knowledge, this is the first study that clotting process. A central catheter (non umbilical) was kept in a
defines the mean values of AF pH and electrolytes at term and patient for 10 weeks and a calcification of a thrombus had taken place
preterm neonates both healthy and with respiratory morbidities. Also - confirmed calcium phosphate content by SEM Energy Dispersive
this study suggests that the Na and K values of AF may be predictors Spectroscopy.
of respiratory distress in neonates, more studies are needed to Conclusion:
evaluate the role of AF pH and electrolytes on prediction of neonatal *The irregular surface of umbilical catheters may be the source of
respiratory morbidities clotting formation, thus a regular thrombosis monitoring is recom-
mended while the catheter’s presence.
Keywords: Amniotic Fluid, pH, Electrolytes, Respiratory Distress *New techniques (ultrasound) allow us a bedside monitoring of the
Syndrome, Transient Tachypnea of Newborn catheter position and thrombus formation. Rough radiopaque
catheters with imprinted numbers may not be needed anymore.
*Careful tweezers’ use while inserting the catheter is recommended
due to its predisposition to damage.

Keywords: Umbilical catheterization, umbilical vessels, thrombo-

genicity, thrombosis, neonatal intensive care, neonates
46 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

550 532
Probiotic supplementation and The belgian prenatal microarray
retinopathy of prematurity, (bemapre) consortium: sharing
bronchopulmonary dysplasia and prenatal genomic array data in a
periventricular leukomalacia in national database
preterm infants: a meta-analysis
J. Muys1, Y. Jacquemyn1, K. Janssens2,
BEMAPRE consortium3, and B. Blaumeiser2
E. Villamor1, E. Villamor-Martı́nez1, L. Filippi2,
G. Cavallaro3, F. Mosca3, and P. L. J. Degraeuwe1 1
University Hospital Antwerp (UZA), Edegem, Belgium, 2Center for
1 Medical Genetics Antwerp, Edegem, Belgium, and 3The ‘BElgian
Department of Pediatrics, Maastricht University Medical Center
consortium on MicroArray in PREnatal diagnosis’ is composed of
(MUMCþ), School for Oncology and Developmental Biology (GROW),
members of all Belgian genetic centers
Maastricht, 6202 AZ, the Netherlands, 2Neonatal Intensive Care Unit,
Medical and Surgical Feto-Neonatal Department, ‘‘A. Meyer’’
Presenter: J Muys
University Children’s Hospital, Florence, Italy, and 3Neonatal Intensive Introduction: In 2013, a national consensus between the eight Belgian
Care Unit, Department of Clinical Sciences and Community Health, genetic centers was reached to use genomic arrays as a first-tier
Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, diagnostic test for the detection of chromosomal aberrations in
Università degli Studi di Milano, Milan, Italy prenatal invasive samples. Consensus guidelines were established
regarding technical aspects, the organization of pre- and post-test
Presenter: E. Villamor counseling as well as the interpretation and reporting of certain copy
Introduction: Recent meta-analyses showed that probiotic supple- number variations (CNV). These guidelines are subjected to constant
mentation reduces the risk of necrotizing enterocolitis (NEC) and late re-evaluation and refinement. Following this uniform reporting policy,
onset sepsis (LOS) in preterm infants but it remains to be determined a national prenatal CNV database was created. We report on the
whether this reduction translates into a reduction of other complica- realization and current status of this database.
tions of the prematurity. Materials and methods: A national consensus approach on how
Materials and methods: We conducted a systematic review and meta- counseling and interpretation of results are managed in Belgium
analysis to evaluate the possible role of probiotics in altering the risk when using microarray in prenatal diagnosis is presented. Belgian
of retinopathy of prematurity (ROP), bronchopulmonary dysplasia genetic centers agreed on using a database provided by Cartagenia
(BPD), and periventricular leukomalacia (PVL). NV (Agilent Technologies). It was decided to include all prenatal cases
Clinical cases & summary results: Sixteen randomized controlled trials with a non-benign CNV with a minimal size of 400kb. A simple,
(5294 infants; probiotics: 2647) were included in the meta-analysis unambiguous, uniform labeling system for all CNVs was implemen-
that showed a significantly decreased rate of LOS (risk ratio, RR, 0.86, ted. Criteria for minimal genotypic and phenotypic information were
95% confidence interval, 95% CI, 0.768 to 0.968, P=0.012) but could drafted.
not demonstrate a significant effect of probiotics on severe ROP (RR Clinical cases & summary results: All centers have imported their data
0.841, 95% CI 0.666 to 1.063, P=0.148, 9 studies), any ROP (RR 1.053, into the database or are in the process of doing so. Approximately
95% CI 0.903 to 1.228, P=0.508, 4 studies), BPD (RR 0.1.066, 95% CI one third of all CNVs in the database are pathogenic in nature (55.4%
0.973 to 1.168, P=0.172, 15 studies), or PVL (RR 1.347, 95% CI 0.979 to de novo, 25.4% maternally inherited, 19.2% paternally inherited). Two
1.851, P=0.067, 6 studies). Meta-regression did not show any thirds of cases in the database are variants of unknown significance
significant association between the RR for LOS and the RRs for the (11.4% de novo, 45.7% maternally inherited, 42.9% paternally
others outcomes. inherited). The first results will be presented.
Conclusion: In conclusion, our results suggest that ROP, BPD, and PVL Conclusion: The BEMAPRE database is almost fully established; nearly
rates are not affected by probiotic supplementation in all prenatal data are imported. The resulting database constitutes an
preterm infants. Further studies addressing this issue are needed to elaborate source of data, which we will now start mining for
confirm our findings that must be interpreted with caution because genotype-phenotype correlations. By ameliorating genotype–pheno-
the effects of probiotics seem to be strain specific and, therefore, type knowledge of prenatally registered CNVs, we will develop a
pooling data from different strains may result in misleading strong scientific base for clinical decision-making in prenatal
conclusions. diagnosis. This work is a collaboration of all Belgian academic genetic
centers.
Keywords: Probiotics, oxidative stress, preterm
Keywords: Invasive prenatal diagnosis, Microarray, genetic
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 47
NEONATAL LUNG – 754 (CASE REPORT) 234
Pulmonary involvement in One year pulmonary outcomes in
neonatal lupus: a challenging the trial of late surfactant
diagnosis (TOLSURF)
S. Pereira1,4, I. Sanmarful1, F. Flor-de-Lima1,4, H. Soares1,4, R. Keller1, E. Rogers1, E. Eichenwald2, A. Hibbs3, D. Black4,
A. Vilan1,4, M. Rodrigues2,4, C. Moura3,4, I. Brito2,4, and K. Wai1, P. Ballard1, J. Asselin1, R. Ballard1 and for the
H. Guimarães1,4 TOLSURF study investigators.
1
Neonatal Intensive Care Unit, Centro Hospitalar São João, Porto, 1
Department of Pediatrics, University of California, San Francisco, CA,
Portugal, 2Pediatric Rheumatology Unit, Centro Hospitalar São João,
USA, 2Department of Pediatrics, University of Texas, Houston, TX,
Porto, Portugal, 3Pediatric Cardiology Department, Centro Hospitalar
USA, 3Department of Pediatrics, Case Western Reserve School of
São João, Porto, Portugal, and 4Faculty of Medicine, University of
Medicine, Cleveland, OH, USA, and 4Department of Epidemiology and
Porto
Biostatistics, University of California, San Francisco, CA, USA

Presenter: F. Flor-de-Lima
Introduction: Preterm Infants requiring mechanical ventilation for
Introduction: Neonatal Lupus Erythematosus (NLE) refers to a clinical
more than 7 days experience episodes of dysfunctional surfactant and
spectrum of cutaneous, cardiac and systemic abnormalities observed
are at high risk for death or bronchopulmonary dysplasia (BPD).
in newborns whose mothers have autoantibodies against Ro/SSA, La/
Infants 28 0/7 wks’ gestational age (GA) ventilated at 7 to 14 days in
SSB or, rarely, anti-U1RNP. It is considered a model of passively
TOLSURF were randomized to late surfactant (calfactant) versus sham
acquired autoimmunity. Pulmonary involvement is relatively frequent
treatment, all received inhaled nitric oxide. There was no difference in
in adult and juvenile patients with Systemic Lupus Erythematosus
the primary outcome of survival without BPD at 36 wks’ post-
(SLE), but its occurrence in newborns is exceedingly rare. Our aim is to
menstrual age, determined by physiologic O2/flow reduction (Ballard
describe a case of Acute Lupus Pneumonitis (ALP) in a newborn
RA, J Pediatr 2015).
with NLE.
Materials and methods: We evaluated the effect of treatment on
Clinical cases & summary results: A newborn was born from a mother
pulmonary outcomes at one year corrected age (CA). 450/ 511
with SLE and positive anti-SSa and –SSb with a previous child who
enrolled infants survived. We collected data on pulmonary morbidity
died due to complications from NLE myocarditis. A prenatal diagnosis
by parental surveys at 3, 6, 9 and 12 months CA. Morbidity was
of heart block was made despite maternal disease control and early
determined if parents reported medications (diuretic, bronchodilator,
transplacental treatment with dexamethasone. Third-degree heart
inhaled or systemic steroid, pulmonary), pulmonary hospitalization, or
block and positive anti-SSa were confirmed at birth. A temporary
home respiratory support. Infants were classified as No Pulmonary
pacemaker was placed at D3 and a definitive pacemaker only at D15
Morbidity (No PM) if no morbidity reported in any survey, and
due to sepsis with concurrent mild respiratory failure. Despite
Persistent Pulmonary Morbidity (Persistent PM) if morbidity reported
adequate antibiotic therapy, negative cultures and decreasing
in 3 surveys (versus No Persistent PM if no or 2 surveys). We
inflammatory parameters at D17 severe hypoxemic respiratory failure
analyzed the effect of treatment assignment on these outcomes with
ensued, requiring mechanical ventilation. Chest x-ray showed
GEE, to account for clustering of siblings, adjusting for imbalances in
symmetrical interstitial infiltrates. ALP and Pulmonary Embolism
baseline characteristics.
were suspected and lung CT angiography revealed diffuse ground
Clinical cases and summary results: There were no differences in GA
glass opacities. After 3 methylprednisolone pulses, followed by oral
(25.31.2 versus 25.31.2, p=0.90), male sex (57 versus 53%, p=0.40),
prednisolone, he improved rapidly. Lung infiltrates regressed and he
percent with intrauterine growth restriction (IUGR 10th percentile,
was discharged home at D46, asymptomatic.
18 versus 14%, p=0.22), or maternal race/ethnicity (p=0.47) in
Conclusion: There are few reports of ALP in NLE and its diagnosis is a
treatment versus control groups
challenge as it is mostly one of exclusion. A high degree of suspicion
Treated infants were less likely to require home respiratory support
by neonatologists and a multidisciplinary approach to these patients
(38.5 versus 53%) relative benefit 1.28 (95%CI 1.07,1.55 p= 0.006). Of
are fundamental in order not to delay establishing a diagnosis.
note, treated infants were less likely to be products of multiple
Although very little has been reported in the literature, early
gestation (26 versus 36%, p=0.02), and had younger mothers
aggressive treatments probably crucial for a favorable outcome
(27.86.1 versus 29.86.6 years, p=0.0007). 110/439 (25%) of infants
without long-term sequelae.
were classified as No PM and 153/426 (36%) as Persistent PM.
Adjusted Relative Benefit for treatment versus control was 1.40 (95%
Keywords: Lupus Erythematosus; Newborn CI 0.96, 2.04, p=0.08) for No PM and 1.24 (95% CI 1.08, 1.42, p=0.003)
for No Persistent PM.
Conclusion: Late surfactant treatment was associated with reduced
requirement for home respiratory support and, in the adjusted model,
for decreased occurrence of persistent pulmonary morbidity during
the first year and a trend toward disease-free outcome. Late
surfactant administration was well tolerated and appears to be safe.

Keywords: BPD, late surfactant, 1 year pulmonary outcome

48 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

logistic regression mixed model, pre-extubation HRCi, PEE-1 fold-

475 change and positive blood culture remained significant independent
Heart rate characteristics index predictors of extubation failure.
Conclusion: The baseline and post-extubation HRCi were significantly
and extubation outcome in different in neonates who failed extubation, compared to those who
succeeded, possibly due to a difference in their respiratory
neonates: a retrospective cohort characteristics. Sepsis increased the risk of extubation failure but
HRCi was a poor predictor of this outcome. In contrast, a low baseline
study and minimal changes to post-extubation HRCi had a strong negative
predictive value, and may add to the confidence of clinicians
N. Goel1, M. Chakraborty2,3, W. J. Watkins4, S. Z. Ansari1, considering extubation.
and S. Banerjee1
Keywords: Neonate, Heart Rate Characteristics, Ventilation,
1
Neonatal Intensive Care Unit, Singleton Hospital, Swansea, UK, Extubation
2
Regional Neonatal Intensive Care Unit, University Hospital of Wales,
Cardiff, UK, 3Department of Postgraduate Medicine and Dentistry,
Cardiff University, Cardiff, UK, and 4Department of Infection and
Immunity, Cardiff University, Cardiff, UK
489
Introduction: Heart Rate Characteristics index (HRCi) is a numerical Pulse oximeter saturation target
score derived from a mathematical model of electrocardiogram
analysis of heart rate variability, asymmetry and entropy to predict limits for preterm infants: a
clinical deterioration. Displaying the HRCi to clinicians reduced
mortality in very low birth weight infants, primarily due to reduction survey among european nicus
in late onset sepsis related mortality. Acute respiratory deterioration
accounts for 34% of the abnormal HRCi spikes, due to the effect of M. J . Huizing1, E. Villamor-Martinez1, M. Vento2 and
breathing pattern alterations, lung inflammation, hypoxia and E. Villamor1
hypercapnia on heart rate variability and decelerations. This retro-
1
spective observational cohort study examines the hypothesis that Department of Pediatrics, Maastricht University Medical Center
HRCi can predict the outcome of a clinical decision to extubate a (MUMCþ), School for Oncology and Developmental Biology (GROW),
neonate from ventilation either before or shortly after the extubation. Maastricht, the Netherlands, 2Hospital Universitario y Politécnico La
Materials and methods: A retrospective review of all ventilated Fe, Valencia, Spain
neonates was undertaken between June 2014 and January 2015 in
Singleton Hospital, UK, where HRCi monitoring is routine. Clinical data
and hourly HRCi were recorded for intended intubation-extubation Presenter: M.J. Huizing
events (episodes). Each episode started 6 hours prior to extubation or Introduction: Oxygen saturation targeting in preterm infants remains a
at intubation (if within 6 hours) and ended at 72 hours post- very controversial topic worldwide. In practice, there is substantial
extubation (controls), earlier if re-intubated (cases). Episodes with variation as to acceptable oxygen saturation limits for these infants.
insufficient HRCi scores were excluded. Mean HRCi of 6-hourly epochs We aimed to survey the current practices on oxygen saturation
were analysed; the post-extubation epoch (PEE) means were normal- targets in European Neonatal Intensive Care Units (NICUs) and the
ised to pre-extubation mean (baseline) as fold changes. Baseline HRCi changes introduced in these practices during the last years.
and subsequent PEE mean fold changes were compared by non- Materials and methods: A request to participate in a web-based survey
parametric tests. A logistic regression mixed model was used to test was sent to a delegate of the National Neonatology Society of 31
for independent variables. European countries, with the request of distributing it among the
Clinical cases & summary results: On initial search, 102 infants were country’s NICUs. The head of the NICU or a senior neonatologist was
identified as ventilated during the study period. Of these, 36 infants asked to complete the survey. The survey was conducted between
were excluded – 14 were not extubated on the unit (died/transferred November 2015 and February 2016.
out), 4 had no HRCi data available and 18 had insufficient HRCi due to Clinical cases & summary results: We obtained valid responses from
a very short period of ventilation following admission to the unit. The 193 NICUs, treating 8590 preterm newborns per year, across 27
remaining 66 infants contributed to 97 episodes included in the final countries. Of these centers, 140 (72,5%) had a unit policy or guideline
analysis. Of these episodes, 18 were cases and 79 controls. Cases had for desired oxygen saturation range for infants born at 28 weeks.
significantly lower gestation (p50.01) and birth weight (p50.01) but Forty different saturation ranges were reported (ranging from 82-93
longer duration of ventilation (p50.05) and more culture positive to 94-99). The five most frequently utilized oxygen saturation ranges
sepsis (p50.01). Baseline HRCi and PEE-1 fold changes were higher in were 85-95 (8 NICUs; 4,1%), 88-95 (23; 11,9%) 90-94 (10; 5,2%), 90-95
cases compared to controls (p50.01). Table 1 shows the relationship (54; 28%), and 91-95 (10; 5,2%). A total of 143 NICUs (74,1%) changed
between HRCi thresholds and extubation failure. In a multi-variable their oxygen saturation limits over the last five years. The five most
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 49
frequently reported previous limits were 85-92 (11 NICUs; 5.7%), 85-95 (Moscow, Russia). 42 intubated neonates who underwent upper
(19; 9.8%), 88-92 (33; 17.1%), 88-93 (14; 7,3%), and 88-95 (10; 5,2%). airway USD and chest X-ray were observed. Imaging was made by
When asked about the strength of the scientific evidence supporting highly qualified ultrasound specialist and pediatric radiologist who
the beneficial/harmful effects of the oxygen saturation targeting were blinded to the results of another method. USD was made by
policy that was used in their NICU, 4 (2,1%) found it very weak, 25 microconvex 4-10 MHz transducer on Loqic S8 ultrasound machine via
(13%) found it weak, 58 (30,2%) found it neutral, 97 (50.5%) found it a suprasternal approach; an aortic arch (AA) was used as a USD
strong and 8 (4,2%) found it very strong. marker; the distance between AA and ETT tip was measured. On chest
Conclusion: We detected a high degree of heterogeneity in the pulse X-ray the distance from the ETT tip to the carina was measured. The
oximeter target limits across European NICUs. A significant number of mean gestation age of the patients was 29.75.2 (23-40 w), mean
NICUs have changed their policy in the last years, probably as a body weight at the day of investigation was 1652.9996 g (520-
consequence of the most recent published investigations and 3990 g).
recommendations. Clinical cases & summary results: The ETT was visualized by US in all
examined neonates. The mean time interval between ultrasonogra-
Keywords: Oxygen, saturation targets, hypoxia, hyperoxia phy and chest radiography was 2.4 hours (0.35-5.0 h). The concor-
dance of chest ultrasound and X-ray data was 98% (41/42); in 1 case
chest X-ray showed the deep ETT position, but at USD the distance
was normal, and US was made 2 hours before radiographic imaging.
Correlation between the distance from ETT tip to carina on chest X-
ray and ETT-tip to aortic arch on US was strong – 0.8 (o50.05). We
542 proposed that deeply positioned ETT on X-ray is registered at Th3-Th4
level, on the US the distance ETT – tip to the aortic arch less than
The feasibility of ultrasound 1 cm. Sensitivity of USD to detect deeply positioned ETT was 91% (10/
diagnostics in confirmation of 11), specificity of USD was 100% (31/31), positive predictive value -
100%, negative predictive value - 97%.
endotracheal tube position in Conclusion: Bedside ultrasound is a feasible imaging modality to
visualize the position of the endotracheal tube which has a very good
neonates correlation with gold standard – chest X-ray and high sensitivity to
determine deeply positioned ETT. The major limitation of our trail is
that a single highly qualified specialist performed all US imaging.
I. Koltunov1, M. Degtyareva2, A. Mazaev1,2, Randomized controlled trials involving nonqualified operators (neo-
A. Gorbunov1,2, K. Chusov1, A. Erokhina1,2, and natologists) are required to implement this technique into routine
A. Demina1 clinical practice.
1
Morozovskaya Children Municipal Clinical Hospital, Moscow, Russia,
Keywords: Endotracheal tube position, ultrasound
and 2Pirogov Russian National Research Medical University, Moscow,
Russia

Presenter: A. Erokhina
Introduction: Endotracheal intubation is the common procedure
routinely managed in neonatal intensive care unit (NICU) and delivery OUTCOME - 016
room. Incorrect endotracheal tube (ETT) position is associated with
serious complications such as right upper lobe and left lung
Maternal inflammatory bowel
atelectases, pulmonary air leak syndromes, hypoxemia and even
death. ETT position can be confirmed by using chest radiography; but
disease during pregnancy is not a
chest X-ray is often delayed and patients are exposed to ionizing risk factor for long-term
radiation. Ultrasound diagnostics (USD) might be a new, quick and
safe method to confirm correct tube placement. The aim of our morbidity of the offspring
investigation was to assess the feasibility of USD in determining ETT
position and to compare its results with the current gold standard –
E Sheiner1, A. Freud1, O. Beharier1, A. Walfisch1,
chest radiography.
Materials and methods: It was a prospective, single-centre, observa- R. Sergienko2, and D. Landau3
tional study conducted at the Morozovskaya Children Hospital 1
Department of Obstetrics and Gynecology, Soroka University
Medical Center, Ben-Gurion University of the Negev, Beer-Sheva,
Israel, 2Epidemiology and Health Services Evaluation, Ben-Gurion
University of the Negev, Beer-Sheva, Israel, and 3Department of
Pediatrics, Soroka University Medical Center, Ben-Gurion University of
the Negev, Beer-Sheva, Israel

Introduction: Our objective was to investigate whether offspring’s of

women suffering from inflammatory bowel disease (IBD) during their
pregnancy are at an increased risk for long-term pediatric morbidity.
Materials and methods: This population-based cohort study compared
the incidence of long-term (up to the age of 18 years) hospitalizations
due to cardiovascular, endocrine, neurological, hematological,
respiratory and urinary pediatric morbidities of offsprings of mothers
affected by inflammatory bowel disease during their pregnancy.
Deliveries occurred between the years 1991 and 2014 in a regional
tertiary medical center. Newborns with congenital malformations as
well as multiple pregnancies were excluded from the study.
50 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Figure 1. Kaplan-Meier survival curve demonstrating the cumulative incidence of hospitalizations up to the age of 18 years in children born to mothers
with and without IBD.
A - Cardiac hospitalizations B - Endocrine hospitalizations C - Hematological hospitalizations D - Neurological hospitalizations E - Respiratory
hospitalizations F - Urinary hospitalizations.
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 51
Clinical cases and summary results: During the study period 255 352 449
deliveries met the inclusion criteria; 0.05% of the offsprings were born
to mothers with inflammatory bowel disease (n=133). During the Growth from birth to age 12.5 in
follow-up period, children born to mothers with inflammatory bowel
disease did not have an increased risk for long-term (up to the age of children born growth restricted
18 years) cardiovascular, endocrine, hematological, neurological,
respiratory or urinary morbidity. F. Beukers1, J. Rotteveel2, M. van Weissenbruch2,
Conclusion: Maternal inflammatory bowel disease during pregnancy is
not a risk factor for long-term morbidity of the offspring.
J. W. Ganzevoort3, J. B. van Goudoever1,2, and
A. G. van Wassenaer-Leemhuis1
1
Paediatric Dept., Academic Medical Center Amsterdam, The
019 Netherlands, 2Paediatric Dept., VU Medical Center, Amsterdam, The
Netherlands, 3Dept. of Obstetrics and Gynaecology, Academic
The association of neonatal mor- Medical Center Amsterdam, The Netherlands
bidity and long-term neurological Introduction: Early onset hypertensive disorders of pregnancy are
outcome in infants who were strongly associated with placental insufficiency and consequently fetal
growth restriction (FGR) and preterm birth. It is suggested that these
growth restricted and preterm children have an increased risk for short stature during childhood, and
decreased adult height, overweight and obesity. In earlier studies we
at birth found that the degree of FGR had a strong positive relation to
anthropometry in early childhood. We aimed to investigate growth
A. G. van Wassenaer-Leemhuis1, N. Marlow2, C. Lees3, from birth to age 12.5 and the associations with the degree of FGR.
H. Wolf4, and for the TRUFFLE research group Materials and methods: Eligible subjects were 149 children born from
mothers participating in the Preeclampsia Eclampsia Trial Amsterdam.
1 Birth weight ratio (BWR) was used as measure of FGR, and was
Department of Neonatology, Academic Medical Center, Amsterdam,
Netherlands, 2Department of Academic Neonatology, Institute for defined as birth weight/ expected birthweight P50 (customized
Women’s Health, University College London, London, United growth charts). Catch up growth was defined as height standard
deviation score (SDS) within target height range (1.6SD). Thinness,
Kingdom, 3Department of Obstetrics, Imperial College, London,
overweight and obesity were defined according to international
United Kingdom, 4Department of Obstetrics, Academic Medical
(IOTF) guidelines. Anthropometry at age 12.5 was done in 96 children.
Center, Amsterdam, Netherlands GA range was 27-38 weeks (mean 32). Mean BWR was at p2.3. Mean
target (parental) height was 0.25 SDS.
Introduction: Although severe neonatal morbidities are often used as Clinical cases and summary results:
surrogates for neurodevelopmental outcome in perinatal research,  The figure shows height, weight, BMI and head circumference
the relationship between the two outcomes is rarely evaluated. In measurements expressed as SDS up to age 12.5.
TRUFFLE, a randomised trial of delivery for very preterm fetuses
 At age 12.5 median pubertal stages were Tanner B4 and G2.
dependent on venous Doppler or cardiotochographic criteria, we
used composite outcomes to evaluate neonatal and developmental  Mean height (SD) at age 12.5 was -0.34 SDS (1.0). A total of 95%
outcomes at 2 years of age. We aimed to study in a secondary had complete catch up growth, including two out of three
analysis, the relationship between neonatal morbidity and two-years children on growth hormone therapy. Height was not associated
neurodevelopmental outcome in a large cohort of surviving children with BWR.
after early fetal growth restriction (FGR).  Mean weight (SD) was 0.02 SDS (1.1). The lower BWR was, the
Materials and methods: Data were collected prospectively from the larger change in weight SDS between age 0 and 12.5.
recognition of fetal growth restriction (and study entry) until age two  Mean BMI (SD) was 0.00 SDS (1.2). Thinness, overweight,
years, corrected for preterm birth. We studied the association obesity were found 15%, 3% and 2% of the cohort respectively.
between neonatal morbidity (NNM) and neurodevelopmental impair- Neither BMI at 12.5 years nor the increase of BMI between 1 and
ment (NDI), retaining trial allocation in all statistical models. NNM 12.5 years was associated with BWR.
included any of bronchopulmonary dysplasia, brain injury, sepsis or Conclusion: In this homogeneous cohort of growth restricted children
necrotising enterocolitis. NDI was a composite of Bayley cognitive at a wide GA range, linear growth is comparable to the population
score 585, cerebral palsy or severe sensory impairment. and 95% of children are within the target height range. Mean BMI SDS
Clinical cases and summary results: This study cohort comprised 402 is comparable to that of the Dutch reference population. The degree
infants born at a mean gestational age of 30 þ 4 (range 26 þ 1 to of FGR was not related to height and BMI at age 12.5.
40 þ 4) and with a mean birthweight of 1023 (SD 321) gram. NNM
Keywords: Fetal growth restricton, growth
occurred in 104 cases (26%) and was more frequent in 17 of 39 infants
(44%) with NDI than in the 87 of 363 infants (24%) with normal
outcome (OR 2.5 (1.3-4.8; p=0.01). However for 22 of 39 infants with
NDI (56%) there was no preceding NNM. As anticipated, NNM was
inversely related to birth gestational age. In contrast, NDI was not
related to gestational age. The incidence of NNM rose as BWR fell. In
multivariable analyses, cerebral ultrasound abnormalities were most
strongly associated with adverse 2-year outcome, together with trial
roup allocation, birth weight ratio (BWR), infant sex and Apgar score.
Conclusion: With the exception of cerebral ultrasound abnormalities,
commonly used neonatal morbidities are poor markers of later
neurodevelopmental impairment and should not be used as
surrogate outcomes for NDI.

Keywords: Fetal growth restriction, prediction, neonatal morbity,

neurodevelopmental impairment
52 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Center, Faculty of Health Sciences, Ben-Gurion University of the

647
Negev, Israel, 3Department of Obstetrics and Gynecology, Azienda
Use of magnesium sulfate in Ospedaliera Universitaria Policlinico di Bari, School of Medicine,
University of Bari ‘‘Aldo Moro’’, Bari, Italy
severe perinatal asphyxia and
short-term neurologic outcomes Introduction: Fetal gender has been explored in the past regarding
pregnancy complications and several associations have been found.
However, fetal and neonatal outcomes have only been scarcely
G. Mullalli-Bime1, G. Kuli-Lito2, and E. Tushe3 explored. In our study we further explore the association of fetal
1 gender with fetal heart rate monitoring, fetal cord blood gas and
Neonatal Intensive Care Unit, University Hospital of Obstertrics and
Apgar scores.
Gynecology of Tirana, Tirana, Albania, 2Paediatric Department, Materials and methods:A retrospective study comparing singleton
University Hospital of Tirana, Tirana, Albania, and 3Head of Neonatal deliveries was conducted. We compared pregnancies with male
Intensive Care Unit, University Hospital of Obstetrics and Gynecology versus female fetuses. Maternal baseline characteristics, pregnancy
of Tirana, Albania complications, delivery complications and neonatal outcomes includ-
ing fetal heart rate monitor patterns and cord blood gases were
Presenter: Gertiana Bime-Mullalli collected. Multivariable logistic regression model analysis was
Introduction: The goal was to study whether postnatal magnesium performed to control for confounders.
sulfate infusion could improve neurologic outcomes at discharge for Clinical cases and summary results: A total of 682 fetuses were
term neonates with severe perinatal asphyxia. included in the study, out of which there were 56% (n=383) males and
Materials and methods: Thirty two term neonates (4= 37 weeks of 44% (n=299) females. Maternal baseline characteristics and pregnancy
gestation) with severe perinatal asphyxia were studied in a complications were comparable between the groups. Male gender
prospective, longitudinal, placebo-controlled trial. Patients were was significantly associated with low Apgar scores (19% vs 10%,
assigned randomly to receive either 3 doses of magnesium sulfate p50.01), lower pH (7.18 versus 7.23, p50.001), higher PCO2 (61.8
infusion at 250 mg/kg per dose (1 ml/kg per dose) 24 hours apart versus 54.9, p50.01) and greater base excess (7.47 versus 6.40,
(treatment group) or 3 doses of normal saline infusion (1 ml/kg p50.01), as compared with females. Male gender was associated with
per dose) 24 hours apart (placebo group). Both groups also a significant higher rates of abnormal fetal monitor patterns, during
received supportive care according to our unit protocol for perinatal the first and the second stages of delivery (68% vs 55% and 78%
asphyxia. versus 68%, respectively p50.01 for both ). A multivariate analysis
was performed for the prediction of abnormal monitor patterns, low
Clinical cases & summary results: In the treatment group, moderate pH and Apgar score, controlling for gestational age, maternal age and
encephalopathy was present in 18% (3 of 16) of the patients and fetal weight (Table). Gender was found to be significantly associated
severe encephalopathy in 31% (5 of 16, 3 were dead) of patients at with both first and second stage pathological monitor patterns, and
admission. In the placebo group 25% (4 of 16) of patients had was also found as an independent risk factor for pH under 7.1, and for
moderate encephalopathy and 37.5% (6 of 16, 2 were dead) of low 1st minute Apgar under 7 (Table).
patients had severe encephalopathy. At discharge, 25% (4 of 16) of Conclusion: Male gender is an independent risk factor for pathological
infants in the treatment group had neurologic abnormalities, monitor patterns and lower pH and Apgar scores.
compared with 37.5% (6 of 16) in the placebo group. Also, Keywords: Fetal heart rate monitoring, fetal gender, fetal outcomes
neuroimaging (transfontanelar sonogram) performed on day 14
yielded abnormal findings for fewer infants in the treatment group
than in the placebo group (31% vs 37.5%). Infants in the treatment
Fetal male gender as a predictor for adverse outcomes.
group were more likely to be receiving oral feedings at discharge
than were those in the placebo group (69% vs 63%). Good short-term
outcomes at discharge occurred for 62.5% of the patients in the
treatment group, compared with 43% of the patients in the placebo Variables OR 95% CI p Value
group.
Pathological 1st stage of labor 1.76 1.28-2.43 0.001
Conclusion: Postnatal magnesium sulfate treatment improves neuro- monitor
logic outcomes at discharge for term neonates with severe perinatal 2nd stage of labor 1.73 1.20-2.50 50.01
asphyxia. pH57.1 1.64 1.14-2.35 0.01
1st minute Apgar57 2.03 1.29-3.20 0.01
Keywords: Perinatal, asphyxia, magnesium sulfate
Adjusting for gestational age, maternal age and fetal weight.

PREECLAMPSIA – 537
Mitochondrial dna methylation in
097
fetal cord blood of iugr and
Fetal gender as a predictor for
preeclamptic pregnancies
adverse perinatal outcomes
1,2,3 1,2,3 1,2,3
C. Novielli1, C. Mandò1, S. Tabano2, N. Carlessi2,
Baumfeld Y., Yohay D., Zilberstein T., P. Antonazzo3, G.M. Anelli1, and I. Cetin1,3
Aricha-Tamir B.,1,2,3 Yaniv Salem S.,1,2,3 Hamou B.,1,2,3 1
‘‘L. Sacco’’ Department of Biomedical and Clinical Sciences, Center
Elharar D.,1,2,3 Idan I.,1,2,3 Yoahy Z.,1,2,3 and Sheiner E.1,2,3
for Fetal Research Giorgio Pardi, Università degli Studi di Milano,
1
Department of Obstetrics and Gynecology, Soroka University Milan, Italy, 2Department of Pathophysiology and Transplantation,
Medical Center, Faculty of Health Sciences, Ben-Gurion University of Università degli Studi di Milano, Milan, Italy, and 3Department of
the Negev, Israel, 2Clinical research center, Soroka University Medical Mother and Child, Luigi Sacco Hospital, Milan, Italy
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 53
Presenter: Chiara Novielli disclose possible differentially methylated mt genes associated to
Introduction: The adverse intrauterine environment in Preeclampsia pregnancy or fetal-origin diseases.
(PE) and Intrauterine Growth Restriction (IUGR) can impact on future Support:FGP;MIUR-20102CHST5
adult health through fetus’ epigenome reprogramming.
We found increased mitochondrial (mt) DNA levels in cord blood of Keywords: IUGR, preeclampsia, epigenetics, mitochondria
IUGR and PE fetuses. The methylation of mtDNA has been recently
showed altered in cancer tissues and cardiovascular diseases.
Here we evaluated mtDNA methylation of loci involved in mt 664
replication (D-loop) and function (TF/RNR1,CO1) in IUGR and PE cord
blood.
Materials and methods: Singleton pregnancies delivering by elective Risk factors for cardiovascular
cesarean section were included. We studied 24 term and 6 preterm
(37weeks) pregnancies with normal fetal growth, 24 IUGR, 14 PE/ disease 11-14 years after severe
IUGR and 9 PE. Fetal blood was collected from a clamped segment of
the cord and analyzed for biochemical parameters. Extracted DNA preeclampsia
was bisulfite-converted and amplification of D-loop, TF/RNR1, CO1 mt
loci obtained with specific primers. Methylation at CpG sites was E. Andolf, C. Salminen-Friesendahl, M. Thorsell, and
quantified by pyrosequencing. Clinical data and methylation levels
were compared between groups using independent-sample t-test
C. Iacobaeus
(eventually adjusted after Levene’s test) or Mann-Whitney U test, Department of Clinical Sciences, Karolinska Institutet, Danderyd
depending on distribution. Correlation between values was assessed University Hospital, Stockholm, Sweden
by Pearson correlation. Differences and correlations were considered
significant when p50.05.
Clinical cases & summary results: Term and preterm controls Presenter: Ellika Andolf
significantly differed only for gestational age (GA) and fetal weight Introduction: Several epidemiological studies show that women with a
(FW). All cases had lower GA, fetal and placental weight than term history of preeclampsia have a higher risk for cardiovascular disease
controls, but GA similar to preterm controls. IUGR (with/without PE) later in life. Few data are available on how those who stay healthy
had lower fetal and placental weight than preterm controls and were after preeclampsia differ from those who dońt.
hypoxic and lactacidemic. D-loop,TF/RNR1 and CO1 loci had no Materials and methods: Women admitted to Danderyd University
significant methylation differences between term and preterm Hospital, Stockholm, Sweden for severe preeclampsia (n=148)
controls and presented low methylation in all cord blood samples. between 1999-2004 were invited to participate in a follow up after
Nevertheless, D-loop methylation levels decreased significantly 11-14 years and 82 agreed to participate. Participants filled in
compared to controls in PE/IUGR (p=0.03) and in the most severe questionnaires on health and family history, on physical activity, stress
cases, i.e. early PE (onset34weeks) and IUGR with altered umbilical and sleep patterns. Blood pressure, Body Mass Index (BMI) and
artery pulsatility index (p=0.003/0.005). Moreover, in pathological various blood markers were analysed. Data from the index pregnancy
cases D-loop methylation correlated with GA, FW and umbilical vein were retrieved from medical records
pO2 (r=0.38/0.39/0.5;p=0.01/0.008/0.004). CO1 methylation levels Clinical cases & summary results: Of 82 participants, 24 had
inversely correlated to mtDNA content in both pathological cases hypertension or were on antihypertensives at follow up. Of these
and whole population (r=-0.43/-0.37;p=0.01/0.006). 24, three had hypertension already before the index pregnancy, all 24
Conclusion: IUGR and PE higher mtDNA levels might be explained by had higher blood pressure in early pregnancy, preeclampsia
D-loop hypomethylation in the most severe cases, being possibly also diagnosed at an earlier gestation and were more often treated for
mediated by other factors influencing mt replication. hypertension at discharge after delivery than those that stayed
The increase of both CO1 accessibility to transcription (due to CO1 healthy. At follow up these 24 also had a higher BMI and HbA1c.
hypomethylation) and mtDNA content might suggest a compensa- There was no difference in age, family history of cardiovascular
tory attempt to energy production. Further analyses are needed to disease, physical activity, stress and sleep patterns.
54 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Conclusion: Women with high risk for cardiovascular disease after 185
preeclampsia can possibly be identified already at the time of the
index pregnancy. Which strategy performs better
Keywords: Preeclampsia, long term consequenses, Hypertension, for the prediction of late PE?
Cardiovascular disease
Meler E., Albaiges G., and Rodriguez I.
677
Salut de la Dona, Dexeus. Hospital Universitari Dexeus
Hypertensive pregnant:
Introduction: Late PE although being milder is much more frequent.
relationship between drug Moreover, there is more and more scientific evidence that its
physiopathology is quite different from early PE, less frequent but
therapy and tension control much more severe. Several approaches have being published for its
prediction. Strategies performed at 1st trimester have poor results.
A. Cadete1, S. Vidal2, A. Correia3, M. Boia3, C. Rainho4, 3rd trimester strategies seem to perform little better. However, few
studies, most of them published by the group of Nicolaides, have
R. Ferreira5, L. Sutil1, and M. Bastos5 evaluated all three trimesters strategies independently and integrated
1
USF Águeda þ Saúde ACeS Baixo Vouga, 2USF Moliceiro ACeS Baixo in a longitudinal strategy model.
Vouga, 3Obstetrics and Gynecology Services of CHBV, 4USF Flor de Sal Materials and methods: To evaluate which strategy performed better
for the prediction of late PE. A model including maternal parameters
ACeS Baixo Vouga, and5Cardiology Service of CHBV
and Uterine Doppler measurement was created. It was evaluated as
an independent model in every trimester of the pregnancy and as an
Presenter: M. Boia integrated model in a longitudinal strategy. We evaluated maternal
Introduction: Gestational hypertension and pre-eclampsia were the parameters such as Maternal Body Mass Index (BMI), Blood pressure
most commonly diagnosed hypertensive conditions in pregnancy, (SBP, DBP, MAP) and uterine Doppler Measurement in all three
and according to the WHO despite all the investigation and trimesters. We considered Late Preeclampsia when diagnosed after 34
treatments available remains a major cause of morbidity and maternal weeks of gestation. We converted Pulsatility Index of Uterine Doppler
and fetal mortality. to MoM values according to Gómez et. al.
Materials and methods: Prospective and observational study of 139 Clinical cases and summary results: 1748 singleton pregnant women
pregnant women, submitted to the accomplishment of ambulatory were included. The incidence of late PE was 1.6% (n=29). The mean
blood pressure monitoring, between January 2007 and June 2015, maternal age was 34.9 years (SDþ/- 4.1) and no differences were
and who met criteria for gestational hypertension or history of found between both groups. Both prevalence for previous PE and
chronic high blood pressure. This study aims to determine the type of IUGR were significantly higher in those patients with late PE (7%
antihypertensive medication prescribed, their impact on blood versus 0.4% and 6.9 versus 1.4%, p 50.05, respectively). Patients with
pressure control and the occurrence of adverse events (AE) in late PE suffered much more from Chronic Hypertension than those
pregnant, postpartum and fetus/newborn; the AE was defined as the without late PE (10.3% versus 0.5%, p 50.001). No differences were
occurrence of mother, fetal or neonatal dead, pre-eclampsia, found among parity. In first trimester evaluation, performed at a mean
eclampsia, gestational diabetes, prematurity and fetal growth of 12.6 weeks (SD 0.5), patients developing late PE presented
restriction. significantly higher BMI (25.7 versus 22.9 kg/m2, p 50.05), MAP (82.5
Clinical cases & summary results: The sample included 139 hyperten- versus 77.7 mmHg, p 50.05) and MoM Uterine Doppler (1.13 versus
sive pregnant women, mean age 326 years, 58% of which with 0.94, p=0.014). At second trimester, at 21.1 weeks (SD 0.6), patients
chronic high blood pressure history and the remaining with developing late PE presented significantly higher MAP (83.3 versus
gestational hypertension. Through Chi-square test was found not to 76.3 mmHg, p 50.05) and MoM Uterine Doppler (0.95 versus 0.84,
be an association between an adequate blood pressure control and p=0.035). Finally, at third trimester, performed at 32.5 weeks (SD 0.7)
the type of hypertension (p=0.5214a). The Fisher exact test shows a patients developing late PE presented significantly higher MAP (92.2
strong association between hypertension and uncontrolled prescrib- versus 78.9 mmHg, p 50.05) and MoM Uterine Doppler (1.14 versus
ing nifedipine alone or associated with methyldopa (p=0.001a). In the 0.96, p 50.001). When evaluating all three models independently,
72 pregnants medicated with methyldopa and in the 10 pregnants third trimester model performed better than the other two. The
medicated with nifedipine, AE occurred in 48.6% and 70% respec- Sensitivity and Specificity for the third trimester model was 82 and
tively; all who met dual scheme had an AE. 78% respectively and the AUC was 0.85. When we integrated all three
Conclusion: Despite the adequate tension control, more than half of determinations in a longitudinal model, the performance did not
pregnant women (51.1%) with the prescribed medication, according improve the one of third trimester model.
to the protocol previously established, had events. This analysis Conclusion: Third trimester performs better than 1st or 2nd trimester
suggests that hypertension in pregnancy does not depend exclusively for the prediction of late PE. The integration of all determinations
on the tension control per se and it looks like to be a multifactorial would not improve its prediction. However, according to our results,
health condition with a pathogenic mechanism not as yet fully the prediction of late PE is nowadays far from being accurate.
understood. More studies are needed to more effective medical
treatment and optimization of pregnancy outcome.
Keywords: Late preeclampsia, prediction
Keywords: Gestational hypertension, Pre-eclampsia, Therapy,
Tension control
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 55
029 PRETERM BIRTH/THE PRETERM INFANT – 767
A randomized controlled trial of Comparison of partosure (pamg-
loading dose only versus 1) and actim partus (phlgfbp-1)
standard dose magnesium sulfate for the prediction of preterm
seizure prophylaxis in severe delivery in patients with preterm
pre-eclamptic women labor and a short cervix
S. P. Rimal, R. Rijal, and R. Bhatt
M. Hadzi Lega, L. Hellmeyer, H. Hanns, M. Josefine,
Department of obstetrics and gynecology BP Koirala Institute of A. Poposka, and A. Daneva Markova
Health Sciences, Dharan, Nepal
Department of Obstetrics and Gynecology, State University Hospital
of Skopje, Skopje, Republic of Macedonia; University Clinic of
Introduction: Magnesium sulfate is the drug of choice for
prevention of seizures in the pre-eclamptic woman. There is no Obstetrics and Gynecology, Medical Faculty, Ss. Cyril and Methodius
agreement in the published randomized trials regarding the University, Skopje, Republic of Macedonia
optimal time to initiate magnesium sulfate, the dose to use
(both loading and maintenance) as well as the duration of Introduction: In the United States 12% of all live births occur preterm.
therapy. The objective of this study is to determine whether Around 50% of these preterm births are a direct consequence of
magnesium sulfate (MgSO4) prophylaxis is needed for up to preterm labor. Literature has shown that preterm birth has a strong
24 hours postpartum in all patients with severe pre-eclampsia for influence of perinatal morbidity and mortality. As many as 28% of
the prevention of seizure. The primary outcome measures were pregnant patients presenting with signs and symptoms of preterm
occurrence of seizure in each group. Secondary outcome measures labor (PTL) are admitted to the hospital [2], but only as few as 5% of
were maternal and neonatal outcome. these women will deliver within 7 days. Therefore, approximately 85%
Materials and methods: This study is a randomized controlled trial. of patients admitted to the hospital for impending PTL do not deliver
Total of 60 pregnant women with severe preeclampsia within the next 7 days. On one hand, this striking statistic explains the
were randomized into standard dose regimen and loading enormous socio-economic and psychosocial burden of PTL on our
dose only regimen. It was conducted from August 2014 to July society.
2015 in obstetric department of BP. Koirala Institute of Health Materials and methods: Patients were eligible to participate in this
Sciences. prospective cohort study upon admission at a tertiary perinatal center
Clinical cases and summary results: Out of 30 cases in each group between 22 and 34 6/7 gestational weeks. They were admitted to the
1(3.3%) patient in standard regimen and 2(6.7%) patient in High Risk Pregnancy Unit with symptoms or complaints suggesting
loading dose only developed seizure. The occurrence of seizure preterm labor including uterine contractions, intermittent lower
is not significant statistically. In both regimens there was no abdominal pain, and pelvic pressure at the time of admission.
maternal mortality. Total of 3 patient needed MICU care and 12 Recruited patients had intact amniotic membranes determined by
patient developed maternal complications. The maternal complica- speculum examination and a cervical dilatation of  3 cm determined
tions were seizure, Abruptio placentae, acute kidney injury, PPH, by digital examination. Women were excluded if they had multiple
HELLP syndrome, hyponatremia and ruptured uterus. MgSO4 pregnancies, ruptured membranes, antepartum hemorrhage, active
toxicities were seen only in standard dose regimen that is in 17 labor, cervical cerclage, or suspected chorioamnionitis (defined by
(56.7%) of the patients. The median number of IM injections of fever, abdominal pain, and/or leukocytosis).
MgSO4 received in standard dose regimen was 82.176. In Clinical cases & summary results: Average cervical length via
standard dose regimen 73.3 percent baby were alive where as transvaginal ultrasound was 24.3 mm. While 38 (67%) patients
in case of loading dose only regimen 93.3 percent of baby were received tocolytic therapy and 38 (67%) patients received corticoster-
alive after 48 hours of delivery. oids, not all patients who received one received the other. While only
Conclusion: Single dose of magnesium sulphate is equally effective as 6 (11%) patients delivered spontaneously within 7 days of presenta-
standard dose regimen in terms of seizure prophylaxis in severe pre tion, 16 (28%) patients delivered spontaneously prior to the
eclamptic women, with added advantage of reduced maternal completion of the 33rd week of gestation. Table 1 outlines these
toxicity and better neonatal outcome. patient characteristics. In the overall study group (n=57), the PAMG-1
test was positive in 10 (5.7%) patients, while the phIGFBP-1 test was
Keywords: Severe preeclampsia, MgSO4, loading dose positive in 17 (29.8%) patients. In the group of patients with cervical
length 525 mm (n=17), the PAMG-1 test was positive in 7 (41.2%)
patients, while the phIGFBP-1 test was positive in 11 (64.7%) patients.
Conclusion: For the prediction of spontaneous preterm delivery within
7 days upon admission, the PAMG-1 test, the phIGFBP-1 test, and
cervical length measurement (using a cutoff of 25 mm) displayed a
sensitivity (SN) of 83.3%, 83.3%, and 100%, respectively; and a
specificity (SP) of 90.2%, 76.5%, and 70.6% (p5.01), respectively. The
positive predictive value (PPV) was at 50.0%, 29.4%, and 29.4%,
respectively; and the negative predictive value (NPV) at 97.9%, 97.5%,

Keywords: Preterm delivery, prediction,the PAMG-1 test,the

phIGFBP-1 test
56 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

7 weeks of gestation with symptoms of preterm labor, clinically intact

631 amniotic membranes and cervical dilatation  3cm were recruited in
An influence of interleukin-6 on the trial. The Actim Partus test was performed and the sampling to
delivery time was assessed.
the risk of preterm labour in Clinical cases and summary results: Results: The Actim Partus test
predicted delivery within 2 days with 80% sensitivity, 78% specificity,
patients with excessive BMI 19% positive predicted value and 98% negative predictive value. Test
predicted delivery in 7 days with 82% sensitivity, 83% specificity, 43%
P. Ossowski, M. Radoń – Pokracka, J. Spaczyńska, positive predicted value and 97% negative predictive value. Test
predicted delivery in 14 days with 61% sensitivity, 84% specificity,
A. Gadamer, M. Nowak, and H. Huras 52% positive predictive value and 89% negative predictive value.
Obstetrics and Perinatology Dept., Jagiellonian University Hospital of Conclusion A positive Actim Partus test in patients presenting with
Krakow, Krakow, Poland symptoms of preterm labor, intact membranes, and cervical dilatation
 3 cm indicates that the delivery within 7 days is quite probable. A
negative result for the Actim Partus test, furthermore, indicates that
Presenter: M. Radoń – Pokracka
delivery within 7 days is highly unlikely.
Introduction: The aim of this study was to assess the relationship
between levels of interleukin-6 and the prevalence of symptoms of
preterm labor in patients with excessive BMI. Keywords: ph IGFBP-1, preterm labor, preterm delivery
Materials and methods: The study group were applied to the data
obtained from 60 patients hospitalized in the Department of
Obstetrics and Perinatology, University Hospital in Cracow during
the period from 1 October 2015. to 31 December 2015. The study was
a prospective cohort of pregnant and covered in a singleton
478
pregnancy who have had a BMI greater than or equal to 25. They A comparison between the phos-
were created three groups of patients (60): 1. Patients with BMI
greater than or equal to 25 who have experienced symptoms of phorylated insulin-like growth
preterm labor (n=20). 2. Patients with BMI less than 25 who showed
signs of preterm labor (n=20). 3. Patients with BMI less than 25 who factor binding protein-1 and the
gave birth to a time (n=20). Statistically significant results were
p40.05. cervical length in prediction of
Clinical cases & summary results: Age of a patients: 20 – 39, average:
26,5. In 1 group concentrations of interleukin-6: 0,7pg/ml – 8,2 pg/ml;
sampling to delivery time in
mediana:1,6 pg/ml. In 2 group: 0,5 pg/ml –16,2 pg/ml; mediana: pg/ patients with preterm labor
ml. In 3 group: 1,0 pg/ml – 13,8 pg/ml; mediana: 4,2 pg/ml.
Conclusion: Confirmed lower levels of interleukin-6 in patients with
excessive BMI group compared to patients with normal BMI. N. Nikolova1, T. Nikolova1, S. Jovchevski1, M. Micevska1,
Confirmed lower levels of interleukin-6 in patients with excessive and S. Nikolovski2
BMI group compared to patients with normal BMI. 1
University Clinic of Obstetrics and Gynecology, Skopje, R. Macedonia
2
Clinical Hospital, Bitola, R. Macedonia
Keywords: INTERLEUKIN-6, OBESITY, PRETERM LABOUR

Introduction: To compare the validity of the bedside Phosphorylated

insulin-like growth factor binding protein-1 test (Actim Partus) with
the cervical length in the prediction of imminent delivery in 7 and 14
451 days from the time of sampling, in cases diagnosed with preterm
labor.
Phosphorylated insulin-like Materials and methods: Prospective, observational study performed at
the University Clinic of Obstetrics and Gynecology in Skopje. Eighty-
growth factor binding protein-1 three (83) pregnant women between 20 0/7 and 36 6/7 weeks of
gestation with symptoms of preterm labor, clinically intact amniotic
in the prediction of preterm membranes and cervical dilatation 3 cm were recruited in the trial.
delivery in patients with preterm The Actim Partus test was performed before the cervical length
measuring and the sampling to delivery time was assessed.
labor Clinical cases and summary results: The Actim Partus test predicted
delivery within 7 days with 82% sensitivity, 83% specificity, 43%
positive predicted value and 97% negative predictive value, whereas
N. Nikolova1, T. Nikolova2, S. Jovchevski2, and and M. CL did it with 56% sensitivity, 71% specificity, 30% positive predictive
Micevska2 value and 88% negative predictive value. The Actim Partus test
1
predicted delivery in 14 days with 61% sensitivity, 84% specificity,
University Clinic of Obstetrics and Gynecology, Medical School, 52% positive predictive value and 89% negative predictive value and
University "Ss. Cyrilus and Methodius", Skopje, 2University Clinic of the CL with 53% sensitivity, 73% specificity, 38% positive predictive
Obstetrics and Gynecology, Skopje, R.Macedonia value and 83% negative predictive value.
Conclusion: A positive Actim Partus test in patients with symptoms of
Introduction: Objectives: To evaluate the validity of the bedside preterm labor, intact membranes, and cervical dilatation  3 cm is an
Phosphorylated insulin - like growth factor binding protein - 1 test objective and more reliable tool for prediction or exclusion of preterm
(Actim Partus) in the prediction of imminent delivery in 2, 7 and 14 delivery in both 7 and 14 days from sampling.
days from the time of sampling, in cases diagnosed with preterm
Keywords: ph-IGFBP - 1, cervical length, preterm labor, preterm birth
labor.
Materials and methods: Material and methods: Prospective, observa-
tional study performed at the University Clinic of Obstetrics and
Gynecology in Skopje. 83 pregnant women between 20 0/7 and 36 6/
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 57

530 Presenter: Laura Almeida

Introduction: Postpartum haemorrhage (PPH) is the leading cause of
Continuous amnioinfusion via a maternal death. In development countries approximately 8% of
maternal death is caused by PPH. The measures adopted in many
subcutaneously implanted port countries to reduce its morbility have mainly focused on prevention.
system with pprom and oligo-/ However, when PPH occurs unexpectedly, following certain strategies
such as the red code have proven to be positive.
anhydramnios 528 þ 0 weeks of The aim of the study is:
 To validate a care protocol generated from literature reviews
gestation: an international pro- before application
spective randomized trial  To assess the adequacy of circuits, infrastructure and human
resources when there is a new protocol activation
Materials and methods: It had been performed two presentation
S. Göbel, Y. Naberezhnev, G. Seliger, and M. Tchirikov sessions of the new postpartum haemorrhage protocol for all
members of the delivery room team, emphasizing the red code
University Clinic of Obstetrics and Prenatal Medicine, Center of Fetal activation (emergency call to quickly get blood products). For the
Surgery, University Hospital of Halle (Saale), Halle (Saale), Germany activation of red code, it has been hung algorithms management
posters at critical points of obstetric spaces (delivery room, obstetric
Presenter: Dr. Yuri Naberezhnev operating room, obstetric emergencies) and the protocol was sent by
email to the obstetric staff. It had been scheduled five in situ
Introduction: Preterm premature rupture of membranes (PPROM) simulation sessions and it was noticed the performance of these
during the second trimester occurs in 1% of all pregnancies leading to simulation sessions to all obstetric staff. It has been designated two
a high neonatal mortality and morbidity rate by causing extreme people who made the record time of critical actions specified in the
preterm birth combined with the ‘‘fetal inflammatory response protocol: It has been made an in situ debriefing with all participants
syndrome ‘‘(FIRS) and thus inducing lung hypoplasia. The evaluation at the end of simulations.
of continuous amnioinfusion therapy joining a 7 day lasting antibiotic Clinical cases & summary results: It can only be performed four (A, B, C
treatment with PPROM and oligo-/anhydramnios (SDP = single and D) of five (A, B, C, D and E) planned sessions because of the high
deepest pocket 52cm) between 22 þ 0 until 27 þ 6 weeks of healthcare pressure. It has been compared the record time for the
gestation compared to the therapy with antibiotics corresponding different simulations sessions. The phone call time activation and out
to the national guidelines (control group) is the objective of this time of blood sample to laboratory and blood bank were similar in
prospective randomized trial. four groups. However, the first red cell concentrate (RBCs) time
Materials and methods: 48 patients will take part in this study, divided reception was different between teams; being 12 minutes (A),
into an intervention or control goup, each containing 24 women. 13 minutes (B), 6 minutes (C) and 6 minutes (D). A and B teams
Entry criteria: Singleton pregnancies, classic PPROM and proven followed the algorithm in the protocol. However, C and D teams had
oligo-/anhydramnios between 22 þ 0 to 27 þ 6 weeks of gestation. to move to laboratory for the blood sample delivery, as well as for the
Exclusion criteria: fetal chromosomal aberrations, malformations, high red cell concentrations and plasma concentration reception because
PPROM, AIS, premature labour. The comparison of both groups of technical problems with the pneumatic tube.
regarding the PPROM-delivery-latency in days represents the primary In debriefings, teams reported improvement aspects for the protocol
criterion, the appearance of FIRS is a secondary endpoint of this (lack of role assignment and lack of technical problems anticipation)
investigation.The ultrasound-based subcutaneous implantation of the as well as aspects of their multidisciplinary work perception.
port system is performed in local anaesthesia. A hypotonic amniotic Conclusion: The use of in situ simulation before the implementation of
fluid-like solution (100ml/h) is used for permanent amnioinifusion (J new health care protocol can be useful to facilitate finding previously
Perinat Med 2013;41:657-63). Patient recruitment shall be completed not valued critical points, allowing make changes before final
by the end of 2017. application. In the case of red code protocol, the use of simulation
Clinical cases and summary results: An earlier retrospective analysis allowed to change the shipping and collection samples circuit,
could show a significant prolongation of the PPROM-delivery-interval improving time reception of first RBCs. From this experience, the
for 49 days and a better neonatal outcome without lung hypoplasia active participation of the multidisciplinary team can provide point
or contractures after treatment with continuous amnioinfusion with improvement in the proposed protocols.
2,4 litres a day (‘‘flush-out’’). Several physicians from 5 countries have
already been taught in the method of port implantation at the Center
of Fetal Surgery, University Clinic of Obstetrics and Prenatal Medicine, Keywords: Postpartum haemorrhage, simulation, red code, obstetric
Martin-Luther-University Halle-Wittenberg. team
Conclusion: Flushing-out bacteria and inflammatory products out of
the amniotic cavity could extend pregnancy, prevent lung hypoplasia
and improve the neontal outcome clearly. This assumption is going to
be verified in this study. Sponsoring: Center of Fetal Surgery,
361
University Hospital Halle (Saale) and Russian Science Foundation, The adherence to the postpartum
Grant- Nr.15-15-00137.
haemorrhage guidelines in
South Australia, a retrospective
QUALITY AND CARE – 739
Validation of new protocols by in study
situ simulation (red code) N. Anthonissen1, S. van Alphen1, G. Matthews2, S. Kuah2,
S. Kane3, G. Dekker3,4, R. Hermens5, M Woiski6, and
L. Almeida, J. Miñano, S. Ferrero, J. Parra, C. Cardona, and B. Mol2,3,4
M.D. Gómez Roig 1
Faculty of Medical Sciences, Radboud University Nijmegen,
Obstetrics Department, Hospital Sant Joan de Déu Barcelona, Spain Nijmegen, The Netherlands, 2Department of Obstetrics and
Gynaecology, Women’s and Children’s hospital Adelaide, Adelaide,
58 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

Australia, 3Department of Obstetrics and Gynaecology, Lyell mcEwin

hospital Adelaide, Adelaide, Australia, 4Discipline of Obstetrics and
Gynaecology, University of Adelaide, Adelaide, Australia, 5Scientific
institute for Quality of Healthcare, Radboud University Nijmegen,
Nijmegen, Australia, 6Department of Obstetrics and Gynaecology,
Radboud University Medical Centre Nijmegen, Nijmegen, Australia

Introduction: Postpartum haemorrhage (PPH) is a major cause of

maternal morbidity. PPH is responsible for 25% of the maternal
pregnancy related deaths. An increasing trend in PPH has been
observed in the past years in a large amount of developed countries.
Both for the early recognition and for treatment of PPH, guidelines
have been developed to assist healthcare professionals in various
clinical situations. It is important that these guidelines are being
315
followed for every patient. Our aim was to evaluate the adherence to Preeclampsia and risk of
the South Australian PPH guideline in two South Australian maternity
hospitals, using a set of validated guideline based quality indicators. developing bronchopulmonary
To see if there is a change in the adherence in the recent years, we
wanted to compare the adherence in 2005 to the adherence in 2015. dysplasia in very preterm
Materials and methods: We studied women suffering PPH in two
maternity hospitals in South-Australia. We evaluated the adherence to
neonates
the statewide PPH guideline by using previously determined guide-
line based quality indicators (QI). These QIs were derived from existing F. A. Wilmink1, J. Reijnierse2, I. Reiss2, E. A. P. Steegers3,
literature. We measured the adherence to the guideline per QI, the and R. De Jonge2
mean adherence in the total study population and the mean
1
adherence per blood loss category. Department of Obstetrics and Neonatology, Radboudumc,
Clinical cases and summary results: We studied 561 women suffering Nijmegen, the Netherlands, 2Department of Pediatrics, Division of
PPH, 245 in 2005 and 261 in 2015. The mean adherence to the PPH Neonatology, Erasmus MC - Sophia Children’s Hospital, Rotterdam,
guideline has significantly improved in 2015 compared to 2005 (70% the Netherlands, 3Department of Obstetrics and Gynecology,
versus 62%, P value 50.0001). The mean guideline adherence in Erasmus MC - Sophia Children’s Hospital, Rotterdam, the Netherlands
women suffering PPH with less than 1000mL of blood loss has
improved (71% versus 62%, p value 50.001). The adherence to the
guideline in women with PPH with a blood loss of 1000-2000mL has Introduction: Bronchopulmonary dysplasia (BPD) is still a serious and
also improved (70% versus 63%, p value 0.003). The adherence to the common complication of prematurity and significantly associated
QIs ‘Identify women at high risk of PPH’ and ‘The determination and with respiratory morbidity in later life. More insight in true
adaption of the policy’ was 8%. The adherence to the QIs ‘To ensure associations is of major importance and can lead to earlier detection
IV access during labour’ and ‘Provide an active management of the and possibly better preventive measurements. It’s been hypothesized
third stage’ was as high as 98% and 92% respectively. Considering the that both BPD and pre-eclampsia (PE) are associated with dysregula-
adherence to the QIs for the management of PPH, ‘Giving 10-15 litres tion of angiogenesis and that offsprings of mothers with PE are at risk
of oxygen by face mask’ was less than 20%. Whereas the adherence to for developing BPD. However, results of several epidemiological
‘Inform obstetrician’, ‘Take blood samples’, ‘Monitor urine production’ studies are inconclusive. This can probably, at least partly, be
and ‘Replace volume’ was higher than 80% in 2015. explained by adjusting outcome data for intermediates rather than
Conclusion: In the management of PPH, guideline adherence for confounders alone. We assessed if PE is an independent risk factor
significantly improved in the last decade. Considering that the total for development of BPD in very preterm neonates.
mean guideline adherence is 70%, there still remains room for Materials and methods: We performed an observational cohort study
improvement. of infants born between 24 þ 0 and 31 þ 6 weeks of gestation
(n=308). BPD was diagnosed at 36 þ 0 weeks postmenstrual age
(pma) and defined as the need for oxygen (FiO240.21) for at least
Keywords: Postpartum haemorrhage, guideline adherence
12 hours per day, for more than 28 days before or at 36 þ 0 weeks
pma, and subdivided in mild, moderate or severe by strict criteria
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 59
applied with an oxygen reduction test. We performed association patient and hospital level, University Hospital was mostly associated
analysis with univariate and multivariate logistic regression. with better adherence especially monitoring heart rate which was
Clinical cases and summary results: After applying our exclusion significant.
criteria we report our primary outcome on 247 neonates. develop- Conclusion: This study showed low adherence to the guideline-based
ment of bpd occurred in 23.9% (n=59) of which 10.9% (n=27) was quality indicators, clearly indicating a problem of quality care in The
moderate to severe. we did find significant evidence that PE is Netherlands. Furthermore, actions taken in the management of PPH
associated with bpd, adjusted odds ratio, 95% confidence interval were largely untimely performed. Additional video observations
4.12 (1.61-10.56). However, after adjusting for additional intermedi- proved valuable to pinpoint exactly at which level improvement is
ates there were no statistical significant associations anymore. this needed. One has to develop a tailor-made implementation strategy to
shows that correctly recognizing true confounders instead of improve quality of Dutch PPH-care.
intermediates (which are part of the causal pathway) is of great
importance in identifying true associations. Keywords: Postpartum hemorrhage, quality of care, guideline
Conclusion: This study shows that PE is an independent risk factor for implementation
development of BPD, however the pathogenesis of BPD in offsprings
of mothers with PE has to be elucidated in the future.

Keywords: Bronchopulmonary dysplasia, pre-eclampsia, premature,

602
respiratory morbidity Experience in the use of carbeto-
cin for prevention of major
490 bleeding in pre-eclampsia
Assessment of the actual care on
I. Bushtyreva1, N. Kuznetsova1, M. Umanskiy1,
postpartum hemorrhage using V. Barinova1, V. Chernavsky1, G. Ilyasova1, and
video images of the third stage E. Fedorchenko2
1
Rostov-on-Don State Perinatal Center, Rostov-on-Don, Russia and
M. Woiski1, S. de Visser1, H. van Vugt1, H. Scheepers2, 2
Rostov-on-Don State Medical University, Rostov-on-Don, Russia
R. Hermens3 and the Fluxim study group
1
Department of Obstetrics and Gynaecology, Radboud Institute for Presenter: Natalia B.Kuznetsova
Introduction: Preeclampsia develops in 2-3% of all pregnancies and is
Health Science, Radboud University Medical Center, 2Department of
a major cause of maternal and perinatal morbidity and mortality.
Obstetrics and Gynaecology, GROW School for Oncology and
Patients with preeclampsia are at increased risk of postpartum
Developmental Biology, Maastricht University Medical Center, haemorrhage. Oxytocin is recommended by WHO for the prevention
3
Department of IQ Healthcare, Radboud Institute for Health Science, of postpartum hemorrhage in caesarean section. According to the
Radboud University Medical Center Cochrane review, the use of carbetocin for prevention of postpartum
hemorrhage reduces the need for a therapeutic doses of uterotonics
Presenter: S de Visser in comparance with oxytocin. The purpose of this study is to evaluate
Introduction: Incidence of postpartum hemorrhage (PPH) still rises, the effectiveness of carbetocin in the prevention of major bleeding in
despite of the development of evidence based guidelines and obste- patients with preeclampsia.
tric emergency skills courses, suggesting an incomplete implementa- Materials and methods: The study included 133 pregnant women with
tion. Insight into actual care is essential for successful implementation. preeclampsia, delivered at the Perinatal Center (Rostov-on-Don,
Studying medical records and using video recordings we assessed Russia) in 2015 by cesarean section. Exclusion criteria were multiple
adherence to the national PPH guideline and Advance-Trauma- pregnancy and large uterine myomas. Patients were divided into 2
Life-Support (ATLS) -based course instructions for obstetric emergency groups. I group included 35 women with preeclampsia, whom
in high-risk patients and its determinants in The Netherlands. carbetocin was introduced at the time of cesarean section immedi-
Materials and methods: A prospective observational multicenter study ately after the birth of the baby (100 mg intravenously). Group II
was performed to assess actual PPH-care with guideline-based quality included 98 patients, who received 5 IU of oxytocin intravenously
indicators (QI) for prevention, management and organization of PPH after extraction of the fetus, followed by 5 units of oxytocin infusion
in 16 Dutch hospitals. Data was extracted from high-risk patients’ over 2 hours. We assessed the amount of blood loss during cesarean
medical records and supplemented with data of prospective video- section.
recordings. Data of the organization of PPH-care was collected using Clinical cases & summary results: The volume of blood loss in patients
questionnaires filled in by one obstetrician per hospital. We calculated with preeclampsia who received carbetocin does not exceed the
adherence and assessed the determinants at patient and hospital allowable amount in 80% of the cases (28 patients). In 5 women in
level. group I (14.3%), the volume of blood loss was 15-20% of total blood
Clinical cases & summary results: Actual care was assessed through circulating volume, in 2 (5.7%) - 20-30% of total blood circulating
medical records of 398 high-risk patients, added with 289 video volume. At the same time in patients who received oxytocin, blood
recordings. As expected, video recordings showed that in general the loss exceeded the limit in 39.8% (39 women), and comprised 15-20%
actual care given was considerably underreported in medical records. of total blood circulating volume in 21 patients (21.4%), 20-30% - in
Overall, a lack of quality in performance, and lack of performance 14 women (14.3%), and 30-40% of blood circulating volume in 4% (4
within the optimal timeframe was observed (fig). patients). Data were analyzed using Fisher’s exact test. The difference
In only 32% the patient was identified as high-risk and appropriate between the carbetocin group and the oxytocin group on frequency
policy documented. In 41% of high-risk women no active manage- of bleeding in excess of 15% of blood circulating volume was
ment was performed and in 20% blood loss was not objectified. significant (p = 0.04).
Although guidelines suggest care to be adjusted to both the amount Conclusion: Use of carbetocin is more effective for the prophylaxis of
of blood loss and vital signs, in almost 80% the vital signs were not massive hemorrhage in patients with preeclampsia than use of
even monitored or monitored not in time. PPH-care in the hospitals oxytocin.
was well organized; 15 hospitals had a local PPH protocol, 12
hospitals organized team trainings. Regarding the determinants at Keywords: Carbetocin, oxytocin, preeclampsia, haemorrhage
60 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

QUALITY AND CARE: NEONATAL – 630 higher than in the intervention group among mothers with MUAC at
baseline 5 the median value (p=0.0251). The intervention group had
higher birth weights (p=0.0312) and birth HC (p=0.0886), higher
Maternal milk supplementation weight -for-age (p=0.0636), length-for-age z-score (=0.0690), and HC-
for-age (p=0.0183) development over the 12 weeks postnatal period,
as part of lactation support compared with the control. Mothers in the intervention group were
intervention improves breast- found to have significantly higher consumption of energy, protein
and carbohydrate, but had similar weight and BMI values to that of
feeding performance, birth and control throughout the study period.
Conclusion: A lactation support program comprising of daily MNS
growth outcomes helps improve EBF rates, birth and growth outcomes, as well as
increasing breast milk production in mothers with lower nutritional
status.
D. Huynh1, N. T. Tran2, L. T. Nguyen2, Y. Berde3, and
Y. L. Low Keywords: Lactation support, maternal milk supplement, exclusive
1
Abbott Nutrition Research and Development Asia-Pacific Center, breastfeeding, breast milk intake
Singapore, 2National Institution of Nutrition, Vietnam, and
3
Statistical Services, Cognizant Technologies Solution Pvt. Ltd.,
Mumbai, India 270

Presenter: Dieu Huynh

A situational simulation training
Introduction: Numerous factors have been identified as being able to scheme for medical and nursing
influence exclusive breastfeeding. A multi-pronged intervention may
be more effective than a single intervention in tackling the staff in neonatal unit
multifaceted challenge of suboptimal breastfeeding. This study
examined the effects of a lactation support program including daily M. Ali1, and D. Boyd2
maternal nutritional supplementation (MNS) on breastfeeding
1
performance. Midyorks NHS Hospital Trust, Wakefield, United Kingdom and
Materials and methods: 228 singleton first-time Vietnamese mothers 2
Wishaw General Hospital, Wishaw, United Kingdom
aged 20 to 35 years at 26 to 29 weeks of gestation were randomized
to the intervention (n=114) receiving 354 mL of MNS daily up to three Aim: To investigate how neonatal medical and nursing staff perceive
months postpartum and four breastfeeding education and support simulation training and how they perceive the educational benefit of
sessions given from enrollment to one month postpartum or to the such training.
control (n=114) receiving standard pre- and postnatal care. Mothers Materials and methods: A neonatal simulation programme aimed at
recorded infant feeding information on a daily basis. Infant breast medical and nursing staff in a neonatal unit was introduced and
milk intake was assessed using 24-hour test weighing. Maternal facilitated by a consultant neonatologist. Over a period of 1 year we
weight, height (baseline only), mid upper arm circumference (MUAC) ran 31 scenarios, in which participants (nurse, doctor, ANNP and
and dietary intake using a 24-hour food recall were collected at others) were assigned to a clinical or observer role, followed by a
baseline, weeks 4, 8 and 12 postpartum. The infant’s weight, length detailed group debrief. Written feedback was obtained from all
and head circumference (HC) were obtained at birth and during the participants via anonymised questionnaires featuring Likert like scales
postnatal period. for satisfaction (Strongly disagree, Disagree, Neither agree nor
Clinical cases & summary results: The intervention sustained a higher disagree, Agree, Strongly agree) and an open text box for self-
rate of exclusive breastfeeding (EBF) over the 12 weeks postpartum reporting of the learning outcomes.
with an increased likelihood of maintaining EBF compared with the Clinical cases and summary results: A total of 84 feedback forms were
control (OR: 2.09, 95% CI: 1.06-4.13, p=0.0325), after adjusting for collected from members of the neonatal multidisciplinary team (some
confounding factors. Infant’s breast milk intake was significantly participated more than once). 83.3% agreed or strongly agreed with
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 61
the scenarios being enjoyable. 97.6% agreed or strongly agreed with Afterwards, information on their behavior and adverse reactions
the scenarios being useful. 96.9% agreed or strongly agreed with the during the visit was collected with the relatives. The results showed
discussion being enjoyable and 96.4% agreed or strongly agreed with that the visits occurred without incidents or problems. The entrance
the discussion being useful. 78.6% agreed or strongly agreed that the of the four children who were not allowed was denied by their
scenarios improved practical skills. 89.7% agreed or strongly agreed families.
that the scenarios and discussion improved knowledge base. 84.5% Conclusion: The protocol was improved throughout the research and
agreed or strongly agreed that the scenarios improved team working has proven adequate in helping on the decision by professionals
skills. The top learning themes reported were communication 33%, involved.
team work 20%, equipment and medication check 17%, clinical
knowledge 16% and clinical skills 11%. Keywords: ICU, humanization in healthcare, patient visitation
Conclusion: Simulation training was reported to be enjoyable &
valuable.The discussion was generally enjoyed more than the
scenarios.Likert-like questions suggested that participants felt most
benefit was from improving knowledge but thematic analysis of the
open text learning outcomes suggested that human factors skills 194
were the most recognised learning outcomes.Although a high
percentage of responders felt that practical skills were improved,the Impact of rapid enteral feeding in
sessions included little or no practical skills training.
very low birth weight infants:
saint or sinner?
F. Belling-Dierks1, K. Glaser1, J. Wirbelauer1, V. Rücker2,
and E. Frieauff1
1
University Children’s Hospital, University of Würzburg, Würzburg,
Germany and 2Institute of Clinical Epidemiology and Biometry,
University of Würzburg, Würzburg, Germany

Introduction: Enteral feeding strategies in preterm infants have long

been subject of controversy. Recent data point to beneficial effects of
rapid enteral feeding regimes on neonatal outcome in very low birth
weight (VLBW) infants. We investigated the association of rapid
advancement of enteral feed volumes with intestinal morbidity in this
cohort. Between 2010 and 2011 we established a standardized rapid
enteral feeding strategy in our unit.
Materials and methods: This single-centre retrospective cohort study
enrolled all inborn VLBW infants between 2008 and 2013 and
compared incidence of intestinal morbidity (defined as necrotizing
355 enterocolitis or intestinal perforation) in slowly enterally fed infants in
Visit the child in the intensive 2008-2010 (10 ml/kg/day increase of milk feeds) to a corresponding
cohort of rapidly enterally fed infants in 2011-2013 (20 ml/kg/day
care unit in a public hospital: increase of milk feeds). Secondary endpoints comprised duration of
parenteral nutrition, length of hospital stay and other neonatal
development of protocol outcomes (mortality, rates of late onset sepsis, intraventricular
hemorrhage III -IV , periventricular leucomalacia and patent ductus
E. Kahhale1,2 and S. Taba1,2 arteriosus). Univariate and multivariable logistic and linear regression
analysis, respectively, were performed to control for confounding
1 variables.
Pontificia Universidade Catolica de São Paulo, São Paulo, Brazil, and
2
Hospital of Cascavel, Parana, Brazil Clinical cases and summary results: A total of 301 VLBW infants were
included in the study. Both groups were similar regarding baseline
demographic and perinatal characteristics. In univariate logistic
Introduction: Child visitation in Intensive Care Unit (ICU) is a conflicting
modeling intestinal damage did not significantly differ between the
situation in which the multidisciplinary team bears the responsibility
two groups (p=0.25), neither did all-cause mortality nor incidence of
of deciding upon allowing or not the child to visit a relative who is
late onset sepsis in multivariable logistic modeling. In contrast, length
hospitalized. This study aims to create a 2-12-year-old child visitation
of hospital stay and duration of parenteral nutrition were significantly
protocol at Adult and Child Intensive Care Units in public hospitals.
shorter in the rapid group (hospital stay: -8.35 days, p=0.012 and
Considering the rights of the child, the patient, and the family as well
parenteral nutrition: -7.13 days, p 50.001). Other neonatal outcome
as the dynamics of this hospital unit, child visitation to critical patients
parameters (intraventricular hemorrhage III-IV , periventricular leuco-
will be understood as a step forward in healthcare improvement, in
malacia and patent ductus arteriosus) showed no differences.
agreement with healthcare policies of the Sistema Único de Saúde
Conclusion: A standardized rapid enteral feeding regime is safe in
(SUS), the Brazilian public healthcare system within the HumanizaSus
VLBW infants and may significantly shorten length of hospital stay
program guidelines.
and parenteral nutrition in this patient cohort.
Materials and methods: In one year, 17 evaluations of child visitation
at adult and child Intensive Care Units, for SUS patients only, were
performed. The requirements for visitation were spontaneous and the Keywords: VLBW infants, rapid enteral feeding, intestinal morbidity
evaluation of permission or restriction included observation and
interview by the researcher with the patient, the child, and the family,
in addition to the team’s judgment and information collected in the
files.
Clinical cases and summary results: From the 17 children evaluated, 13
were allowed entrance and were followed in the visitation.
62 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

THE PRETERM INFANT - 130 hypotension in ELBW without obvious signs of a hypovolemia and
shock. Further researches, without volume expansion use are needed.
Dopamine and NS in treatment
for arterial hypotension in ELBW Keywords: Newborn, ELBW, arterial hypotension, NICU

D. Kryuchko , E. Baibarina , E. Balashova , A. Kirtbaya, and

O. Ionov
752
Federal State Budget Institution ‘‘Research Center for Obstetrics,
Gynecology and Perinatology’’ Ministry of Healthcare of the Russian Predicting factors of resistance to
Federation, Moscow, Russia ibuprofen for treatment of patent
Introduction: Arterial hypotension is a common problem in NICU. The ductus arteriosus in preterm
incidence of arterial hypotension is 16-52%. Reduced perfusion of
organs such as the brain, kidneys, heart, and gastrointestinal tract infants
may lead to acute dysfunction and be associated with permanent
injury. Various therapeutic strategies are used for cardiovascular C. Chazal1, S. Goudjil1, E. Carpentier1,
support, including volume expansion, inotropes, corticosteroids. But
the initiating therapy has traditionally been volume expansion. As we
L. Razafimanantsoa1, F. Moreau1, A. Leke1, and
know, AH is poorly correlated to blood volume in preterm infants and G. Kongolo1
hypovolemia is a rare reason of AH, especially in extremely preterm
NICU, University Hospital of Amiens Picardie, GRAMFC Inserm U1105,
newborns. Also the excess volume expansion in condition of PDA can
Amiens, France
lead to deterioration of respiratory problems. The goal of our study
was: To compare two ways of therapy of AH - Dopamine and volume
expansion in ELBW. Introduction: In many hospitals, surgical ligation is propose to close
Materials and methods: Criteria of inclusion were: ELBW þ Arterial the ductus arteriosus after failure of two 3-days courses of ibuprofen.
Hypotension (Mean BP5GA in weeks). Criteria of exclusion were: This therapeutic modality often comes after 10 days postnatal age,
congenital anomalies, obvious signs of a hypovolemia and shock. the time to achieve the initial medical treatment. Some authors
Randomization: odd-numbered infants received Dopamin and even- believe that this delay aggravates the exposure to harmful effects of
numbered - Normal saline. Intervention: Dopamine starting from 2 ductal shunt which could be avoided by performing surgery earlier, if
mg/kg/min with dose increase until BP became normal (BPGA),NS - we could identify the early signs of resistance to ibuprofen.
10 ml/kg in 30 min. Sometimes one, sometimes two boluses were The aim of this study was to identify predictors of resistance to
used, but never more, than two. If NS was inefficient, Dopamine was ibuprofen by analyzing early data from clinical signs and echographic
prescribed. We checked efficiency of therapy (BP normalization criteria obtained at the time of diagnosis of patent ductus arteriosus.
(mBPGA)) after one hour, Diuresis (before/after intervention, Materials and methods: Retrospective matched case-control study
within a day), effective dose of Dopamine (if needed), total dose of including preterm infants  32 gestation weeks (gw) in our NICU
Dopamine within a week, total duration of inotrope support. Also we betwen 2010 and 2014. Each infant treated by surgical ligation was
evaluated the heart hemodynamics (CO, EF, SF) and regional matched with an other infant randomly selected among those in
hemodynamics in ACA, AR, AMS (Ri, Tamx, Pi, MD), blood sample whom PDA closed after ibuprofen treatment.
(pH, lactate, BE, HCO3) and outcomes (PDA, MV duration, BPD, NEC, Study variables: maternal characteristics, clinical signs, blood gaz
PVL, mortality before discharge, stay in NICU) 41 newborns were composition in the infant at the moment of diagnostic of PDA by
accepted according to the criteria of inclusion, 2 was excluded due to echography. Echographic findings and the dates of treatment.
congenital heart diseases.2 groups were founded (18 in NS group, 21 Statistical analysis: Median (interquartile interval) and proportion
- Dopamine group). (95% confidence interval) for description of variables. Logistic
Clinical cases and summary results: After one hour the mean BP was regression was performed for identifying the predictive factors of
higher than GA in all newborns from Dopamine group (100%) and resistant to ibuprofen for PDA treatment and linear correlation for the
38.8% in NS group exhibited the need for Dopamine for BP analysis of quantitative variables.
normalization. There were increasing of the diuresis and ejection Clinical cases & summary results: During the period of this study, the
fraction in both groups after infusion. The cerebral, renal and closure of ductus arteriosus occurs after medical treatment in 341
mesenterial blood flow were normalized. We found out that in the infants. In 27 infants, surgical ligation was necessary after PDA failed
Dopamine group the cardiac output (CO) didn’t increase, but in NS to close at the end of two 3-days ibuprofen’s course. There were no
group the CO increased more, than 1.5 times. At the same time the differences between cases and matched-controlled cases for the all
efficiency of Dopamine in normalising the BP was 100%, and variables studied (clinical signs, biological and echographical char-
efficiency of the isolated volume loading - 61.2%. The effective daily acteristics). Differencies were found in the correlation analysis
dose of Dopamine (if needed), mg/kg/min was significantly higher in describing in the responders a strong relation between the maximal
those, who had previously received NS (3.60.63 vs 1.850.64, velocity in ductal flow and the mean blood flow velocity in the left
p?0.0001) Duration of mechanical ventilation and observing in NICU pulmonary artery (coeff = 0.20, r2 = 0.40, p50.01), and with the arterial
was more in NS groupe, than in Domamine group (p=0.02 and blood PaCO2 (-0.18, r2=0.3, p50.05). In contrary, these relationships
p=0.03). Children from NS group had the bigger diameter of PDA also were lacking in infants nonresponders to ibuprofen.
(1.61.44 vs 2.6 1.47, p=0.04). Conclusion: Direct analysis of clinical and echographic criteria are not
Conclusion: Dopamine was more effective in BP normalization than informative for discrimination between responders and non respon-
isolated NS for ELBW. If Dopamine was required, the dose sufficient ders to ibuprofen. The only characteristics different were the lack of
for pressure normalization was higher for newborns who had coupling between ductal flow, pulmonary blood flow and PaCO2.
previously received NS. Dopamine increases EF more effectively, but These findings suggests disturbances in pulmonary mechanics,
NS increases CO more effectively. Dopamine and NS are equally alveolar gases’s exchanges, ductal wall function and dysfunction in
effective in blood flow normalization in ACA, AR, AMS. The incidence neuro-autonomous pathes. Further studies are needed for the
of sPDA and severe BPD were higher in newborns who received NS determination of optimal time for surgical ligation.
for AH treatment. The duration of MV and stay in NICU were longer
for newborns who received NS for AH treatment. It is not obvious, Keywords: Patent ductus arteriosus, neuro-hemodynamics, preterm
that we should use volume loading for treatment of arterial infants, ibuprofen
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 63
281 the duration of breastfeeding had a significant effect on gut
microbiota development. In a logistic regression model, late preterm
Late preterm birth has direct and birth had an independent impact on intestinal bifidobacteria.
indirect effects on gut microbiota Conclusion: Early intestinal Bifidobaterium microbiota composition
differs significantly between late preterm and full-term infants.
development during the first 6 Environmental factors such as antibiotic exposure are common in
late preterm infants and modulate gut colonization but preterm birth
months of life also affects gut microbiota development independently. While
effective means of preventing preterm birth are desperately
needed, the impact of perinatal and neonatal treatment modalities
M. Forsgren1, E. Isolauri2, T. Poussa3, S. Salminen4, on gut microbiota development should also be assessed.
and S. Rautava5
1
Department of Paediatrics, University of Turku, Turku, Finland, Keywords: Prematurity, gut microbiota
2
Department of Paediatrics, University of Turku & Turku University
Hospital, Turku, Finland, 3STAT Consulting, Nokia, Finland, 688
4
5
Functional Foods Forum, University of Turku, Turku, Finland, and Development of intestinal micro-
Department of Paediatrics, University of Turku & Turku University
Hospital, Turku, Finland biota in very preterm infants
Introduction: Abnormal gut microbiota composition in early infancy R. Ambrosino1, E. Martı́n Álvarez1, A. M. Gil Fenoy1,
has been associated with disease risk in later life. Several environ- J. A. Maldonado Lobon2, A. D. Valero2, and
mental factors, which, in addition to immunological immaturity, may
negatively affect gut colonization tend to cluster in preterm infants.
J. A. Hurtado Suazo1
We aimed to study gut colonization patterns in late preterm and full- Complejo Hospitalario Universitario de Granada, Granada Spain, 2
term infants during the first 6 months after birth. Biosearch Life, Granada, Spain
Materials and methods: Late preterm (n=43) and full-term infants
(n=75) were included in this nested case-control study from ongoing
clinical trials within the NAMI (Nutrition, Allergy, Mucosal Presenter: R. Ambrosino
Immunology and Intestinal Microbiota) Research Program. The Introduction: Fetal gastrointestinal tract has been considered tradi-
subjects were selected based on availability of fecal samples collected tionally sterile. Recent studies suggests that fetal intestine may be
immediately following birth, and at 2-4 weeks and 6 months of age. exposed to many bacteria resulting from the colonization of amniotic
The presence of clinically relevant bifidobacteria was assessed using fluid. After birth, a rapid process of colonization occurs thanks to the
quantitative PCR. Logistic regression analyses were performed to micro-organisms deriving from the mother and the environment.
determine whether the observed differences in gut microbiota In very preterm infants (5 32 weeks of GA), this process could be
composition were attributable to prematurity per se or perinatal affected by different techniques and treatments conducted in the
exposures, which may have a detrimental impact on gut microbiota NICU and influenced by systemic inflammatory processes.
development. New molecular biology techniques have contributed to identify
Clinical cases and summary results: The gut microbiota in full-term bacteria that were difficult to observe in traditional growth medium.
infants was characterized by a high level of bifidobacteria while late The aim of our study is to analyze the composition of the intestinal
preterm infants displayed lower levels of bifidobacteria directly after microbiota and the changes that occurs in very preterm infants.
birth (Figure 1). The presence of Bifidobacterium genus in late Materials and methods: This is a descriptive study of fecal colonization
preterm infants reached the level of full-term infants by the age of 6 in stools samples taken from newborns  32 of GA from a Neonatal
months, but differences remained in the presence of specific species. Unit, along one year (October 2013-October 2014). 43 newborns were
The mode of birth, intrapartum and neonatal antibiotic exposure, and envolved in the study; four stool samples were collected in the first
month of life: S1 (meconium 5 48h); S2 (7 days old); S3 (15 days old),
64 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

S4 (30 days old). Five bacterial groups were described using qPCR and 4Department of Pediatrics, Hospital Universitario
techniques: Escherichia Coli, Clostridium, Bacteroides, Bifidobacterium Materno-Infantil de Canarias, Las Palmas de Gran Canaria, Spain
and Lactobacillus. Several perinatal and neonatal variables were
registered: risk factors of perinatal infection, antibiotics in mother and
Presenter: R. M. Moonen
newborn, type of feeding, development of necrotizing enterocolitis
Introduction: Carbamoyl-phosphate synthetase 1 (CPS1) is a key
(NEC) or sepsis. enzyme in the de novo intestinal synthesis of the nitric oxide (NO)
Statistic program SPSS v2.0.
synthase substrate L-arginine. The CPS1 gene polymorphism
Clinical cases & summary results: In this study were enrolled 43
p.Thr1406Asn is a C-to-A nucleotide transversion (c.4217C4A) in
newborns with an average GA and weight of 29,71 weeks and 1233 g exon 36, which results in the substitution of asparagine (Asn) for
at birth.
threonine (Thr) in the critical N-acetylglutamate-binding domain of
(1) Prenatal factors:
the enzyme. It has been suggested that individuals with the A-allele
 73.7% of the infants had risk factors for perinatal infection; 39.5% may have an advantage in terms of NO production, especially under
of mothers received antibiotics antepartum and 100% conditions of environmental stress. We reported, in a previous
intrapartum. retrospective series of 17 preterm infants with necrotizing enteroco-
litis (NEC) and 34 controls, that patients with NEC showed an
(2) Postnatal factors overrepresentation of the C-encoded variant of the p.Thr1406Asn
 Type of feeding: most of infants received breast milk, followed polymorphism.
by those who received formula and finally those on absolute Materials and methods: In this multicenter prospective study, we
diet. investigated the association of the p.Thr1406Asn polymorphism of
 6.7% received antibiotics at 7 days, 11.4% 15 days, 20.8% 1 the CPS1 gene with NEC in 477 preterm infants (36 cases of NEC) from
month of life. 4 European neonatal intensive care units (Maastricht, Las Palmas de
 Development of NEC and/or sepsis: 6.7% at 7 days, 8.5% at 15 gran Canaria, Mantova, and Milan).
days, 8.3% at 1 month of life. Clinical cases & summary results: Allele and genotype frequencies of
the p.Thr1406Asn polymorphism did not significantly differ between
the infants with and without NEC. In contrast, the minor A-allele was
In first month of life the content in E. coli is higher than other groups
significantly less frequent in the group of 64 infants with the
(Table 1). A high number of E. coli was observed in newborns who did
combined outcome NEC or death before 34 weeks of corrected
not receive antibiotic at 15 and 30 days of life, although no significant gestational than in the infants without the outcome (0.198 vs. 0.311,
differences were found (1.80105 vs 1.47109 p=0.07; 1.5110*6
P=0.01). In addition, the dominant [adjusted odds ratio (aOR) 0.51,
vs 8.68109 p=0.07). No significant relationship were observed
95% confidence interval (CI) 0.28 – 0.95)] and the additive genetic
between colonization process,feeding and infection risk factors.
model (aOR 0.56, 95% CI 0.32 – 0.92) showed a significant association
Conclusion: The colonization process of studied bacteria is delayed in of the A-allele of the p.Thr1406Asn polymorphism with decreased risk
preterm babies, except for E. coli. The ab-sence of beneficial bacterial
of the combined outcome NEC or death.
groups (as Bifidobacterium) opens the possibility of implementing
Conclusion: Our study showed that the minor A-encoded, Asn variant
nutri-tional strategies to achieve the process of colonization by these of the CPS1 p.Thr1406Asn polymorphism protects against the
beneficial bacteria.
combined outcome NEC or death before 34 weeks of corrected
gestational age. This finding provides further evidence that genetic
variants of the CPS1 gene may contribute to NEC.

495 Keywords: Necrotizing enterocolitis, arginine, preterm

Association between the
P.THR1406ASN polymorphism of 319
the carbamoyl-phosphate High loading dose of caffeine
synthetase 1 gene and necrotiz- citrate in preterm infants and the
ing Enterocolitis: a prospective effects on cranial ultrasound
Multicenter study findings and neurological
outcomes
R. M. Moonen1,, 2, G. Cavallaro3, M. J. Huizing1,
G. E. González-Luis4, F. Mosca3, and E. Villamor1 B. Firman and P. H. Gray
1
Department of Pediatrics, Maastricht University Medical Center Newborn Services, Mater Mothers’ Hospital, Brisbane, Queensland,
(MUMCþ), School for Oncology and Developmental Biology (GROW), Australia
Maastricht, the Netherlands, 2Department of Pediatrics, Atrium
Zuyderland Medical Center Parkstad, Heerlen, the Netherlands, Introduction: The aim of this study is to compare outcomes for very
3
Neonatal Intensive Care Unit, Department of Clinical Sciences and preterm infants receiving high and standard loading doses of caffeine
Community Health, Fondazione IRCCS Cà Granda Ospedale citrate, with particular focus on cranial ultrasound findings and
Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy, neonatal neurological outcomes. A recent small randomised trial has
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 65
shown that early high loading doses of caffeine citrate may be Yudin in Moscow. 30 cases of timely delivery, as a result of which 30
associated with cerebellar haemorrhage and neonatal hypertonia. were born full-term infants were included in the control group. In the
Both high and standard loading doses of caffeine citrate have been third stage of labor and intraoperatively during a caesarean section
used at the Mater Mothers’ Hospital Neonatal Unit in recent years, were carried out samplings of umbilical cord blood from women all
providing the data for this study. This current study aims to assess the subgroup comparisons.
safety of higher loading doses of caffeine citrate in very preterm Clinical cases and summary results: There was a significant increase in
infants. NSE, S-100 protein, MBP in serum as compared with the values in the
Materials and methods: This retrospective study included preterm control group. It is noted that at high concentrations NSE determined
infants inborn at the Mater Mothers’ Hospital, Brisbane over a 3 year at time of birth at 22-25 weeks, indicating a greater depth CNS this
period (2011-13). Infants included were born at 528 weeks gestation group of children (NSE = 150.8). In the umbilical cord blood of babies
and received a loading dose of caffeine citrate in the first 36 hours of born at 22-25 weeks duration, in the NSE index is 4.3 times higher
life. The caffeine dose was determined by consultant choice. Two than the values of the control group (p50.001). High concentration of
groups were identified with 158 neonates in the high dose cohort S-100 protein shows significant morphological damage of brain
receiving a median of 80mg/kg (range 70-101mg/kg) and 60 neonates structures in prenatally and during the birth. For a period of 22-25
in the standard dose cohort receiving median of 20mg/kg (range 15- weeks marker level was 1.9 ng/ml and was significantly higher than
24mg/kg). Both groups received a maintenance dose of caffeine the value in the control group to 9.5 times (p 50.001). The control
citrate of 20mg/kg/day, until ceased at 34-36 weeks gestational age. group did not exceed the value of MBP 1.5 ng/ml. With decreasing
Routine cranial ultrasounds, all with mastoid views, were performed gestational age at birth increased the concentration of the marker,
together with a neuromotor behavioural assessment (NMBA) prior to and in the period of 22-25 weeks was 9.0 ng/mL, which is 6 times
discharge. higher than the standard values (p 50.001). The mild degree of CNS
Clinical cases and summary results: Clinical characteristics were similar damages previled in groups with the greater gestational age at birth:
between groups. The mean (SD) gestational age was 25.6 (1.1) weeks in a group of 29-32 of the week - in 14 (53.85%) and in the group of
in the high dose group and 25.8 (1.3) weeks in the standard dose 33-36 weeks - 17 (65.38%). Severe CNS lesions dominated the
group (p=0.24). Survival rates were 83% in the high dose group and subgroup 22-25 weeks - 21 (80.77%). Most lesions were of hypoxic-
88% in the standard dose group (p= 0.5). The incidence of cerebellar traumatic genesis. When mild CNS damages the value of NSE, S-100
haemorrhage detected on cranial ultrasound in both groups was low: protein, MBP was significantly lower than in the moderate and severe
Cerebellar haemorrhage was identified in 4 (2.5%) infants in the high lesions of the CNS, when assessing the level of antibodies to nerve
dose group and 1 (1.7%) infant in the standard dose group (p= 1.0). growth factor - the situation is reversed.
There were no differences in other cranial ultrasound findings: IVH Conclusion: The content of CNS damages markers in cord blood
Grade 1-4 was identified in 26% of the high dose group and 25% in depends on the gestational age at delivery, depends on the degree of
the low dose group (p= 1.0). Total NMBA results were similar between maturity of the central nervous system and is associated with the
the groups with a mean of 63 (SD 8.6) in the high dose group and 64 severity of CNS lesions in preterm infants.
(SD 8.4) in the standard dose group (p=0.62). Additionally there was
no difference in the neurological subscale of the NMBA between the Keywords: Preterm birth, perinatal outcomes, cerebral lesions,
groups. biochemical markers
Conclusion: Use of early high loading dose caffeine citrate in preterm
infants of528 weeks gestation does not appear to be associated with 543
adverse outcomes with no association with cerebellar haemorrhage
or abnormal neonatal neurological outcomes. Long-term follow-up of Perinatal risk factors and mode of
both groups is required.
delivery associated with neonatal
Keywords: Preterm, caffeine, cerebellar haemorrhage, neuromotor
behavioural assessment
mortality among very low birth
weight infants before 28 weeks of
435
gestation
The use of serum CNS damages
S. E. Cetinkaya1, S. Sahin2, F. Soylemez1, A. Koc1,
markers for assessing the E. Okulu3, H. Akduman3, B. Atasay3, and S. Arsan3
perinatal outcomes of preterm 1
Ankara University Faculty of Medicine, Department of Obstetrics
birth and Gynecology, Ankara, Turkey, 2Sami Ulus State Hospital, Ankara,
Turkey, and 3Ankara University Faculty of Medicine, Department of
Neonatology, Ankara, Turkey
I. Ignatko, A. Strizhakov, and N. Popova
I. Sechenov First Moscow Medical University Presenter: F. Soylemez
Introduction: The optimal obstetric management and the impact of
Introduction: Currently, the incidence of preterm births in the various delivery mode on the survival of VLBW infants remain controversial.
regions of Russia is 6.3-12.5%, which is comparable with the The improvements in perinatal and neonatal care have led to an
frequency of premature births in the world. In children with perinatal increase in cesarean rates to decrease mortality and morbidity for very
hypoxia with the absence of gross structural changes in the central low birthweight (VLBW) infants. However, increasing cesarean rates
nervous system, can form significant neurologic and neuropsychiatric also add to maternal morbidity significantly. The optimal mode of
abnormalities, restrictive social adaptation. delivery of very low birth weight infants is still an obstetric challenge.
Materials and methods: The aim of the study was to identify the In this retrospective cohort study, we aimed to investigate the
characteristics of the course of preterm labor, the assessment of the association of perinatal risk factors including mode of delivery with
premature newborn, as well as the definition in the umbilical cord mortality for VLBW infants born before 28 gestational weeks in a
blood levels of NSE, of MBP (myelin basic protein), of S100 protein, tertiary hospital setting.
and the antibody to nerve growth factor (NGF). The object of our Materials and methods: Records of liveborn VLBW infants born at 528
study is based on 96 cases of preterm labor for a term of 22 to 36 gestational weeks (n=92) were retrospectively analyzed. Details of
weeks of gestation in the maternity clinical hospital named after S. clinical/obstetrical maternal data (Age, parity, chronic diseases,
66 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

preeclampsia/eclampsia, premature rupture of membranes, antenatal Presenter: M. Radon-Pokracka

steroids, tocolytic treatment, antenatal magnesium use, placental Introduction: Antenatal anemia is a common problem in perinatology.
abruption, placenta previa, Doppler findings, gestational age at birth, In the literature there is still little research about this topic. The
mode of delivery, birthweight, intrauterine growth restriction, multi- objectives of this study were to check the influence of antenatal
ple pregnancy, fetal presentation, indications and presence of labor anemia in pregnant woman during antenatal period on the route of
prior to cesarean section) and neonatal outcome data were evaluated. delivery and neonatal outcomes.
ROC analysis was used to determine a cut off gestational week at Materials and methods: The study included 450 pregnant women who
birth for infant mortality. Uni/multivariate logistic regression models gave birth in Department of Obstetrics and Perinatology UJ CM from
were used to determine the risk factors associated with infant January to June 2015. In the study group 90 patients had anemia and
mortality. 360 women were admitted with appropriate hemoglobin level.
Clinical cases & summary results: The median gestational age at birth Patient groups were randomly assigned. As an antenatal period, the
was 26 weeks (21–276/7 weeks) and the median birthweight was period of seven days before giving birth was defined. Anemia was
755g (400–1470g). The cesarean section rate was 59.8%. The overall defined as hemoglobin level 511g/dl in the antenatal period. We
mortality rate was 52.2% (43.6% for infants born by cesarean section analyzed: RBC, hemoglobin levels, hematocrit, MCV, MCH, MCHC.
and 64.9% for infants born vaginally, p=0.05). Mortality was Neonatal outcomes were analyzed based on birth weight, body
significantly higher for infants born at 25 gestational weeks and for length, and number of points in the Apgar score. Women’s groups did
infants with a birthweight of 750g. At ROC analysis a cut off of 25.5 not differ significantly in terms of demographic and socioeconomic
weeks was determined with a sensitivity of 66.7% and specificity of factors. To compare groups we used chi square test.
86.4% (AUC 0.818, 95% CI: 0.731–0.905) (Figure 1). On univariate Clinical cases & summary results: The low maternal hemoglobin level
analysis antenatal steroid treatment, gestational week at birth, in antenatal period increased risk of having a baby with birth weight
birthweight, mode of delivery, primigravidity, antenatal steroids, 52500g more than 4-times (OR 4,6 CI 95% p50,05), increased risk of
magnesium therapy were found as candidate independent variables having baby with 58 points in Apgar score in first minute of life
for infant mortality. On multivariate analysis gestational week at birth almost 5-times (OR 4,9 CI 95% p50,05) and increased risk of birth
and the absence of or partial antenatal steroid treatment were found before 37th week of pregnancy more than 3-times (OR 3,56 CI 95%
as independent risk factors for mortality (Table 1). p50,05) but had no effect on the route of delivery.
Conclusion: Gestational week at birth, birth weight and antenatal Conclusion: Antenatal maternal anemia is a risk factor for preterm
steroid therapy are the most important risk factors for mortality in birth, low body weight in newborns and worse neonatal outcomes.
VLBW infants born before 28 gestational weeks. Mode of delivery does The important part of perinatal care is to make more efforts to
not seem to affect infant mortality. Further larger studies are required. maintain the proper level of hemoglobin and others red blood cells
indices.
Keywords: Very low birth weight, infant mortality, mode of delivery,
perinatal risk factors Keywords: Anemia, preterm labour, fetal weight

531
728 Impact of socioeconomic
Relationship between preterm environment in cognitive
birth, neonatal outcomes and low development of five years old
maternal hemoglobin level children born preterm
M. Radon-Pokracka, H. Huras, J. Spaczynska, S. Dirani, V. Datin-Dorriere, B. Guillois, P. Thibon,
M. Nowak, P. Ossowski, and P. Janas G. Launoy, and L. Launay,
Dept of Obstetrics and Perinatology, University Hospital in Krakow, Neonatal department, University Hospital of Caen, Caen, France
Krakow, Poland
Presenter: DIRANI Sabine
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 67
Introduction: Prematurity concerns 6.5% of live births in France, of
which more than 10,000 are born before 33 weeks of gestation.
Mortality has decreased but morbidity is of concern. Preterm infants
are at high risk for long-term neurological impairment, especially
cognitive. Many neonatal risk factors for lower cognitive development
in preterm infants exist as gestational age, low birth weight, male
gender or bronchopulmonary dysplasia. Apart from these factors
inherent to prematurity, there are also socioeconomic and contextual
factors. The aim of this study was to evaluate the impact of the
socioeconomic environment on cognitive development of 5 years old
severe preterm children born in Normandy.
Materials and methods: Preterm infants born before 33 weeks of
gestation, from 1998 to 2010, in our regional University Hospital of
Caen were prospectively included in the PREMA32 cohort, after
parental consent . This cohort represented our database. Cognitive
development (DC) at five years was assessed by neuropsychological
tests (K-ABC1 and WIPPSI III after 2007), calculating the composite
mental process. The socioeconomic level of parents was defined by
the European Deprivation Index (EDI) computed from their addresses.
Clinical cases & summary results: Among the 1354 preterm infants Materials and methods: Retrospective study of complicated MC
included in the PREMA 32 cohort, 591 received a cognitive pregnancies by the demise of one twin referred between 2011 and
assessment at 5 years and had an EDI corresponding to their 2015 in our Unit. Ultrasound follow-up (Neurosonography) was made
addresses. Preterm children were divided into five quintiles according in all cases and MRI of the survivor 4 weeks after intrauterine fetal
to their respective EDI, ranging from the most (Q5) to the less demise in 17 of the cases. Cerebral ecography after birth and
deprived (Q1). neurological follow-up (assessed at 5 months to 4 years old) were
The DC was below 85 (5 -1SD) in 12.9% of preterm infants living in analized in these children.
the most favored areas versus 37.2% in the most deprived areas. No Clinical cases & summary results: We studied 22 cases with intrauterine
preterm children had a DC less than 70 (5-2 SD) in less deprived areas death of one twin. 13 of these monochorionic pregnancies were
while 10.7% of the preterm infants living in the most deprived areas complicated by TTTS, 6 by II-III type sIUGR and 2 cases by discordant
had a DC 5 -2 SD (p = 0.005). Other variables significantly related to malformation. Fetal therapy had been undergone in 16 cases (7
the DC were birth weight and parity, inversely associated with DC. fetoscopic selective laser ablation of placental anastomosis and 8
Gestational age was not associated to the DC. Children lost to follow- UCO). There were 6 cases of spontaneous fetal loss. Mean gestational
up were twice as much in disadvantaged areas (18.8% versus 38.5%, age when co-twin demise occurs was 21 w (16 to 30.2w). Neurological
p=0.006). complications were observed in 3 cases: 1- Mild ventriculomegaly
Conclusion: Cognitive development at five years in severe preterm (TTTS with fetoscopic selective laser ablation of placental anastomo-
infants in Lower Normandy, is significantly correlated with the sis. Normal neurological outcome), 2- type III sIUGR with spontaneous
socioeconomic level of parents, defined by the European Deprivation death of one twin in week 18 (ventriculomegaly, destructive white
Index. Identifying this risk factor should lead to a targeted follow-up matter lesions and microencefaly); parents requested a voluntary
after discharge from the hospital, with early interventional programs interruption of pregnancy in this second case.3- type III sIUGR and
to support maternal care and good maternal-to-child interaction. It spontaneous fetal loss at 30 weeks: surgery was offered but patient
may also reduce lost to follow-up children in deprived socio- refused it; survivor twin suffered from acute exsanguination after co-
economic areas. twin death and urgent cesarean section was performed 1 day after
cause severe anemia and intraventricular hemorrhage were sus-
Keywords: Preterm children, socioeconomic development, cognitive pected. Now this child is 2 years old, presents a normal psychomotor
development, European Deprivation Index development, but strabismus and hearing loss.
Conclusion: Intrauterine death in one monochorionic twin is
associated with increased mortality and morbidity in the surviving
co-twin. This is likely to occur as a consequence of exanguination of
the survivor just before or at the time of death when its blood
TWINS 1 - 734 pressure drops dramatically. The risk of cerebral damage in the
surviving twin is greater when the fetal demise is spontaneous than
Monochorionic twins and single when it occurs after intrauterine therapy.
intrauterine demise: neurological
Keywords: Fetal loss, monochorionic pregnancies, TTTS, fetoscopic
outcome selective laser ablation

I. Duyos, M. De la Calle, E. Antolı́n, A. Fernández, and

J. L. Bartha
313
Obstetrics and Gynecology Dept, Hospital Universitario La Paz,
Madrid, Spain Trial of labor in growth estimated
Presenter: Marı́a de la Calle
discordant twins
Introduction: Objectives: 1. To evaluate the presence of cerebral injury
in the survivor twin after intrauterine death of the co-twin in C. S. Pietersma, R. Rijpma, R. J. Derks, and K. E. A. Hack
monochorionic pregnancies (MC) comparing spontaneous fetal loss
Department of obstetrics and gynaecology, University Medical Center
vs fetal demise after therapeutical procedure: fetoscopic selective
laser ablation of placental anastomosis or umbilical cord occlusion Utrecht, Utrecht, The Netherlands
(UCO). 2. To analyze neurological and developmental outcomes in
these children. Introduction: Twin pregnancies are often affected by a growth
difference of the infants. Discordant twins are at increased risk for
68 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

perinatal morbidity and mortality. In contrast to the majority of relation between cholestasis of pregnancy and pre-gravid body mass
publications on adverse outcome in discordant twin pairs (even in index (BMI) in twin pregnancy.
relation to the smaller twin within the discordant pair), little is known Materials and methods: A retrospective cohort study of 542 women at
about mode of delivery in these twins. In general, twins with intrapair the 1st Department of Obstetrics and Gynecology, Medical University
birth weight discordance are more commonly delivered by caesarean of Warsaw, between 2007 and 2015 was performed. Medical records
section (CS). If a trial of labour (TOL) is conducted, the rate of of patients pregnant with twins, delivering at 22 gestational weeks
successful vaginal birth is unclear. We therefore studied mode of were included. Pre-gravid weight was defined as weight before
delivery in discordant twin pregnancies according to size of the first conception (self-reported) or 510 weeks of gestation (measured by a
presenting twin. medical assistant. ). The cohort was divided into four groups
Materials and methods: This is a retrospective cohort study. All patient depending on the pre-gravid BMI: underweight (BMI 5 18.5 kg/m2),
charts of twin pregnancies at the University Medical Centre Utrecht normal weight (18.5 - 24.9 kg/m2), overweight (25 - 29.9 kg/m2) and
(UMCU) delivered between January 2005 and July 2014 were obese ( 30 kg/m2). The study outcome was ICP diagnosed by
reviewed. All patients with an estimated fetal weight available pruritus and raised serum bile acids (4 10 mmol/L) during the second
within (and including) 8 days of delivery were included. Primary or third trimester of pregnancy.
outcome measurement was mode of delivery. Secondary outcome Clinical cases and summary results: 49 patients developed ICP (9%).
concerned adverse outcome related to size of the first presenting Underweight and obese women were at a higher risk of ICP and
twin and mode of delivery. Multivariate logistic regression to identify overweight patients were at lower risk of ICP than normal weight
risk factors that were independently associated with mode of delivery. mothers. There was no linear (p=0.5) but significant U-shaped relation
Clinical cases and summary results: 304 twin pregnancies were between BMI and ICP (p=0.005). The lowest risk of ICP development
included in this study, of which 63 pregnancies (21%) were affected was related to BMI of about 25-26 kg/m2.
by birth weight discordancy420%. In half of these cases the first twin Conclusion: Non-linear relation between ICP occurrence and BMI
was considered to be the smallest within the twin pair. TOL was suggests that using homogeneous ICP risks for BMI groups may be
attempted in 51% of discordant twin sets compared to 85% in incorrect.
normally grown twins (p50.01). Seventy-five percent had a successful
vaginal delivery. Risk factors for failed TOL were nulliparity, IUGR of Keywords: Twin pregnancy, intrahepatic cholestasis of pregnancy,
either fetus and a discordant larger first child. An elective CS was body mass index
chosen more often in case the second presenting twin was smaller
than its co-twin (63% versus 33%, respectively, p=0.02). The rate of
successful trial of labor was also lower if the second twin was smaller
than the first presenting twin (67% and 80%, respectively, p=0.02).
Neonatal outcome did not differ between the discordant growth
group and the control group (26.2% and 22.6% respectively, p=0.40).
Within the discordant group neonatal morbidity of one or both
children occurred more often in twin pairs with a small twin B
compared to twin pairs with a small twin A (34.8% and 16.7%
respectively, p=0.02), irrespective of mode of delivery.
Conclusion: Although TOL is less often achieved irrespective of size of
the first presenting twin, vaginal delivery seems feasible in growth
discordant twin sets. Caution is warranted regarding twin pairs with
significant lower estimated fetal weight of twin B as compared to twin
A, since these pregnancies have a smaller change of successful
vaginal delivery and increased risk of adverse outcome in both
children. With selection of patients trial of labor seems feasible in
discordantly grown twin sets.

Keywords: Growth discordance, twin, trail of labour

417 195
Is the risk of inrahepatic Obstetrical outcome of sponta-
cholestasis of pregnancy related neous twins pregnancy versus IVF
to body mass index in women twins pregnancy
pregnant with twins? S. Garcı́a, M. Urtasun, M. Donazar, A. Safont, N. Abian, B.
Pérez, J. Barrenetxea, and C. Larrañaga
K. Kosinska-Kaczynska and I. Szymusik
Servicio de Ginecologı́a y Obstetricia, Complejo Hospitalario de
1st Department of Obstetrics and Gynecology, Medical University of Navarra, Navarra, España
Warsaw, Poland
Introduction: Socioeconomic changes and delayed conception mater-
Introduction: Intrahepatic cholestasis of pregnancy (ICP) is a condition nal age has led to an increase in the need for assisted reproductive
related to a high risk of bad neonatal outcome. While troublesome techniques to achieve pregnancy. The use of assisted reproduction
pruritus is a main problem for the mother, stillbirth or intrauterine techniques entails an increase in multiple gestations. Sin ce the
hypoxia are the most serious complications for the fetus. The risk of beginning of assisted reproductive techniques, there is a social and
pregnancy cholestasis is related to pre-gravid body mass index in scientific concern about the outcome of such pregnancies. The
singleton pregnancy. The aim of our study was to determine the purpose of our study is to compare the obstetric and perinatal
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 69
outcome of spontaneous twin pregnancies with twin pregnancies Materials and methods: Retrospective observational study of triplet
conceived by IVF. pregnancies followed at the Obstetrics Departments of Hospital
Materials and methods: This is a retrospective study of 456 twin Universitari Vall d’Hebron (Barcelona) and Hospital Universitario La
gestations, 319 pregnancies were conceived spontaneously and 137 Paz (Madrid) from 2009 to 2014. Transvaginal ultrasound scans were
by in vitro fertilization. They gave birth in our hospital, Complejo periodically performed for evaluation of the cervical length (CL).
Hospitalario de Navarra, between 2012 and 2015. The following Patients with CL525 mm and no uterine contractions were proposed
variables were compared: threatened abortion rate, rate of evanes- to carry a cervical pessary. We describe the characteristics of this
cent twins, rate preterm labor income and prematurity (gestational population and the outcomes for the groups with and without
age less than 37 weeks). Also we compared: rate of inductions, type of pessary.
delivery, fetal weight, rate of pathological ph and destinaton of Clinical cases and summary results: Between 2009 and 2014, there
newborn. were 70 triplet pregnancies surveyed in either of the two Centers
Clinical cases and summary results: The average age of patients with involved in the study. Of them, 24 (34.3%) patients met the criteria
spontaneous twin pregnancy was 33.57 years compared with 34.69 and gave their consent for the insertion of a cervical pessary. The
years in women with twin pregnancy by IVF, the differences were mean gestational age for the insertion was 24 weeks (range 20-30).
statistically significant. On the other hand, 81% of pregnant women There were no statistical differences between groups for chorionicity,
with spontaneous twin pregnancy were nulliparous versus 93.6% of mode of conception, need for admission at the hospital or indication
women with twins by IVF. The differences were also significant. for admission at the hospital. Mean CL was significantly shorter in the
Significant differences were found regarding the threat of abortion pessary group (22.2 mm, 95%CI: 20.5-23.9 versus 33.4 mm, 95%CI:
rate, 6.8% of spontaneous twins versus 25.6% in twins by IVF. 32.1-34.6). Mean gestational age at birth was 32.2 weeks (95% CI:
Pregnancy through IVF had a higher rate of evanescent twins (9.3% 31.4-33.1), with no statistical differences between groups. Regarding
versus 3.4%). We also found a higher rate of income preterm labor in the indications to end the pregnancy (all of them by cesarean
twins by IVF (29% versus 15%) with statistically significant differences. section), there were 25% of patients with preeclampsia or Doppler
Higher percentage of births was also found before 37 weeks of alterations in the non-carriers group (vs 0% in the carriers group),
gestation in twins by in vitro fertilization (41% versus 30.4%) differences being almost statistically significant (p=0.058).
statistically significant differences. No differences in the rate of Conclusion: The prevalence for use of cervical pessary in our triplet
induction of delivery were found. Regarding childbirth no difference pregnancies sample (34.4%) is much higher than that described for
in the rate of caesarean sections were found, however spontaneous twins (5%). Even though there are significant differences for CL
pregnancies had lower instrumental deliveries rate than pregnancies between groups (taking into account the potential bias for the
through IVF (16% versus 28%). The mean fetal weights showed no presence of the device while making the CL measurements), the
significant differences (2379 gr spontaneous versus 2356 gr versus in gestational age at delivery was the same for both groups. This
IVF twins). Higher rate of pathological pH (pH 57.2) was found in strongly suggests that cervical pessary is an effective tool to prevent
pregnancies by in vitro fertilization (27% versus 19%) with significant extreme prematurity in triplet pregnancies.
differences. Finally, newborns IVF required more frequently admission
to the neonatal unit than newborns after spontaneous pregnancy Keywords: Cervical pessary, triplet pregnancies, prematurity
(23% versus 17%).
Conclusion: Twin pregnancies through IVF have worse obstetrical
outcomes than spontaneous pregnancies. These differences could be
due to the technique but also to the patient profile that uses them.
Patients with twin pregnancies through IVF had a higher mean age TWINS – 652
and higher rate of Nulliparity. Both age and parity can be
confounding factors when comparing obstetrical and perinatal
Evaluation of the implementation
outcomes between the two types of pregnancies, since they imply
a higher rate of complications in pregnancy.
of the dutch national guideline
on twin pregnancies and its
Keywords: Twin pregnancy, Asissted reproduction technics
effects on perinatal outcome of
monochorionic twin pregnancies
302 Post W. M.1, Hack K. E. A.2, Boon J.3, Evers I. M.4, Drogtrop
The use of cervical pessary in a A. P.5, Boekkooi PF5, Graziosi G. C. M.6, Huisjes A. J. M.2,
and Derks J. B. 1
spanish population of triplet 1
Divisie Vrouw en Baby, UMC Utrecht, 2Gelre ziekenhuis Apeldoorn,
pregnancies 3
Diakonessenhuis Utrecht, 4Meander Medisch Centrum Amersfoort,
5
Elisabeth-Tweesteden ziekenhuis Tilburg, and 6Sint Antonius zie-
M. De la Calle1,T. Illescas2, M. Goya M2, S. Fernandez2, kenhuis Nieuwegein
S. Arevalo2, E. Martin Boado1, C. Rodo2, E. Carreras2,
and J. L. Bartha1 Presenter: Post W. M. or Hack K. E. A.
Introduction: In 2011, a new guideline on twin pregnancies has been
1
La Paz University Hospital, Madrid, Spain, and 2Vall d’Hebron introduced. Herein it is advised to induce labour in uncomplicated
University Hospital, Barcelona, Spain monochorionic diamniotic (MCDA) twin pregnancies around 36-
37weeks of gestation. The aim of this study was to evaluate the
Introduction: Preterm birth is the main cause of perinatal morbidity implementation of this guideline by the district hospitals of Utrecht
and mortality, especially in multiple pregnancies. In the last years, and the subsequent effects on perinatal outcome after introduction
cervical pessary has been tested as an effective intervention to of the guideline.
prevent prematurity in patients with a shortened cervix during Materials and methods: Methods: All MCDA twin pregnancies of at
pregnancy. Our objective is to describe the outcomes in a Spanish least 20 weeks of gestation were included retrospectively and the
population of patients carrying a cervical pessary during a triplet differences between pregnancy outcomes in the period before and
pregnancy. after introduction were compared. Prospective risks of mortality and
morbidity were calculated by dividing affected cases by total of
70 Abstract – Oral J Matern Fetal Neonatal Med, 2016; 29(S1): 1–313

ongoing pregnancies at the beginning of a 2weeks gestational age Presenter: R. R. Aapkes

block period. Trends of these determinants were plotted per year and Introduction: Necrotizing enterocolitis (NEC) is one of the most
per period before and after the introduction of the guideline. common gastrointestinal emergencies in the newborn infant. The
Clinical cases & summary results: Results: In total 894 MCDA twin exact pathophysiology of NEC remains unknown. It is a disorder
pregnancies were included. Overall there were no major differences in manifested by ischemic necrosis of the intestinal mucosa. NEC seems
characteristics between pregnancies in both time periods besides a to be more common in monochorionic than dichorionic multiple
higher proportion of women with hypertensive disorders in the births, also when corrected for birth weight and term. This suggest a
period before introduction of the guideline and a higher incidence of relationship between placental abnormalities occurring in mono-
(gestational) diabetes in the period after introduction of the guide- chorionic twins, such as anastomoses, and the pathophysiology of
line. The maximum gestational age after introduction of the new NEC. In order to understand the pathophysiology and the risk factors
guideline was 37 þ 6 weeks. The prospective risk of fetal death  32 for development of NEC, we compared dichorionic and monochor-
weeks of gestation (per fetus) before and after the introduction was ionic pregnancies, ultrasound studies in pregnancy en placental
1.2% and 0.3% respectively (p=0.138); after introduction of the abnormalities.
national guideline no avoidable deaths occurred. The incidence of Materials and methods: Multiple pregnancies delivered in the
neonatal death and morbidity however showed a reversed trend. University Medical Centre, Utrecht (UMCU) (1995-2015)were collected.
Early neonatal death occurred in 0.5% en 1.1% respectively (p=0.264) Monochorionic and dichorionic twins were compared in terms of
and neonatal morbidity occurred in 1.6% en 2.5% in the periods pregnancy data, mortality en morbidity. For the monochorionic twins
before and after the introduction respectively (p=0.257). placenta pathologic reports and ultrasound data were also collected.
Conclusion: The national guideline seems to be well implemented in In the monochorionic twin group, we compared de differences in
the local policy of the hospitals of the district of Utrecht which placental anastomoses and ultrasound findings between the children
resulted in less fetal deaths. However, there seems to be a correlation with and without NEC.
with a higher amount of early neonatal death and morbidity. When Clinical cases & summary results: In total 1499 multiples with
considering elective delivery of these pregnancies this should be dichorionic placentation and 464 multiples with monochorionic
taken into account. placentation included, a total of 4006 children. The incidence of
NEC was higher in het monochorionic group than in the dichorionic
group (3.1% and 1.6% respectively, p=0.011), but after multivariate
Keywords: MCDA TWINS
regression analysis with adjustment for birthweight and gestational
age at delivery, this difference was not significant anymore adjusted
OR 0.672 95% confidence interval 0.417-1.084). In the monochorionic
group, no differences in occurrence of abnormal Doppler studies of
the umbilical artery were found between cases with and without NEC.
667
There were also no differences in the presence of abnormal umbilical
Necrotizing enterocolitis in twin cord insertions or variety of placental anastomoses. Unbalanced
interfetal transfusion through arteriovenous (AV) anastomoses
pregnancies: can we find a seemed to occur more frequently in NEC cases than in cases without
NEC (50% versus 37% respectively, p=0.163).
pathophysiologic key in placental Conclusion: The increased risk of NEC in monochorionic twins seems
abnormalities? to be related to the lower birth weight and gestational age at birth.
However, unbalanced interfetal transfusion through AV anastomoses
might be related to the higher incidence of NEC in monochorionic
R. R. Aapkes1, P. G. J. Nikkels2, C. Koopman-Esseboom1, twins and needs further investigation.
and K. E. A. Hack2
1
Keywords: Twins, triplets, multiple birth, ultrasound, monochorionic,
Hospital Gelderse Vallei Ede, Ede, the Netherlands. and 2University Necrotizing enterocolitis, placenta, anastomoses
Medical Centre Utrecht, Utrecht, the Netherlands.
DOI: 10.1080/14767058.2016.1191212 Abstract – Oral 71
and chorionicity: 1) monochorionic selective IUGR twins (86
719 neonates), 2) dichorionic selective IUGR twins (170) 3) monochorionic
The neonatal outcome in twin non-selective IUGR twins (28) 4) dichorionic non-selective IUGR twins
(34). Neonatal data included gestational age at birth, the 1st and 5th
gestations complicated with minute Apgar score, neonatal mortality, respiratory support, bronch-
opulmonary dysplasia, intraventricular hemorrhage, necrotizing
selective or non-selective enterocolitis, sepsis, congenital infections, length of hospital stay
(LOS) and length of Neonatal Intensive Care Unit hospitalization.
intrauterine growth restriction Clinical cases & summary results: The total IUGR incidence in the
surveyed group was 32.9%. Among them, 81.3% were selective IUGR
W. Ananicz1, J. Maret1, K. Szarla1, K. Kosinska-Kaczynska2, twins and 18.7% non-selective IUGR twins.
and I. Szymusik2 Non-selective IUGR twins were delivered later than selective IUGR
twins (delivery at 35.7 vs. 34.8 gestational weeks; p=0.016). Non-
1 selective IUGR twins, regardless of the chorionicity, had increased
Students’ Scientific Association at the 1st Department of Obstetrics
and Gynecology, Medical University of Warsaw and 21st Department mortality (OR=4.49; 95%IC 1.87-10.8; p50.01) and risk of NICU
of Obstetrics and Gynecology, Medical University of Warsaw hospitalization (OR=2.11; 95%IC 1.21-3.68; p50.01). Monochorionic
non-selective IUGR twins had higher risk of NICU hospitalization
(OR=8.89; 95%IC 3.1-24.8; p50.001) and congenital infections
Presenter: Katarzyna Kosinska-Kaczynska
(OR=4.79; 95%IC 1.7-13.7; p=0.0035).
Introduction: The incidence of intrauterine growth restriction (IUGR) in
Conclusion: Twins with non-selective IUGR have worse neonatal
twins is significantly higher (15-47%) than in singletons (3-10%),
outcome than twins with selective IUGR.
which is associated with elevated risk of neonatal mortality and
morbidity in multiple gestations. Intrauterine growth restriction in
twin gestations, both monochorionic and dichorionic, may affect one Keywords: Twin pregnancy, intrauterine growth restriction
or both fetuses (selective or non-selective IUGR). The aim of the study
was to compare the neonatal outcome in twin gestations with
selective and non-selective IUGR.
Materials and methods: A retrospective analysis of medical records of
505 patients pregnant with twins, hospitalized in 2005-2015, was
made. The surveyed group was divided in four subgroups depending
on the number of neonates with IUGR (birth weight510th percentile)
 http://informahealthcare.com/jmf
ISSN: 1476-7058 (print), 1476-4954 (electronic)

J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

! Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/14767058.2016.1191212

POSTER
ABNORMAL PLACENTATION – 043 058
Nonlinear analysis of fetal heart Associated factors of blood
rate dynamics in fetuses compro- transfusion for cesarean section
mised by asymptomatic partial in pure placenta previa
placental abruption V. Titapant
J. K. Hoh1 and Y. S. Park2 Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj
Hospital, Mahidol University, Bangkok, Thailand
1
Obstetrics and Gynecology Dept., Hanyang University Hospital,
Seoul, South Korea, and 2Mathematics and Research Institute for Introduction: The factors associated with blood transfusion during
Natural Sciences Dept., Hanyang University, Seoul, South Korea cesarean delivery in placenta previa pregnancies have been
previously reported but still unclear. One study found a previous
Introduction: We analyzed fetal heart rate (FHR) parameters, dynamics, cesarean section, maternal age greater than 34 years and a history of
and outcomes in pregnancies with asymptomatic partial placental more than one dilatation and curettage to be risk factors associated
abruption (PPA) compared with those in normal pregnancies. with blood transfusion during cesarean section in placenta previa
Materials and methods: We examined nonstress test (NST) data pregnancies. Another report found the risk factors for transfusion to
acquired from 2003 to 2012 at our institution. Normal pregnancies be delivery at 32–35 weeks of gestation and cesarean hysterectomy.
(n ¼ 170) and PPA cases (n ¼ 17) were matched for gestational age, Due to the conflicting results of these studies and their inclusion of
fetal sex, and mean FHR. NSTs were performed at 33-42 weeks of placenta accreta cases, which might be an important confounding
gestation. FHR parameters obtained from the NST and perinatal factor, the risk factors for blood transfusion during cesarean section in
outcomes were analyzed using linear methods. Nonlinear indices, pure placenta previa pregnancies are still needed to be found out.
including approximate entropy (ApEn), sample entropy (SampEn), The aim of this study is to determine the risk factors of blood
short-term and long-term scaling exponents (a1 and a2), and transfusion during cesarean section in pure placenta previa pregnan-
correlation dimension (CD), were used to interpret FHR dynamics cies, which would aid preoperative planning.
and system complexity. The area under a receiver operating Materials and methods: A case-control study was conducted among
characteristic curve (AUC) was used to evaluate the nonlinear indices. 405 pregnant women with pure placenta previa who underwent
Clinical cases and summary results: There were no significant cesarean delivery between 2004 and 2013. Cases consisted of 135
differences in general characteristics and FHR parameters between women who received blood transfusion. Another 270 women who
the PPA and control groups. However, gestational age at delivery, did not receive any blood transfusion were randomly selected and
birth weight, 5-min Apgar scores, ApEn, SampEn, and CD were served as controls. Maternal antepartum profiles and obstetric
significantly lower in the PPA group than in the control group outcomes were compared and analyzed by univariate and multi-
(p50.05). The long-term scaling exponent (a2) and crossover index variate analysis respectively.
(a2/a1) of the PPA fetuses were significantly higher than those of the Clinical cases and summary results: The results after multivariate
controls (p50.01). A multiple regression model showed better analysis show significant independent associated factors of blood
performance in predicting PPA (AUC, 0.92, sensitivity 82.35%, transfusion as followed: previous cesarean section (OR 2.30, 95% CI
specificity, 94.12%). 1.36-3.90), anterior placenta previa (OR 2.30, 95% CI 1.15-4.60), major
Conclusion: Nonlinear dynamic indices of FHR in asymptomatic PPA placenta previa (OR 2.39, 95% CI 1.34-4.22), pre-operative bleeding of
were qualitatively different from those in normal pregnancies, more than 250 ml (OR 6.11, 95% CI 2.35-15.90), pre-operative anemia
whereas the conventional FHR parameters were not significantly (OR 2.31, 95% CI 1.34-4.00) and emergency cesarean section (OR 2.14,
different. 95% CI 1.08-4.22).
Conclusion: Previous cesarean section, anterior placentation, major
Keywords: Approximate entropy, correlation dimension, fetal heart placenta previa, pre-operative bleeding of more than 250 ml, pre-
rate, nonlinear dynamic indices, partial placental abruption, sample operative anemia and emergency cesarean section were the
entropy, short-term and long-term scaling exponents independent factors that increased the risk of blood transfusion
during cesarean section in placenta previa.

Keywords: Placenta previa, blood transfusion, cesarean section,

associated factors
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 73
Materials and methods: Material and methods: There were analyzed
the total number of births in specific period, the incidence of birth of
197 newborns from mothers with Placenta Preavia, mortality of this group
Importance of the suspected of newborns, the gestational age of deceased newborns, the time of
death of these newborns, the structure of death according to
diagnosis of placenta accreta diagnosis. During the past 3 years (2009–2011) at Special Hospita for
Gynecology and Obstetrics, there were 9496 newborns. 9415 were
born alive (99.14%), 81 died (0.85%). Out all newborns, 20 or 0.21%,
S. Garcı́a, M. Urtasun, B. Pérez, N. Abian, B. Gastón, were born from mothers with placenta preavia.
J. Barrenetxea, and C. Larrañaga Clinical cases and summary results: Results: The mortality in this group
of newborns with placenta praevia is 17.39%. The gestational age of
Servicio de Obstetricia y Ginecologı́a, Complejo hospitalario de all deceased newborns is less than 33 weeks. During the first 12 hours
Navarra, Navarra, España the percentage of deaths is 50%, from 13–24 hours 25%, from 25–48
12.5% and after 48 hours 12.5%. According to patho-histological
Introduction: Placenta accreta is defined as an abnormal implantation analysis that were done on 100% of the deceased newborns, 38.1%
of the placenta, in which the chorionic villi are inserted directly into form this risk group of newborns died from hyalinomembrane disease
the myometrium. The incidence of accretism is 3/1000 pregnancies. In as the main cause of death, 14% from intercranial hemorrhage. 42%
the last 30 years the incidence of Placenta accreta has increased had as a main cause of death hyalinomembrane disease and
threefold due to the large increase in the cesarean rate. There are intercranial hemorrhage, and 6% fall in the group of rare other causes.
other risk factors for placenta accreta, which are: previous cesarean Conclusion: The high percentage of death of these newborns is
section, placenta previa, age 435 years, multiparity, Asherman’s determined by maturity and adaptability of these newborns.
syndrome, endometritis or previous curettage, etc. The presence of
placenta accreta increases maternal morbidity and mortality due to: Keywords: Placenta praevia, newborns, morbidity, mortality
risk of massive bleeding and need for transfusions, risk of injury to
adjacent organs, etc.
Clinical cases and summary results: We report a case of placenta
accreta occurred in our hospital, Complejo Hospitalario de Navarra, in
2015. Patient 41 years old with a history of normal pregnancy and
childbirth in 1999. After his first delivery, underwent a curettage due
to retention of placental cotyledon. After curettage, the patient had 215 (CASE REPORT)
amenorrhea, being diagnosed in 2003 of Asherman’s syndrome,
which was corrected by hysteroscopy. During 2015 she is pregnant Conservative management of
with her second pregnancy. During the course of gestation, the
patient is diagnosed occlusive total placenta previa with thinning of
placenta increta - a case report -
the myometrium placental interface on the back side. It requires three
hospital admissions for self limited bleeding. In the presence of risk
Belo Horizonte, Minas Gerais,
factors and sonographic suspicion, it was decided to schedule a Brazil
cesarean with subsequent hysterectomy in 37 weeks. The patient had
expressed accordance with the intervention. In week 37 we
proceeded to carry out the Caesarean section and hysterectomy C. Reis Gonçalves1, F. Cabral Piancastelli2, G. Cotta
which passed without major incidents. Histopathology confirmed the Lipiani2, I. Serra Ribeiro2, L. Rezende2, N. Jannotti
diagnosis. Rodrigues2, and T. Queiroz2
Conclusion: Placenta accreta is a disease that is increasing in
1
incidence. Accretism increases the risk of morbidity and mortality Maternidade Odete Valadares, Belo Horizonte, Minas Gerais, Brazil
both maternal and fetal. The diagnostic suspicion based on risk and 2Faculdade da Saúde e Ecologia Humana, Vespasiano, Minas
factors and echocardiographic signs are essential to anticipate Gerais, Brazil
possible complications that may arise.
Introduction: Placenta accreta (PA) is characterized by an abdonrmal
Keywords: Placenta accreta implantation of the placenta into the uterine wall. There are three
different types of accretism, in wich PA is defined as superficial
invasion, placenta increta is middle layer invasion and placenta
percreta as deep invasion of the myometrium. PA can cause massive
hemorrhage leading to maternal morbi-mortality. We will presenta
a case report of a 32 years old woman with expectant management
213 of placenta increta and make a review of conservative management
of accretism.
Placenta praevia: frequency, Clinical cases and summary results: L.A.S., a 32 year old nullipara,
28 weeks 3 days gestational age from Santo Antônio do Monte, Minas
morbidity, mortality and Gerais, Brazil. She had known chronic hypertension with further
structure of death severe superimposed preeclampsia. She was referred to a high
complexity maternity hospital in Belo Horizonte, Minas Gerais, Brazil,
on may 19, 2015. Her BP was 160/120mmHg and she had frontal
G. Bushinoska-Ivanova1, J. Ivanov2, and L. Hoxha3 headache. The ultrasonographic evaluation has showed anterior
1 placenta with no signs of invasion, IUGR (EFW 977g - under the 10th
UK JZU Gynecology-Obstetrics Clinic Skopje, Macedonia, 2Clinical percentile) and reverse end-diastolic blood flow in umbilical artery.
Hospital Acibadem Sistina, Skopje, Macedonia, and 3PZU DONA, Magnesium sulfate was initiated, and c-section was performed.
Skopje, Macedonia Newborn’s Apgar score was 6 and 8, and birth weight was 725g.
During the surgery placenta increta was diagnosed, as it reached the
Introduction: Objective: The aim of this study is a retrospective myometrium. The surgeon was not able to remove it completely, and
analysis of premature neonatal death of newborns born to mothers the placenta was partially left on the uterine wall. Uterus was
with placenta preavia. preserved and the patient remained sable. She was discharged after
four weeks of intra hospitalar observation, without any additional
74 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

bleeding. Her endovaginal ultrasonography on june 8th showed an 482 (CASE REPORT)
heterogeneous endometrium, poorly delimited of 1,9 mm thick and a
myometrial heterogenity in the anterior entometrial wall measuring
28x6,7mm. She was followed on our service remained stable and with Massive obstetric hemorrhage
no infecction after 10 months. Her ultrasound scan made on that
period has shown no residual placental-like image inside her uterus, due to placenta increta during
with return to regular menses and negative B-HCG.
Conclusion: Nonsurgical conservative management has been used
second trimester pregnancy ter-
successfully tomanage some women with placenta accrete, shoing
that with a good follow up and strict surveillance, it is possible to
mination: a case report
avoid a hysterectomy, mainly in patients that desire have future
pregnancies. M. Ozturk1, U Keskin2, M. Dede2, and M. C. Yenen2
1
Obstetrics and Gynecology Dept. Etimesgut Military Hospital,
Keywords: Placenta accreta, placenta increta, conservative
Ankara, Turkey and 2Obstetrics and Gynecology Dept. Gülhane
management
Military Medical Academy, Ankara, Turkey

Presenter: Mustafa Ozturk

Introduction: In this case report, we aimed to inform about massive
408 hemorrhage due to placenta increata during the abortion process and
emphasize the importance of fast decision making in management.
The pregnancy outcomes Clinical cases and summary results: An eighteenth week pregnant
woman was diagnosed with anhydramnios and absence of fetal heart
associated with placenta previa pulse. Due to massive vaginal bleeding during pregnancy termination
and placenta accreta procedure, hysterotomy was decided and performed immediately.
Failure to achieve bleeding control and detection of placenta increata
led to hysterectomy
S. Posokhova1,2, S. Galych1, and I. Rayzantcev2 Conclusion: In the termination procedure of the second trimester
1
pregnancy anomalies of placenta insertion should be thoroughly
Odessa National Medical University, Odesa, Ukraine and 2Odessa considered. Morbidity and mortality can be avoided with early
oblast Perinatal Center, Odesa, Ukraine diagnosis and fast decision making for management.

Introduction: Placenta previa poses a high risk for massive hemor- Keywords: Induced Abort, Massive Uterine Hemorrhage, Placenta
rhage. This condition increases the risk of maternal and neonatal Increata
mortality and morbidity. In cases of placenta previa, the prenatal
prediction of sudden bleeding during pregnancy and blood loss
during Cesarean section, and the assessment of risk for adherence of
the placenta using an ultrasound examination, can improve the
perinatal outcome. In women who have had a prior cesarean delivery,
placenta previa increases the risk of placenta accreta, risk increases
significantly as the number of prior cesarean deliveries increases (from
about 10% if they have had one cesarean delivery to 460% if they
have had 44).
Materials and methods: The aim of this retrospective cohort study was
to evaluate the pregnancy outcomes in patients with placenta previa
(PP) and placenta accreta (PA). This was a retrospective study
conducted in the Odessa oblast perinatal center during 5 years.
A total of 262 pregnancies complicated by placenta previa with
(n ¼ 622.4%) and without (n ¼ 200) placenta accreta were reviewed.
Maternal and neonatal data were obtained from medical records and
the hospital database system.
Clinical cases and summary results: Total number of deliveries during
this period is 19.486. The incidence of placenta previa was 1.35%.
Mean age of presentation was 29 ± 2.2 yrs. Multigravidae were 61.8%
of women, 64.1% presented between 28–34 weeks gestational age.
Among them 188 (72%) of women had previous history of surgical 506
intervention. During cesarean delivery 85 (32.4%) patients had bled
massively, among them placenta accreta was in 62 patients and Placental abruption as an emer-
placenta increta or percreta in 14 patients, and in 18 patients uterine
atony was the cause of massive bleeding. Cesarean hysterectomy was ging problem in preterm delivery
performed in 26 patients and bilateral mass uterine artery ligation
with uterine packing in 68 patients. These patients required blood Curkovic Aleksandar2, Sokolovic Curkovic Danijela1,
transfusion. Perinatal mortality was 16- 6.1% cases and maternal Babic Slobodanka2, Djurdica Cecez3, Lazic Mitrovic
mortality was nil.
Conclusion: Early diagnosis of placenta previa and accreta and timely Tanja3, and Pesic Stevanovic Ivana4
intervention with arrangement of blood transfusion, and a good 1
EUROMEDIK 2 Belgrade, Zemun, Serbia, 2G/O Clinic Narodni front,
anesthetic, surgical and pediatric team improves maternal and
Belgrade, Serbia Polyclinic department, 3G/O Clinic Narodni front,
perinatal outcome.
Belgrade, Serbia, Neonathology department, and 4G/O Clinic Narodni
front, Belgrade, Serbia, Transfusiology department
Keywords: Placenta previa, placenta accreta, antepartum and post-
partum haemorrhage, maternal mortality, perinatal mortality
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 75
Presenter: Aleksandar Curkovic genotype and chorionic detachment using the criterion 2 significant
Introduction: Placental abruption(PA)is one of the most severe association was found only for the gene MTHFR A1298C. In carriers of
complications during pregnancy. In practice it affects 0,5 - 0.7% of the heterozygous form of the gene MTHFR the risk of retrochorial
all deliveries, our task is to be very vigilant about it occurrence, hematoma fornation increased 1.865 times (OR = 1,865; CI [1,035-
namely for it high fatality for mother and infant and to see through 3,359], chi2 = 4,36, p = 0.03677). The link was also confirmed in the
delivery patients with diagnosed partial and total PA, occurring dominant model, which suggests that the effect on penetrance
before 37 gestational weeks (GW). Also we must follow the conditions appears both in homozygous and in heterozygous for an allele 1298C
of the neonates after delivery, comparing the data with the control ([AA] [AC + CC]) (OR = 1,738; CI [1,000-3,019], chi2 = 3,88, p =
group, without PA, with delivery before 37GW. 0.04890). Obtaining this reliable link can prove the fact that this
Materials and methods: Test group- 53 patients with PA. 46 of them mutation is a risk factor of retrochorial hematoma. In the analysis of
had CS. Control group-100 patients with preterm labor, without PA. polymorphisms of MTHFR C677T, MTR A2756G and MTRR A66G
24 had a CS. All the results were statistically tested. association with retrochorial hematoma was not detected.
Clinical cases and summary results: PA had a much higher rate of CS Conclusion: In heterozygous form the polymorphism A1298C of the
(87.6:24%)-ratio of the duration of hospitalization was 4.1:1, for test MTHFR gene increases the risk of retrochorial hematoma 1,865 times.
group, cost was 5.7 times higher. Deliveries were much shorter in test This gene mutation leads to a decrease in MTHFR activity, that
group, and consumption of blood derivates was 4.0 times higher. transforms the dietary (food) folate and synthetic form of folic acid in
Control-neonates had higher Apgar score (8.77:6.83). Control group a biologically active L-methylfolate. Vitamin and mineral complexes
lost none neonate intrapartum-test had 3. One postpartum hyster- that contain folic acid and its active form metafolin can be an
ectomy in test-control group none. Average gestation:test 34.2 GW, effective tool of folate deficiency preventing.
control 35 weeks 6 days. Keywords: Genetic polymorphisms, folate cycle genes, retrochorial
Conclusion: Test-much higher rate of previous miscarriages, renal hematoma, metafolin, folic acid, vitamin and mineral complexes
failure, hypertension, gestational diabetes and anemia. Age-no
influence. Placental insertion was mainly on the front wall-test,
control-evenly spread. Previous uterine operations had 19 (35.4%)-
test, control-9(9%). Even though it makes up to 0.7% of all deliveries 619
PA is the highest rate killer during delivery, pre or in term - It has to be
always on our minds. The management of placenta
Keywords: Placenta, Abruption, Preterm, Delivery, Complications praevia and accreta: three cases
reported
515
J. Xiberta, J. Acosta, R. Peiró, A. Navarro, S. Sánchez, E.
Genetic polymorphisms of folate Gil, and J. Leira
cycle genes and their role in the Obstetrics Dept., Hospital Universitari General de Catalunya. Quirón
Salud. Sant Cugat del Vallès, Barcelona, Spain
formation of retrochorial
hematoma Presenter: JM Xiberta
Introduction: Placenta accreta, is a rare obstetric condition with the
I. Bushtyreva1, N. Kuznetsova1, V. Barinova1, V. Dibova2, risk of massive intraoperative haemorrhage and urologyc complica-
and V. Dudareva2 tions. Previous cesarean deliveries is the most important risk factor.
Although it is difficult to diagnose placenta accreta antenatally, an
1 accurate diagnosis is one of the most important objectives for the
Rostov-on-Don State Perinatal Centre, Rostov-on-Don, Russia, and
2
Rostov-on-Don State Medical University, Rostov-on-Don, Russia successful management of maternal haemorrhage; and this can be
achieved using magnetic resonance imaging and ultrasonography.
In women with a final diagnosis of placenta increta or percreta,
Presenter: Irina O. Bushtyreva
antenatal diagnosis was associated with reduced levels of haemor-
Introduction: Due to the relatively high frequency of retrochorial rhage and a reduced need for blood transfusion . Making no attempt
hematoma occurrence (4% -22%) and its adverse effects on to remove any of the placenta prior to hysterectomy is associated
pregnancy outcome (the increase of risk of spontaneous abortion with reduced levels of haemorrhage and a reduced need for blood
above 2.18 times and premature birth - 1.4 times) the search for the transfusion.
risk factors of pregnancy complications still continues. The role of Clinical cases and summary results: We present three cases of placenta
genetic polymorphisms of the folate cycle is also actively studied. praevia and placenta increta or percreta.
Materials and methods: The study included 245 patients who were In all cases, previous cesarean section was the main risk factor. In
examined and treated in the Rostov-on-Don State Perinatal Center cases number 2 and 3, previous diagnosis to delivery of placenta
from 2011 to 2016. All patients were divided into 2 groups: the first increta or percreta was carried out by ultrasonography and magnetic
group (I) - 172 patients with retrochorial hematoma detected in resonance imaging, and protocols to prevent massive haemorrhage
gestation of 6 to 12 weeks, the second (control) group (II) -73 patients during delivery were established (preoperatory cistoscopy, ureteral
without retrochorial hematoma. The average age in the group I stent and bilateral prophylactic occlusion balloon catheters placed in
comprised 30 ± 4.8 years, in the 2d group - 29,4 ± 5,4 years (r  0,05). both internal iliac arteries). In case number one, placenta increta
The groups were comparable. A genotyping of polymorphisms of wasn’t diagnosed antenatally.
folate cycle in the peripheral blood was conducted: MTHFR C677T, In case number one, after delivery, the attempt to remove the
MTHFR A1298C, MTR A2756G, MTRR A66 G. Tests for compliance of placenta was followed by massive haemorrhage. An emergency
equilibrium of the Hardy - Weinberg and the identification of peripartum hysterectomy was carried out and 16 units of packed red
associations was carried out by DeFinetti program. blood cells were transfused. Injury to the bladder was produced and
Clinical cases and summary results: Genotype distribution matched the repaired.
expected balance at Hardy-Weinberg equilibrium in the group with In cases number 2 and number 3, after cesarean section, programmed
retrochorial hematoma and in the control group for all polymorphic hysterectomies were carried out and in case number 2 5 units of
loci of studied genes. In identifying the relationship between
76 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

packed red blood cells were transfused, while in case number 3 only 2
735 (CASE REPORT)
units were needed.
No urological injuries were noticed. Successful conservative manage-
Conclusion: Many cases of placenta accreta, increta, and percreta are
currently not diagnosed antenatally, despite the presence of risk ment of placenta accreta
factors.
In women with a final diagnosis of placenta increta or percreta, an
C. Infante Cárdenas, V. Bebia Conesa, I. Mejia Jiménez,
antenatal diagnosis is associated with reduced levels of haemorrhage
and a reduced need for blood transfusion D. Garcı́a Alcázar, A. Dı́ez Alvarez, and L. Forcén Acebal
The use of prophylactic occlusion balloon catheters could reduce the Gynaecology and Obstetrics department, Hospital 12 de Octubre,
need for transfusion.
Madrid, Spain
Preoperatively cistoscopy and ureterals stents could reduce the risk
for urologyc complications.
I. Mejı́a Jiménez
Keywords: Placenta praevia, increta, percreta, massive haemorrhage
Introduction: Placental accretism is a rare, and potential severe
complication of pregnancy, that can lead to hemorrhage, puerperal
infection and hysterectomy.
634 The main risk factor is the presence of placenta previa. The frequency
of accretism among women with no placenta previa increases as the
Uterine rupture due to the pla- number of uterine scars do.
Placetal accretism represents a diagnostic challenge during preg-
centa percreta in second trime- nancy, and most of the cases are recognized after a high clinical
ster of pregnancy suspicion (based in patient’s clinical history) and indirect signs in
ultrasonography.
Although the standard treatment is cesarean section and histerect-
E. Kudela, P. Zubor, K. Biringer, M. Nachajova, omy, this compromise patient’s fertility.
J. Visnovsky, and J. Danko We present a clinical case of a primigesta with no risk factors, that
presented placenta accreta with a succesful outcome after a
Department of Obstetrics and Gynaecology, University Hospital in conservative management.
Martin, Jessenius Faculty of Medicine in Martin, Comenius University Clinical cases and summary results: A 38-y-o patient with a history of
in Bratislava, Slovakia shortened cervix in the current pregnancy was admitted to our
hospital at 28 + 0 GW with an acute preterm labour and metrorrhagia
Presenter: E. Kudela diagnosis. In the US scan it was not possible to rule out any accretism
area on the anterior uterine wall and fundus.
Introduction: Placenta percreta presents abnormal implantation of We assisted a spontaneous vaginal birth at 30 + 2 GW, being
placental villi which invade and penetrate the myometrium. impossible to deliver the placenta with conventional maneuvers. As
Abnormal placentation including also placenta accreta and increta the bleeding stopped, and the patient had no other children, we
has become the most common cause of postpartum hysterectomy. In decided to follow a conservative approach with the patient’s
most cases it occurs in the third trimester leading to life-threatening approval, who was aware of the risks implied. We administered
uterine perforation and postpartum bleeding. Spontaneous uterine broad-spectrum antibiotics and performed a prophylactic uterine
rupture in the second trimester of pregnancy is an extremely rare arteries embolization. On the 2nd day of puerperium, a temperature
complication. High risk factors are previous scars on the uterine peak up to 39 C was registered, so a second embolization and
myometrium including myomectomies and caesarean sections, subsequent manual curettage were performed, achieving a succesfull
dilatation and curettage, advanced maternal age, in vitro fertilization delivery of the whole placenta. Afterwards, no fever was registered,
procedure and abnormal placentation. and the patient was dismissed 10 days later with general wellbeing.
Clinical cases and summary results: A 27-year old primgravida in 17th Conclusion: Uterine conservation is an option in patients with fertility
week of gestation was admitted to our department with abdominal sparing desire, or when the risk of hemorrhage or other organs lesion
pain and vomitus lasting twelve hours. She had a history of no would be high if a hysterectomy was performed. It’s a posible
previous operation on the uterus and she was diagnosed with approach if there’s a consensus with an aware patient, considering
tuberous sclerosis four years ago. The ultrasound confirmed a free the possible risks of infection, hemorrhage, later hysterectomy or
fluid in small pelvis and a living fetus inside the uterine cavity. An adverse future obstetric outcomes. Delayed hysteroscopy to take
exploratory laparoscopy was indicated that was due to the massive away the remnants of the placenta may be a successful option, but
haemoperitoneum converted to laparotomy. The fundus of the uterus there is limited expierence on this issue.
filled with placental tissue was completely perforated in length of
7 cm and the fetus was expulsed in the abdominal cavity. The other Keywords: Placenta accreta, uterine arteries embolization
internal organs were undamaged. We proceeded with the resection
of altered myometrium, curettage of uterine cavity and suture of
myometrium in two layers. The blood loss was estimated to be
3000 ml. After the surgical procedure the patient was fully compen-
CESAREAN SECTION - 011
sated and the follow up with bHCG controls until the zero value was Genital injuries in neonates
advised.
Conclusion: Spontaneous rupture of the uterus due to placenta following breech presentation:
percreta is one of the most acute obstetrical complications resulting
in quick exsanguination and high mortality. Haemoperitoneum and is early caesarean indicated?
uterine bleeding need an urgent surgical treatment along with
postpartum hysterectomy. In this case we decided for conservative P. Batra, M. Saroha, P. Dewan, and M. M. A. Faridi
treatment with strict follow up of the patient with regular laboratory
and ultrasound controls. Division of Neonatology, Department of Pediatrics, University College
of Medical sciences and Guru Tegh Bahadur Hospital, Dilshad
Keywords: Placenta percreta, uterine rupture, haemoperitoneum
Garden, Delhi - 110095, India
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 77
Introduction: Breech presentation is seen in 3–4% of babies born. bilateral orchidectomy had to be done (Figure 1, 2a, 2b). Case 3 had
Delivering a breech baby through vaginal route is difficult and carries similar clinical presentation at birth, with Doppler ultrasound
a much higher complication rate than cesarean sections. Breech born suggestive of epididymitis and normal flow to both the testis. Cases
babies carry an overall increased risk of maternal morbidity, neonatal 4, 5 and 6 were female babies who suffered labial injuries after birth.
mortality, birth asphyxia and birth injuries. Various types of birth Case 4 had posterior forcehette tear that was repaired immediately
injuries to the babies have been reported following breech delivery, after birth (Figure 3). Babies needing surgical exploration were treated
but genital injuries are less commonly reported and thus, less with intravenous antibiotics for 10 days, though blood culture was
anticipated. These injuries can lead to significant short and long-term sterile. Rest four babies, who did not require surgical intervention, were
morbidity in these babies. Keeping high index of suspicion, an early given prophylactic amoxicillin clauvillinic acid. All these cases were
cesarean section could have been an aide in preventing these born after a prolonged period of labour.
complications. Conclusion: Genital injuries following breech delivery is an under
Materials and methods: We report here spectrum of genital injuries in reported entity. Considering the grave prognosis of these injuries, a
6 neonates (3 males and 3 females), delivered in a tertiary care cesarean section should be considered early in breech presentations.
hospital after prolonged labor. This will help in preventing these significantly morbid complication
Clinical cases and summary results: We present here spectrum of genital and thus, optimizing the perinatal outcome of breech deliveries.
injuries following breech delivery in six neonates. Table 1 gives
comparative details of these cases. Case 1, 2 and 3 were male babies
Keywords: Neonate, breech, genital injury, testicular torsion, labial
who presented with scrotal and penile swelling with redness and
injury
tenderness. Case 1 (Figure 1) and 2 showed no blood flow on Doppler
ultrasound and thus were taken for urgent surgical exploration. Both
were found to have bilateral blackened and necrotic testis, for which

Table 1. Comparative details of the cases.

Parameter Case 1 Case 2 Case 3 Case 4 Case 5 Case 6

Gestation Term Term Term Term Term Term

Parity 3rd 2nd 1st 2nd 1st 1st

Duration of labour 23 hours 24 hours 18 hours 30 hours 20 hours 14 hours
Mode of delivery Caesarean (indi- Caesarean section Breech vaginal Breech vaginal Caesarean (indi- Breech vaginal
cation-breech (indication-pre- delivery delivery cation-Primi delivery
with obstructed vious caesarean with breech
labour) with failure of presentation)
trial of vaginal
delivery)
Birth wt (kg) 2.9 2.6 2.5 2.2 3.3 2.4
Gender Male Male Male Female Female Female
Genital Examination Scrotal and Scrotal and penile Scrotal swelling Labial edema Labial edema Hematoma pre-
penile swelling swelling and red- with bluish- with bleeding with bluish dis- sent bilaterally
with reddish dish discoloration reddish per vaginum. coloration and over labia
discoloration of scrotal skin discoloration Tear of poster- tenderness. minora
and excoriation ior forchette
of the overlying present
skin
Colour Doppler and Absent blood Decreased blood Normal blood Not done Not done Not done
ultrasound flow to both flow to both flow to both
testes sugges- testes, left more testes, Features
tive of necrotic than right suggestive of
testes (5 hours) (3 hours) bilateral
epididymitis.
Co morbid conditions Birth asphyxia Sepsis None None None None
and sepsis
Specific Treatment Surgical explora- Surgical explora- Conservative Repair of poster- Conservative Conservative
tion; revealed tion, revealed management ior forchette management. management.
blackened, necrotic testes tear.
enlarged and bilaterally, bilat-
edematous eral orchidecto-
bilateral testes, mey done
bilateral orchi-
dectomy done
Supportive treatment Intravenous Intravenous Oral amoxycillin Oral amoxicillin Oral amoxicillin Oral amoxicillin
Piperacillin and Piperacillin and and clauvulinic clauvulinic acid and clauvulinc and clauvulinc
Tazobactem for tazobactum acid for 5 days for 7 days acid for 5 days acid for 5 days
10 days
Biopsy Hemorrhagic Infarction of bilat- - - - -
infarction of the eral testicular
testicular tissue tissue
78 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

032 033
Reoperations following cesarean Uterine cesarean scar proprieties
section - risk factors and do not depend on period from
procedures: single center study previous cesarean section: elas-
tin, collagen type VI, alpha
M. Nowak, M. Radon-Pokracka, and H. Huras
Obstetrics and Perinatology Department, University Hospital of
smooth muscle actin, smooth
Cracow, Cracow, Poland muscle myosin heavy chain,
Introduction: Cesarean section is the most often operation in area of
endothelial cell marker CD31
minor pelvis proceed in a young women population. Each operation
has a risk of complication: anesthesiological, surgical, microbiological.
immunoexpression in the scarred
Reoperation is one of the most challenging procedure in postpartum lower uterin
period. The analysis of indications to this procedure may reduce
number of these complications.
Materials and methods: A retrospective study was conducted at the M. Zietek and Z. Celewicz
Obstetrics and Perinatology Department in Cracow, between January
Department of Perinatology, Obstetrics and Gynecology, Pomeranian
2013 and November 2015. During this period 5308 cesarean sections
Medical University, Szczecin, Poland
were performed and 28 (0,5%) patients were reoperated. Indications
to reoperation and type of surgical procedure were analyzed.
Clinical Cases and Summary Results: In case of primary cesarean Introduction: Cesarean section is the most frequently performed major
section reoperation rate was 0.45% whereas in case of more than one surgical procedure, and its rate significantly has risen in last few years.
previous cesarean section reoperation rate was 0,7%. Planned In many cases patients are cesareased upon request and subsequent
cesarean section was followed by reoperation in 0.39%, while deliveries are also terminated by cesarean, due to a fear, that the
emergency cesarean section was complicated in 0.68%. Indications uterus is weakened by the previous cesarean section. The process of
for reoperation were divided into four groups: active bleeding into myometrial wound healing determines the future morphology,
peritoneal cavity (43%), hematoma (28%), uterine atony (14%) and functional behavior and risk of uterine scar rupture in subsequent
others (14%). To other’s group were included single cases of surgical pregnancies. Subsequently the incidence of cesarean scar defects
failure like: massive bleeding from vagina despite medical manage- become a problem. Despite wound healing is a normal biological
ment, acute appendicitis, dehiscence of wound and intestinal process in the human body, there are multiple factors, that can lead
paralysis. In 19 from 20 cases of bleeding into peritoneal cavity to impaired wound healing. Local factors (oxygenation, infection
there were added sutures and drainage. In one case B-Lynch foreign body, venous sufficiency) directly influence the wound
technique was performer and in one case uterine arteries were proprieties while systemic factors (age, sex hormones, stress,
occluded. Four patients were qualified to hysterectomy. A group of ischemia, diabetes, obesity, alcoholism, smoking) are the overall
women who have undergone reoperation did not differ significantly health or disease state of the individual that affect the ability to heal.
with respect to age, number of previous pregnancies, comorbidities, The wound repairing is conditioned by a fibro-proliferative response
drug use, and technic of performance caesarean section. involving mediators, blood cells and extracellular matrix parenchymal
Conclusion: Emergency cesarean section and state after more than cells . All this process overlaps in three phases: inflammation (onset of
one previous cesarean section were important risk factors. The most injury to days 4–6), tissue formation (days 4–14), tissue maturation
common cause of reoperation was bleeding, which required the use and remodeling (week 1 to year 1). There is no evidence to support
of additional stitches. Awareness and diligence in securing hemostasis the theory, that optimal myometrial structure and functional integrity
during cesarean section may reduce complication rate. with minimal risk of uterine scar rupture in a subsequent pregnancy
are obtained 24 months after cesarean section. We postulate that
uterine cesarean scar proprieties in the next pregnancy do not
Keywords: Cesarean section, reoperation, bleeding
depend on period from previous cesarean section. The aim of the
study was to analyze changes of myometrial elastin, collagen type VI,
alpha smooth muscle actin, smooth muscle myosin heavy chain,
endothelial cell marker CD31 immunohistochemical expression in
scarred uteri, depending on interdelivery period in term pregnancies.
Materials and methods: Eighty healthy pregnant women, who
underwent previously one cesarean section were analyzed.
Depending on period from previous cesarean section, women were
divided into three groups: group 1 (12–17 months, n=3), group 2 (18–
23 months, n=11), group 3 (more than 24 months, n=66) . During
cesarean section, a sample of uterine lower segment was collected
and fixed in buffered 4% formalin for immunohistochemistry (IHC)
analysis. During a multi-step process, detecting the target antigen
with antibodies was performed for identification of elastin, collagen
type VI, alpha smooth muscle actin, smooth muscle myosin heavy
chain, endothelial cell marker CD31.
Clinical Cases and Summary Results: There were no differences in
myometrial immunoconcentration of elastin, collagen type VI, smooth
muscle myosin heavy chain, endothelial cell marker CD31 in analyzed
groups, which means that uterine cesarean scar proprieties do not
depend on interpregnancy interval length period. However, the
myometrial immunoconcentration of alpha smooth muscle actin was
significantly higher in patients, where cesarean section was
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 79
performed in period less than 2 years from previous caesarean, than Keywords: Carbetocin, uterine atony, Cesarean delivery, cost and
those who were delivered later. resource utilization
Conclusion: In conclusion we suggest that uterine cesarean scar
proprieties do not depend on period from previous cesarean section,
but this suggestion still requires the availability of well controlled 049
clinical studies on the topic of recommendations.
Obstetric care at the hospital
Keywords: Uterine scar, uterine rupture, cesarean section, elastin,
collagen type VI, alpha smooth muscle actin, smooth muscle
Estadual da Mãe-Mesquita -RJ -
myosin heavy chain, endothelial cell marker CD31 Brazil
A. Cunha, F. Aguiar, S. Teixeira, E. Gerde, and C. Soeiro
Hospital Maternidade Terezinha de Jesus. Hospital Estadual da Mãe.
035 Mesquita, RJ, Brazil
Carbetocin in prevention of
Introduction: The Federal Government decided for the policy of
uterine atony following delivery building two big maternities (45000 births/year each), one for low
by cesarean section - Polish and medium risk pregnancies: Hospital Estadual da Mãe (Motheŕs
State Hospital) - RJ - Brazil and another for high risk pregnancies:
multicenter retrospective study Hospital da Mulher (Womeńs Hospital) - RJ - Brazil, in Baixada
Fluminense, an area with 3 500 000 inhabitants and 11 counties - Rio
of cost and resource utilization de Janeiro State - BR.
Materials and methods: The Motheŕs Hospital has the following
infrastructure: reception area (5 offices and 4 observation beds), 12
A. Bierut6, K. Pacocha1, I. Pienia˛z_ ek1, M. Sobkowski2, delivery rooms, the motheŕs area (for the use of non-pharmacological
Z. Celewicz3, J. Kalinka4,5, K. Szymanowski2, M. Serafin5, methods for analgesia during labor) between the delivery rooms,
K. Szpak3, A. Grzymała-Figura3, and J. Walczak1 2 operating theatres (next the delivery rooms, across a hall), 35
1
double apartments (70 patients), 1 intermediate newborn care
Arcana Institute, Krakow, Poland, 2Gynecological and Obstetrics (8 beds). The human resources include all specialists necessary
Clinical Hospital of Poznan Medical Science University, Poland, to the care: 42 obstetricians, 12 obstetrical nurses, 21 pediatricians,
3
Department of Perinatology, Obstetrics and Gynecology, 21 anesthesiologists, extra nurses for supporting, divided in teams
Pomeranian Medical University in Szczecin, Poland, 4Department of 24 hs/7 days and physiotherapist, psychologist, nutrician, social
Perinatology, Medical University of Lodz, Poland, 5M. Pirogowa worker, phono audiologist, breast feeding nurse. The method is the
Regional Specialized Hospital in Lodz, Poland and 6Ferring Humanizing Delivery Program. The humanized delivery consists of a
Pharmaceuticals Poland set of behaviours and procedures that are intended to promote
healthy labor and birth, and the prevention of maternal and perinatal
morbidity and mortality. The scientific evidence was the basis for the
Introduction: Postpartum hemorrhage (PPH) is not only a traumatic Program for Humanization of Prenatal and Birth (Ministry of Health
experience for both the patient and medical staff but also a cost- 2000). However, its implementation is hampered by problems
absorbing event for the hospital. The aim of the study was to estimate dependent on its actors: the patient (culture), health professionals
the resource utilization and costs related to carbetocin use in (training and update) and managers (training and prioritization of
prevention of uterine atony following delivery by Cesarean section in resources). The analysis was made with the SigQualis program.
comparison to standard methods (oxytocin) based on data from three Clinical cases and summary results: Humanized birth (n = 6688)
medical centers in Poland. resulted in:
Materials and methods: This was a multicenter retrospective study 1. A low cesarean-section rate (24%, 1605)
based on data from patient medical records. The questionnaire was 2. A low rate of episiotomy (23.95%)
developed to gather resources used and costs related to the 3. Three cases of maternal deaths in 2015
prevention of uterine atony as well as the management of PPH. The 4. Intrapartum fetal death rate 5.6/1000
questionnaire covered two perspectives: hospital and public payer. 5. Early neonatal death rate 4.07/1000
Six subpopulations were considered depending on patient character- 6. Early neonatal death rate (2,500 g) 1.97/1000
istics or PPH occurrence. 9. Asphyxia neonatal 11/1000
Clinical cases and summary results: 275 medical records were included 10. Motheŕs satisfaction 99%
into the study: 135 and 140 for carbetocin and oxytocin, respectively. Conclusion:
The subpopulations were quite homogenous between centers and 1. The results show that it is possible to implement a Humanizing
treatment arms, which was a premise for pooling the data. Real Birth Program.
practice data confirmed that carbetocin was very well tolerated. In 2. Although the unit is reference for low risk pregnancies, it receives
five of six considered subpopulations, use of carbetocin instead of many high risk patients due to a bad reference system.
oxytocin generated overall savings ranging from 25 to 1500 EUR. The 3. As the unit was planned to be a low risk one it does not have a
highest savings were observed in a population that experienced neonatal intensive care unit (NICU), but just an intermediate care unit
severe PPH. According to the study results, the cost of services related 4. The prenatal care in primary care units is of bad quality, so many
to Cesarean delivery, prevention of uterine atony, and PPH manage- patients come with problems (preeclampsia/eclampsia and many
ment borne by the hospitals was higher than the refund received others)
from a public payer for these medical services. Nevertheless, the loss
generated by this underfunding was lower in the carbetocin group
versus oxytocin. Keywords: Cesarean sectiion, labor, delivery, perinatal mortality
Conclusion: Use of carbetocin in uterine atony prevention is safe and
generally brings savings to hospitals. The study provides very
important information on underestimation of the medical services
related to Cesarean delivery and PPH by Polish National Health Fund.
80 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

163 (CASE REPORT)

Pyoderma gangrenosum in the 205
operative wound after caesarean The impact of cesarean delivery
section on immediate and short-term
outcome of late preterm infants
I. Žebeljan1, A. Cokan1, F. Mujezinović1, and P. Marko2
1
Department for Perinatolpogy, Clinic for Obstetrisc and Gynecology,
K. Ben Ameur, N. Neffeti, H. Ben Hamida, O. Maatouk,
University Clinical Center Maribor, Maribor, Slovenija and F.Z. Chioukh, and K. Monastiri
2
Dermatology Clinic, University Clinical Center Maribor, Maribor, Department of Neonatal Intensive Care, Teaching Hospital of
Slovenija Monastir, Faculty of Medicine of Monastir, Tunisia

Introduction: Pyoderma gangrenosum is a rare ulcerative cutaneous Introduction: To evaluate the immediate and short-time outcome of
disease. Diagnosis is based on symptoms, signs, disease progression the late preterm infants born after cesarean delivery resulting from a
and elimination of other causes. There are no typical histopathologic mono fetal pregnancy in a cephalic presentation.
or laboratory features. The etiology of the disease is poorly Materials and methods: One-year (2013) mono centric retrospective
understood. Lesions occur spontaneously, after surgery or after an study, comparing 2 populations of late preterm infants distributed by
injury. We present the case of a 23-year old patient with a skin mode of delivery in neonates born by vaginal birth and by cesarean
ulcerative lesion after caesarean section. The wound was not healing section. The comparison was made between the neonatal morbidities
properly despite standard care, surgical intervention and antibiotic and the medical assists until the end of the first hospitalization.
therapy. On 21. postoperative day pyoderma gangrenosum was Clinical cases and summary results: During the period of the study, 214
diagnosed and proper therapy with high doses of corticosteroids was neonates were compiled: 132 were born by vaginal delivery and 82 by
introduced. Early diagnosis and treatment of this disease is crucial in cesarean section. In this population, regardless the effect of possible
order to limit the spread of the disease and scarring. confounders, the impact of cesarean delivery was significant on
Clinical cases and summary results: 23-year old patient was admitted increasing the risk of having an Apgar score lower than 5 at the first
at 33 6/7 weeks of gestation. Emergency caesarean section for minute (ORa ¼ 5.3 p ¼ 0.008), developing a neonatal distress syn-
suspected abruption of placenta was performed. Perioperatively she drome (ORa ¼ 1.41 p ¼ 0.021), a transient tachypnea (ORa ¼ 1.96
received cefazolin 1g i.v. On day 3 Cefuroxim 500 mg/8h p.o. was p ¼ 0.011), requiring a neonatal intensive-care-unit admission
introduced. On day 7 wound developed periincisional erythema and (ORa ¼ 2.07 p ¼ 0.001) and having a length of hospital stay more
corner ulcerations. Severe wound pain was present. Ceftriaxone 2g i.v. than 10 days (ORa ¼ 5.76 p ¼ 0.008). In the two groups matched by
and Clindamycin 600 mg/8h i.v. were introduced. Inflammation, confounders, the newborns resulting from cesarean delivery had
violaceous coloured wound borders and serohemorrhagic discharge required more oxygen therapy and invasive ventilation (p=0.035) and
was observed. On day 14 plastic surgeon dehisced the wound. The had acquired feeding autonomy later than the others (1.5 days versus
wound expanded in a butterfly shape with granulation,necrotic tissue 1 day p=0.05)
and ulcerations at the borders with surrounding erythema. On day 21 Conclusion: The choice of delivery mode, in this context, should
pyoderma gangrenosum was diagosed and piperacillin with beta consider the risks associated with cesarean section.
lactamase and methylprednisolone 125 mg i.v./day was started.
Topical DiprogentaÕ gel and InadineÕ gaze was used. After
Keywords: Neonatology, neonate, late prematurity, delivery (proce-
72 hours the wound defect stabilized and the pain diminished.On
dure), cesarean
day 54 patient was discharged with decreasing doses of daily
methylprednisolone.
Conclusion: Pyoderma gangrenosum is a rare ulcerative cutaneous
disease best diagnosed by dermatologyst. Diagnosis is frequently
missed due to the rarity of the disease and is based on symptoms,
signs, progression and elimination of other causes. Early diagnosis
and treatment is crucial to limit the spread and scarring. Therapy
includes high doses of corticosteroids and antibiotics to prevent
secundary infection. 8 months after the surgery the wound was
completely healed with a large ‘‘parchment paper’’ scar.

Keywords: Pyoderma gangrenosum, cesarean section, wound, com-

plication, corticosteroids, cutaneous ulcers
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 81

225 282
Demographic features and preg-
Relationship between postpar-
nancy outcomes among women
tum women’s sexual self and
who undergone cesarean section
their sexual quality of life
without medical indication
N. Tugut1, G. Demirel2, and S. Karakus3
A. Bashiri, T Eshkoli, A. Y. Weintraub, Z. Yohay, 1
B. Aricha-Tamir, and D. Yohay Department of Nursing, Faculty of Health Sciences, Cumhuriyet
University, Sivas, Turkey, 2Department of Midwifery, Faculty of Health
Soroka Medical Center, Beer-Sheva, Israel Sciences, Cumhuriyet University, Sivas, Turkey, and 3Department of
Obstetrics and Gynecology, Faculty of Medicine, Cumhuriyet
Introduction: To identify demographic features and pregnancy University, Sivas, Turkey
outcome among women who undergone cesarean section without
medical indication. Introduction: Sexuality-related issues concerning the society in terms
Materials and methods: A retrospective study was conducted of the overall health rank the first among health problems which
including 48 women who gave birth by cesarean section without make people unhappy. The postpartum sex life is not addressed
medical indication (study group), compared to 48 women, randomly adequately within the scope of healthcare services given during
selected, who gave birth vaginally (control group). Deliveries occurred pregnancy and after childbirth. Women’s sexual self-schema has an
between the years 2009 and 2012 in a tertiary medical center. Using a effect on sexual intercourse, sexual stimulation, imaginary compe-
questionnaire and medical records, demographic characteristics and tence, emotions and sexual experience. Considering that most of the
pregnancy outcomes were compared between the two groups. studies conducted in Turkey have focused on sexual dysfunction, this
Clinical cases and summary results: Women who had cesarean section study is thought to contribute to the understanding of sexuality and
without medical indication are elder than those who delivered vaginaly sexual quality of life by investigating and evaluating the sexual self-
(34.0 ± 6.2 versus 29.2 ± 5). There was no statistical significance in schema concept.
pregnancy complications (Gestational Diabetes, Hypertension, Intra- Materials and methods: This cross-sectional study was conducted in
uterine growth retardation, polyhydramnios, oligohydramnios or order to determine the relationship between postpartum women’s
vaginal bleeding) between two research groups, accept higher Body sexual quality of life and their sexual self-schema. The study sample
mass index (29.4 ± 4.5 versus 26.7 ± 3.5) and longer hospitalization included 134 women who gave cesarean birth to the obstetrics clinic
(5.29 ± 1.6 versus 3.42 ± 1.1) in the study group. Likewise, there were no or outpatient clinic of Cumhuriyet University Health Services Research
statistical or clinical significance in pregnancy outcomes between the and Application Hospital between May 5 and November 5, 2014. To
two groups. Vacuum birth in the past rate higher in women who had collect the study data, the ‘‘Personal Information Form’’, ‘‘The Sexual
cesarean section without medical indication compared with women Quality of Life-Female (SQOL-F) questionnaire’’ and "Sexual Self-
who had vaginal delivery (25% versus 2.1%). Schema Scale" were used. The data were evaluated in the SPSS (22.0)
Conclusion: Women who had cesarean section without medical software package and tabulated through the use of averages,
indication are elder, with a high body mass, single or divorced and standard deviations, percentages, the two samples t test, the one-
with a high rate of vacuum births in their past. way analysis of variance. Statistical significance was examined at the
level of p 50.05.
Keywords: Cesarean section without medical indication, vaginal Clinical cases and summary results: The total mean score the
delivery, demogrphic characteristics, pregnancy outcomes participants obtained from the sexual self-schema scale was
133.29 ± 23.8. The mean scores they obtained from the subscales
were as follows: 50.23 ± 10.2 from the romantic/passionate subscale,
44.15 ± 11.5 from the embarrassed or conservative subscale and
38.89 ± 6.3 from the open/direct subscale. Their mean score for the
Sexual Quality of Life-Female (SQOL-F) questionnaire was
71.97 ± 12.98. There were statistically significant differences between
the mean scores the participants obtained from the SQOL-F
questionnaire in terms of their socio-demographic and obstetric
characteristics such as education, family type, etc. (p 50.05). There
were statistically significant differences between the mean scores the
participants obtained from the Sexual Self-Schema in terms of
the variables such as education, family type, and place of residence
(p 50.05). There was a low positive correlation between the
participants’ sexual quality of life and sexual self-schema.
Conclusion: The participating women’s sexual quality of life and
perception of sexual-self levels can be said to be moderate. Increased
perception of sexual self positively affects sexual quality of life. There
was a low, positive correlation between the participants’ sexual
quality of life and sexual self-schema.

Keywords: Postpartum period, sexual self, sexual quality, women

82 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

patients is divided in two subgroups: operated in weekend and

332 operated in weekdays.
Evaluation of complications and Clinical cases and summary results: If we will calculate the intravenous
liquids administered in two groups resulted to be increased with 28%.
risk factors for umbilical cord It is very important the difference between two groups in
administration of antibiotics that resulted 23 % higher in the group
prolapse, followed by cesarean operated in weekend compared with the other group operated in
weekdays. Oxytocin administration resulted to be 14 % higher in the
section weekend group of operated patients. Administration of analgesics is
increased by 9 % in weekend groups. The patients satisfaction was
M. Valadan, Z. Rezaee, M. Shariat, B. Ebrahim, and much more higher in weekdays compared with weekend because the
B. Sedighi frequency of midwives visits to the patients is lower in weekends as
well as blood pressure measured by midwives is in frequency
Tehran university of Medical Sciences, Tehran, Iran difference by 48 minutes. The same difference is for fever measure,
respiratory frequency and pulse rate. The hospital stay is higher in
Introduction: Considering the rarity of umbilical cord prolapse (UCP) weekend other than weekdays.
and lack of accurate data about the risk factors and health outcomes, Conclusion: Comparison between two groups operated in weekend
we aimed to evaluate cases of cesarean section (CS) due to UCP in and operated in weekdays shows differences in overtreatment and
order to reduce treatment costs and provide information about the lower attention for patients from their doctors and midwives. Days off
mortality and morbidity associated with this condition. influenced directly the consultations of operated patients. The
Materials and methods: Of 35 259 cases of CS performed in four individual treatment cost for the hospital will be increased in
hospitals during 2004–2012, 103 cases of UCP were selected as the weekend compared with weekdays.
case group, on the other hand, 318 cases without UCP were classified
as the control group. Information was extracted from patients’ Keywords: Cesarean section, post operation treatment, operation’s
records and analyzed by SPSS version 18. weekday
Clinical cases and summary results: Prevalence of UCP was estimated
at 0.2%. In the case group, cord prolapse in the active phase of labor
was reported 1.4 times (81% versus 57% — p 50.00), engagement
8 times (14% versus 2% — p 50.001), transverse presentation 8 times
(6% versus 2% — p 50.002), grand multiparity 3.9 times (4% versus
0 — p 50.001), oligohydramnios 4.7 times (5% versus 0 — p 50.0001, 401 (CASE REPORT)
and polyhydramnios 5.9 times (6% versus 0 — p 50.001). UCP was
more prevalent in post-term deliveries (p 50.043). One-minute Apgar Postpartum uterine rupture
score 57 was 3 times more prevalent in neonates of the case group
(p 50.00). Prepartum vaginal bleeding was 4 times more common in T. Esteves, A. Codorniz, A. Ramos, and F. Fernandes
the case group, compared to the control group, also, decreased fetal
movement and heart rate drop were more prevalent in the case Obstetric Dept, Hospital do Espı́rito Santo de Évora E.P.E.
group. Mortality rate was 5.2% in the case group and 1.7% in the
control group. Overall, the control group had a better general health Introduction: Uterine rupture in pregnancy is a rare and often
at discharge, compared to the case group. catastrophic complication in obstetrical practice. It occurs when the
Conclusion: A statistically significant correlation was detected integrity of the myometrial wall is compromised, and it can occur
between UCP and gestational age, active phase of labor, fetal during the last weeks of pregnancy, labor or delivery. More rarely it
presentation, engagement, parity, and amniotic fluid volume. can happen postpartum. One of the main predisposing factors for
uterine rupture is the scarring of the uterus due to a previous
Keywords: Complications, CS, risk factors, umbilical cord prolapse surgery, namely caesarean sections, but also labor augmentation
with oxytocin and/or prostaglandins. It can have serious complica-
tions not only to the baby (severe hypoxia, fetal demise) but also to
375 the mother — massive postpartum hemorrhage and death. A case
report with a uterine rupture after an elective cesarean section is
Differences of post caesarean described.
Clinical cases and summary results: A healthy 23 years-old women,
section treatment based on G4P3, with 3 previous cesarean sections, is admitted into the infirmary
at 27 weeks gestation with a placenta previa and uterine contractions.
operation’s weekday According to hospital protocol, she remains under surveillance and an
elective cesarean section is performed at 34 weeks. Intraoperatory,
R. Qirko1, A. Mile2, B. Benja3, and E. Koroveshi3 after placenta delivery, a prophylactic dose of oxytocin is adminis-
tered. Ten hours after surgery, the patient starts complaining of sharp
1
Obs & Gyn Department, University Hospital, University of Medicine abdominal pain. At examination, the uterus is contracted, but vaginal
in Tirana, 2Hygeia Hospital, Albania, and 3University Obstetrics & blood loss is higher than expected. The pain is resistant to medical
Gynecology Hospital ‘‘Queen Geraldine’’ therapy and keeps worsening, an ultrasound is performed, showing
free fluid in the abdomen. Suspecting a post-operative complication,
Introduction: It is important to attend the patients in post operation an emergency exploratory laparotomy is performed — after
period. The doctor is changing the treatment everyday based on aspiration of 500 ml of blood, an anterior uterine rupture is noted,
patients’ conditions. It is very important to reduce the treatment by 2 cm inferior of the cesarean hysterotomy. Due to the friability of the
days if the section cesarea is uncomplicated. Midwives are very myometrium, a repair could not be executed and so it was performed
important in the follow up process of uncomplicated section a subtotal hysterectomy. Her postoperative condition was stable.
caesarean. Conclusion: Due to the high increase in the number of cesarean
Materials and methods: We included in this study all uncomplicated section, associated complications (such as uterine rupture) will occur
section caesarean for the period Jan 2012 to Dec 2014 performed in more. The most common presentation of uterine rupture is
Tirana University ‘‘Queen Geraldine’’ Hospital. This group of operated intrapartum, but rupture can be diagnosed ante- or postpartum.
In the postpartum period, a clinical diagnosis is difficult and a high
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 83
index of suspicion is essential. In our patient, the identified risk
459
factors were multiparity, three previous cesarean sections and use of
oxytocin. Non-medical factors contributing
Keywords: Uterine rupture, multiple cesarean section to the probability of having an
unplanned caesarean section
C. Steeman1, S. Melman2, S. Kuijk3, J. Nijhuis1, and
H. Scheepers1
1
450 Gynecology Dept. Maastricht University Medical Centre, Maastricht,
Netherlands, 2Gynecology Dept. Zyuderland Hospital, Heerlen,
Assessing quality of care for Netherlands, and 3Epidemiology Dept. Maastricht University Medical
women having caesarean Centre, Maastricht, Netherlands

sections in a district general Introduction: Rising caesarean section (CS) rates can only partially be
explained by differences in maternal characteristics and socio-
hospital in the UK demographic factors. we hypothesized that non-medical factors,
times of ‘‘changing shifts’’ and the hours around midnight would lead
S. Islam and S. Bodnar to different decision making and an increased probability of having a
CS. this study was part of a larger study (simple study) on guideline
Department of Obstetrics and Gynaecology, University Hospital of adherence regarding cs care amongst 21 Dutch hospitals.
North Tees, Stockton-On-Tees, United Kingdom Materials and methods: Included for this analyses were nulliparous
women who had a non-planned CS or vaginal birth with singleton
Introduction: Caesarean section is major abdominal procedure. We vertex positioned foetus between 37 and 42 weeks gestation age. We
perform approximately 700 cases per year in our district general analyzed known medical risk factors for cs (bmi, age, length, ethnicity,
hospital which is about 20% of the total births. Like any procedure fetal weight, epidural, induction, non progressive dilatation and
there are risks and benefits. When it is indicated we need to ensure labour) and non-medical factors (teaching or non-teaching hospital,
clinical effectiveness, safety and maximise patient experience. We 24h availability of micro-blood testing, 24h availability of st-analysis,
standardise our perioperative care in comparison to national (NICE 24h availability of epidural, 24h availability of anesthesia, operation
clinical guideline132) and local guidelines. We completed an audit team in hospital 24h, free after duty, if the hospitals have cs audits
cycle regarding our caesarean section perioperative care in 2013 and and hour of birth). Hour of birth was subcategorized in three groups
2014. (‘‘09.00–10.00, 16.00–19.00’’ and ‘‘22.00–01.00’’ and the remaining
Materials and methods: In this audit and re-audit cycle, 50 cases were hours of the day). All were analyzed using logistic regression.
collected on two occasions, prospectively covering both emergency Clinical cases and summary results: From the original database of 2098
and elective caesarean sections over two sets period of 3 months in women, 708 women were eligible for inclusion. All the pre-set risk
2013 and 2014. We assessed following criteria: consenting, adminis- factors for caesarean birth (with exception of ethnicity) significantly
tering pre-incision antibiotics, completing a theatre WHO check list, contributed to the probability of having a CS. Most non-clinical
duration of hospital stays, thromboprophylaxis, patient and theatre factors did not contribute to the probability of having a CS. However,
team debriefing. in the hours during changing shifts and around midnight, the risk of
Clinical cases and summary results: We noted our good practice of having a cs is significantly higher, independent of medical risk factors
consenting in providing adequate verbal and written information for like labour induction, signs of fetal distress or progression.
women’s informed choice with 100% compliance to standards. Conclusion: In this study the non-clinical factors did not contribute to
Patients received pre- incision in 95% of elective caesarean section the probability of having a CS, suggesting increased availability of
(ELCS) and 93% emergency caesarean sections (EMCS) in 2013. In resources does not lower the risk. Nonetheless, time of day seems to
2014 100% patient had pre-incision antibiotics. VTE prophylaxis have a pronounced effect suggesting delaying or anticipating
improved from 86% and 89% to 96% and 93% respectively in ELCS behavior by individual caregivers. Currently, however, no clear
and EMCS. Most patients had early post-operative enhanced recommendations are available indicating when a CS is required for
discharge, only 8–9% patients stayed in the hospital for 3–4 days. A both unreassuring fetal condition and non-progressing labour.
culture of patient debriefing had been gradually developing from
only 0 to 5% in 2013 to 55–65% in 2014. Significant improvement was Keywords: Caesarean section, practice variation, non-clinical factors,
noted in theatre WHO check list completion, from 10% to 96% for decision making
ELCS and from 0 to 52% for EMCS. In both the years there was lack of
documental evidence of theatre team briefing which obviously needs
further attention. Though we tried to avoid verbal consenting, still
were happening in up to 12 to 15% of category 1 caesarean sections.
Conclusion: The audits demonstrated that with a dedicated multi-
disciplinary team approach and commitment it is possible to
consistently improve quality of perioperative care for women
having caesarean sections. Patient and staff debriefing are gradually
becoming part of our routine practice to ensure women are having
high satisfaction while going through a stressful life event and that
the caring team members also feel well engaged and satisfied for
their role and contribution.

Keywords: Caesarean section, quality

84 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

485 If a liquid diet was tolerated, a regular diet was permitted. If the
woman complained of uncomfortable symptoms sufficient to refuse
Risk factors for intolerance to any oral diet, feeding was withheld until the passage of first flatus and
return of bowel movements. We classified the subjects into 2 groups
early oral feeding after cesarean according to tolerance to early oral feeding: group 1, the good
section tolerance group, and group 2, the poor tolerance group.
Demographic characteristics and the incidence of postoperative
complications were examined.
H.J. Seol, J.Y. Park, and J. Chae Clinical cases and summary results: Of 364 women who underwent
cesarean section under regional anesthesia during the study period,
Dept. of Obstetrics & Gynecology, Kyung Hee University Hospital at 293 (80.5%) were prescribed early oral feeding after cesarean. Of
Gangdong, Seoul, Republic of Korea those, 277 (94.5%) were in good-tolerance group and 16 (5.5%) in the
poor-tolerance group. The most common symptoms in the poor-
Presenter: H.J. Seol tolerance group were abdominal distension (12/16) and nausea
(6/16). The two groups showed no significant differences in age,
Introduction: Cesarean section is one of the most common operations parity, gestational age at delivery, operative time, postoperative
worldwide and the rate is increasing globally. About 37% of pregnant hemoglobin change, or incidence of preterm delivery, twin preg-
women delivered by cesarean section in Korea in 2012. Early oral nancy, and maternal medical disease. Body mass index (BMI) in the
feeding after cesarean delivery has been reported to reduce hospital poor-tolerance group was higher than that in the good-tolerance
stay and the time to first breastfeeding by promoting the return of group (29.1±6.9 vs. 27.7±4.0, p=0.006), but there was no significant
bowel function without any additional complications, compared with difference in pre-pregnancy BMI between the groups. Indications for
conventional delayed feeding that withholds a diet until the passage cesarean section were not significantly different between the groups
of flatus or stool. Although randomized clinical trials showed no (Table 1). There were no postoperative complications in either group.
detrimental effect of early oral feeding after cesarean delivery, some Conclusion: Most women tolerated early oral feeding after cesarean
women experienced abdominal discomfort sufficient to refuse food. without any complications. BMI was higher in women in the poor-
The aim of this study was to analyze the characteristics of women tolerance group that in those in the good-tolerance group, but no risk
with intolerance to early oral feeding after cesarean delivery. factor for poor-tolerance to early oral feeding after cesarean section
Materials and methods: A retrospective chart review was performed was identified.
for women who underwent cesarean section under regional
anesthesia by one surgeon (H.J.S) from January 2009 to December Keywords: Cesarean section; early oral feeding
2015. Early oral feeding permitted sips of water within 6 hours post-
operatively, followed by liquid food on postoperative day 1 morning.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 85
pregnant women with one prior cesarean delivery of 12 de Octubre
504 hospital in the first trimester of 2016, to assess the performance of 3
Premature delivery-maternal statistical models already published in predicting successful VB in
patients attempting a trial of labor after one previous lower segment
complication in cesarean section cesarean section (TOLAC) in our population.
Materials and methods: Retrospective observational study of women
that underwent TOLAC; only singleton, vertex presentation, 37
D. Sokolović Curkovic1, A. Ćurković2, V. Soldo3, S. Babic2, weeks GA pregnancies with one previous CS were included. We
L. Nejkovic2, S. Jankovic Raznatovic3, N. Karadzobv Orlic4, applied 3 models of prediction of VBAC: The Smith et al.; The
S. MIhajlovic2, A. Radovanovic2, S Novakovic2, Grobman et al.; Troyer and Parisi’ model. The models use different
G. Radovanovic5, and K. Ikodinovic5 parameters to determine the chance of TOLAC success. Smith et al.
includes maternal age, height, previous vaginal births, sex of the
1
EUROMEDIK 2, Belgrade, Zemun, Serbia, 2G/O Clinic Narodni front, fetus, GA, and induction of labor. Grobman et al. registers the
Polyclinic dept. Belgrade Serbia, 3G/O Clinic Narodni front, Maternity maternal age, body mass index, ethnicity, prior vaginal delivery, and
and delivery dept. Belgrade Serbia, 4G/O Clinic Narodni front, High indication for the prior CS. Troyer and Parisi’ model uses a scoring
risk pregnancies dept. Belgrade Serbia, and 5Public Health Center system based on: prior CS indication, prior vaginal delivery;
Sabac, Serbia nonreassuring fetal heart tracing on admission; and induction of
labor in the current pregnancy.
Clinical cases and summary results: During the 1st trimester of 2016,
Presenter: Aleksandar Curkovic
we had 1040 deliveries, 110 (10,6%) of them in patients with prior CS.
Introduction: Premature delivery is one before 37 gestational weeks, Mode of delivery and indications are shown in Image 1. We excluded
with the MC between 28-35 days and accurate date of LMP. In our 5 preterm births (4 VB and 1 CS) and 1 antepartum stillbirth (VB) of
region it covers period up from 26 gw (or/and body mass of 1000 our analysis. The characteristics of the study population were: a mean
grams and more) (WHO 2003/07/13.). World population has a rate of maternal age of 34 years (min: 20, max: 46), mean height 158 cm (min:
12%, we 5-10% with yearly increase. Deliveries can be vaginal or CS. 147, max: 174), mean weight 68kg (min: 44, max: 100) and mean
Complications are frequent, with high risk ratio, both for mother and pregestational BMI of 26 (min:19, max: 38). The mean of birth weight
the neonate. with successful VB was 3.39 kg, (max: 4.13 kg); on the other hand the
Materials and methods: Investigate maternal complications, with CS in mean birth weight among the RCS was 3.44kg, (max: 4.26kg). Results
premature birth, and compare it with control group, Methodology of the application of the 3 different models are described in Table 1.
Two groups are formed-test and control. Test-premature CS birth Using the Smith model, 15 of our patients(18%) had high risk of CS of
patients in 2009/10.-310 of them. Control-CS term patients, same whom only 8 required emergency CS. According Grobman et al. 31
period, 100 of them. Groups had the same protocol operations, (37%) had high risk of CS, of whom 15 required CS. Troyer and Parisi
preoperative and postoperative care, according to the status and predicted 5 CS (6%), 3 of them (60%) really needed it. There was 1
preexisting conditions. All were statistically tested. uterine rupture (in a patient who underwent labor induction) and 3
Clinical cases and summary results: Age dispersion and the education newborns with 5 min Apgar score 57 in the TOLAC group. We had
level were the same. Test-latent period over 48 hrs with pPROM is also a perinatal death in a ERCS patient (fetal bradycardia on
significantly larger. Infective agents from urine and cervical smear- admission). The predicted rate of successful VBAC (including low and
very different. Number, severity and outcome of complications is moderate risk) using Smith et al. model was 81%; using Grobman
higher in test group. Hospitalization, blood and drug cost much et al. model: 62% and using Troyer and Parisi’ model 94%. The most
higher in tested. Test-17 reoperations, control-none. Test-two similar to our real rate (70.5%) was Smith model, although the rate of
hysterectomies. One fatality in tested, 3 days after reoperation. ‘‘false negative’’ was near to 50%.
Conclusion: CS is a method of choice in some cases, with limitation. Conclusion: 62 (70,5%) of the 88 patients who underwent TOLAC
Large number, severity and cost of maternal complications. achieved a successful vaginal delivery. That means a high chance of
Indications for CS are not always obstetric. Multidisciplinary approach VBAC with less complications and greater cost effectiveness than
needed in every case. Right decision in right time, adequate pre/ ERCS; hence those patients must be counseled to attempt vaginal
postoperative care, operative technique, can lower the bad maternal birth. Even with unfavorable characteristics, TOLAC can be allowed on
outcome. Eradication-still very far away. maternal request.
There’s no perfect predictive model, but they can be useful to
Keywords: Cesarean section, premature birth, maternal, encourage women who have doubts about the route of delivery after
complications a previous cesarean section.
Keywords: Vaginal birth after cesarean section; trial of labor;
predictive models
549
Validation of vbac predictive
models
A. Coves1, P. Barbero2, A. Villalba3, V. Iglesias4,
C. Bellido5, I. Mejı́a6and A. Bartolomé7
1-6 Hospital 12 de Octubre, Madrid, Spain

Presenter: I. Mejı́a
Introduction: In the last 2 decades the rates of cesarean section (CS)
have seen a steady rise in developed countries without improving
perinatal outcomes. A useful strategy addressed to reduce rising CS
rates is encouraging women with a prior CS to attempt vaginal birth
(VB) instead of elective repeated cesarean section (ERCS) in
subsequent pregnancies. A retrospective observational study of the
86 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

cesarean section (APCS) may be an option for an atraumatic delivery

599 where the baby is delivered within the intact membranes.
Amnion protective cesarean sec- Materials and methods: Between January 2015 and April 2016
inclusive, there were 36 livebirths at or beyond 22 weeks of
tion: an atraumatic mode of gestational age weighing less than 1500g in our institution. Out of
those 36, 4 babies were delivered by APCS, the outcomes of which
delivery for very low birth weight were retrospectively evaluated.
Clinical cases and summary results: The 4 pregnancies undergoing
infants APCS were complicated either by severe preeclampsia or severe
superimposed preeclampsia. The gestational ages at delivery ranged
F. F. Yanik1, N. Sahin Uysal1, C. Gulumser1, Deniz Anuk between 24 and 29 weeks and birth weights ranged between 585 and
Ince2, O. Turan2, and A. Ecevit2 1000g, where 2 of the babies were growth restricted. Two babies
presented with breech. All of the 4 deliveries were atraumatic with
1
Obstetrics and Gynecology Department, Division of Perinatology, APCS. APGAR scores of the babies were 2,7,9 and 9 at 5 minutes after
Baskent University Faculty of Medicine, Ankara, TURKEY and birth and arterial pH values were 6.55, 7.19, 7.27 and 7.39 respectively.
2
Pediatric Department, Division of Neonatology, Baskent University One of them died 2 hours after birth and one other developed
Faculty of Medicine, Ankara, TURKEY pneumothorax on the postpartum 3rd day and died on the
postpartum 9th day. The one weighing 585g at birth is alive now
on the postpartum 18th day and the one weighing 1000g at birth has
Presenter: Filiz F. YANIK
been discharged from the neonatal intensive care unit on the
Introduction: Cesarean section (CS) is the preferred mode of delivery postpartum 56th day. These two babies had no evidence of
for malpresenting preterm very low birth weight (VLBW) neonates in intracranial bleeding or neurologic deficit until now.
many centers, but this is controversial for the vertex-presenting ones. Conclusion: APCS may be a good option for the delivery of VLBW
When there is preterm labor with or without rupture of the infants when there is no labor and membranes are intact but delivery
membranes, most singleton vertex-presenting VLBW infants are is necessary for fetal or maternal indications.
delivered vaginally unless there is evidence of fetal distress.
Keywords: Amnion protective cesarean section, Very low birth
However CS may be preferred in some conditions such as
weight
preeclampsia or fetal growth restriction, when delivery is necessary
although there is no labor. In such circumstances, amnion protective
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 87
Introduction: Uterine rupture is one of the most serious obstetric
complications due to its high morbidity and maternal mortality. Most
cases in high income countries are associated with an attempted of
vaginal birth after a previous cesarean. The aim of the study was to
review uterine rupture cases occurred during the last eleven years
after a trial of labor, to determine its incidence, risk factors and
maternal and fetal results.
Materials and methods: We have conducted a retrospective cohort
study between January 2005 and December 2015 in the Department
of Obstetrics and Gynecology of the University Hospital Fundación
Alcorcón in Madrid Spain. We have included all pregnant women with
history of a previous cesarean section and who had not contra-
indication for a vaginal delivery. A Trial of labor after cesarean
(TOLAC) was offered to this group. A systematic review of the
electronical medical records was performed, evaluating the risk
factors described in the literature, maternal complications and
neonatal outcomes. 1392 women with history of a previous cesarean
were attended during this period. 1074 pregnant women attempted a
vaginal delivery.
Clinical cases and summary results: 10 uterine rupture (UR) were
registered in the TOLAC group, representing an incidence of 0.93%.
No UR occurred in those women (318) requesting a repeat Caesarean.
The average age was 34.4 years; 8 cases (80%) were non-European. 6
were women in their second pregnancy and 4 cases had history of a
previous vaginal delivery. In 100% of cases the period between the
first cesarean section and the uterine rupture was greater than 24
642 months. Four cases (40%) occurred after labor induction, accounting
Uterine rupture during trial of for the 1.17% of all women requiring induction in the TOLAC group.
Regarding the perinatal outcomes, we reported a case of neonatal
labor after cesarea section: our 11 death, no cases with five minutes Apgar score 57, and a case with
umbilcal cord pH 57.01. Three patients needed deep resuscitation
year experience in a single center maneuvers and no infants required admission to the neonatal
intensive care unit. Among the related maternal complications, we
had an obstetric histerectomy, 2 women need blood transfusion and
C. Cabrera, PH. Crispin, Z. Luengo, C. León, AM. Ortega, 2 bladder injuries were repaired.
and MB. Adiego Conclusion: UR incidence found in our study was similar to that
described in the literature. In our series, it did not appear to have a
Obstetric & Gynecology Deparment, University Hospital Fundación
significant influence, the intergenesic period or the antecedent of a
Alcorcón, Madrid, Spain
prior vaginal delivery. Although been uterine rupture a very serious
complication after cesarean delivery, we have recorded good
Presenter: Cesar Cabrera perinatal outcomes with 9 healthy newborn, except one case of
88 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

neonatal death (in the group of 1392 women). No cases of maternal 2

Department of Obstetrics and Gynecology ‘‘St. Pantelimon’’, Clinical
death occurred. Emergency Hospital ‘‘St. Pantelimon’’ Bucharest, Romania
Keywords: Uterine rupture, cesarean section
Presenter: Ina Popescu
Introduction: We are witness to modern obstetrics, a prophylactic one,
in which the c-section is not only a way to prevent dystocia, but also
645 an important - widely used - practice to prevent it (asit is natural). The
Evaluation of the uterine niche c-section is becoming the prevalent way of giving birth, gaining the
support of the patients and also the obstetricians. This tendency is
also a repercussion to an increasing number of uterine scars and also
C. Olaru, F. Olaru, A. Corpade, S. Balta, and A. Purv of c-sections performed on uterine scars. In the following articlewe
will try to evaluate this occurrence rationally by numbers.
Obstetrics and Gynecology Department, City Emergency Hospital
Materials and methods: We gathered data from our birth registers and
Timisoara, Romania made up a database of all declared births in the year 2014 in 3
maternities, where the authors work. We proceeded to a statistical
Presenter: Constantin Olaru analysis of the data together with data from the ‘‘Directory of Health
Statistics’’ from the National Heath Institute, National Center of
Introduction: The proportion of delivery through cesarean section has
Statistics and Informatics in Public Health, Ministry of Health,
reached over 30% in most countries in the last decade. One of the
Bucharest, 2014.
long-term side-effects is the uterine scar defect (also known as uterine
Clinical cases and summary results: We notice the obvious accelerated
niche or isthmocele) with the following symptoms: dysmenorrhea,
rise of the number of c-sections performed in Bucharest from 58.33%
intermenstrual bleeding and uterine rupture in a future pregnancy.
in 2009 to 74.52% in 2013. The capital city of Romania being also its
Materials and methods: Lately, the interest in evaluating the uterine
largest Academic city has registered something similar to a ‘‘liberal-
scar is growing, specifically using ultrasound and hysteroscopy.
ization’’ of performing the c-section, although the total number of
There are few studies concerning risk factors and presence or severity
births has decreased steadily. The c-section index from our study
of the niche, but treatment of the isthmocele is of great interest.
group (gathered from three maternities in 2014) is 70.10%, of which
Currently it is being analyzed what surgical technique would be best
20.09% represent uterine scars from the total number of c-sections;
for repairing this defect.
and 14.08% represent the uterine scars from the total number of
Clinical cases and summary results: We have identified 10 cases of
births.
uterine niche after cesarean section, using transvaginal ultrasono-
Conclusion: The rate of complications associated with previous uterine
graphy and in 2 cases we performed diagnostic hysteroscopy. In all
scars and the c-section is above the cited levels (we only had one case
cases the thickness of the uterine wall at the scar site was 2.5-3 mm.
of morbidly adherent placenta of 2480 births and no cases of uterine
Conclusion: The study of consequences and benefits of surgery for
rupture associated with previous uterine scars and c-section (400
isthmocele is early stage, and until management conclusions are
patients) of the total of 2840 births).
being established, all cases must be followed-up.
Keywords: C-section, uterine scar
Keywords: Uterine niche, isthmocele, hysteroscopy, vaginal
ultrasound

662
Subsequent cesarian delivery in
adolescents
C. Moisei1, R. M. Sima1,2, A.D. Stanescu1,2, L. Ples1,2, and
I. Sosievici2
1
The ‘‘Carol Davila’’ University of Medicine and Pharmacy, Bucharest
and 2‘‘Bucur’’ Maternity, ‘‘St. John’’ Hospital, Bucharest, Romania

Presenter: R. M. SIMA
Introduction: Cesarean delivery rate is increasing worldwide lately,
supposed to be the result of changes in medical conditions. Cesarean
deliveries are categorized as primary or subsequent (ie, after a
previous cesarean birth). Cesarean delivery is performed when the
clinician and/or patient believe that abdominal delivery is likely to
provide a better maternal and/or fetal outcome than vaginal delivery.
Indications for cesarean delivery fall into two general categories:
651
‘‘medically/obstetrically indicated’’ or ‘‘on maternal request.’’ The
C- Section on uterine scar - three most common indications for primary cesarean delivery in the
United States account for almost 80 percent of these deliveries: failure
modern trends to progress during labor (35%), nonreassuring fetal status (24%) and
fetal malpresentation (19%).
Materials and methods: We performed a retrospective study in ‘‘Bucur’’
M. Dimitriu1, I. Târcomnicu2, I. Popescu2, M. Bănacu1, Maternity. It included the evaluation of deliveries between 1 January
D. Călin2, and C. Ionescu1 2015 and 31 December 2015. We focused mostly on Cesarean
1
University of Medicine and Pharmacy, ‘‘Carol Davila’’ Bucharest, deliveries. The main idea was to identity the Cesarean sections in
adolescents. We focused in this study on a particular condition in
Department of Obstetrics and Gynecology ‘‘St. Pantelimon’’, Clinical
adolescent pregnancies with second Cesarean section. We observed
Emergency Hospital ‘‘St. Pantelimon’’ Bucharest, Romania and
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 89
the maternal age, the gestational age of delivery, the maternal due to uterine inertia. We always performed total hysterectomy and,
pathology or addictive behavior and fetal outcome. The infectious in half of the cases, hypogastric artery ligature. There have been 3
maternal pathology was considered important for our study, as well maternal deaths, 11 stillbirths and 9 early neonatal deaths. In our
as drug abuse during pregnancy. We followed the patients in territory, before the year 2000 the incidence of cesarean section was
postpartum period regarding uneventful outcome. We noted also still a decent one, which is no longer the case today. Perinatal
ethical aspects related mainly to the age of the women and their hysterectomy was, in those circumstances, a rare operation, even that
socio-economical-educational status. the medical resources were limited compared with the present time.
Clinical cases and summary results: The number of deliveries in our Conclusion: Any cesarean section is a risky situation, exposing the
unit in 2015 was 1983 and the number of living new-born was 1996. woman in the future to the eventuality of emergency hysterectomy.
This difference is justified by twin pregnancies and new-born transfers Young doctors must be trained to respect the art of obstetrics, to
from other medical units. The total number of Cesarean sections was practice the obstetrical maneuvers, to limit as possible the indication
1129 (56.93% from total deliveries) with 354 subsequent Cesarean of c-section when not absolutely needed, to remember that anytime
sections (31.35%). The teen pregnancies referred to our hospital was an elective c-section may complicate and get to hysterectomy. They
654 (32.98%) and 325 (28.78%) adolescents delivered by Cesarean should realize that is not sufficient to know to perform a c-section but
section. Among those, 128 (39.38%) were subsequent Cesarean a hysterectomy in emergency also.
sections. We observed that maternal infectious pathology wasn’t
more frequent in adolescent mothers than adult women.The maternal Keywords: Perinatal hysterectomy, emergency hysterectomy, cesar-
abandon occurred more often in adolescent mothers. Drug abuse ean section
appeared to be more frequent during pregnancies of teen mothers
and it is also a concern. The hospital stay didn’t correlate with the
adolescent period. Neonatal outcome didn’t seem to be influenced by
683
maternal age, the only important factor was the gestational age of
delivery. Deliveries by robson system clas-
Conclusion: In 2015 the rate of Cesarean was very high section, most
women delivering by C section. The teen pregnancies are a sification of ceasarean sections
worldwide issue dueing to social, medical, economic and psycholo-
gical aspects. This is also a social challenge in Romania. In our unit and the level of perinatal care in
teen pregnancies were finalized mainly by C section which provide
and additional risk factor for subsequent C section. Morbidity and
five obstetric hospitals in warsaw
mortality among women and new-born is thus seriously increased
and also the costs of healthcare. M. Troszynski, K. Szamotulska, and T. Maciejewski
Institute of Mother and Child, Warsaw, Poland

674 Presenter: K. Szamotulska

Perinatal hysterectomy in later Introduction: In Poland, caesarean section (CS) rate is high and it was
42,3% in 2014. The rates do not express expected differentiation by
decades: trends and implications the level of care and they range from 40,7% at the 1st level and 39,1%
at the 2nd level to 48.3% at the 3rd level. We conducted a pilot study
L. Strat to better understand the reasons of almost uniform distribution of CS
rates by the level of care. We looked for differences in the structure of
Obstetrics and Gynecology Dept., University of Medicine and the populations at risk and risk-group specific CS rates by the level of
Pharmacy of Iaşi, Iaşi, Romania, Clinical Hospital of Obstetrics and care.
Gyunecology Iaşi Materials and methods: Data from 5 Warsaw hospitals (14462 cases,
that is 48.4% of all births in Warsaw in 2012) were used. Deliveries
Presenter: L. Strat were classified according to the level of prenatal care and 10 groups
of Robson classification. The relative size of the groups, groups-
Introduction: Perinatal hysterectomy is a drama in obstetrics, as being specific CS rates and their contribution to the overall CS rate were
motivated very often by conditions that represent a life-threatening calculated by the level of care. In statistical analysis a chi-square test
matter and needing an emergency intervention of a complex medical was used.
team. As reported in the literature, the incidence of emergency Clinical cases and summary results: In studied hospitals, the overall
peripartum hysterectomy varies from 0.25 in 1000 deliveries in caesarean section rate was 34.6%: 42.4% vs. 29.0% at the tertiary and
Western and Northern Europe countries to 2.5 in 1000 deliveries in secondary level, respectively (p50.001). The higher CS rate at the
USA. In the last three decades, in our territory its incidence raised, due tertiary in comparison to the secondary level results from higher
to a lot of changes in this period. incidence of CS in primiparas (group 1 + 2 together: 38.9% vs 27.3%,
Materials and methods: We analyze the incidence and the motivations p50.001) and multiparas without previous CS (group 3 + 4: 16.3% vs
of perinatal hysterectomy in our service (which is a wide-territory 7.4%, p50.001). Also a higher contribution of preterm deliveries and
covering), in an interval of time of 25 years (1991-2015) following the groups in which CS are especially often performed (groups 5-10:
political regime change in Romania. The total number of deliveries 30.4% vs 16.9%, p50.001) is responsible for the higher CS rate at the
was of 82033 cases and the number per year varied narrowly around tertiary level. High CS rates in groups 5-10 did not differ between the
3000 (between 2991 and 3516). On the other side, the annual 2nd and the 3rd level of care, except in case of preterm deliveries. The
incidence of the cesarean section raised continuously and varied rates in preterm deliveries (group 10) were 47.6 i 37.4% (p=0.003),
significantly from 16.22% in 1991 to the highest value of 46.63% in respectively.
2013. Conclusion: The necessary condition for lowering caesarean section
Clinical cases and summary results: The perinatal hysterectomy had rates, is a common language among clinicians. Robson system brings
been performed in 85 cases, representing 1.03 in 1000 deliveries. It a common platform for auditing CS and making comparative analyses
must be said that the large majority of cases in our study (66 from 85) of CS rates between levels of care, hospitals and in time. It should be
have been reported after the year 2000, concomitant with an widely applied in Polish healthcare.
important raise of the cesarean incidence. The main indications for
hysterectomy were uterine apoplexy, ruptured uterus after previous
c-section, abnormal adherent placenta, uncontrollably hemorrhage
90 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Materials and methods: We analyzed all the women with a previous

687 cesarean section who had birth in University Hospital Fundación
Birth delivery after successful Alcorcón in Madrid, Spain between 2005 and 2015. In this study we
analyse the wome’s choice of delivery route after a previous cesarean
external cephalic version of section and the resulting route of delivery in women who chose a trial
of vaginal birth. Information was collected from medical electrónical
breech presentation at term records.
Clinical cases and summary results: 21303 births have been attended in
our center during 2005-2015; 1654 with history of one or more
L. Bonilla, S. Copado, J.M. Puerta, M.C. Diaz, cesarean sections. 15.4% (255 women) had an obstetric indication to
V. Di Girolamo, and A. Puertas deliver by caesarean (fetal malpresentation, Iterative cesarean section,
medical condition, etc.). Subtracting this group, and a small group
Obstetrician Dept., Hospital Materno Infantil de Granada, Granada
with fetal malformations, 1392 women were offered the choice
between trying a vaginal delivery or a repeat cesarean. In the group
Presenter: Alberto Puertas Prieto of 1392 women, 318 (22,84%) chose planned cesarean section, while
1074 (77,16%) chose trial of vaginal birth. From those who chose trial
Introduction: The purpose of this study was to evaluate the rate and
of labor: 818 (76,16%) had a vaginal birth (122 operative vaginal
indications of birth delivery after a successful external cephalic
deliveries) and 256 (23,84%) needed a second cesarean section.
version (ECV)
Women with a previous cesarean due non-vertex presentation had
Materials and methods: A retrospective study was performed from
greater probability of having a vaginal birth, with an 83% success, OR
patients who where delivered in our hospital (Hospital Materno
1,7(1.2-2,5, p50,01). Women with a first cesarean for arrest of dilation
Infantil, Granada) between 2010 and 2016. We revise 137 clinical
or descent had the lowest success with a 70% of vaginal births (OR 0,5
histories from women who where underwent a ECV and we separate
(0,4-0,7) p50,05).
the outcomes in two groups: successful and unsuccessful external
Conclusion: Our statistics are comparable to the literature, which
cephalic version
refers 60-80% of vaginal birth resulting of trial of labor after cesarean
Clinical cases and summary results: A total of 132 patients were
section. Women who achived VBAC were more likely to be younger,
included in this study. The percentage of successful ECV was 40%.
with a parity 3 or more and with a previous cesarean due to fetal
Among successful external cephalic versions, the onset of labor were
malpresentation.
spontaneous in 33 of the cases, this represent the 63%. The rate of
induction deliveries were 37%, the causes of the induction were in Keywords: Cesarean section, trial of labour
most cases (37%) due to a postterm pregnancy, the rest of the labor
induction were because of premature rupture of the fetal mem-
branes, meconium-stained amniotic fluid, Bishop score 4 7, among
others. Patients with successful ECV were more likely to have a
successful vaginal delivery, the 64% were normal labor, the 23% were
operative deliveries. The rate of cesarean delivery after a successful
external cephalic version was 13%. Patients with successful ECV were
more likely to have a cesarean delivery cause to fetal distress.
Conclusion: Most of successful ECV conclude in spontaneous and
normal deliveries. The main cause to indicate a cesarean delivery in
our study is fetal distress, although some studies conclude that the
rate of cesarean delivery for dystocia is increased after a successful
trial of ECV. We found that patients with a successful ECV have lower
rates of cesarean delivery than normal deliveries at term, considering
a baseline cesarean delivery rate of 20% in our hospital
Keywords: External cephalic version = ECV

699
718
Delivery rout after cesarean Perinatal results and maternal
section: our results 2005-2015 morbidity in women with a pre-
P.H. Crispı́n-Milart, L. Frı́as-Aldeguer, I. Fares Bejarano, vious cesarean section
D. Cerdeira-San Miguel, Z. Luengo-Fernández, and
B. Adiego-Burgos Z. Luengo-Fernández, P. Crispı́n-Milart, C. León-Rivera,
C. Cabrera-Coca, D. Cerdeira-San Miguel, and
Obstetric & Gynecology Department, University Hospital Fundación
Alcorcón, Madrid, Spain.
M.B. Adiego Burgos
Obstetric & Gynecology Department, University Hospital Fundación
Presenter: Patricia Crispı́n-Milart Alcorcón, Madrid, Spain.
Introduction: Caesarean is one of the most common surgeries
worldwide, with rates in some countries over 30% of deliveries, Presenter: Zenia Luengo-Fernández
therefore the importance of the obstetric future of the patients Introduction: The aim of our study was to stablish the differences
submitted to a first caesarean. According to Spanish Society of among the perinatal outcomes and the maternal complications in
Ginecology and Obstetric guideline, in our center every pregnant those women who gave birth by planned cesarean section or trial of
woman with a previous cesarean section is offered the choice among vaginal birth after a previous cesarean. We presented our data in a
trial of vaginal birth or planned cesarean section, in the abscence of single center during years 2005-2015, after 21303 deliveries attended.
any factors against it.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 91
Materials and methods: During this eleven years, 1392 women with a giant myoma and 14 + 1 weeks pregnancy. The myoma grew quickly
previous cesarean section were offered to choice their route of growing arriving to mesure 14x14 cm during the pregnancy (she had
delivery. 1074 (77,16%) women chose trial of labor after cesarean a normal ultrasound five moths before), and the patient refered pain
(TOLAC) and 318 (22,84%) chose a elective repeated cesarean delivery and breathing difficulties, especially in supine. She did not suffer
(ERCD). Data about perinatal outcomes (Apgar Score, Umbilical cord constipation or urinary problems. Her blood test did not show any
pH, neonatal resuscitation maneuvers, ICU admission) and maternal anomally. Tumoral markers were negative. We decided the admission
complication (uterine rupture, hysterectomy, transfusion, uterine of the patient and arranging a laparotomic myomectomy inmediately.
atony, uterus laceration, wound infection, bladder injury) were The myomectomy was performed without incidents. The pregnacy
obteined. We perfomed an intention to treat analysis. arrives to term, and then a cesarean was performed, getting a 2750 g
Clinical cases and summary results: Perinatal Outcomes: 1 neonatal newborn. Any dehicence in the myometrium was observed.
death case occurred in the TOLAC group. 5 minutes Apgar score 57 Conclusion: A succes pregnancy a term is possible after a laparotomic
was more frequent in the TOLAC group (5 cases vs 0 cases). Deep myomectomy in our centre.
resuscitation maneuvers were more necessary in the TOLAC group
(9,49% vs 2,2%, RR 4,6, 95% CI 2-11 p50,05). No differences in Keywords: Myomectomy, pregnancy
umbilical artery pH 5 7,01 (1,67% TOLAC group vs 0,94% in the ERCD
group, (RR 1,79, 95% CI 0,5-7,6) neither in pH 5 7,10 (RR 1,1, 95% CI
0,5-2,25) were found; nor difference in ICU admisión rates (1 case in
each group). 760
Maternal complications: During the last eleven years, as severe
complications in the TOLAC group we have had 10 uterine ruptures
Why do we run in emergency
(0.93%) and 3 obstetrical hysterectomies (0.27%). No cases occurred in
the group of ERCD. Maternal complications are presented in the table.
cesarean sections?
The low rate of maternal complications does not allow statistical
analysis. I. Garcia-Ruiz, L. Gomila, A. Suy, and E. Carreras
Conclusion: Although deep neonatal resuscitation maneuvers were
Obstetrics Dept., Vall D’Hebron Hospital, Barcelona, Spain
more necessary in the TOLAC group, no difference were found in the
umbilical cord pH results. Unfortunately, we have to report a neonatal
death case after 1074 trials. Severe maternal complications were Introduction: There are a number of obstetric complications in which a
associated with a a failed trial of labor, but with very low rates. Given ‘‘crash’’ emergency cesarean section is necessary to save the fetus or
the good neonatal outcomes and the very low rates of maternal the mother.
complications, vaginal delivery after cesarean section is our recom- Materials and methods: We analyzed prospectively collected singleton
mendation for both mother and newborn. maternal and neonatal data of all emergency cesarean deliveries
performed in Vall D’Hebron Hospital, Barcelona, from January 1 to
December 31, 2015. The objective of the study was to determine the
rate and clinical indications for emergency caesarean sections.
Clinical cases and summary results: 240 emergency cesarean sections
were performed, representing 8.73% of all deliveries and one in three
cesareans. In pregnancies from 24 to 29 weeks of gestation, the main
reasons for emergency cesarean sections are: placental abruption (7/
20) and non reassuring fetal status in the context of chorioamnionitis
(4/20). 188 cesarean sections were performed in pregnancies between
35 and 42 weeks. 68 were women in spontaneous labor (36.17%); and
112 were induction of labor (60.1%). There were 4 cases of umbilical
cord prolapse; and 4 cases due to uterine rupture. The main reason
for emergency cesarean delivery was fetal distress (95.74%), which
includes from suspicious cardiotocography tracing to scalp pH 57.20.
Analyzing neonatal weight we identified 31 cases (17.22%) of fetal
growth restriction not detected antenatally.
722 Conclusion: Emergency cesarean section is performed to save the
Myomectomy of a huge myoma pregnant woman or the fetus at risk. The main indication for
emergency cesarean section is fetal distress. Iatrogenic procedures
in pregnancy and delivery at term during labor or misdiagnosis of fetal growth restriction, are
preventable causes of fetal distress and emergency cesarean section.
V. Serrano de la Cruz Delgado, C. Signes Pons, Keywords: Emergency, cesarean, section
L. Giménez Roca, J. Dası́ Carrasco, VJ Diago Almela,
J. Monleón Sancho, and A. Perales Marı́n
Dept Obstetrics and Gynecology HUP LA FE Valencia Spain

Presenter: Verónica Serrano de la Cruz Delgado

Introduction: Uterine myomes are the most common pelvic tumor in
women during their reproductive life. In pregnancy they are
associated with preterm birth. Althought there are a lot of different
treatments available, during pregnancy our possibilities are really
reduced. We report the case of a 31 years old woman who attended
our centre due to a giant myoma and 14 + 1 weeks pregnancy.
Materials and methods: We report the case of a pregnant with uterine
myomes followed in our centre in 2015.
Clinical cases and summary results: We report the case of a 31 years
old woman who attended our centre in September 2015 due to a
92 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Conclusion: The preliminary results of this study demonstrated that

762 750 cc, the level of Class I hemorrhage according to American College
What is the threshold blood loss of Surgeons, could be a threshold level for postpartum hemorrhage
following to cesarean section in which minimal physiological changes
level for postpartum hemorrhage expected to occur.

following to cesarean section? Keywords: Blood Loss, Cesarean Section, Postpartum Hemorrhage,
Transfusion

S. Bodur1, K.E. Karasahin1, U. Savasci2, M.F. Kinci1,

M.A. Babayigit3, U. Keskin1, U. Fidan1, and A.I. Saygi1
772
1
Gulhane Military Medical Academy, Department of Obstetrics and
Gynecology, Ankara, Turkey, 2Gulhane Military Medical Academy,
External uterine compression by
Department of Infectious Diseases and Clinical Microbiology, Ankara, elastic bandage as a method of
Turkey, and 3Gulhane Military Medical Academy, Department of
Public and Environmental Health, Ankara, Turkey hemostasis in severe postpartum
Introduction: The exact definition of postpartum hemorrhage (PPH)
hemorrhage
following to cesarean section is not defined yet. The guidelines used
different definitions for primary PPH. While the American College of A. Mikhailov, V. Shman, N. Derzhavina, and S. Nalivaiko
Obstetrician and Gynecologists practice bulletin defines PPH
41000 mL for cesarean delivery, the Royal Australian and New Maternity Clinic #17, Mechnikov NW State Medical University,
Zealand College of Obstetricians and Gynecologists guideline defines St.-Petersburg, Russia
PPH as 4500 mL during puerperium and classifies severe PPH as
blood loss of 41000 mL. The Royal College of Obstetrician and Introduction: Postpartum hemorrhage due to uterine atony or
Gynecologists guideline divides PPH into 3 categories: minor (500 mL extensive trauma of birth canal after vaginal or during cesarean
to 1 L), moderate major (41 L to 2 L), or severe major (42 L). delivery leading to hypovolemic shock and coagulopathy is main
This study was conducted to analyze cesarean sections to distinguish killer in obstetrical practice. There are steps between active manage-
a threshold blood loss level for defining PPH following to cesarean ment of third period of labour and hysterectomy as a final step of
section. bleeding cessation. A final result in postpartum hemorrhage strongly
Materials and methods: A total of 301 low risk pregnancies underwent depends on to timeliness of the taken measures that should be
to cesarean section were enrolled to the study. The estimated blood appropriate to the volume and speed of blood loss. A consequence of
loss level was calculated based on a standard formula as described by delays and incorrect decisions could lead to clinical disaster.
Papovic et al. The patients needed blood transfusion was compared Clinical cases and summary results: External uterine compression by
with uncomplicated cases. Further clinical features associated with elastic bandage (EUCEB) applied as a step of atonic postpartum
increased blood loss were assessed by the help of logistic regression hemorrhage in 17 cases, 16 - as a step of surgical hemostasis after
analysis. Cesarean delivery, in one case after vaginal delivery. Indication for
Clinical cases and summary results: The mean estimated blood loss EUCEB was uterine atony and continuation of bleeding despite of
was found to be around 800cc and 350cc in cases with and without uterotonic agents intravascular administration. Starting blood loss
transfusion, respectively. Increased number of gravidity and general volume in EUCEB were from 850 to 1000 ml. EUCEB exposition time
anesthesia were found to be associated with increased blood loss and varied from 30 to 140 min. In 10 cases EUCEB was the only method of
increased odds of having transfusion. surgical hemostasis. From 7 cases EUCEB application were completed
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 93
by B-Linch suture in 3, bilateral uterine and ovarian arteries ligation in
3 and ligation of arteries iliaca interna in 1. Average final blood loss 040
volume was 1816 ml (930 - 3550). Hysterectomy was not needed in
any cases.
Prenatal diagnosis and types of
Conclusion: External uterine compression by elastic bandage is a
simple and inexpensive method of hemostasis in severe postpartum
structural congenital malforma-
hemorrhage. EUCEB could be only the final method of surgical tions in diabetic pregnancy - a
hemostasis or provide additional time possibilities for appropriate
organization of other surgical steps for bleeding cessation. tertiary multicentric study
C. Berceanu1, S. Vlădăreanu2, E. Brătilă3, M. M. Cı̂rstoiu3,
DIABESITY - 020 V. Gheorman4, C. Mehedinţu3, R. Ciortea5,
D. Comandaşu3, and S. Berceanu1
Recurrent stillbirth in diabetic 1
Department of Obstetrics-Gynaecology, University of Medicine and
pregnancy - are there any lessons Pharmacy of Craiova, Romania, 2Department of Neonatology, ‘‘Carol
to be learned? Davila’’ University of Medicine and Pharmacy, Bucharest, Romania,
3
Department of Obstetrics-Gynaecology, ‘‘Carol Davila’’ University of
Medicine and Pharmacy, Bucharest, Romania, 4Department of
B. I. Stefanescu1,2, M. Bratu1, and M. R. Stefanescu2 Psychiatry, University of Medicine and Pharmacy of Craiova,
1
Obstetrics and Gynecology Department, Clinical Hospital Romania, and 5Department of Obstetrics-Gynaecology, ‘‘Iuliu
‘‘St. Andrew’’ Galati, Romania and 2University ‘‘Dunarea de Jos’’ Haţieganu’’ University of Medicine and Pharmacy, Cluj-Napoca,
Galati, Faculty of Medicine Romania

Introduction: Pre-existing diabetes is associated with an almost 5 Introduction: It is widely recognized that the incidence of congenital
times increase of stillbirth rate and about 2 times increase of neonatal malformations in pregnancies complicated by Type I-pregestational
death rate compared with women who did not have this condition. insulin-dependent diabetes, is 3–4 times greater than in control
The rates of stillbirth in women with type 2 diabetes is reported groups. The study presents prenatal diagnosis data, types and
higher than in women with type 1 diabetes and this suggests that incidence of structural congenital malformations, in pregnant women
other factors such as advanced maternal age, poor social condition, with diabetes type I.
obesity, higher parity could be important as well. Although the insulin Materials and methods: The study was conducted in five tertiary-care
treatment in pregnancies with type 1 diabetes has improved the referral centres, between 2012 and 2016 on a group of 228 pregnant
overall outcome, there are still a significant number of stillbirths as women diagnosed with diabetes type I, aged between 17 and 40.
well as congenital malformations, birth trauma, neonatal hypoglyce- Patients were assessed by: ultrasound in estimating gestational age,
mia and respiratory distress syndrome. first trimester screening, second trimester screening, fetal growth
Clinical cases and summary results: We report a case of a 23 years old evaluation, third trimester ultrasound and monitoring. Singleton
woman, II G II P, addressed to our department with a 32 weeks pregnancies only.
pregnancy, live fetus in cranial presentation, diabetes mellitus type 1 Clinical cases and summary results: The most commonly affected
known for 8 years with ketoacidosis. Her past history revealed a systems and organs were cardiac 84 cases (36.84%). musculo-skeletal
stillbirth at 38 weeks of gestation 3 years ago with a fetus of 4550 33 (14.47%). CNS 21 (9.21%). urogenital 16 (7.01%). facial 9 (3.94%).
grams born by C-section due to fetal-maternal disproportion. gastro-intestinal 7 (3.07%). There have been diagnosed other/
Ultrasound scan revealed a live fetus with biometry appropriate for combined or multiple malformations (single umbilical artery. amniotic
32 weeks of gestation, normal amniotic fluid index, high thickness band syndrome. polyhydramnios) 58 cases (25.43%).
anterior wall placenta. No Doppler study was performed. CTG showed Conclusion: Cardiac defects are the most common congenital
fetal tachycardia and reduced variability. It was discussed the malformations in pregnancies complicated by type I diabetes, the
opportunity of fetal extraction but, due the critical condition — frequency is 3–4 times higher than in non-diabetic pregnancies.
shortness of breath, high blood pressure, pulse 130/min, blood Musculo-skeletal, CNS, urogenital and the combined malformations,
glucose 405 mg/dL, acidosis, high levels of ketones in urine — the have significantly increased incidence. Although the data are
patient was admitted in the intensive therapy unit with specific suggestive and causation can be inferred, the teratogenic mechanism
support treatment. The patient condition gradually improved but remains unclear. Diabetic embryopathy, involving early morphogen-
unfortunately, the fetus died within this time. esis defects, having as a pathogenic background maternal glucose
Conclusion: Poor socio-economic status, lack of pregnancy follow-up, variations, remains the main mechanism to explain the increased
bad control of the glucose levels are the main factors for the critical incidence of malformations. Current therapeutic resources for
condition at admittance. Severe metabolic impairment associated maternal glycemic control in preconception and especially in the
with a high anesthetic risk requires emergent supportive therapy. As first trimester, bring favorable conditions for prevention and
in our case, this therapy proved beneficial for the patient but maternal-fetal outcome of this pathology.
postponed the obstetrical decision of fetal extraction. It is thus
imperative that the diabetic pregnancies should be very carefully Keywords: Cardiac defects, teratogenic, glycemic control
monitored by the obstetrician and the diabetologist as well.

Keywords: Diabetes, pregnancy, stillbirth

Prenatal diagnosis and types of structural congenital malformations in
diabetic pregnancy

Malformation type Diagnosis Incidence

Cardiac Ventricular septal defect 39 (17.10%)
Atrial septal defect 30 (13.15%)

(continued )
94 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Continued related to Women and Descriptive Information Form about Perinatal

Characteristics. For the assessment of the data, SPSS v 22.0 statistical
Prenatal diagnosis and types of structural congenital malformations in software program, percentages, arithmetic means and standard
diabetic pregnancy deviations, chi-square and Fisher’s exact chi-square test and Man
Withney U test were employed.
Malformation type Diagnosis Incidence Clinical cases and summary results: In the study there was significant
differences between 1st case group and control group in terms of
Cardiomyopathy 10 (4.38%)
Tetralogy of Fallot 3 (1.31%) premature membrane rupture, cesarean delivery, preterm labor,
Coarctation 2 (0.87%) forceps assisted vaginal delivery, duration of hospital stay, meconium
amniotic fluid, fetal distress, neonatal asphyxia, hospitalization to
Musculo-skeletal Limb reduction defects 21 (9.21%) neonatal intensive care unit, neonatal hypoglycemia and hyper
Vertebral anomalies 5 (2.19%) bilirubinemia (p 50.01) whereas a statistically significant difference
Clubfoot 4 (1.75%) existed between 2nd case group and control group in terms of
Syndactily 2 (0.87%) cesarean delivery and duration of hospital stay (p 50.01).
Polydactily 1 (0.43%) Conclusion: It was determined that GDM was correlated with
CNS Anencephaly 8 (3.50%) undesirable perinatal outcomes but BGDM did not affect neonatal
Neural tube defects 5 (2.19%) outcomes except cesarean delivery and duration of hospital stay.
Hydrocephalus 4 (1.75%)
Microcephaly 3 (1.31%) Keywords: Hyperglycemia in pregnancy, gestational diabetes melli-
Holoprosencephaly 1 (0.43%) tus, perinatal outcomes
Urogenital Hydronephrosis 6 (2.63%)
Megalo-urethera 5 (2.19%)
Renal agenesis 2 (0.87%)
Hypoplastic genitalia 1 (0.43%)
Micropenis 1 (0.43%) 243
Multicystic dysplasia 1 (0.43%)
An early-customized low
Facial Cleft lip 4 (1.75%)
Cleft palate 3 (1.31%) glycaemic-index (GI) diet
Eyes - cataract 2 (0.87%)
prevents adverse pregnancy
Gastro-intestinal Duodenal atresia 4 (1.75%)
Omphalocele 2 (0.87%) outcomes in overweight/obese
Gastroschisis 1 (0.43%)
women
E. Petrella, V. Tamborrino, V. Bertarini, I. Neri, and
F. Facchinetti
088
Mother-Infant Dept, University of Modena and Reggio Emilia, Italy
The effect of hyperglycemia in
pregnancy and gestational Introduction: A high pre-pregnancy BMI is associated with many
unfavorable pregnancy outcomes such as gestational diabetes
diabetes mellitus upon perinatal mellitus (GDM) and large for gestational age babies (LGA), pregnancy
induced hypertension (PIH) and Preterm Birth (PTB). While lifestyle
outcomes: retrospective case interventions (diet, physical activity or mixed approach) are effective
in reaching an optimal gestational weight gain, they did not shows
control study substantial effects on other clinical outcomes. The aim of the present
study is to determine whether an early detailed lifestyle changes
N.B. Duman1, Ü. Görkem2, and M.Ö. Bostanci3 program (consisting of a customized caloric restriction and a constant
moderate PA) and a close follow-up reduce the incidence of
1
Department of Gynecology and Obstetric Nursing, School of Health, unfavorable maternal/ neonatal outcomes among overweight/obese
Hitit University, Corum, Turkey, 2Department of Gynecology and women.
Obstetric, Faculty of Medicine, Hitit University, Corum, Turkey, and Materials and methods: This is a case-control study (1:3) included
3
Department of Physiology, Faculty of Medicine, Hitit University, singleton pregnant women with BMI25. Cases (95), referred from
Corum, Turkey antenatal clinics in Modena, were enrolled between the 9th - 12th
week and advised to follow a low-GI diet of 1700/1800 Kcal/day (for
obese/overweight) plus 30 minutes of physical activity at least 3
Introduction: This study aimed at determining the effect of times/week. A dietitian and a gynecologist, both attendant,
hyperglycemia in pregnancy and gestational diabetes mellitus counseled women from the enrollment until delivery, with four
(GDM) upon perinatal outcomes retrospectively. follow-up visits planned at 16th, 20th, 28th and 36th week of
Materials and methods: The population of the study was composed of pregnancy over their regular planned visits with by the obstetricians
women who gave birth at Hitit University Training and Research in charge. Controls (275) received just a simple nutritional booklet
Hospital between March 2012 and April 2016. In the study, 30 women about a healthy lifestyle, than attended their scheduled visits until
whose 50gr. and 100 gr. oral glucose tolerance tests were high and delivery by the obstetricians in charge.
who were diagnosed as Gestational Diabetes Mellitus constituted 1st Clinical cases and summary results: Gestational weight gain was similar
case group, 30 women whose 100gr. oral glucose tolerance tests were between groups, despite obese women were higher in Cases (67.4%)
within normal limits but 50 oral glucose tolerance tests were high and than in Controls (54.5%, p=0.029). The occurrence of GDM was lower
who were diagnosed as Borderline Gestational Diabetes Mellitus in Cases (21.5%) than in Controls (32.7%, p=0.041). Such reduction
constituted the 2nd case group while another 30 women whose 50 g remained related with the group of intervention (p=0.00) after
OGTT results were normal constituted the control group. The data correcting for confounders (BMI 30, a family history of diabetes, age
about the study were collected using Descriptive Information Form 35 and ethnicity). Controls developed more frequently PIH (11.6%
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 95
versus 1.1%, p ¼ 0.00). PTB occurred in one Case (medically indicated 341
for severe PIH) and in 28 Controls (10.2%)( p ¼ 0.00). In the half of
them, PTB was spontaneous. Controls showed in respect to controls The impact of gestational
an higher rate of macrosomia (3.2% versus 11.6%, p ¼ 0.01) and LGA
babies (10.9% versus 1.1%, p ¼ 0.00). Birth weight (3395.5 ± 370 in diabetes in pregnant
cases versus 3344.5 ± 592.6 in controls) and incidence of SGA babies
(10.5% in cases versus 15.6% in controls) not differed between
hypertensive women
groups.
Conclusion: The current practice of providing general lifestyle advices S. Vidal1, A. Cadete2, A. Correia3, C. Rainho4, R. Ferreira5,
to overweight/obese women early in pregnancy through leaflets or C. Palmeira1, and M. Bastos5
directly by providers is not sufficient to reduce the occurrence
1
adverse pregnancy outcomes complications. Such study suggest that USF Moliceiro – ACeS Baixo Vouga, Aveiro, Portugal, 2USF Águeda +
a structured, multidisciplinary approach is able to increase the Saúde – ACeS Baixo Vouga, Aveiro, Portugal, 3Serviço de Ginecologia
compliance with the healthier lifestyle recommendations in such at e Obstetrı́cia do CHBV, Aveiro, Portugal, 4USF Flor do Sal – ACeS
risk population Baixo Vouga, Aveiro, Portugal, and 5Serviço de Cardiologia do CHBV,
Aveiro, Portugal

271 Introduction: Women with a history of common pregnancy complica-

tions, including fetal growth restriction, preterm delivery (PTD), low
Challenges of implementation birth weight (LBW), hypertensive disorders of pregnancy and
gestational diabetes (GD) have increased risk of having cardiovascular
of universal screening for disease (CV) throughout life. The objective of this work was to assess
hypertensive pregnant women, referenced to hospital consultation in
gestational diabetes mellitus relation to the prevalence of GD and the impact of the occurrence of
in a Singapore tertiary hospital adverse events (AE) in pregnancy. Adverse events were considered:
Low birth weight, Preterm delivery, preeclampsia (PE), fetal (FD),
mother (MD) and/or neonatal death (ND).
J. W. C Tan, S. C. D Koh, and K. H. Tan Materials and methods: Prospective and observational study. Sample:
pregnant women with hypertension who performed Ambulatory
O&G Dept., KK Women’s and Children’s Hospital, Singapore Blood Pressure Monitoring between January 2007 and June 2015.
Pregnant women were excluded if they did not meet hypertension
Introduction: In Singapore, a targeted (risk based) screening model (HT) criteria. The follow-up took place until delivery (262 ± 28 days).
was used to diagnose gestational diabetes mellitus (GDM) in Clinical cases and summary results: 139 pregnant, age 32±6 years. Of
pregnant women. From 1 January 2016, KK Women’s and Children’s the 58 pregnant with gestational HT, 10 had GD in the current
Hospital (KKH) offered universal (routine) screening to all pregnant pregnancy, of 81 with chronic HT, 19 had GD. Statistical analysis of
women, following the recommendations of local and international pregnant with/without GD is in the attached table. It was found that
studies. It is important to compare the uptake rates and detection had GD in previous pregnancy was statistically significant in terms of
rates of GDM based on universal and targeted screening models. AE in current pregnancy (X2: p=0.006). Analyzing the Kaplan-Meier
Materials and methods: From 1 January 2016 to 31 January 2016, an survival curves, newborns with lower average birth weight, had worse
estimated 990 women, regardless of their risk factors, were eligible for survival curves (Log Rank 129.2, p50.001), pregnant with previous GD
GDM screening between 24–28 weeks gestation at KKH. GDM was versus no previous GD have a higher occurrence of AE during
diagnosed using the oral glucose tolerance test (OGTT) which pregnancy (Log Rank 4.5, p=0,033). The GD in the current pregnancy
consisted of a fasting glucose measurement followed by 2 hour wasn’t associated with greater likelihood of AE (Log Rank 0.797,
measurement taken after consuming 75g glucose solution. These p=0.372). In a multivariate Cox analysis adjusted for potential
results were compared to the 970 pregnant women in January 2015 confounders, the PE and the diastolic blood pressure in consultation
when a targeted screening model was used. were the most predictive of AE in the subgroup without DG - p=0.045
Clinical cases and summary results: 570 (57.6%) women had OGTT in and 0.015, respectively. The reclassification test was carried out to
the universal screening cohort while 434 (44.7%) women were in the 93.1% of pregnant with GD. Of these, 10.3% fulfilled criteria of
targeted screening cohort. The detection rate for GDM in the Impaired Glucose Tolerance, which gives them an increased CV risk.
universal screening group was 9.5% (94 women) based on IADPSG Conclusion: The prevalence of gestational diabetes in the sample was
and 10.6% (105 women) based on WHO criteria. 10 out of the 570 21%. In this sample, the previous gestational diabetes attended with
women were found to have overt GDM. In the targeted screening an increased risk of adverse events. 10% of pregnant women with
group, the detection rate for GDM was 6.5% (63 women) based on gestational diabetes in the current pregnancy had impaired glucose
IADPSG and 8.7% (84 women) based on WHO criteria.12 out of 434 tolerance after delivery.
women were diagnosed with overt GDM.
Conclusion: With the increasing prevalence of Singaporean women at Keywords: Gestational diabetes, hypertensive disorders of
high risk for type 2 diabetes and GDM, the issue of universal screening pregnancy
is becoming increasingly important. Our study showed that universal
screening is superior to risk based model as it detected an additional
3% of women with GDM by screening 12.9% more women. Clearly, by
improving the uptake rate for universal screening, this will further
increase the detection rate and reduce missing cases of GDM.
96 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

371 cases, due to maternal complications in 30.7% cases, or due to mixt

fetal-maternal causes in proportion of 46.15%.
Gestational diabetes and Conclusion: Gestational diabetes is a pathology that requires a
multidisciplinary team and close monitoring of pregnancy due to
pregnancy morbidity and multiple perinatal complications in order to avoid or reduce them in
outcome both short and long-term.

Keywords: Gestational diabetes, perinatal complications, pregnancy

E. Bratila1, D. E. Comandasu1, G. Iacob1, C. Teodorescu1, outcome
M. Cirstoiu2, R. Bohiltea2, C. Berceanu3, and
C. Mehedintu4
1
"Carol Davila" University of Medicine and Pharmacy, Department of
Obstetrics and Gynecology, "Saint Pantelimon" Clinical Emergency
Hospital, Bucharest, Romania, 2"Carol Davila" University of Medicine 372
and Pharmacy, Department of Obstetrics and Gynecology, University
Emergency Hospital, Bucharest, Romania, 3Craiova University of
Multiple organ dysfunctions in
Medicine and Pharmacy, Department of Obstetrics and Gynecology, offspring of obese mothers —
Emergency County Hospital Craiova, Romania, and 4"Carol Davila"
University of Medicine and Pharmacy, Department of Obstetrics and experimental study
Gynecology, "Nicolae Malaxa" Clinical Emergency Hospital,
Bucharest, Romania D. E. Comandasu1, E. Bratila1, B. Virgolici2, H. Virgolici2,
E. Gagniuc3, C. Berceanu4, C. Mehedintu5,
Introduction: Gestational diabetes is a form of diabetes that appears M. Constantinescu2, D. Miricescu2, D. Lixandru2, and
during pregnancy and although the disease regresses after birth,
leaves its marks on the health of the mother and fetus in the perinatal
M. Mohora
period and on the long term, while proper treatment could reduce its 1
Department of Obstetrics and Gynecology, "Saint Pantelimon"
effects. Clinical Emergency Hospital, "Carol Davila" University of Medicine
Materials and methods: Underlying this paper stands a multicenter
and Pharmacy, Bucharest, Romania, 2Department of Biochemistry,
study conducted over a period of two years, in which were examined
‘‘Carol Davila’’ University of Medicine and Pharmacy, Bucharest,
2,200 pregnant women, aged between 17 and 39 years, of which
43 were diagnosed with gestational diabetes. Romania, 3University of Agronomic and Veterinary Medicine,
Clinical cases and summary results: Gestational diabetes prevalence in Bucharest, Romania, 4Department of Obstetrics and Gynecology,
the study group was 1.95%. The risk factors most commonly Emergency County Hospital, Craiova University of Medicine and
associated gestational diabetes were obesity (27.9%) and pregnancy- Pharmacy, Craiova, Romania, and 5Department of Obstetrics and
induced hypertension (9.3%). Hydramnios was observed in 20.93% of Gynecology, "Nicolae Malaxa" Clinical Emergency Hospital, "Carol
patients with diabetes and oligoamnios in 6.97%. Regarding birth Davila" University of Medicine and Pharmacy, Bucharest, Romania
weight, 13.9% of patients had fetuses with macrosomia, but were also
found fetuses with intrauterine growth restriction in 4.65% of cases, Introduction: Maternal obesity represents a pathology with continu-
especially in patients with gestational diabetes associate with ingly rising incidence and prevalence. Pregnancy obesity causes
hypertension and oligoamnios. Another important aspect is the high dyslipidemia and oxidative stress during which have major impacts
rate of premature births, respectively 23.25%. Regarding the method on the fetus development. Our study aims to investigate the systemic
of delivery, 16.27% of births were vaginal and 79% by caesarean effects of the dysfunctional metabolism generated by maternal
section. The indications were due to fetal complications in15,38% of obesity on the offspring development.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 97
Materials and methods: Ten obese Wistar rats females were started of delivery, newborn weight, mode of delivery, preeclampsia, serum
hypercaloric/hyperlipidic diet administered by gavage during preg- HbA1c in the third trimester and insulin needs. Non parametric tests
nancy (group O) while another ten normoponderal rats were fed were used to compare numeric variables (Kruskal-Wallis and Mann-
normocaloric standard diet during pregnancy (group N). At gestation Witney) and qui-square for categorical variables.
term the rat females were sacrificed and hematoxylin-eosin stained Clinical cases and summary results: A total of 464 GD pregnancies were
organ (liver, kidney, heart) sections and biochemical measurements followed in our institution during this period, 248 of which (53%)
on plasma and organ homogenates were done both from mothers were diagnosed during the 2nd trimester. Of those pregnant women
and their offspring. Spectrophotometric measurements were with GD diagnosed using GTT the mean and standard deviation for
performed. the numeric variables were: GA at delivery(w) 37,7(25,4); Newborn
Clinical cases and summary results: In obese pregnant rats versus weight(g) 3106(490); HbA1c in third trimester 5,18(0,35). The rate of
normoponderal ones, we found higher levels (mg/dl) of plasma hydramnios, need of insulin and vaginal delivery were 4,2%(n=9),
cholesterol 74 versus 35 (p 50.05), triglycerides 360 versus 175 34%(n=91) and 66%(n=147) respectively. Group 1 included 64
(p50.01), enzymatic activity (IU/L) ALT 105 versus 66 (p50.05), AST patients and group 2 was composed by 184 patients (29 in the
190 versus 74 (p50.01), GGT 8.9 versus 3.7 (p50.05), and uric acid 4.5 subgroup 2A, 64 in the subgourp 2B and 91 in the subgroup 2C). Both
versus 2.1 (p50.05), and lower levels (p50.05) of albumin and total groups presented similar values for the studied variables (gestational
blood glutathione. On liver homogenate total glutathione and total age delivery, newborn weight, hydramnios, hbA1c in third trimester
thiols were lower in group O (p50.05) while lipid peroxidation was and need of insulin). Newborn weight (g) was significantly increased
higher (p50.02) in comparison to group N. The histopathological in subgroup 2A (3345(436)) in comparison with the other two:
aspect determined medium hepathopathy, kidney tubular necrosis (Subgroup 2B: 3140(550); Subgroup 2C: 3115(347)) (p=0,16). No other
and inter- miofibrilar cardiac edema associated with low inflammatory differences on those subgroups were found.
reaction in the newborn rats from group O. Normal aspect for tissues Conclusion: Improvements in surveillance and diagnosis accuracy
was observed in group N. resulted in better outcomes in GD. However, the goal of achieving
Conclusion: Obese pregnant Wistar rat females fed with hipercaloric/ similar outcomes in women with or without GD have not yet been
hiperlipidic diet during pregnancy presented a dyslipidemic and high accomplished. In this study, the pattern of the GTT abnormalities did
oxidative stress status, which caused medium hepathopathy and not identified pregnant women with worst metabolic control or
minor injuries in the kidney and in the heart of their offspring. adverse outcomes.
These findings highlight the need to search for new tools that
Keywords: Pregnancy obesity, organ dysfunction, offspring outcome support clinicians in recognizing patients prone to poor metabolic
control and obstetrics outcomes.
Keywords: Gestational diabetes, Pregnancy, glucose tolerance test,
metabolic control
477
Is it possible to predict the
metabolic control and obstetrics 481

outcomes using the pattern of Patient age’’ to be used as a new

the gtt abnormalities? criteria in dignosing grey scale
GDM
C. Soares1, M. Marinho1, E. Ferreira2, S. Monteiro3,
M. J. Oliveira3, C. Ferreira1, and M. Barbosa1 M. Ozturk1, and I.A. Saygı2
1 1
Gynaecology and Obstetrics Dept., Centro Hospitalar de Vila Nova Obstetrics and Gynecology Dept. Etimesgut Military Hospital,
de Gaia/Espinho, Portugal, 2Dietetics Dept., Centro Hospitalar de Vila Ankara, Turkey, and 2Obstetrics and Gynecology Dept. Gülhane
Nova de Gaia/Espinho, Portugal, and 3Endocrinology Dept., Centro Military Medical Academy, Ankara, Turkey
Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Presenter: Mustafa Ozturk
Introduction: Pregnancy is characterized by insulin resistance,
Introduction: The aim of this study is to assign the detection rate of
mediated primarily by placental secretion of diabetogenic hormones.
the clinical gestational diabetes mellitus with using American
Gestational diabetes (GD) develops during pregnancy in women
Diabetes Association criteria, and to compare the 130 and 140 g/dL
whose pancreatic function is insufficient to overcome this insulin
results of the 50g Glucose Challenge Test and 100g Oral Glucose
resistance. Several adverse outcomes such as hydramnios, macro-
Tolerance Test.
somia and perinatal mortality have been associated to GD. In
Materials and methods: September 2009 - August 2010, between
Portugal, the prevalence of GD is 5,8%. The diagnosis is made
24-28 weeks of gestation 211 pregnant women who had 50 g Glucose
according to a national consensus program using fasting blood
Challenge Test positive were evaluated retrospectively. 100g Oral
glucose in the first trimester and by performing 75-gram, two-hour
Glucose Tolerance Test test results were examined. Pregnant women
oral glucose tolerance test (GTT) at 24-28 weeks of pregnancy. This
with positive 50 gr Glucose Challenge Test between 130-139 g/
study was conducted to investigate whether metabolic control and
dL(grey scale) (n:62) divided into two groups. Group 1; pregnant
obstetrics outcomes could be predictable using the pattern of the
women with abnormal GCT under 25 years old (n: 14) and pregnant
GTT abnormalities.
women with up 25 years aold (n: 48).
Materials and methods: We performed a retrospective cohort study of
Clinical cases and summary results: The prevalence of the gestational
all cases of GD diagnosed on the second trimester with GTT, who
diabetes mellitus were all of the patients (130-139 g/dL) were % 16.1
were admitted to our facility between 2012 and 2014. The study
(10/62), In Group 1, the prevalence of the gestational diabetes
population was divided in two groups: Group 1-pregnant women
mellitus were %10 (1/10), in group 2%90 (9/10).
with more than one abnormal value in GTT and Group 2-pregnant
Conclusion: The patients with 50gr Glucose Challenge Test test result
women with only one abnormal value in GTT. These last one, was
is 130-139 mg/dl and 425 years old should be closely follow-up such
subdivided in three subgroups according to which GTT value was
as gestational diabetes mellitus patients.
abnormal (fasting (subgroup 2A), one hour (subgroup 2B), or two
hours(subgroup 2C)). The evaluated outcomes were gestational age Keywords: Gestational Dabetes Mellitus, Age, Grey scale
98 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

585
533 Insulin therapy in prediction
Obesity and periodontal diseases glycemic parameters, fetal
in pregnancy: inflammation and echography and perinatal
antioxidant levels in saliva outcomes in pregnancies compli-
C. Mandò1, M.I. Mazzocco1, G.M. Anelli1, C. Novielli1,
cated by diabetes mellitus
A. Lissoni2, P. Castellani2, M. Cardellicchio1, B. Bottazzi3,
I. Babović1, M. Arandjelović1, A. Ćurković1, S.
M. Zambon1, C. Garland3, I. Cetin1, and S. Abati2
Plešinac1O. Kontić-Vučinić1, and N. Radunović1
1
Unit of Obstetrics-Gynecology, Sacco Hospital, University of Milan, 1
School of Medicine, University of Belgrade, Serbia, and 2Clinic for
Italy, 2Unit of Oral Diseases, San Paolo Hospital, University of Milan,
Gynecology and Obstetrics, Narodni front, Belgrade, Serbia
Italy, and 3Humanitas Clinical and Research Center, Milan, Italy

Presenter: Ćurković A
Presenter: Chiara Mandò
Introduction: Objective to determinate body mass index (BMI) and
Introduction: Obesity (OB) is associated with chronic mild inflamma-
hemoglobin A1c (HbA1c) levels, as predictors of insulin therapy (IT),
tion and higher gestational risks. OB is also associated with oxidative
on fetal echography findings and perinatal outcomes in pregnancies
stress. Periodontal diseases (PD), i.e gingivitis (G) and periodontitis (P)
were complicated by diabetes mellitus (DM).
may also represent a source of low-grade systemic inflammation
Materials and methods: Material and Methods we intended to
potentially impairing pregnancy outcomes. We previously showed
evaluate the values of BMI and HbA1c levels on fetal interventricular
increased oral inflammation in obese (OB) compared to normal
septum (IVS) thickness, atrioventricular inflow E/A velocity ratio and
weight (NW) pregnant women. Few studies investigated saliva (S)
perinatal outcomes. According to IT, we evaluated three groups of 32
biomarkers in pregnant women. Here we analyzed C-reactive protein
patients of gestational DM treated with dietary changes, (GDMA1
(CRP) concentrations and total antioxidant capacity (TAC) in saliva of
group), 27 patients of GDM with IT (GDMA2 group) and 22 patients of
pregnant women with different pre-pregnancy BMI, investigating
type 1 diabetes (T1D group) in the 38th gw.
their association with plasma CRP and with PD.
Clinical cases and summary results: Results In T1D group, we found
Materials and methods: 59 singleton pregnancies (15 NW, BMI 18-24.9;
statistical significant correlation BMI to IVS thickness (p 0.036); HbA1c
44 OB, BMI 30) were studied at 3rd trimester. 15 obese women had
to IVS thickness as well as mitral E/A velocity ratio (p 0.013 vs. p
gestational diabetes mellitus (GDM). Periodontal status was assessed
0.007). In T1D group, HbA1c showed statistically significant correla-
by oral clinical examination in 24 OB and 15 NW. P: at least 4 teeth
tion to BW (p 0.037). We determinated statistically significant
with pockets 4 mm. G: soft and/or calcified bacterial plaque and/or
difference between BMI and neonatal RDS (p 0.027). Statistically
gingival bleeding in 4 or more teeth. In 36 women (15NW, 21OB - 8
significant difference was confirmed between HbA1c level and RDS,
with/13 no GDM) unstimulated S-samples were collected for analysis
as well as ICH in T1DM group (p 0.048 vs. p 0.018). HbA1c was
of CRP (ELISA) and TAC (AntiOxidant Assay). CRP was also measured in
statistically different to RDS in GDMA2 group (p 0.036).
44 (10NW, 34OB -11 with/23 no GDM) plasma samples (ELISA). Clinical
Conclusion: Conclusion in DM and GDM pregnancies, maintaining
and molecular data were compared between groups using indepen-
optimal glucose levels determine fetal echography findings and
dent-sample t-test adjusted by Levene’s test. Correlations between
perinatal outcomes.
values were assessed by Pearson test. Results were considered
significant when p50.05. Keywords: Diabetes mellitus, gestational diabetes mellitus, fetal
Clinical cases and summary results: S-CRP levels were significantly echography, perinatal outcomes
related to BMI (p=0.03; R=0.44), with increased content in OB vs NW,
reaching significance in OB with GDM (p=0.04). TAC was significantly
higher in all OB vs NW (total OB vs NW: p=0.01; OB without GDM vs
NW: p=0.04; OB with GDM vs NW: p=0.01) and significantly correlated 614
with S-CRP (p=0.00; R=0.77). Plasma CRP levels were significantly
increased in all OB vs NW (total OB vs NW: p=0.00; OB without GDM vs
Effect of gestation on the 75g
NW: p=0.05; OB with GDM vs NW: p=0.01), correlating with both 2-hour OGTT
S-CRP (p=0.00; R=0.65) and TAC (p=0.00; R=0.59). 83.3% OB and 40%
NW had PD (P/G). PD in NW did not enhance molecular values, while
in OB the presence of PD increased CRP/TAC compared to healthy Klemetti M. M.1, Stach-Lempinen B.2, Hämäläinen E.3,
NW, reaching significance for both S-TAC (p=0.02) and plasma CRP Nenonen A.4, Kautiainen H.5, and Teramo K.6
(p=0.018). 1
Conclusion: Mild inflammation was reported in many OB tissues, but Dept. of Obstetrics and Gynecology, Helsinki University Hospital and
nothing is known on markers in S of OB pregnant women, which University of Helsinki, Helsinki, Finland, 2Dept. of Obstetrics and
represents an effective non-invasive diagnostic tool. CRP increase in Gynecology, South Karelia Central Hospital, Lappeenranta, Finland,
3
OB plasma, marker of systemic inflammation, was confirmed in S. HUSLAB, Helsinki University Hospital, Helsinki, 4Laboratory Center,
Higher S-TAC suggests the induction of a systemic antioxidant South Karelia Central Hospital, Lappeenranta, Finland, and
5
response detectable in OB-S. GDM possibly contributes to these MedCare, Äänekoski, Finland
increases. The higher PD frequency in OBvsNW might enhance CRP
and compensatory antioxidant defenses in women with both OB-PD Presenter: Miira Klemetti
Keywords: Pregnancy, obesity, oral pathology, saliva Introduction: The Finnish Current Care Guideline recommends fasting
plasma glucose (PG) 5.3, 1h PG 10.0, or 2h PG 8.6 mmol/l in a
75g oral glucose tolerance test (OGTT) as thresholds for gestational
diabetes (GDM) diagnosis in both early (12-16 weeks) and late (24-28
weeks) gestation. Based on the HAPO study, the International
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 99

Association of Diabetic Pregnancy Study Groups (IADPSG) recom- gestation, probably due to lower insulin resistance in early pregnancy.
mends GDM diagnosis when the fasting PG value is 5.1, 1h value Using the current criteria, the GDM frequencies both in early and late
10.0, or 2h value 8.5 mmol/l in the 2h 75g OGTT. IADPSG does not gestation were high, which could reflect both the high prevalence of
currently recommend routine OGTTs before 24 weeks’ gestation due obesity in southeastern Finland as well as genetic predisposition in
to insufficient evidence on the benefits of early OGTTs. In early this population. The results suggest that the same diagnostic
pregnancy, IADPSG recommends screening of fasting PG at the first thresholds should not be used in early and late pregnancy OGTT.
antenatal care visit and diagnosis of GDM with values 5.1 but Large prospective population-based studies are needed to determine
57 mmol/l. However, this method may not effectively identify appropriate diagnostic thresholds for early-pregnancy OGTT.
parturients with impaired glucose tolerance in early pregnancy. No
studies have yet determined appropriate OGTT diagnostic thresholds Keywords: Gestational diabetes, oral-glucose tolerance test
for early pregnancy. We hypothesize that the pathological thresholds
for post-glucose-load PG are lower in early than in late pregnancy
OGTT due to lower insulin resistance in early pregnancy. The objective 649
of this study was to examine the effect of gestation on OGTT results.
Materials and methods: All women booking for an early-pregnancy Pregnancy in obese women:
ultrasonography at South Karelia Central Hospital and Honkaharju
Hospital, in southeastern Finland, were invited to participate during maternal and neonatal outcomes
3/2013-6/2015. 29% of all invited parturients refused and 7% were
excluded (e.g. due to diabetes, medications affecting glucose S. Paracchini, L. Attamante, A. Piazzese, B. Masturzo, and
metabolism, or insufficient language skills). All participants (n=665) T. Todros
gave an informed consent. All participants had a 2h 75g OGTT at 12-
16 weeks’ gestation (OGTT1). Parturients with a normal OGTT1, using Department of Surgical Sciences, Sant’Anna Hospital, University of
the current criteria, had another OGTT at 24-28 weeks (OGTT2). PG Turin, Turin, Italy
was analyzed using a photometric hexokinase method.
Clinical cases and summary results: Using the current diagnostic Presenter: S. Paracchini
thresholds, 107/665 (16.1%) of subjects had early GDM based on
OGTT1 and were treated accordingly. At OGTT2, 69/496 (13.9%) of Introduction: In the last 35 years, overweight and obesity have shown
participants had late GDM. The mean (SD) fasting PG value was higher a growing trend. The WHO classifies overweight and obesity as
and the post-glucose load PG values were lower at OGTT1 than at follows: normal weight (NW, BMI 18.5-24.9 kg/m2), overweight (OW,
OGTT2, when the results of patients without early GDM (n=496) were BMI 25-29.9), class 1-2-3 obesity (OB1-2-3, BMI 30-34.9, 35-39.9, 440).
compared [TABLE]. In Italy more than 40% of the population is overweight or obese, and
Conclusion: The mean fasting PG values are lower in OGTT at 24-28 it is considered high-risk. The main aim of this study was to evaluate
weeks’ gestation compared to OGTT at 12-16 weeks’ gestation, the influence of the BMI on the pregnancy outcomes, both on the
probably due to the increasing uptake of glucose by the placenta as maternal and the neonatal side.
the pregnancy progresses. The post-glucose load values were lower Materials and methods: We designed a retrospective study on data
in OGTT at 12-16 weeks’ gestation compared to OGTT at 24-28 weeks’ from S. Anna Hospital’s database. We included 28.039 singleton at
100 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

term pregnancies (gestational age 37-42 weeks) who delivered from of natural aversion of mice to brightly lit areas and the preference for
January 2011 to December 2015, with pre-pregnancy BMI 418.5 kg/ closed and small places. A Morris water maze was used to measure
m2. Patients were stratified in 5 BMI classes according to the WHO spatial learning and memory functions. Mice are required to learn the
classification. Moreover, the population was divided in two classes: location, within a circular pool, of a slightly submerged platform (B)
15.089 nulliparous (Null) and 12.950 multiparous (Mult). We examined invisible to swimming mice (located below the water level, dyed with
maternal (incidence of gestational diabetes mellitus GDM, pre- non-toxic paint), guided by external signals (A)
eclampsia, induction of labor, cesarean section after failure of the Clinical cases and summary results:
induction) and neonatal (macrosomia 44.000 g, APGAR 57 at 5’)  ODM showed greater anxiety than SHAM. F (1,32)= 23,80;
endpoints. Odds ratios were calculated with a 95% confidence p50.001.
interval applying Chi-square test to compare each class with the  ODM spent less time in the area of g the platform than SHAM. F
normal weight group. (1,29)= 32,18; p50.001
Clinical cases and summary results: The population was composed of  ODM spent more time outside the platform area and less time
21.004 NW, 4.898 OW, 1521 OB1, 459 OB2 and 160 OB3. BMI within the area, compared to SAHM
distribution was found significantly different (p value 50.001) F (1,28)= 4,20; p50.05.
between Null and Mult: among Null, 79.09% was NW, 14.96% OW, ODM did not remember the location of the platform and looked
4.25% OB1, 1.27% OB2 and 0.42% OB3; among Mult, 70% was NW, around the tank, rather than focusing on the area where the platform
20.39% OW, 6.8% OB1, 2.04% OB2 and 0.74% OB3. was located as the SHAM did.
Odds ratios were found statistically significative for Conclusion: The adult mice born to diabetic mothers shown higher
 GDM (Null: OW 2.66, OB1 4.9, OB2 5.03, OB3 9.70; Mult: OW anxiety state level and learning and memory difficulties than control
2.71, OB1 4.43, OB2 7.72, OB3 12.87) mice.
 pre-eclampsia (Null: OW 2.33, OB1 4.68, OB2 4.77, OB3 11.22;
Mult: OW 3.78, OB1 4.79, OB2 6.13, OB3 13.08) Keywords: Diabetes and pregnancy, offspring, neurobehavioral,
 induction of labour (Null: OW 1.41, OB1 2.0, OB2 and OB3 2.0; anxiety, learning
Mult: OW 1.45, OB1 2.03, OB2 2.2, OB3 2.78)
 cesarean section after failure of the induction (Null: OW 2.04, OB1
3.14, OB2 3.99, OB3 3.76; Mult: OW 1.18, OB1 4.67, OB2 2.43,
OB3 10.6)
 macrosomia (Null: OW 1.44, OB1 1.57; Mult: OW 1.69, OB1 1.5,
OB2 2.1, OB3 2.76)
 APGAR at 5’ 57 (Null: OW 1.77, OB2 3.49; Mult: OW 1.86, OB1
2.34, OB2 2.3, OB3 6.17)
Conclusion: Our study is based on a large case series collected from a 3rd
level Center, and confirms that overweight and obesity are relevant risk
factors not only for the long term health of women, but also for
pregnancy outcomes, both on the maternal and the neonatal side.
Moreover, it suggests that in future studies nulliparous and multiparous
have to be considered as different populations, with higher risks in
multiparous that could be ascribed to higher average age and BMI.
Keywords: Pregnancy outcomes, obesity, overweight

660
Effect of maternal diabetes
neurobehavioral their offspring
González González N. L., López Hernández B. P.,
Castro Ruiz I., Puertas Avendaño R., Armas M., and
Damas-Hernández M. C.
Fundación Canaria para la Investigación en Salud, Hospital
Universitario de Canarias, Tenerifeand Universidad de La Laguna.
Tenerife. SPAIN

Presenter: Gonzalez Gonzalez NL 706

Introduction: Diabetes during pregnancy is a well-known risk factor for Is insulinogenic index test valid
congenital anomalies in various organ systems, including the nervous
system. Thus, it has been observed that infants of diabetic mothers for diagnosing gestational dia-
(IDM) are more likely to present deficits of attention, learning and
memory may appear, as well as impaired sensorimotor functioning betes mellitus?
and hyperactivity. This has only been studied at early ages.
Aim: To study the effects of maternal diabetes on the state of anxiety A. Alkilic, F. Soylemez, O. Kan, and T. Yuce
and learning and memory functions related to the hippocampus
during adulthood. Obstetrics and Gynecology Dept., Ankara University School of
Materials and methods: Experimental subjects: We used CD1 mices, (4 Medicine, Ankara, Turkey
months). a.- ODM: offspring of mothers in who diabetes mellitus was
induced by administering 250 mg/kg of Streptozotocin, and b.- SHAM: Presenter: A. Alkilic
offspring of the mice injected with the vehicle. I light-dark box was
sed to measure anxiety behavior of animals. Based on the assumption
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 101
Introduction: We compaired the insulinogenic indices of pregnant association between the value of PAPP-A and the development of
women who had abnormal GCT, with glucose tolerance status after DG, not even after adjustment for multiple variables. There was also
100g oral glucose tolerance test (OGTT) to evaluate the performance not a statistical association between the value of PAPP-A and the
of insulinogenic index (IGI) in predicting GDM and insülin fasting blood glucose levels on first or second trimester.
requirement. Conclusion: Gestational diabetes is a serious condition, associated
Materials and methods: 207 pregnant women attending Ankara with adverse outcomes. The ability of a blood test to predict the
University Hospital between March 2014- September 2015 with a GCT development of such condition in the first trimester of pregnancy
4130 mg/dL were included in this study. Women with pregestational would allow the implementation of measures to avoid it. Our results
diabetes mellitus were excluded. Plasme glucose levels after 100g were unable to confirm this hypothesis. Further research on this
OGTT and insulinogenic indices were evaluated and insulin require- subject is needed.
ment of the diabetic pregnant women were also noted.
Clinical cases and summary results: 43 of the 207 pregnant women Keywords: Gestational diabetes, PAPP-A
were diagnosed with GDM according to the Carpenter&Coustan
criteria,141 had normal OGTT results and 23 were in the impaired
glucose tolerance (IGT) group. Mean values of insulinogenic indices in
the groups were as in Table-1. IGI results were lower in GDM group DOCTORS AND MIDWIVES: CARE OR CURE
and it was statistically significant (p50,05). According to the ROC - 015
analysis, the cut-off of the IGI for the pregnant women was 0.837 with
a spesifity of 63.8% and a sensitivity of 69.8%. 17 women who were Comparison of temporal artery
diagnosed with GDM were in need of insulin therapy support, 24
women had normal plasma glucose levels with only diet and 2
thermometry with axillary and
women needs oral antidiabetic therapy (sulfonamide). There was not
an association between the insülin requirement and IGI results
rectal thermometry in full term
(p=0,072). neonates
Conclusion: Insulinogenic index can be used for the diagnosis of GDM.
But we need more studies for the prediction of insülin requirement.
P. Batra and E. Goswami
Keywords: Gestational diabetes mellitus, insulinogenic index, fasting
blood glucose, fasting insulin, oral glucose tolerance test Division of Neonatology, Department of Pediatrics, University College
of Medical Sciences (University of Delhi) and Guru Tegh Bahadur
Hospital, Delhi - 110095, India

Introduction: Measurement of accurate body temperature and

detection of both fever and hypothermia is crucial in the diagnosis
and management of neonates. Ideal methods for core body
temperature measurement are invasive, hence cannot be used in
clinical practice. Rectal temperature, closest to core temperature
carries its own drawbacks. There is no consensus on the non-invasive
method of accurate temperature measurement among neonates.
Hence, the present study was conducted to assess the efficacy of
747 temporal artery thermometer in febrile and hypothermic neonates in
comparison to axillary thermometer.
Using papp-a to predict Materials and methods: It was a cross-sectional observational study.
Study participants included 210 neonates admitted in neonatal
gestational diabetes intensive care unit of a tertiary care teaching hospital, India divided
into three groups of 70 each, namely normothermic, febrile and
M. Boia, A. Correia, S. Pedrosa, A. Cruz, M. Almeida, and hypothermic. Temperatures were measured using temporal artery,
axillary and rectal thermometers in each patient.
S. Neto Clinical cases and summary results: Temporal artery temperature
Department of Obstetrics and Gynecology - Centro Hospitalar Baixo showed a good correlation with rectal temperature in normothermic
Vouga and febrile group with a correlation coefficient of 0.831 and 0.824,
respectively, but it did not co-relate well hypothermic neonates
(Fig 1). Axillary temperature showed a poor correlation with rectal
Presenter: M. Boia temperature in all the three groups.
Introduction: A low maternal serum concentration of pregnancy- Conclusion: Temporal artery thermometer can accurately predict
associated plasma protein A (PAPP-A) is associated with adverse temperature in febrile and normothermic full term neonates but is
perinatal outcomes, namely fetal growth restriction and hypertensive not an accurate predictor in hypothermic neonates. Further studies
gestational conditions. Recently, it has been suggested by some are required before advocating temporal artery thermometry as a
studies the ability of a low value of PAPP-A to also predict the replacement of rectal thermometry among this group of population.
development of gestational diabetes (GD). This study has been
designed to evaluate the relation between the value of PAPP-A in the Keywords: Rectal thermometry, temporal artery thermometry,
first trimester screening and the development of GD. axillary thermometry, neonates
Materials and methods: Retrospective analysis of 610 pregnant women
first trimester screening tests performed during 2015 in our hospital,
and the development of GD on the same group.Demographic,
obstetric and neonatal data was also analyzed. Linear regressions and
independent t tests were conducted, using a value of p50,05 as
statistical significance.
Clinical cases and summary results: 610 pregnant women were
included in the study. The incidence of GD was 11%. The women
with GD were significantly older and had higher BMI. No relation was
found concerning smoking habits. There was not a statistical
102 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

133 144
Professional socialization in a Health council is effective to
sample of iranian midwives avoid environmental tobacco
practitioner smoke in the perinatal period
M. Javadnoori1, L. Dehnavi2, and Sh. Najar2 D. Muñoz, G. Ortega, R. Casademont, G. Olivera, and
1
A. Hidalgo
Reproductive Health Promotion Research Center, School Of Nursing
and Midwifery, Ahvaz Jundishapur University of Medical Sciences, ASSIR Mollet, Barcelona, Spain
Ahvaz, Iran and 2Department of Midwifery, School Of Nursing and
Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Introduction: Program ‘‘Infància Sense Fum’’ (Children without smoke)
Iran started in 2012 as part of of the Catalonia Public Health Agency
Strategies for Prevention and Control of Smoking. In the study ‘‘BIBE’’
Introduction: Professional socialization(PS) is an important require- * we proved that a brief intervention in primary care consultation was
ment of any specialist, particularly in the health system. Socialization effective in reducing exposure to environmental smoke (second hand
is a process in which people learn how to effectively participate in smoke) in infants.
society as a member. PS is the process of accepting professional roles Materials and methods: Online training: With an innovative and
and it is concerned with the individuals’ culturalization in the existing attractive design, it includes a theoretical and a practical part in the
patterns in an organization. It is assumed that the process of PS form of outpatient simulation game with clinical cases representing
occurs when an individual is studying in an educational context, while patterned movements that reflect the expression of the faces.
it is in progress after graduation and until the time when individuals Different situations arise in the visits from which professionals have
work in that profession. PS is also affected by the environmental to make choices. According to the decision they make, they receive a
conditions and individual experiences when they become compatible return as a feedback. It is a learning process ‘‘trial and error’’.
with professional roles. The acquisition of socialization skills is Intervention guide for professionals: We developed a guide in order
necessary for professional midwives. There is no evidence about the to formalize and standardize this intervention in the outpatient.
level of professional socialization of midwifery graduates in Iran. This Intervention’s support materials: Different materials have been made
study aimed to determine professional socialization among midwives for the Intervention Support as clinic councils to avoid environmental
working in Iran hospitals. tobacco smoke in childhood.
Materials and methods: This descriptive study was conducted on 96 Clinical cases and summary results: The on-line training demonstrated
midwives working in the maternity wards in the 12 public hospitals the effectiveness in regards to better professional knowledges and
(3 educational hospitals and 9 non-educational) in Khuzestan attitudes as well as patient satisfaction. We have launch 12 editions of
Province, 2015. The inclusion criteria were holding a bachelor’s it and over 3000 trained professionals have evaluated positively
degree in Midwifery, and a working experience less than three years. (490%) the organization, the materials, the methodology, applic-
Data on their professional socialization were collected using Toit’s ability, expectations, etc.
Professional Socialization Questionnaire composed of 48 items show Conclusion: On-line courses eliminate geographical and schedules
the extent of their Interesting in midwifery, accepting midwifery, restrictions, allowing to reach many more professionals. The design is
responsibility, and satisfaction. a very important matter: making it attractive and interactive, it
Clinical cases and summary results: The professional socialization of improves acceptance and allows us to reach professionals with less
midwives was 1% at the poor level and 16.7% and 82.3% at the interest a priori, raising awareness in doctors and nurses in pediatric
average and high levels, respectively. professional socialization have health care. Our goal is to continue expanding this training program
no significant relationship with age, grade point average, the to more professionals.
university, place of work, or years of midwifery practice experience
(p4 0.05). Keywords: Primary care, environmental smoke, passive smoking
Conclusion: The professional socialization of employed midwives have
reached a desirable level after three years since their work start-up,
and they have obtained necessary clinical and professional skills in
performing their midwifery duties. But, there are still 18% of midwives
without any professional socialization.
153
Keywords: Midwives, professional socialization, Iran
Obstetrical care providers’
attitude to patients who disagree
Table 1. The professional socialization domains in midwives (n ¼ 96). with medical advice
Levels of professional M. Hollander1, L. Holten2, J. van Dillen1, and
socialization Professional Poor Average High E. de Miranda3
socialization domains (550) (50–75) (475)
1
Obstetrics and Gynaecology Dept., Radboud University Medical
Interesting in midwifery 2.1% 19.8% 82.3%
Accepting midwifery 2.1% 13.5% 84.4% Centre, Nijmegen, the Netherlands, 2Midwife, PhD, teacher, Midwifery
Responsibility 3.1% 12.5% 84.4% Academy (AVAG), Amsterdam, the Netherlands, and 3Midwife, PhD,
satisfaction 1% 22.9% 76% researcher, Academic Medical Centre, Amsterdam, the Netherlands
Overall 1% 16.7% 82.3%
Introduction: Obstetricians and midwives are increasingly confronted
with pregnant women who either request interventions that are not
medically indicated (such as caesarean section on maternal request)
or refuse medically indicated interventions such as a hospital birth,
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 103
foetal monitoring, oxytocin etcetera. It is currently unknown how consulted twice a pediatrician, 94% had one blood test, and 55% had
providers feel about these requests and refusals and how they an epidural. During the 3 months follow-up after discharge, 80%
manage them. consulted a gynecologist, 43% a midwife (3 times on average mainly
Materials and methods: Online questionnaires were sent to all Dutch for promoting and supporting breastfeeding), and 33% a phy-
obstetricians and midwives. Reminders were sent after two weeks. siotherapist (7 times on average). In general, blood tests were
Data were gathered through on online Survey Monkey account and performed routinely but not coherently, the frequency of ultrasounds
imported into an SPSS database (version 22). was higher than the Belgian recommendations (2 according to KCE,
Chi-quare tests were used for 2x2 tables and Mann-Whitney U tests CSS and IMA), there was a high proportion of C-sections (15–18%
were used for ordinate variables. An ordinate logistic regression according to WHO) and a low rate of midwife consultations.
model was used to correlate answers with the characteristics of the Conclusion: We observed important discrepancies between reality ‘‘on
responders. Opinions on statements were gathered with a 7-point the field’’ and official recommendations in Belgium. It is crucial to
Likert scale. improve the (quality of) information towards the health care
Clinical cases and summary results: The total response rate was 22%. professionals and mothers-to-be in order to reduce the observed
Two-thirds of those who received one or more requests for caesarean discrepancies, to contribute to a better quality of care and use of the
section on maternal demand honoured at least one of these requests, available financial resources.
whereas over 40% of those who received a request for less care had
denied at least one of these. Some of the reasons given for refusal Keywords: Pregnancy, midwife, ultrasounds, surveillance,
were fear of a bad outcome and fear of litigation. Over 12% of consultations
providers had had at least one patient who wanted to have an
unassisted birth (UC) and 8% had been asked to assist during or after
an attempted UC. Nine statements were presented to the responders,
the most interesting one of which was whether or not they would be
willing to ignore a patient’s refusal of an intervention in case of foetal
distress. Responders were also asked about reporting patients to 256
social services and about how much extra time these patients cost in
consultations. The effects of newborn screening
Conclusion: Obstetricians and midwives in the Netherlands are more
willing to comply with a request for more care than indicated as tests education on the knowl-
opposed to less care than indicated. A surprising number are willing
to overrule a competent patient’s wishes, which is not allowed by edge level of mothers
Dutch law.
F. EVCILI1, G. DEMIREL1, ZB. YURTSAL1, and E. ALTUN2
1
Midwifery Dept., Faculty of Health Science, Cumhuriyet University,
253 Sivas, Turkey and 2Nursing Dept., Faculty of Health Science,
Medical and paramedical Cumhuriyet University, Sivas, Turkey

management of the mother-to-be Introduction: Newborn screening (NBS) is the process of testing
newborn infants for certain hormonal, genetic, metabolic, and other
in belgium: from pregnancy to disorders. Most screening is done with a simple blood test. In order to
enable treatment and life saving interventions for afected newborns,
3 months after delivery 30 disorders have been identified for routine screening. Screening for
hearing impairment is also routinely performed in many facilities as
R. Van Tielen and R. Van Woensel part of the overall newborn screening profile. Early diagnosis and
proper treatment can make the diference between long-term
Mutualités Libres-Onafhankelijke Ziekenfondsen (MLOZ), impairment and healthy development. AWHONN recommends that
Representation and Studies Dept, Brussels, Belgium NBS programs include the following key elements: parent education.
The aim of the study was to determine the effects of newborn
Introduction: Evaluation of the health care use from pregnancy to 3 screening tests education on the knowledge level of mothers.
months after delivery (preventive/curative and medical/paramedical) Materials and methods: This study has been planned to experimental
during a 365 days follow-up. research which women in-patient Sivas County Hospital during
Materials and methods: Descriptive retrospective analysis with real life postpartum period in the central district Sivas province, between
data of (reimbursed) health care use during 3 specific periods: 9 October-December 2014. This study has been realized with volunteers
months of pregnancy, the period of hospitalization for delivery and 3 of totally 464 women in postpartum period (p=0.15, a=0.05, d ± 0.05).
months follow-up after discharge. Data (from 2012 to 2014) were The research data were collected using Newborn Screening Tests
extracted from administrative databases of the Independent Health Information Form. After the women have fulfilled the all forms, there
Insurance Funds (Mutualités Libres - Onafhankelijke Ziekenfondsen). will be an education which used ‘‘Guide for Newborn Screening Tests’’
Reimbursements of all preventive and curative care were included in on the basis of the literature will given to mothers by researchers. And
the analysis. then after this education, the women have fulfilled information test
Clinical cases and summary results: 19,323 women (15–47 years, again. SPSS 14.0 was used to determine frequencies, paired t test, one
average: 30.5) gave birth in 2013. Nearly all (99%) births occurred in way anove of responses. p 50.05 was applied as a general level of
hospitals or clinics (0.6% and 0.4% took place in a private home or in significance.
One Day, respectively). 22% of women had a C-section (14% in 1997). Clinical cases and summary results: The median age of women
During pregnancy, 98% had an average of 3 blood tests, 76% HIV enrolled in our study was 27 ± 5.53, 89% women have no job, 44%
testing, 88% T. gondii IGG/IGM (4 times on average), 79% CMV IGM/ women graduated from primary school degree, 8.2% women
IGG (3 times on average), and 56% Rubella (once), 51% had 5 marriaged with relatives. It is found that 43.3% women have no any
ultrasounds, 76% had 3.3 prenatal cardiotocographies. On average, knowledge about newborn secreening tests and 84% women have
pregnant women had 10.6 gynecological consultations, and 49% had some knowledge about newborn secreening tests which obtained by
prenatal midwife consultations (at home or at the hospital, 3.5 times health professinals. Women who have education, before and after
on average). During hospitalization, 99.9% of deliveries were made by newborn screening tests knowledge score’s means are found
gynecologists, and 95% had midwife assistance, 91% of mothers statistically significant (p 50.05). After the education, women’s
104 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

newborn secreening tests knowledges are increases (8.9–17.2%). Conclusion: The success of any screening program requires public
Women who have job, before and after newborn screening tests participation and awareness. Midwives, nurses, obstetrician and
knowledge score’s means are found statistically significant (p 50.05). pediatrician should be involved in the education of parents regarding
Conclusion: Raising the level of mothers’ knowledge about the availability of NBS testing, the benefits of early detection of
newborn screening tests can affect on the early diagnosis and disorders for which screening is performed, the risks that exist for
proper treatment can make the difference between long-term newborn infants who do not receive screening, the process of
impairment and healthy development. Health prefessional should screening, and need for follow-up.
provide to improve the availability of medication and formulas,
genetic counseling, medical interventions, communication, education Keywords: Newborn, mothers, newborn screening
materials, and awareness.

Keywords: Newborn, mothers, newborn screening

286
The effect of painful processes
261
performed to newborn on parent-
Newborn screening tests:
infant attachment
determination of maternal
views and participation status F. Evcili, Zb. Yurtsal, B. Cesur, and N. Kaya
in screening programs Midwifery Dept., Faculty of Health Science, Cumhuriyet University,
Sivas, Turkey

F. Evcili, B. Cesur, Z.B. Yurtsal, and N. Kaya Introduction: Many newborns are obliged to spend the first weeks of
Faculty Of Health Sciences, Department Of Midwifery, Cumhuriyet life in intensive care unit and they are faced with many painful
University, Sivas, Turkey practises (heel to draw blood, arterial catheters, newborn examina-
tion, dressing changes, inserting a gavage tube, injection etc.). Painful
interventions are stressful for parents as it is for newborns. Besides
Introduction: Newborn screening (NSB) is a public health program
physical and mental development of the newborn, the pain also
designed to screen infants shortly after birth for a list of conditions
negatively affects emotional development of newborn and the
that are treatable, but not clinically evident in the newborn period.
relationship / interaction between infant and parent. However, in
Some of the conditions included in newborn screening programs are
the literature the number of studies carried out to determine the
only detectable after irreversible damage has been done, in some
effect of pain experienced by newborn on parent-infant interaction is
cases sudden death is the first manifestation of the disease. Babies
quite limited. The aim of this study is to determine the effect
that are born in a hospital should be screened before they leave the
of painful processes performed to newborn on parent-infant
hospital. Parents should take babies that are not born in a hospital or
attachment.
those that were not screened before leaving the hospital to a hospital
Materials and methods: The sample is consisted of 354 parents (177
or clinic to be checked within a few days (between 3 and 7 days) of
mothers, 177 fathers) whose babies are at newborn clinics of a
birth. This study was planned to determine mothers’ views and
university hospital between November 2015-March 2016 dates. For
participation status in screening programs.
the implementation of the study, written permit from Cumhuriyet
Materials and methods: Descriptive study’s sample is consisted of 398
University Research and Application Hospital and approval from
women staying in postpartum clinic of a university hospital between
Cumhuriyet University Non-Invasive Clinical Research Ethics
November 2015-March 2016 dates. The purpose of the study was
Committee were received. Parents were informed about the purpose
explained to women in related clinics, verbal consent was taken. After
of the study, verbal consent was taken. After that, from parents
that women were asked to fill out Personal Information Form and
Parental Pain Assessment Form, from mothers Maternal Attachment
Identification of Maternal Opinions Concerning Newborn Screening
Inventory (MAI) and from fathers Postnatal Paternal-Infant
Tests Survey. After postpartum discharge, meeting was made with
Attachment Questionnaire (PPAQ) were asked to fill out. The data
women and they were asked if they resorted to health organizations
were evaluated by using SPSS 22.0 program package. The level of
to get newborn screening tests done after postpartum discharge.
statistical significance was accepted as p 50.05.
The data were evaluated by using SPSS 22.0 program package. The
Clinical cases and summary results: Painful processes performed to
level of statistical significance was accepted as p 50.05.
infants in newborn clinics are listed by parents as establishing
Clinical cases and summary results: 11.6% of mothers made
vascular access (100%), bloodletting (68.4%), application of injection
consanguineous marriages were determined in the study. It was
(62.1%). 74% of parents’ thought that baby’s crying, 60.5% of them
found that 51.4% of mothers’ find their information on newborn
wrinkling the forehead were reactions to the pain. 72.3% of parents’
screening tests partly sufficient. 54.8% of mothers’ know that
think that making calming sounds, 61.6% of them breastfeeding
certain diseases may pass to the baby through the mother or
would be effective in reducing baby’s pain sensation. The total
father, 56% of them know consanguineous marriage is influential in
average score mothers took from MAI was found to be 83.5 ± 8.7 and
the emergence of inherited diseases, 51.3% of them know these
the total average score fathers took from PPAQ was found to be
diseases can cause irreversible brain damage in infants, 48% of
55.6 ± 10.2. In the study, no statistically significant difference was
them know diagnose can be made with two drops of blood taken
found between maternal age, country of residence, mother’s
from the baby’s heel. 46.7% of mothers’ are undecided about the
education status, sex of the baby and MAI average scores. However,
relationship between heel blood and nutrition, 48.2% of them are
as the duration of hospitalization increases, mothers’ attachment
undecided about the best time for the heel blood to be taken. 219
points were found to increase, too (p 50.05). Statistically significant
of mothers’ were contacted after postpartum discharge. 48.4% of
difference was found between the education level of the father, the
mothers’ resorted to health organizations after 1 week postpartum,
baby’s gender and PPAQ average scores.
65.8% of them said that newborn screening test was performed by
Conclusion: Health professionals should develop awareness consider-
midwives, 77.6% of them stated that they were informed about the
ing the fact that the pain affects not only physically but also mentally
process.
and emotionally. For effective pain management in newborns, there is
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 105
a necessity to work with the family and to consider them as part of
356
the team. This approach will contribute to the reinforcement of
parenting roles of mothers and fathers, emotional support that Alternatives to vaginal touch
newborns needs by parents and establishment and strengthening of
the attachment process in an earlier period. during labor
Keywords: Newborn, pain, attechment, parents M. C Roig Garcia1, A. C. Chamizo Murillo2, and
J. Martinez Céspedes3
1
Midwife Hospital Universitario Aranau De Vilanova Lleida, 2Midwife
Hospital Universitario Aranau De Vilanova Lleida, and 3Nurse Centro
Atención Primaria Lleida
351
Use of folic acid and knowledge Introduction: The purpose of Vaginal Touch (TV) is to check the
evolution of childbirth, entails risk infections, malaise, generating
level of pregnant women anxiety and morbidity and mortality in poor countries. According
to WHO, guide NICE, Cochrane . . . the number of TV should be
the minimum, recommending its implementation every 4 hours.
S. Şen, N. Bolsoy, S. Ulaş, and B. Oğuz Alternatives to TV: Purple Line, maternal behavior, dilation of the anal
Celal Bayar University Faculty of Health Sciences, Manisa, Turkey area,breath, groaning, straining, positions, facial sweating, changes in
uterine dynamics. The purple line goes from the anus to the coccyx,
estimates how many centimeters stretch has the mother. It indicates
Introduction: While there is no general nutritional supplement with progression, grows from the anus to the coccyx 10 cm expansion.
folic asit which prevents the risk of neural tube defect in pregnancy Materials and methods: Literature review of their databases of
period nowadays, the studies on vitamin supplement in pregnancy Cochrane, PubMed, Medline, and others.
period have been performed in recent years. It is also stated that the Clinical cases and summary results:
effects of folic asit can be protective against the risk of growth (1) According to the scientific evidence on TV performed too
deficiency and low birth weight. In folic asit deficiency NTD such as frequently, and too many professionals during childbirth.
anencephaly and spina bifida occurs. The object of the research is to (2) In a study 82% of the women report pain on TV and 68% He
determine the use of folic asit and knowledge levels of pregnant reported discomfort during TV. Besides women report insensitivity,
women living in city center in Manisa. little privacy and lack of dignity to be explored.
Materials and methods: The research is a descriptive research. 2954 (3) The effectiveness of the purple line and others advancing signs of
pregnant women living in city center in Manisa constitute the scope dilation if they are observed give us advance information dilation.
of the research. The paradigm of the research was calculated as 384 Conclusion:
with 5% margin of error, 50% unknown prevalence in 95% confidence (1) Lack of studies on the effectiveness of the purple line and other
interval in Epi Info 6 program. The research data were collected from signs of advancing dilatation.
two random family health centers. The data were collected by using (2) If the TV is not a good measure of progress, there is an urgent need
face-to-face interview method by the researchers. The data collection for identify and evaluate an alternative measure to ensure the best
tool consists of a total of 31 questions. There are questions about outcome for mothers and newborns.
sociodemographic information in the first section and there are (3) The TV should be performed only when necessary, by the same
questions about the use and knowledge of folic acid in the second supplier, guaranteeing the right of women to information, respect,
section. The data analysis was performed with 15.0 statistics program. dignity and life Private.
Numerical percentage distribution was used in the data analysis.
Clinical cases and summary results: It was determined that the average
age of the pregnant women was 27.35 ± 5.28 in the scope of the Keywords: Perinatal health, Vaginal Touch, Dlibery
research, 29% of them were primary school graduates and 82.0% of
them were housewives and the average marriage age was
21.18 ± 3.74. It was detected that the average gestational week of
the pregnant women was 20.12 ± 9.34, the average total number of
the pregnant women was 2.43 ± 1.65, and the average number of
living children was 1.07 ± 1.40. It was determined that 18.6% of the
pregnant women started to use folic acid in pre-pregnancy period
and 73.7% of them used folic acid early pregnancy period, and 38.2%
of them started to use folic acid upon the advice of the family
physician. When we consider the knowledge level of pregnant
women about the use of folic acid, 18.0% of them know that folic acid
is a group B vitamin, and 37.7% of them accurately know the foods
containing folic acid, and %26.5 of them know that neural tube defect
can be developed in the case of folic acid deficiency.
Conclusion: It is determined that the most of the pregnant women did
not use folic acid in pre-pregnancy period and they did not have
sufficient information about folic acid.

Keywords: Folic acid, pregnant, use of folic acid

106 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Presenter: Büşra CESUR

357
Introduction: Becoming aware of our feelings is a skill that needs to be
Oral involvement in pregnacy developed rather than an innate property. Our emotions are the most
important indicator of who we are, why we do what we do, who we
want to be and have a direct impact on our skills. Emotional literacy is
A. C. Chamizo Murillo1, M. C. Roig Garcia2, and
the ability of recognizing, understanding own and others’ feelings in a
J. Martinez Cespedes3 healthy way and the ability to respond to these feelings. In addition,
1
Midwife Hospital Arnau de Vilanova Lleida, 2Midwife Hospital Arnau emotional literacy can be explained as to use the information that we
have about our feelings in shaping our behaviors and in commu-
de Vilanova Lleida, and 3Nurse Centre de Atención Primaria Lleida
nicating with others by understanding our true feelings.
Materials and methods: Midwifery is one of the professions that is in
Introduction: Any problem in the health of the pregnant woman can intensive communication with people and serve people directly.
affect the perinatal health. Interest gingival changes in pregnancy is Many midwives feel inadequately prepared for the interpersonal and
based not so much on its severity, if not his enormous prevalence. emotional roles that sometimes occur in their practice. Midwives’
According to WHO, tooth decay affects almost 100%, 15–20% of levels of emotional literacy must be adequate to recognize, under-
middle-aged adults suffer from periodontal diseases with consequent stand the feelings of individuals they care, to understand their
loss of teeth. Unfavorable socioeconomic conditions influence the problems, to empathize with them and to solve their problems
onset of periodontal disease. In pregnancy gingivitis prevalence varies effectively.
between 35 and 100%. During pregnancy increases the susceptibility Clinical cases and summary results: Studies carried out on students
of gum-related hormonal changes causing vascular changes, cellular, show that students with high emotional literacy skills have better
microbiological and immunological. The protocol for monitoring and academic achievements, social skills, peer relationships, empathic
control pregnancy should include an oral health program for basic skills and motivating themselves better. For this reason, curriculum of
health areas. midwifery education should be organized in such a way that will
Materials and methods: Literature review in databases: Cochrane, improve emotional literacy of students’ from the educational process.
MEDLINE, PubMed and others. Conclusion: Thus, the development of emotional literacy skills of
Clinical cases and summary results: Major dental conditions in the midwife candidates’ will be ensured. Graduate midwives who are
pregnancy: Caries; Acid erosion of teeth; Gingival inflammation emotionally literate will not only meet the physiological needs but
(60–70%); Periodontal disease and tooth loss; Epulon gravidum (10%); also meet the emotional needs of individuals effectively and in this
xerostomia; Ptialism / drooling (rare) way they will have contributed to improvement of the quality of
Conclusion: It is important the midwife cares in oral health of pregnant midwifery care. This article aims at examining the emotional literacy
women to adequate education care, including oral health education and its importance in the profession of midwifery.
in health programs of control of the pregnancy.
Keywords: Midwifery profession, midwifery students, emotional
Keywords: Perinatal health, oral health and pregnancy literacy

716 (CASE REPORT)

Unusual behaviour related to
planned home birth
L. Ples1,2, RM. Sima1,2, D. Carp2, I. Sosievici2, and
C. Moisei2
1
The ‘‘Carol Davila’’ University of Medicine and Pharmacy, Bucharest
and 2‘‘Bucur’’ Maternity, ‘‘St. John’’ Hospital, Bucharest, Romania

Presenter: R.M. SIMA

Introduction: The prevalence of planned home birth varies by country.
The American College of Nurse Midwives (ACNM) and the American
Public Health Association (APHA) has policy statements supporting
the practice of planned out-of-hospital birth in select populations of
pregnancies. The World Health Organization (WHO) has released a
statement indicating women can choose to deliver at home if they
have low-risk pregnancies, receive the appropriate level of care, and
formulates contingency plans for transfer to a properly-staffed/
574 equipped delivery unit if problems arise. In Romania there is no
statement or guideline regarding planned home birth. Lately it was
Emotional literacy in terms of a observed a new trend for Romanian patients: some pregnant women
who require home birth assistance.
qualified midwife and quality of Clinical cases and summary results: We retrospectively evaluated the
home births that after delivery were referred to our unit in 2015. It
care was observed that we had 5 home births from a total number of 1983
births. 4 home births were unplanned. They were incidental situations
B. Cesur, and Ş. Ertekin Pınar caused by: long distance between home and hospital (one case),
prematurity (2 cases) and homeless (one case). We report the only
Asst. Prof. Cumhuriyet University Faculty of Health Sciences, case that was registered as planned home delivery because it
Department of Midwifery, Sivas, Turkey associates an unusual maternal behavior. The patient M.I, 32 years
woman, was admitted in our unit in the third period. She had a home
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 107
birth assisted by a doula and she gave birth to a 3200 g healthy baby
boy. The mother and doula decided to come to hospital because of
retained placenta. The placenta delivered naturally immediately after
hospitalization. Maternal and neonatal outcome was favorable. The
particularity of this case is that the mother wanted to receive the
placenta to take it home. Her considerations were cultural and non-
medical.
Conclusion: Planned home birth is an isolated situation in our medical
unit according to medical charts from 2015. Unplanned home birth
has also a low rate among vaginal deliveries. We presented that
particular case because the mother had that special wish: to take
home the placenta. This is an uncommon situation in our medical
units. The woman explained that the placental tissue is for her
personal usage (to be eaten), being influenced by foreign similar
practices that she have seen on internet.

EPIGENETICS AND METABOLOMICS IN

PERINATOLOGY - 053 (CASE REPORT)
250 (CASE REPORT)
Raging vessels: a case report on
Do we always propose the same
pregnant young overt diabetic
patient with cerebral cavernous diagnostic for the low gain
malformation presenting as pon- ponderal in neonates and
infants? importance of early
tine hemorrhage and hepatic
hemangioma delection of metabolopathies
A. Campos Martı́nez, A. Montoro Sánchez, L. Zamorano
J. Paulino-Morente, V. Penolio, and I. Cacas Bonilla, P. Cid Galache, R. Pérez Iáñez, and
Department of Obstetrics and Gynecology, Quirino Memorial Medical A. Rodriguez Leal
Center, Quezon City, Philippines
Paediatric Dept, Motriĺs Hospital, Granada, Spain

Introduction: A 29-year-old G5P4 (4004) was admitted at 23 weeks and 6

days age of gestation due to left-sided hemiparesis and slurring of Introduction: We often find that infants do not gain weight in the first
speech. Past history reveals three previous admissions for severe anemia weeks of life. We usually associate it with poor tolerance of artificial
requiring multiple blood transfusions and a fourth admission for ligation feeding, technical problems with breastfeeding or intolerance or
of esophageal varices with hepatic hemangioma as the cause of portal allergy to cow’s milk proteins. However, we forget other assessments
hypertension. A multidisciplinary team was assembled to manage the from a difficulty in the assimilation of food.
neurologically stable patient who underwent caesarean section with Clinical cases and summary results: Girl of 15 days was admitted to our
bilateral tubal ligation at 35 weeks age of gestation. Magnetic resonance hospital with recurrent vomiting, irritability and poor weight gain.
angiography revealed a cavernoma. Fueled by exclusive breastfeeding. The physical examination revealed
Clinical cases and summary results: Review of literature shows that little adipose tissue, and profuse sweating. Active. Current weight of
cavernous malformation is rare affecting 0.47% of individuals and 2400 gr. Personal history: controlled pregnancy, vaginal delivery at
increased risk of hemorrhage from cavernous malformation and risk of term. Intrauterine growth restriction with birth weight 2350 g. GBS
hemangioma rupture during pregnancy is possibly due to an increase in negative and negative maternal serologies. Family history: systemic
Vascular Endothelial Growth Factor (VEGF) during placental develop- lupus erythematosus affects mother. On admission, the following
ment. VEGF has also been found to be increased in in Diabetes Mellitus. diagnoses are suspected: hypertrophic pyloric stenosis, urinary tract
Cavernous malformation is a rare disease with scant data associating it infection, intolerance or allergy to cow’s milk proteins, breast milk
with pregnancy. Current literature has not reported its occurrence with excess. We request blood count, biochemistry with electrolytes,
hepatic hemangioma in a single patient and no data has linked it with glucose, urea, and total E imunoglobulin (cow’s milk fractions), TSH,
Diabetes Mellitus. Currently, there are still no management guidelines venous blood gas and urine sediment with results within normal
regarding cavernous malformation in pregnancy. limits. The abdominal ultrasound scan was normal too. While entering
Conclusion: Increased levels of VEGF in pregnancy may predispose to poor tolerance persists puffs, vomiting and poor weight gain so you
developing vascular anomalies such as cavernous malformation but is decide to try hydrolyzed formula achieving excellent oral tolerance.
still rarely encountered in pregnancy. It’s occurrence with another Stresses maintained profuse sweating. In these days, we received the
vascular malformation, hepatic hemangioma and Diabetes Mellitus screening of inborn errors of metabolism results practiced in our
where VEGF levels are also increased opens the door for analytical country with the diagnose suspected of cystic fibrosis. Chlorine test is
research in this rare clinical presentation. performed in sweat with a confirmatory result. Start enzyme
replacement therapy and protein hydrolyzate feeding keeps improv-
ing weight gain and irritability.
Keywords: Cerebral cavernous malformation, vascular endothelial Conclusion: In many cases the low weight gain, poor tolerance of milk
growth factor or an infant irritability are associated with the same basic diagnosis,
without considering the possibility of other diseases such as cystic
fibrosis or other metabolic disorders. Emphasize the importance of
universal screening for inborn errors of metabolism to early diagnosis
of these pathologies.
108 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

457
Keywords: Screening, metabolic disorders, cystic fibrosis
Plasma metabolic profile in
gestational diabetes mellitus
424
Influence of sexual dimorphism M. Skotnicki1, D. Dudzik2, M. Zorawski3, A. Garcı́a2,
W. Zarzycki4, S. Angulo2, and C. Barbas2
on women blood coagulative 1
Clinical Department of Perinatology, Public Clinic Hospital, Medical
system in physiological University of Bialystok, Bialystok, Poland, 2CEMBIO (Center for
Metabolomics and Bioanalysis), San Pablo CEU University, Faculty of
pregnancy Pharmacy, Madrid, Spain, 3Department of Clinical Medicine, Medical
University of Bialystok, Bialystok, Poland, and 4Clinical Department of
T. L. Botasheva, E. A. Kapustin, N. V. Palieva, Endocrinology, Diabetology and Internal Diseases, Public Clinic
V. V. Barinova, A. V. Hloponina, and L. V. Kaushanskaya Hospital, Medical University of Bialystok, Bialystok, Poland

Rostov Scientific-Research Institute of Obstetrics and Pediatrics,

Introduction: A growing number of metabolomics studies, aimed at
Rostov-on-Don, Russia uncovering the metabolic signature of type 2-diabetes, focusing
Introduction: Sex of the fetus is a genetically determined factor in the on potential biomarkers of altered glucose tolerance and onset
formation of certain differences in the functioning of various parts of of insulin resistance. In the present study, we devised an untargeted
the functional system "mother-placenta-fetus". It is evident that the metabolomics approach for determination of the metabolic alterna-
sex of fetuses can influence differently on the antenatal period of tions in plasma during GDM.
ontogenesis and have different impact on pregnancy outcomes, Materials and methods: The study sample consisted of 64 participants
including the state of coagulative system. - 36 healthy pregnant women and 28 women with GDM (2-h 75-g
Materials and methods: Retrospective evaluation of blood coagulation OGTT) matched according to week of gestation and age were
in 259 women with physiological pregnancy in I, II and III trimester collected following gestational and postpartum time trajectory (2nd,
with no abnormalities of the blood was conducted. Of these, 116 3rd trimester of gestation, 1 month and 3months after delivery). An
women had female fetuses (I group), 143 - male fetuses (II group). Sex Agilent Technologies 7100 CE system coupled to an Agilent
of the fetus was determined by two-dimensional ultrasound. Technologies 6224 Accurate-Mass TOF mass spectrometer system
Hemostasis parameters - hemoglobin, hematocrit, red blood cells, with an electrospray source was used for metabolomics analysis.
erythrocyte sedimentation rate, fibrinogen, platelets, activated partial Comprehensive data mining including data pre-processing, data pre-
thromboplastin time, prothrombin time, thrombin time, prothrombin treatment and data treatment have been applied to the study.
index, international normalized ratio, soluble complexes of fibrin- Clinical cases and summary results: A data matrix consisting of 135
monomer were determined using an automatic hematology analyzer. metabolic features were evaluated by univariate and multivariate
Clinical cases and summary results: We found that with increasing statistical analysis. The metabolic perturbation identified in this study,
gestational age the increased activity of coagulative hemostasis was mainly related to amino acids and carnitine pathways, may provide an
noted in both clinical groups, but the rate of these changes was important further insight into the molecular pathophysiological
higher and reached a maximum in II trimester in women with a male mechanism of the onset and progression of GDM.
fetus, whereas in women with female fetus pace of these changes Conclusion: Metabolomics offers a powerful tool for identification of
was less pronounced. D-dimer levels were higher in women with male key metabolites involved in the biological or pathophysiological
fetuses (p=0.0478), especially in the II trimester (21%). A significant processes at a molecular level. That, allow for new insight and the
(p=0.0352) difference in platelet count was revealed in the I trimester: elucidation of disease mechanisms, onset and progression.
average values were higher (26%) in pregnant women with male
fetuses (p=0.0451). In II trimester of pregnancy in women with a male
Keywords: Metabolic profile, GDM
fetus we revealed a tendency to a higher fibrinogen. The average
values of thrombin time in women with male fetuses were rising,
while in pregnant women with female fetuses these values were
lower (within the band of normal) as it approaches delivery date.
Conclusion: In women with male fetuses we revealed higher
coagulation readiness in physiological pregnancy, indicating the
tension of coagulation system in this variant of sexual dimorphism. 511
Higher levels of D-dimer in pregnant women with a male fetus can
also be explained by greater morphological and functional "vulner-
The effect of cell growth and
ability" of uterine-placental complex and by more frequent occur- proliferation factors (EGF/PDGF
rence of placental insufficiency.
signaling pathway) on the etio-
Keywords: Sex of the fetus, pregnancy, blood coagulation
pathogenesis of intrauterine
growth restriction
S.C. Iscan, M.A. Ozek, and M. Bayram
Gazi University Department of Obstetrics and Gynecology,

Presenter: M.A. Ozek

Introduction: Intrauterine growth restriction (IUGR) is defined as

inability of the fetus to gain its growth potential because of various
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 109
pathological issues. IUGR is observed in 3-8% of all pregnancies and it
is an important reason of fetal morbidity and mortality. One of the
685
most important aims of the antenatal care is to detect fetuses which Perinatal outcomes in fetuses
have insufficient growth. It is highly probable that the subgroups of
EGF/PDGF (epidermal growth factor/platelet-derived growth factor) with cystic hygroma
signaling pathway may be involved in the etiopathogenesis of IUGR.
For example, it is known that apoptosis (programmed cell death) is
the key mechanism in cell homeostasis, cell growth and immune
Seval M.M.1, Katlan D.C.1, Yakıştıran B.1, Tuncalı T.2,
response. Apoptosis plays an integral role in successful placental Ilgın Ruhi H.2, Koç A.1, and Söylemez F.1
devolopment. 1
Ankara University School of Medicine, Department of Obstetrics and
Materials and methods: In our study, EGF/PDGF signaling pathway
Gynecology and 2Ankara University School of Medicine, Department
gene profile was studied comprehensively with Reverse transcriptase-
Polyerse chain reaction(RT-PCR) by using ‘‘Human EGF/PDGF of Genetics
Signaling PCR Array’’ in placentas obtained from 6 women with
healthy pregnancies and 6 women with intauterine growth restricted Introduction: Cystic hygroma is a congenital malformation character-
fetuses. The genes related with cell survival and growth; such as ized by the presence of abnormal fluid collection at sites of
apoptosis, cell cycle, cell differentiation cell growth, cell motility, cell lymphatic-venous collection within neck, mediastinum, abdomen,
proliferation gene groups were studied. and axillary region [1]. It is also defined as a subgroup of
Clinical cases and summary results: The parity, gestational week at lymphangiomas with the cystic variety, and filled with protein-rich
delivery, Apgar scores at first and fifth minutes were not significantly fluid [2]. Cystic hygroma is classified as septated and non-septated.
different between the IUGR and control groups. However, the women The overall incidence of cystic hygroma is approximately 1/1000–6000
in IUGR group were younger and slimmer. Additionally, AFP values births and 1/750 spontaneous abortion [3]. In this study, we aimed to
were higher in IUGR group when compared to those of the control evaluate the gestational and fetal outcomes of fetuses with cystic
group. It seems that PRKCA gene is the only gene which shows a hygroma.
significant expression difference between the IUGR and control Materials and methods: We conducted a retrospective study based on
groups. a review of medical records of patients who had fetal septated cystic
Conclusion: It is highly probable that the expression variations in the hygroma, diagnosed by ultrasonography in the Ankara University
genes in pregnancy cause changes onto placental and fetal School of Medicine, Department of Obstetrics and Gynecology,
development by affecting apoptosis and cellular events on different between December 2012 and February 2016. Cystic hygroma was
aspects. At the present time, the progressing studies of diseases and defined as an enlarged sonolucency with clearly visible septations
gene therapy are individualized. We believe that different genetic extending along the fetal body axis, in contrast to NT, which was
origins of IUGR and other diseases of pregnancy for different described as a nonseptated sonolucent area confined to the fetal
individuals will be found and individual gene therapies for them neck (Figure 1) [7]. Data about karyotypes of fetuses, and gestational
will be generated in the near future. outcomes were collected either from the records of Obstetrics and
Gynecology, and Genetics Departments, or from direct phone calls to
Keywords: Intrauterine growth restriction, egf, pdgf, cell, growth, patients.
proliferation Clinical cases and summary results: 4589 singleton pregnancies were
enrolled for first and second trimester sonography between
December 2012 and February 2016. We observed 18 cases of fetal
cystic hygroma among these patients (0.39%). The details of the cases
with cystic hygroma were summarized in table 1.
A normal karyotype was revealed in 11 cases (61.1%), whereas 7 cases
(38.9%) had abnormal karyotypes. The abnormal karyotypes were:
Turner syndrome (45 X0) in 3 (16.7%), trisomy 21 in 2 (11.1%), trisomy
18 in 1 (5.6%) and mosaic Turner syndrome in 1 (5.6%) patient.
Sonographic scan revealed associated findings in 7 (38.9%) cases.
These findings were: hydrops and pleural effusion (n=3, 16.7%), pes
equinovarus (n=1, 5.6%), pectus carinatum (n=1, 5.6%), perimem-
branous VSD (n=1, 5.6%), multicystic dysplastic kidney (n=1, 5.6%)
and short femur-humerus (n=1, 5.6%).
Conclusion: At least half of the cystic hygroma cases were reported to
be coexisting with chromosomal abnormalities [8]. If NT measure-
ment was above 2 mm, 60% were related with abnormal karyotype
and 1/4 of these cases were detected to have T21. In conclusion, the
presence of cystic hygroma carries a high risk for aneuploidy and
major structural malformations. Invasive prenatal diagnostic proce-
dures for fetal karyotype analyses and parental counselling about
poor perinatal prognosis is mandatory.

Keywords: Cystic, hygroma, perinatal, outcomes, neurologic

https://www.eiseverywhere.com/eselectv2/backendfileapi/
download/144836?id=mgojsxFpyJk%3D
https://www.eiseverywhere.com/eselectv2/backendfileapi/
download/144836?id=KJ%2F1udZrliI%3D
110 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

FETAL DISEASE - 013 039

Are term fetuses with isolated Echocardiographic evaluation of
single umbilical artery at an the interatrial communication in
increased risk for perinatal the foetuses with hypoplastic left
mortality? heart syndrome - criteria for the
E. Sheiner, G. Gutvirtz, O. Beharier, and A. Walfisch
need of in-utero catheter
Department of Obstetrics and Gynecology, Soroka University Medical
intervention
Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
R. Bejiqi1, H. Bejiqi2, R. Retkoceri1, N. Zeka1, A. Retkoceri2,
Introduction: Single umbilical artery (SUA) has been associated with L. Kryeziu3, and R. Bejiqi2
fetal growth restriction and preterm delivery, and was found to be an 1
Pediatric Clinic, University Clinical Center of Kosovo, Prishtina,
independent risk factor for perinatal mortality. We sought to
Republic of Kosovo, 2Main Center of Family Medicine, Prishitna,
determine whether SUA is an independent risk factor for perinatal
mortality in the full-term neonates with normal estimated fetal Republic of Kosovo, and 3Clinic for Neonatolgy, University Clinical
weight prior to delivery. Center of Kosovo, Prishtina, Republic of Kosovo

Keywords: Materials and Methods: A population-based study was Introduction: Introduction Intact or very restrictive atrial septum in
conducted, including all deliveries occurring between 1993 and 2013, foetuses with hypoplastic left heart syndrome (HLHS) is a highly lethal
in a tertiary medical center. Pregnancies with and without isolated combination. It has long been recognized as a predictor of poor
SUA were compared. Multiple gestations, chromosomal, and struc- outcome despite of early postnatal left atrial decompression and
tural abnormalities were excluded from the cohort to fit the definition palliative surgery. Echocardiographic evaluation and correlation of
of isolated SUA. Only pregnancies delivered at term with normal EFW the foetal pulmonary venous flow (PVF) with severity of atrial septal
evaluated prior to delivery were included in the analysis. Stratified restriction (ASR) is the parameter of choice for assessment of need for
analysis was performed using multiple logistic regression models to emergent atrial septostomy in newborns with HLHS. Despite the
evaluate the risk of adverse outcomes and perinatal mortality for palliative intervention many of these infants will die from severe
isolated SUA fetuses. persistent pulmonary vascular resistance.
Clinical cases and summary results: During the study period, 233,123 Materials and methods: A retrospective review of echocardiography
deliveries occurred at the Soroka University Medical Center, out of records of 18 patients with hypoplastic left heart syndrome and
which 786 (0.3%) were diagnosed with isolated SUA. Different restriction at the atrial level born, between 2010 and 2006 was
pregnancy complications were more common with isolated SUA performed. Age at diagnosis was from 16 to 26 gestational weeks
fetuses including: placenta previa (OR=2.9), placental abruption (mean 22 ± 4 days). Patients with an intact atrial septum or an
(OR=3.4), true knot of cord (OR=3.5) and cord prolapse (OR=2.8). interatrial communication less than 2 mm by color Doppler flow
Induction of labor and cesarean delivery were also more common in mapping on initial postnatal study, or evidence of obstruction to left
these pregnancies (OR=1.5 and OR=1.9, respectively). Isolated SUA atrial egress on foetal echocardiogram, were included. Patients were
neonates had lower Apgar scores at 1 and 5 minutes (OR=1.8, OR=1.9, subdivided into two groups based on severity of obstruction.
respectively) compared to the control group and perinatal mortality Clinical cases and summary results: Eighteen patients met inclusion
rates were higher both antenatally (IUFD, OR=8.1) and postnatally criteria and basing on the degree of obstruction patient were divided
(PPD, OR=6.1). In the multivariable regression model, SUA was found in two group: eight have had most severe form of anatomic
to be independently associated with perinatal mortality. obstruction (group 1), and 10 had a lesser degree of obstruction
Conclusion: Isolated SUA appears to be an independent predictor of (group 2). Thirty-day cumulative survival for all was 68%: 38% for
adverse perinatal outcomes in full-term neonates. group 1 and 94% for group 2 (p ¼ 0.001). All foetuses were prenatally
diagnosed and to any fetus prenatal intervention has been done. All
Keywords: Spontaneous preterm labor; nitroglycerin, NO donors, fetuses in group 1 and two in group 2 had progression of atrial level
nifedipine, calcium channel blocker, preterm delivery, preterm restriction from the first foetal study to the first postnatal study. 13
birth patients (72%) prenatally diagnosed with severe restriction under-
went planned caesarean section followed by immediate catheter-
Table. Multiple logistic regression for prediction of perinatal mortality. based intervention, with 8 survivors (61%). In the absence of cardio
surgery services in Kosovo all these have been transferred out for
Variable OR 95% CI p Value surgical treatment. In four pregnant in-utero transport to tertiary level
with cardiosurgery services abroad Kosovo was performed where
SUA 5.13 3.18–8.26 50.01 surgery or balloon intervention was done.
Polyhydramnios 3.14 2.49–3.94 50.01 Conclusion: Hypoplastic left heart syndrome with an intact atrial
Oligohydramnios 4.02 3.07–5.26 50.01 septum is a highly lethal condition despite prenatal diagnosis and
Placental abruption 32.56 25.22–42.04 50.01 immediate intervention at birth. Foetal intervention should be
Cord prolapse 6.43 4.11–10.06 50.01 considered for these high-risk foetuses. Prenatal diagnosis did not
True knot of cord 3.46 2.41–4.98 50.01
improve initial hospital survival or cumulative survival for either group
NRFHR 2.67 1.95–3.65 50.01
Vasa previa 6.33 2.48–16.12 50.01
Keywords: Fetal echocardiography, hypoplastic left heart syndrome,
baloonatrioseptostomy
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 111
Introduction: Introduction rubela infection occuring for the first time
048 during pregnancy is diagnosed through detecting specific IgM
Trends on the fetal mortality antibodies after mild febrile status followed with skin rash Although
rubela causes mild acute infection in adults, it has a devastating
rates, Brazil, 2001–2010 impact on the fetus especially if infection occurs in pregnant women
in the first 12 weeks of pregnancy or in last 10 weeks Although Rubela
infection is mild in children and adults, it is severe in fetus causing
A. Cunha1, M. Nascimento2, S. Teixeira1, E. Gerde1, and intrauterine death or preterm birth with severe congenital abnorm-
C. Soeiro1 alities anophtalmia,microphtalmia,galucoma, congenital heart defect
1
as stenosis of a pulmonalis Congental rubella infection at birth is
Hospital Maternidade Terezinha de Jesus, Mesquita, Rio de Janeiro, presenting present as SGA, pallor, jaundice, heaptosplenomegalia,-
Brasil and 2Instituto de Saúde Coletiva, Universidade Federal microcephalia, hypotonia, failure to thrive. After birth, it can be
Fluminense, Niterói, Rio de Janeiro, Brasil diagnosed either using detection of specific IgM in umbilical blood or
by PCR method detecting the virus in newborn tissues The most
Introduction: Prenatal care with service supply of quality it is essential important is to recognize this infection without knowing anything
for gathering satisfactory maternal and perinatal outcomes. Although, mothers condition during pregnancy as it is usal at neonatal
in Brazil, the prenatal coverage can be considered universal, the fetal departments attached to children’s hospital. Our case is indicative
death still is a challenge for policy-health-makers. and convenient for learning because nowadays rubella infections are
Materials and methods: Official sources about live births (Live Births rare due to immunization Doctors do not recognize this syndrome, do
Information System - SINASC) and deaths (Mortality Information not even think about it, especially when they do not have any contact
System - SIM) have universal coverage in Brazil and were consulted for with the mother or her medical documentation but only deal with
getting total of live births and fetal deaths, occurred from 2001 to neonate.
2010. Microsoft Excel Programä was used to calculate rates and Clinical cases and summary results: First baby from the first pregnancy,
produce trend graphic. Time series were analyzed using Prais-Winsten mothers age -13 years living, very low social status, GS 36 weeks,
regression and the Annual Percent Changing - APC and 95% meconial amniotic fluid, aspiration of meconium, BW 2250 gr BL
Confidence Interval (CI), after logarithmic transformation of rates 45 cm/SGA/HC 29/microcephalia/, retro and microgenia, microphtal-
was estimated with the use of STATA Statistical Packageä. mia culi bil, heart murmor, palor and jaundice of skin, hypotonia,
Clinical cases and summary results: In Brazil, from 2001 to 2010, letargia. Our first diagnose was that preterm baby suffers from sepsis
344 492 and 29 789 298 babies were born dead and alive, respectively. but our lab test showed negative CRP and procalcitoni values, normal
The average fetal mortality rate was 11.43 by 1000, ranged from 12.29 level of WBC, anemia and trombocytopenia, direct hyperbilirubinae-
by 1000 (2001) to 10.69 by 1000 (2010). Visual inspection (Image) of mia. Ultrasound of brain with calcifications was the first fact that make
the ranked rates by year showed reducing trend. Annual Percent out diagnose toward congenital intrauterine infection and after
Changing was statistically significative with fetal mortality dropped at gaining positive specific IgM, we were sure that all these signs were
a yearly rate of 1.59% (95% CI 2.04%, 1.13%) due to congenital rubela infection When we have made contact with
Conclusion: Although the time series analysis has shown significant mother we found out that she was never vaccinated and during this
decrease in fetal mortality rates, the figures are still high, suggesting pregnanacy had rash that was meant to be allergic reaction toward
that more investments should be prioritized to improve the prenatal food. Mother did not want to keep this child as it was unwanted and
care and childbirth in Brazil. due to prognosis for very poor psychomotor development of this
child, it was sent to health care centar for social care and has severe
Keywords: Stillborn, mortality, fetus, time series mental and motor handicap/original picture/
Conclusion: This case can be very instructive for parents who do not
want to give rubela vaccination to their children as antovaccination
wave present nowadays in high developed countries because every
unvaccineted girl can gain rubella infection during pregnancy and
then loose child or give birth to this syndrome.

Keywords: Rubella, congenital infection, neonate

052 (CASE REPORT)

Rare clinical case of rubela
infection diagnosed in neonate
period
S. Stefanovic, I. Kavecan, Jadranka Jovanovic,
Milenko Kolarski, V. Stefanovic, and V. Stefanovic
Medical Faculty, Institute for Children’s and Youth Healthcare,
University of Novi Sad, Novi Sad, Serbia
112 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

060 (CASE REPORT) 070

The role of prenatal ultrasound Intrauterine treatment of fetal
screening for pre-auricular skin hydrops in Rh-immunized women
tags in foetuses: a case report of M. Beluga1, I. Kurlovich1, V. Semenchuk1, T. Vashchilina1,
goldenhar syndrome T. Jurkevich1, and V. Bialuha2
1
Republic Research and Practical Center, Laboratory of Obstetrical
I. Putri and K.W.S. Tan and Gynecological Pathology, Minsk, Belarus and 2Grodno State
Obstetrics and Gynaecology Department, The Calvary Hospital, Medical University, Obstetrics and Gynecology Department, Grodno,
Australian Capital Territory, Australia Belarus

Introduction: The incidence of external ear malformations in newborns Introduction: Fetal and neonatal hemolytic disease results from
is around 1:8000. Ear abnormalities are important in the diagnosis of a maternal alloimmunization to red cell antigens, for which mother
variety of congenital malformations or syndromes in newborns. and fetus are incompatible. The resulting progressive fetal
Ultrasound is considered to be a reliable non-invasive method for the anemia leads, when untreated, to fetal hydrops due to hypoprotei-
early diagnosis of specific disorders associated with the pregnancy nemia and perinatal death in approximately 18% of pregnancies.
and assessing fetal growth. Research has shown that the highest yield The best way of treatment of severe fetal anemia is intrauterine
at detecting structural ear abnormalities between 20 and 24 weeks of blood transfusion.
pregnancy. Keywords: Objectives: To evaluate the effects of serial intravascular
Clinical cases and summary results: We report a 28-year-old blood and albumin transfusions on RhD-alloimmunized fetuses with
primigravida patient with stable Graves disease who had a screen hydrops at the time of the first transfusion by measuring multiple
negative aneuploidy screen in the first trimester, serology negative hematological/biochemical blood variables.
with a negative glucose tolerance test. A fetal medicine morphology Materials and methods: Forty seven singleton pregnancies were
scan was performed at 19 weeks which revealed presence of bilateral referred for management of fetal anemia due to RhD alloimmuniza-
pre-auricular skin tags (2 on the right and 1 on the left). Growth scans tion with a total of 133 blood transfusions. Eleven fetuses had
were done at 24, 30 and 34 weeks which showed satisfactory interval hydrops on presentation and several blood with albumin transfusions
growth. Genetics was consulted and the diagnosis of oculoauriculo- were performed. Ultrasound and Doppler examinations in MCA were
vertebral syndrome was discussed. A male infant was born at 39 + 3 performed before intrauterine transfusions.
gestation through spontaneous vaginal birth with Apgars of 9 and 9, Clinical cases and summary results: Intrauterine transfusion was
weighing at 3.23kg. A paediatrician review at 1 hour of age revealed performed in hydropic fetuses at a median gestational age of 26
bilateral multiple pre-auricular skin tags with no obvious external ear (95% CI, 21–30) weeks. Median hemoglobin concentration before
anomalies, thin upper lip, high arched palate, beaked nose, small intrauterine transfusion was 4.0 (95% CI, 2.8–4.7) g/dL. Median
retrognathnia, presence of simian creases in the right and left hand. general protein concentration before intrauterine transfusion was 2.7
Cardiovasculatory system was normal. A clinical diagnosis of (95% CI, 2.4-3.1) g/dL. Median albumin concentration before
Goldenhar syndrome (Oculoauricular dysplasia) was made based on intrauterine transfusion was 1.9 (95% CI, 1.5-2.3) g/dL.
the findings. The incidence of Goldenhar Syndrome is about 1 in 3500 Hematological and biochemical blood variables improved to normal
to 1 in 26000 live births. Causes are multifactorial consisting of an values after serial blood with albumin transfusions. No signs of
interaction of between genetics and the environment. It is hydrops fetalis were diagnosed after 3 to 4 intrauterine transfusions.
characterised by the incomplete development of lips, ears, nose, Median hemoglobin concentration in newborns after intrauterine
soft palate and mandible, generally on one side of the body. Ten treatment was 15.0 (95% CI, 12.4-17.2) g/dL (p50.05). Median general
percent of cases occur with defects on both sides of the body. It can protein concentration was 4.9 (95% CI, 4.5-5.5) g/dL (p50.05). Median
also cause incomplete development or entire absence of organs. albumin concentration was 3.4 (95% CI, 2.9-3.6) g/dL (p50.05).
Patients may also suffer from scoliosis, hearing loss, deafness or Conclusion: Serial intrauterine blood with albumin transfusions
blindness unilaterally and sometimes bilaterally, and occasionally resulted in improvement of hematological and biochemical blood
granulosa cell tumors in their life. variables and reduction of fetal hydrops syndrome. The reported
Conclusion: The ultrasound detection of pre-auricular skin tags in the treatment improved neonatal outcomes: no fetal loss was registered.
fetus during the second trimester of pregnancy warrants further
investigation and should include referral to genetics to look for any
possible association with genetic syndromes. Follow up surveillance Keywords: Rh-alloimmunization, fetal hydrops, intrauterine blood
may include serial growth scans for fetal wellbeing and postnatal transfusion
review by a paediatrician to confirm diagnosis.

Keywords: Goldenhar syndrome, oculoauricular dysplasia

DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 113

071
A case report of prenatal
manifestation of Waldman’s
disease
M. Beluga1, D. Sankavets1, I. Kurlovich1, V. Bialuha2, and
K. Marahovski1
1
Republic Research and Practical Center, Laboratory of Obstetrical
and Gynecological Pathology, Minsk, Belarus and 2Grodno State
Medical University, Obstetrics and Gynecology Department, Grodno,
Belarus

Introduction: Primary intestinal lymphangiectasia (PIL) or Waldmann’s

disease is a rare protein-losing gastroenteropathy caused by congenital
malformation or obstruction of intestinal lymphatic drainage resulting
in lymph leakage into the small bowel lumen and responsible for
protein-losing enteropathy leading to lymphopenia, hypoalbuminemia 134 (CASE REPORT)
and hypogammaglobulinemia. PIL is generally diagnosed before 3 years
of age but may be diagnosed in older patients. The main symptom is
A rare case of congenital cystic
predominantly bilateral lower limb edema. Edema may be moderate to adenomatoid malformation with
severe with anasarca and includes pleural effusion, pericarditis or
chylous ascites. hiatal hernia and anal atresia
Clinical cases and summary results: We reported a case of a 32-year-old
woman, gravida 2, para 1, without immune antibodies referred to our A. Biri1, A. Saygi2, A. Yagmurlu3, F. Mutlu4, and O. Ozek1
department at 23/0 weeks of gestation, presenting an abnormal
ultrasound with fetal hydrops (ascites, hydropericardium, hydro- 1
Obstetrics and Gynecology Dept., Koru Hospital, Ankara, Turkey,
thorax, soft tissue edema). She had an acute respiratory disease at 20 2
Obstetrics and Gynecology Dept., Etimesgut Military Hospital,
weeks of gestation. We performed an amniocentesis and cordocent- Ankara, Turkey, 3Paediatric Surgery Dept., Ankara University Faculty
esis. Normal karyotype was found. Blood sampling revealed of Medicine, Ankara, Turkey, and 4Obstetrics and Gynecology Dept.,
hypoproteinemia, hypoalbuminemia, thrombocytopenia, leukopenia.
Yuksek _Ihtisas Faculty of Medicine, Ankara, Turkey
No parovirus B19, nor CMV or other infection agents were found in
fetal blood by PCR. Repeated (every 2 weeks) intrauterine intravenous
into umbilical vein infusions of human immunoglobulin and Sol. Introduction: The aim of the study is to report one rare case of
Albumini 20% were performed. But biochemical and hematological congenital cystic adenomatoid malformation (CCAM) with hiatal
blood variables did not change significantly. Male premature infant hernia and anal atresia in the same patient.
was born by cesarean section at GA 33 weeks because of PPROM, Clinical cases and summary results: Fetal intrathoracic cystic lesions
weight - 3340 g, length - 45 cm, Apgar score at the 1st and 5th were detected by ultrasonography at the right posterolateral aspect
minutes was 5/7. Newborn was immediately intubated. In the of the heart at 16 weeks in the first pregnancy of a 39-year-old
dynamics patient’s condition remained grave due to cardiopulmonary woman. After detailed screening for fetal anomalies and cardiac
failure, infectious-toxic shock, respiratory distress. The baby was defects at the 16 weeks scan with normal ultrasound findings and
carried maximum therapy including: high-frequency oscillatory intra-abdominal left-sided stomach bubble confirmed a case of CCAM
ventilation, anti-shock measures, combined antibacterial therapy. type 2. The fetal karyotype was normal after amniocentesis following
Attempts of enteral feeding failed in digestion and weight gain, a high-risk screening test for trisomy 21. At 24 weeks’ gestation,
resulted in increase of polyserositis and aggravation of hypoprotei- ultrasound examination demonstrated new onset of fetal abdominal
nemia, that required parenteral nutritional correction with infusion of ascites and the amount of ascites decreased on follow-up ultrasono-
albumin and immunoglobulin. Waldman’s disease (primary intestinal graphy at 28 weeks’ gestation. Intra-abdominal stomach bubble was
lymphangiectasia (PIL) was diagnosed on the basis of a biopsy of the observed at the posterior aspect of the heart in the thoracic region at
intestinal wall (edema of lymph vessels with lymphangiectasia of 34 weeks’ gestation. The male newborn (APGAR 5/8, weight 2480 g)
duodenal mucosa) and clinical signs (edema of lower extremities, was delivered by cesarean section. After describing anal atresia, hiatal
intolerance of enteral feeding), laboratory data (persistent hypopro- hernia and CCAM on the first neonatal examination surgery of
teinemia and hypoalbuminemia). paediatrics consultation was made.
Conclusion: Fetal hydrops can develop not only because of immune Conclusion: There is no definition of anal atresia, CCAM, and hiatal
factors, infectious diseases and other nonimmune factors, but also hernia in the same case in the literature. However, differential
because of rare disorders caused by congenital malformation or diagnosis in patients with CCAM, hiatal hernia and congenital
obstruction of intestinal lymphatic drainage. PIL is a rare disorder that diaphragmatic hernia must be considered particularly via monitoring
should be kept in mind to rigorous follow-up and to avoid difficult of small, displaced or absent stomach bubble with unexplained
complications that can lead to death. polyhydramnios. Because of normal fetal karyotyping, decreasing
ascites levels by 28 weeks and due to lack of other symptoms we
designed conservative treatment. Especially when the detected cases
Keywords: Waldman’s disease, pregnancy, cordocentesis, intrauter-
of the CCAM Type 2, cardiac, skeletal, urogenital, and gastrointestinal
ine infusion therapy
system anomalies should be excluded in such cases.

Keywords: CCAM, Stomach bubble, anal atresia

114 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

149
Efficacy and safety of rectal
ibuprofen for ductus arteriosus
closure in very low birth weight
infants
Erdal Peker, Nihat Demir, _Ibrahim Ece,
Ragıp Balahoroğlu, and Oğuz Tuncer
Department of Pediatrics, Division of Neonatology, Yuzuncu Yil
University School of Medicine, Van, Turkey

Introduction: To compare rectal ibuprofen with oral ibuprofen for

closure of hemodynamically significant patent ductus arteriosus
(hsPDA) in very low birth weight (VLBW) preterm infants.
Materials and methods: In a prospective, randomized study, 78 VLBW
infants who have hsPDA received either rectal or oral ibuprofen at an
initial dose of 10 mg/kg, followed by 5 mg/kg at the second and the
third day. The plasma concentration of ibuprofen and renal functions
were determined in both groups by high performance liquid
chromatography (HPLC) method and cystatin-C (cys-C), respectively.
Clinical cases and summary results: The hsPDA closure rate of the
group that received rectal ibuprofen was similar to oral ibuprofen
(88.8% versus 85.7%) after the first course of the treatment (p= 0.265).
A statistically significant difference was identified between the mean
plasma cys-C levels before and after treatment in both the rectal and
oral ibuprofen groups (p ¼ 0.004, p50.001 respectively). The mean
plasma ibuprofen concentration was similar in both groups after the
first dose (rectal 44.06 ± 12.2, oral, 49.71 ± 23.5) and also the third
dose (rectal, 44.82 ± 24.2, oral, 49.73 ± 23.9) (p 4 0.05 for all values).
Conclusion: Rectal ibuprofen is as effective as oral ibuprofen for hsPDA
closure in VLBW infants. The rise in the cys-C level with rectal and oral
treatment shows that patients with borderline renal function should
be evaluated and followed closely.
150
Keywords: Ibuprofen, rectal, oral, patent ductus arteriosus, preterm A single center experience of cns
anomalies or neural tube defects
in patients with Jarcho-Levin
syndrome
Erdal Peker, Nihat Demir, _Ismail Gülşen, Kemal Ağengin,
Sultan Kaba, and Oğuz Tuncer
Department of Pediatrics, Division of Neonatology, Yuzuncu Yil
University School of Medicine, Van, Turkey

Introduction: Jarcho-Levin Syndrome (JLS) is a genetic disorder

characterized by distinct malformations of the ribs and vertebrae,
and/or other associated abnormalities such as neural tube defect,
Arnold-Chiari malformation, renal and urinary abnormalities, hydro-
cephalus, congenital cardiac abnormalities, and extremity
malformations.
Materials and methods: The study included 12 cases at 37-42 weeks of
gestation and diagnosed to have had JLS, Arnold-Chiari malformation
and meningmyelocele (MMC).
Clinical cases and summary results: All cases of JLS had Arnold-Chiari
type 2 malformation, there was corpus callosum dysgenesis in 6,
lumbosacral MMC in 6, lumbal MMC in 3, thoracal MMC in 3, and
holoprosencephaly (HPE) in 1 of the cases.
Conclusion: With this paper, we wanted to underline the neurologic
abnormalities accompanying JLS and that each of these abnormalities
is a component of JLS.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 115

Keywords: Jarcho-Levin Syndrome, neural tube defect, Arnold Chiari after 37 week of gestation was 6539 (80.4%). Ultrasound examination
type 2, newborn of the umbilical cord was performed in a total of 2923 pregnant
women (35.9%), while the incidence of nuchal umbilical cord was
diagnosed in 521 pregnant women (17.8%). The analysis of data
showed that there was no significant difference in the incidence of
nuchal umbilical cord in all patients who gave birth after 37 week of
gestation (1009 to 15.4%) and in patients in control group. False
182 negative results were obtained in 42 pregnant and false positive
results in 24 pregnant women in this group, so that the accuracy of
Nuchal umbilical cord: the myth ultrasound was as followed: sensitivity 92.2%, specificity 98.9%, and
negative predictive value 98.2%. There was no significant difference
or real threatening of fetus? between the frequency of vaginal and cesarean births and fetal
outcome measured by Apgar scoring system according to the
J. Visnovsky, K. Dokus, E. Kudela, M. Visnovska, presence of nuchal umbilical cord. In our dataset, there was no
M. Nachajova, and J. Danko perinatal death.
Conclusion: The nuchal umbilical cord is not associated with an
Department of Gynaecology and Obstetrics, Jessenius Faculty of increased number of surgical deliveries. The authors found no
Medicine and University Hospital, Kollarova 2, Martin, Slovakia difference in perinatal morbidity and mortality in the group of
patients with a confirmed diagnosis of nuchal umbilical cord
Introduction: Umbilical cord wrapped around the fetus, its individual compared to the group without it.
parts, and usually around the neck of the fetus is a common Acknowledgments: This work was supported by project ‘‘Virtual and
complication in pregnant women in term and could be associated Simulation Tuition as a New Form of Education at JFM CU in Martin’’,
with peripartal complications and adverse perinatal outcomes. The ITMS: 26110230071, co-funded from EU sources and European Social
possibility of ultrasound detection of nuchal umbilical cord is Fund.
connected with variety of professional medical problems but also
serious alteration and psychological problems in mothers, who are Keywords: nuchal cord, outcome, 3D/4D sonography
facing the diagnosis of nuchal umbilical cord. A prospective clinical
study was conducted to evaluate the validity of ultrasound detection
of nuchal umbilcal cord, as well as to evaluate the impact on perinatal
morbidity and mortality.
Materials and methods: The study was conducted at the Department
of Gynecology of Obstetrics, Jessenius faculty of medicine and
University Hospital in Martin. The study was conducted between
196
January 2011 and December 2015. This study enrolled pregnant
women who were examined by ultrasound and diagnosed with/
Hydrocephaly – a case report
without the nuchal umbilcal cord between 38 and 41 weeks of
gestation in the period before the onset of uterine contractions. The B. Derbli, M. Nicolay, C. Toscano, D. Alves, R. Salles, and
detection of nuchal umbilical cord was performed using ultrasound, A. Cunha
which was carried out between 14 to 21 days before the expected
date ofdelivery by the experienced ultrasonographer, using combina- Obstetrics Dept, Hospital Central Do Exército, Rio De Janeiro, Brazil
tion of real-time and 3/4D mode. The result of ultrasound
examination was not known to affected pregnant women and their Introduction: The screening of fetal anomalies is an important test to
obstetrician. termination of pregnanncy where it is permitted or even to prepare
Clinical cases and summary results: During the 3-year period there was the parents to face the problem. In case of anomalies compatible with
a total of 8132 births, of which 2472 (30.4%)were terminated by survival to prepare facilities to assist the newborn. Hydrocephaly has a
caesarean section and 158 by forceps (1.9%). The number of births prevalence of 3:1000 to 1:2000 pregnancies. It can be caused by
116 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

genetic anomalies, infections or trauma. It can be classified in Introduction: Placental abruption consists on partial or complete
obstructive or non obstructive. The prognosis is as worse as separation of the placenta that occurs before the delivery of the fetus.
precocious, with the risk of intrauterine death. Typical clinical manifestations are vaginal bleeding, abdominal pain,
Clinical cases and summary results: A woman 28 years, G2 P1, one uterine rigidity and tenderness, contractions and unsatisfactory
previous vaginal delivery with a healthy baby. In this pregnancy the cardiotocographic record. Nevertheless, some cases of placental
hydrocephaly was detected in an exam in the 22th week, without any abruption happen to be asymptomatic, and this situation makes the
other anomaly. The tests for infectious disease were negative. As the process of diagnosis more difficult. A retroplacental clot is the
lesion was precocious it most likely be genetic. The patient had characteristic ultrasound finding and it strongly supports the clinical
emesis in the 29th week when she was admitted. When she recovered diagnosis. The presence of more than half of the placental surface
from the emesis, the fetal death was diagnosed. She bedelivered a separated, increases the likelihood for acute disseminated intravas-
stillborn in 30th week after the induction of labor. The patient was cular coagulation and fetal death. We present a case of abruption
support by a psychologist and was discharged one day later. with a fateful ending.
Conclusion: The routine exam in the second trimester is essential to Clinical cases and summary results: 35 year-old primigesta, morbidly
detect fetal anomalies. The Brazilian law does not allow the obese, asthmatic and smoking 8 cigarettes a day. Normal first
termination of pregnancy for fetal anomalies, except for anencephaly trimester screening. Apparently normal morphology in prenatal
diagnosis ultrasound with partial occlusive placenta (technical
Keywords: Hydrocephaly, genetic anomaly, fetal disease, fetal death, difficulty due to morbid obesity). Control ultrasound was performed
ultrasound 4 weeks later: early intrauterine growth retardation. A comprehensive
study was implemented at 33 + 2 weeks of gestation due to the
appearance of high blood pressure at home. Preeclampsia was
discarded. At 33 + 5 weeks of gestation, the patient came to the
emergency referring painless genital bleeding. Exploration: no painful
abdomen with normal uterine tone. Closed cervix through which
heavy red bleeding came out. Ultrasound examination: cephalic live
fetus. Non occlusive, posterior placenta. Despite the normality of
urgent blood and urine analysis, and also cardiotocographic record,
the patient was hospitalized under observation. Due to persistent
bleeding, exploration was repeated and ultrasound scan confirmed
stillbirth. Vaginal misoprostol was used to induce labor.
Conclusion: Obstetric haemorrhage is still a potential maternal and
fetal morbidity and mortality cause. Genital bleeding during third
trimester of gestation may involves different possible diagnoses to
bear in mind: placenta previa, placental abruption and vasa previa.
Exhaustive fetal monitoring is essential in order to prevent fatal
results within a few seconds.

Keywords: Obstetric haemorrhage, placental abruption, stillbirth

211
Unusual case of fetal
megaduodenum
P. Domashev, and E. Kaleja
Fetal Medicine Unit, Riga Maternity Hospital, Riga, Latvia

Introduction: At the second trimester USG screening a huge

abdominal thin wall, smooth cyst with homogenous, anechogenic
content has been detected. Diagnosis of suspected mesenteric cyst
was confirmed by MRI. On follow up the cyst’s size has been
progressively increasing. The fetus did not show signs of compromise
except slowly progressing polyhydramnion. At 34 + 5 g.w. after PROM
was born a boy with weight 3400 g. and abdominal diameter 45 cm.
After the birth the suspected diagnosis of megaduodenum was
200 (CASE REPORT) confirmed on surgery, when duodenal resection was performed. Later
on due to feeding problems on re-laparotomy were found newly
Placental abruption: according to enlarged duodenum (with thick hipertrophied walls and reverse
peristaltic) and intestinal malrotation. Till now six laparotomies were
a clinical case performed and prognosis is still unclear.
Clinical cases and summary results: At the second trimester USG
B. Gastón, J. Barrenetxea, B. Pérez, N. Abián, A. Safont, screening at 30 y.o. healthy woman with normal the first trimester
M. Donázar, S. Garcı́a, and C. Larrañaga combined screening a huge abdominal cyst at male fetus was
detected. The cyst was thin wall, smooth, with homogenous,
Departamento de Ginecologı́a y Obstetricia, Complejo hospitalario anechogenic content, occupying most part of the abdominal cavity.
de Navarra, Pamplona, Navarra, España All other abdominal organs were visible. Amniotic fluids volume was
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 117
normal. No chromosomal abnormalities were detected. Diagnosis of well-being. There was no history of consanguinous marriage, Rh
suspected mesenteric cyst was later confirmed by MRI. On follow up isoimmunization, toxoplasmosis, rubella or syphilis infection or family
the cyst’s size has been progressively increasing (from 10% till 30% of history of birth defects. The pregnant underwent amniocentesis,
EBW), AFI has been slowly increasing as well (from normal till 32 cm). which revealed Turner’s syndrome (45,X). After explaining the disease
Doppler, TTD and lung volume were normal all the time of follow up. and associated fetal morbidity, the couple accepted the medical
At 34 + 5 g.w. after PROM by means of cesarean section was born a termination of pregnancy. Pregnancy was terminated at 19 weeks 3
boy with weight 3400g., Apgar score 7/8, abdominal diameter 45cm. days after induction with 400mcg of vaginal misoprostol. The fetus
At birth in course of gastric intubation a big amount of fluid was had a cervical cystic estructure and extensive generalized anasarca.
sucked and new diagnosis of mega-duodenum was confirmed at The autopsy may reveal other associated birth defects.
surgery when huge duodenum was resected. Conclusion: Ultrasound is essential in prenatal detection and diagnosis
Conclusion: of cystic hygroma and fetal hydrops. Fetuses with these sonographic
(1) Rare diagnoses can be a big problem detecting them prenatally. markers have increased morbidity. Given the poor prognosis,
(2) Value of MRI in prenatal diagnosis is limited. termination of pregnancy might be considered, especially when it is
(3) Big abdominal masses of fetus can cause problems in the associated with chromosomal anomalies or other structural
development of intestinal tract. abnormalities.

Keywords: Abdominal mega cyst, mega-duodenum

273 (CASE REPORT)

A case of foetal supraventricular
tachycardia
239 (CASE REPORT)
Severe cystic hygroma and S. Islam, and J. Angrish

hydrops fetalis in a Turner’s Department of Obstetric and Gynaecology, Wexham Park hospital,
Slough, UK
syndrome
Introduction: Foetal arrhythmias affects 1%-2% of pregnancies. The
1 2 1 1 most common foetal arrhythmias are atrial extra-systoles and
C. Bragança , L. Caseiro , F. Barata , and M. Janeiro
supraventricular tachycardia (SVT). Atrial extra-systoles are usually
1 benign and do not need treatment. Foetal SVT is the most common
Obstetrics Dept., Hospital José Joaquim Fernandes, Beja, Portugal
and 2Obstetrics Dept., Hospital Espı́rito Santo, Évora, Portugal type of foetal tachyarrhythmia. Foetal heart rate can range between
200–300 beats/minute. They are typically detected during ausculta-
tion of the foetal heart or by cardiotocography or by an antenatal
Introduction: Hydrops fetalis is a pathological and excessive fetal fluid
ultrasound examination. Sustained SVT can cause foetal congestive
accumulation which can express as ascites, pleural effusion,
heart failure leading to non-immune foetal hydrops, prematurity,
pericardial effusion and/or generalized subcutaneous edema.
perinatal morbidity and mortality. Treatment depends upon gesta-
Nowadays, non-immune etiology is responsible for more than 90%
tional age at diagnosis and the presence or absence of hydrops
of cases. in which Turner’s syndrome is included. On ultrassound,
fetalis. Options are: no intervention but close monitoring, antiar-
increased nuchal translucency, cystic hygroma and renal and cardiac
rhythmic drugs and delivery.
defects are typical findings. This chromosome abnormality is
Clinical cases and summary results: A 34 year Caucasian lady, para 1
associated with 50–80% of cystic hygromas, which result from
with previous delivery of an IUGR baby, attended our Breech clinic at
miscommunication between lymphatic and venous system in the
37 weeks gestation to discuss options. Her BMI was 27.There was no
neck. The lack of communication can lead to the development of
consanguinity or family history of congenital disorders. Down’s
hydrops fetalis. Hydrops fetalis represents a significant fetal compro-
Screening was of low risk. Anatomy scan did not detect any
mise and is associated with high rates of perinatal morbidity and
abnormality. Symphysiofundal height was 30 cm at 34/40 weeks. An
mortality.
USS revealed normal foetal growth and a breech presentation. A
Clinical cases and summary results: A 18 years old multiparous
repeat scan confirmed Breech presentation. Patient refused ECV and
pregnant with 16 weeks 3 days, without prior surveillance, was
requested an elective caesarean section. Foetal heart sound with
diagnosed with an extensive and septated cystic hygroma, associated
sonic aid was 244 bpm. Patient was apyrexial. A cardiotocograph was
with large bilateral pleural effusion, polycystic kidneys, abdominal
misreading the baseline foetal heart rates at 125 with reduced
wall edema and oligoamnios, during ultrasound for evaluation of fetal
118 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

variability. USS confirmed foetal tachycardia of 250 beats per minutes.

There were no signs of foetal hydrops. Due to persistent foetal
tachycardia a Category 1 Caesarean section was performed on that
day. The baby girl was pale at birth and needed inflation breaths.
Heart rate was 270/minute. Birth weight was 2.36kg. Arterial cord
blood pH was 7.19, Base excess was 9.5. Baby was transferred to
SCBU. It was diagnosed with SVT and was initially treated with a stat
dose of Adenosine 150mg. Heart rate was brought down to 140–150/
minute. Later the baby was started on Propranolol. Echocardiogram
showed an atrial septal defect, mild mitral regurgitation and mal-
alignment of the ventricular septum. After cardiology review it was
advised to continue propranolol. Baby’s condition was stable.
Conclusion: Sustained SVT needs urgent and appropriate treatment
depending upon gestation and signs of foetal hydrops. Our case was
at term and due to sustained tachyarrhythmia was dealt with urgent
delivery to ensure optimum outcome.

Keywords: Foetal, supraventricular, tachycardia

275 (CASE REPORT)

292 (CASE REPORT)
Paroxysmal tachycardia in one of Diagnosis and management of
the fetuses of a twin pregnancy - pregnancies complicated by fetal
perinatal management, a case supraventricular tachycardia
report
Theodora M.1, Maritsa V.1, Kiaffa M.2, Laskari K.2,
1 2 1 1
L. Vakrilova , R. Marinov , St. Hitrova , P. Radulova , Antsaklis P.1, Sindos M.1, and Daskalakis G.1
B. Slancheva1, and T. Pramatarova1 1
Maternal Fetal Medicine Dept, st Dept of Obstetrics & Gynecology,
1
Medical University of Sofia, Faculty of Medicine, University University of Athens, Alexandra Hospital and 2Onasseio Hospital
Obstetrics and Gynecology Hospital "Maichin dom" and 2National
Cardiology Hospital, Sofia Introduction: The purpose of this study is to present the diagnosis and
management of pregnancy complicated by fetal supraventricular
Introduction: Paroxysmal tachycardia is a rare disease in the fetal tachycardia.
period. If not properly treated it can lead to cardiac decompensation Clinical cases and summary results: We present three cases diagnosed
with serious consequences as fetal and neonatal hydrops. with fetal supraventricular tachycardia. Anti-arrhythmic drugs were
Clinical cases and summary results: This case report concerns a twin administered to the mother under close monitoring of maternal and
pregnancy. In 23 gestational week (gw) a fetal heart rate (HR) of 250– fetal heart rate. All pregnancies progressed to full term, women were
300 bpm was established in one of the twins, complicated by delivered, no neonatal complications were observed. Supraventricular
hydrops, pleural and pericardial effusions. The echocardiography tachycardia is diagnosed in 1:10 000 pregnancies. Fetal tachycardia
excluded cardiac abnormalities in both fetuses. A sotalol (320mg/day) greater than 200 beats per minute leads to decreased filling of the
treatment of the mother was started and resulted in a HR of 120– ventricles and decreased cardiac output. When this condition is not
140 bpm without negative effects for the other twin. The follow up diagnosed and treated promptly leads to fetal hydrops and possibly
showed a rapid reduction of the heart failure and hydrops, but with a death. The administration of anti-arrhythmic drugs in the mother
mild intrauterine retardation. Cesarean section was performed in usually restores normal heart rate.
35gw (Feb 2016), the birth weight of the 1-st twin was 2400g, of the Conclusion: The fetal supraventricular tachycardia is a rare condition in
2-nd - 1600g. The echocardiograpphy confirmed an absence of the general population. Usually occurs at the end of the second or in
cardiac abnormalities and closure of the fetal communications. In the the third trimester and therefore the diagnosis can be missed.
first days of life the HR was in the reference range with a sinus Treatment of fetal tachycardia is usually achieved by the administra-
rhythm. From D 3 paroxysmal attacks (HR 260–300bpm) were tion of anti-arrhythmic drugs in the mother. If it is not treated, fetal
established once a day and were set under control after brief vagal hydrops and death may follow.
stimulation. From D 12 the paroxysmal rhythm became permanent,
i.v. digitalisation was started, but it was difficult to find the adequate Keywords: Fetal tachycardia
dose to suppress the paroxysmal attacks without signs of toxicity. This
happened after stabilizing the plasma levels just below the upper
reference range. The baby was discharged home with treatment p.o.
and dispensarised in the cardiology for follow up.
Conclusion: Paroxysmal tachycardia is often difficult to treat in fetal
and neonatal period. The etiology is unknown - often on additional
atrio-ventricular wire connection. After starting the cardiotonic
therapy monitoring of the serum levels is necessary to set under
control the therapy and avoid toxicity.

Keywords: Paroxysmal tachycardia, fetus, newborn infant

DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 119

323 (CASE REPORT)

Prenatal management of a fetal
dyshormonogenetic goiter : a
case report and review of the
literature
G. Aubry1, M. Chesnais2, R. Favre1, and I. Nisand1
1
Prenatal Diagnosis Dept, University Hospital of Strasbourg,
Strasbourg, France and 2Prenatal Diagnosis Dept, University Hospital
of Poissy, Paris, France

Introduction: Congenital hypothyroidism with a goiter is rare but

represents 15% of congenital hypothyroidism, which is the
most common curable cause of mental retardation. Both the fetal 325 (CASE REPORT)
goiter and hypothyroidism can be associated with severe perinatal
morbidity and long term neurologic sequelae. Systematic neonatal Neonatal progressive ischemic
screening programs permits early treatment which usually result in
normal developmental outcomes. However, degree of neurological changes with gangrene of the
damages may persist in some children. Improvements in ultrasound
technology have led to an increased and earlier detection of fetal
right forearm of a term baby
goiters. Several techniques to confirm the diagnosis have been
reported, as well as the indications and modalities of an active D. Bajraktari and A. Simeoni
prenatal therapy. As these are invasive procedures, the risk to benefit
ratio has to be questionned. Obstetrics-Gynecology Dept., American Hospital of Tirana, Tirana,
Clinical cases and summary results: We present a case of a fetal Albania
dyshormonogenetic goiter diagnosed at 20 weeks of gestation, in a
woman with no past history of thyroid disease. Her thyroid tests were Introduction: AS 31 years old, G1P0. No history of chronic diseases. BMI
normal, including the absence of auto-antibodies. As the goiter was 31. No gestational diabetes. At 38w2d shepresented respiratory
enlarging, a cordocentesis was performed and confirmed fetal difficulties, cough and fever 38 grade Celsius. Laboratory results were:
hypothyroidism. Intra-amniotic injections of L-Thyroxine were adminis- WBC 11600, RBC 4.600.000, Hgb 13, CPR 5. an antibiotic treatment
tered and led to a rapid decrease of the thyroid size. The patient normally with ceftriaxone 2g/day was started. After 48 hours the women came
delivered a neonate with no palpable goiter or clinical sign of back to the hospital with ruptured membranes. The amniotic fluid
hypothyroidism. However neonatal thyroid tests showed a persistence was transparent. Low intensity contractions were registered in CTG.
of biological hypothyroidism. Few cases of dyshormonogenetic goiters The baby had vertex presentation. A male fetus was born. The weight
have been reported. Ultrasound examination allowed an early diagnosis. was 4060 gr. Apgar score 8/9. No umbilical cord around the neck and
The interest of invasive procedures to confirm diagnosis remains the limbs was observed. Immediately cyanosis and edema with a
controversial when the mother is euthyroid. Plus, in the absence of fragile covering skin of the right forearm, hand and fingers was
goiter’s complications, indications for prenatal treatment in order to observed. The head, body and other limbs appeared normal.
prevent hypothyroidism sequelae are not yet clearly standardized. Clinical cases and summary results: The laboratory exam of the mother
Conclusion: This case reports the favorable evolution of a dyshormo- same day after c section showed normal biochemical markers and
nogenetic hypothyroid fetal goiter after active prenatal management. electrolytes. But CPR 5.1, WBC 17700 with neutrophilia, Hgb 13, early
Questions regarding modalities of in utero management are still morning glucose 17 (that suggested a possible diabetes of pregnancy
unresolved. It seems that goiter’s size and its related complications that was not diagnosed during pregnancy though the baby had
are the only factor justifying indisputably prenatal therapy. The normal values of glicemia, hypoalbuminemia, hypoproteinemia. Next
ultrasound scan is essential to follow the fetus and the evolution is day WBC 15000 with neutrophilia, Hgb 10.1, CRP 2.7. After 48 hours
generally favorable. Pluridisciplinary teams would be needed to WBC 12700 with neutrophilia, Hgb 11.1, CPR 0.4. (almost normal
elaborate clear recommandations. values). Doppler ultrasonography of the proximal part of the right
arm and carotid arteries of the baby revealed not any tipical view of
Keywords: Fetal goiter, intra-amniotic injection, prenatal therapy, arterial thrombosis. The general conditions in the following days were
hypothyroidism, ultrasonography stable, the baby needed no oxygen, he was feeded well by oral route,
normal urination and defecation. One week after delivery the parents
transferred the baby in Weil Cornel NY hospital for the following
treatment. It was impossible to have any kind of medical information
about the conditions of the baby, exams, treatment or possible
interventions performed. In the present case, gangrene of the right
forearm was probably caused by a brachial right arm artery
malformation.
Conclusion: It is advisable to rule out deficiencies and/or thrombo-
philic factors in the coagulation system. It is important to test the
parents for various factors. The amputation wasn’t performed. The
hyperglycemia of the mother after delivery suggests possible glucose
intolerance during pregnancy that wasn’t diagnosed. The bacterial
pulmonary infection of the mother might have influenced in the
insufficient placental circulation.

Keywords: Gangrene, ischemia

120 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

outcome. A MRI should be offered when an absence of the CSP is

suspected on US to rule out a narrow CSP which carry good
prognosis.

Keywords: CSP, fetal imaging, neurodevelopmental outcome, MRI

373 (CASE REPORT)

Prenatal diagnosis of achondro-
plasia - case report and literature
review
R. Bohiltea1, V. Radoi2, M. Cirstoiu1, E. Bratila3,
D. E. Comandasu3, C. Berceanu4, C. Mehedintu5, and
333 L. Bohiltea2
Prenatal MRI features and 1
Obstetrics and Gynecology Department, University Emergency
Hospital, ‘‘Carol Davila’’ University of Medicine and Pharmacy,
neurodevelopmental outcome Bucharest, Romania, 2Medical Genetics Department, ‘‘Carol Davila’’
University of Medicine and Pharmacy, Bucharest, Romania,
of cavum septum pellucidum 3
Department of Obstetrics and Gynecology, "Saint Pantelimon"
abnormalities Clinical Emergency Hospital, "Carol Davila" University of Medicine
and Pharmacy, Bucharest, Romania, 4Department of Obstetrics and
Gynecology, Emergency County Hospital, Craiova University of
S. Cooper1*, O. Bar-Yosef1*, M. Berkenstadt2, Medicine and Pharmacy, Craiova, Romania, and 5Department of
C. Hoffmann3, R. Achiron4, and E. Katorza4 Obstetrics and Gynecology, "Nicolae Malaxa" Clinical Emergency
1
Pediatric Neurology, Edmond and Lily Safra Children’s Hospital, Hospital, "Carol Davila" University of Medicine and Pharmacy,
2
The Danek Gertner Institute of Human Genetics, 3Diagnostic Bucharest, Romania
Radiology, and 4Antenatal Diagnostic Unit, Department of Obstetrics
and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Introduction: Achondroplasia is one of the best-known and most
Israel common types of nonlethal skeletal chondrodysplasia (forms of short
limb dwarfism). The incidence is about 1:20000. Before the relation-
ship between fibroblast growth factor receptor 3 (FGFR3) gene and
Introduction: The cavum septum pellucidum (CSP) is a fluid-filled
this disease was identified, it was hard to differentiate between
cavity found between the leaves of the septum pellucidum.
variant types of chondrodysplasias, such as metatropic dysplasia, Ellis-
Abnormalities in the CSP detected postnatally are associated with
van Creveld syndrome, or diastrophic dysplasia.
neurodevelopmental delay, mental retardation, and neuropsychiatric
Clinical cases and summary results: A 34-year-old female was
disturbances. The growing use of prenatal imaging led to an increase
presented to our clinic because of short fetal femurs (52 percentile)
in prenatal detection of CSP abnormalities. A wide CSP detected
on ultrasound scan at 22 weeks. These findings led to diagnosis of
prenatally was associated with aneuploidy. The aim of the present
achondroplasia, which was confirmed by DNA testing from amniotic
study is to describe the different abnormalities of the CSP detected
fluid. She had nonspecific medical and obstetrical history. The
prenatally, the clinical prenatal related factors, morphologic char-
ultrasound scan at 32 weeks of gestational age revealed rhizomelic
acteristics of fetal MRIs, and neurodevelopmental outcome
shortening of the extremities, frontal bossing and the over rounded
evaluation.
metaphyseal - epiphyseal interface at the femur ends while
Materials and methods: This is an observational retrospective study of
connecting to diaphysis, also called ‘‘collar hoop’’ sign. Nowadays,
39 women who were referred for fetal brain MRI due to a CSP
achondroplasia is suspected only after the third trimester due to the
abnormality detected in an US examination between 2011 and 2015.
late appearance of this disease. These fetuses almost always have a
Data collected included: prenatal history, MRI features, sonographic
long bone below the third percentile for gestational age but normal
follow up, and neurodevelopmental outcome using Vineland II
size of head and abdominal circumference. Conventional 2D
adaptive behavior scale.
ultrasound alone is extremely challenging for diagnosing achondro-
Clinical cases and summary results: Most of the cases (34/39) had an
plasia. Several case series reports have speculated that the accurate
abnormal CSP on MRI. They were divided into 4 groups according to
diagnosis rate ranges from 30% to 70%. The ‘‘collar hoop’’ sign at the
the CSP abnormality on MRI: narrow CSP (n=23), wide CSP (n=7),
proximal end of the femur in fetuses with achondroplasia seemed to
septal agenesis (n=3), and CC agenesis (n=1). Only 4/12 cases that
improve the prenatal diagnosis of achondroplasia.
were referred with US diagnosis of absent CSP were confirmed by
Conclusion: The gold standard method of diagnosis is DNA testing for
MRI, the rest had narrow CSP. Follow up was performed in 24 cases
mutations of FGFR3 from CVS or amniotic fluid.
with an abnormal CSP and 4 cases with a normal CSP on MRI. All cases
had a normal neurodevelopment.
Conclusion: To our knowledge this is the first study that examines the Keywords: Achondroplasia, FGFR3 mutation, ultrasound diagnosis
outcome in a narrow and a wide CSP detected prenatally. It appears
that there is a spectrum of normal development and closure of the
CSP. An abnormal width of the CSP prenatally, without an associated
fetal abnormality such as aneuploidy, appears to have a normal

Affiliated with Sackler School of Medicine, Tel Aviv University, Tel

Aviv, Israel.
*Both authors contributed equally to this study.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 121

431 438
When is a post-mortem skeletal Fetus heart rhythm disorders is
survey of the fetus indicated, and the problem of modern
when not? perinatology
K. Kamphuis-van Ulzen1, D. Koopmanschap1, I. Ignatko, A. Strizhakov, and A. Rodionova
C. Marcelis2, J. Van Vugt3, and W. Klein1 III. Sechenov First Moscow Medical University
1
Dept of Radiology and Nuclear Medicine, 2Dept of Clinical Genetics,
and 3Dept of Obstetrics, Radboud university medical center, Introduction: Small anomalies of the fetal heart (SAFH) - account for
Nijmegen, the Netherlands 33% of all diseases of the cardiovascular system. Fetal arrhythmias -
FA (heart rhythm disorders of the fetus - HRDF, fetal dysrhythmia)
Introduction: Radiography after fetal or perinatal death has become a according to different authors observed in 3–8%. In the structure of
routine part of post-mortem diagnostics. However, only a selected infant mortality, component 58–60% of mortality among children
subset of these babygrams or fetal post-mortem skeletal surveys under the age of 14, a significant role played by fetal cardiac rhythm
(FPSSs) provides useful information. We investigated the indication (HRDF).
for a FPSS. Materials and methods: In general, fatalities FA reach 85%, and a third
Materials and methods: Inclusion consisted of the routinely made FPSS of them designated by the authors as a syndrome of sudden death of
(2002–2012) in our university hospital in cases of fetal or perinatal the fetus. The reasons of FA are systemic and autoimmune diseases of
death up to 7 days after birth. We categorized the diagnostic value of the mother, diabetes, inflammatory diseases of the genitourinary
the FPSS as no, minor, major or pathognomonic. Regression analysis system, hypothermia, hypoxia, hypokalemia, SAFH, as well as defects
was used to determine the selection criteria for a useful FPSS. and tumors of the fetal heart, intrauterine infection. Currently no data
Clinical cases and summary results: 337 FPSS were included. 305 (91%) about the peculiarities of history / pregnancy when the fetus FA and
FPSS showed no or minor skeletal malformations. 14 (4.2%) FPSS had SAFH, not clear their etiology, there is no uniform classification of the
major skeletal malformations. In 18 (5.3%) cases the diagnosis was FA, no exhaustive clinical and laboratory diagnostic algorithm, there is
based on the pathognomonic skeletal malformations on the FPSS. no single approach to obstetric tactics for FA and SAFH.
Two cases were false positive after major birth trauma. The presence Clinical cases and summary results: Supraventricular tachycardia (SVT).
of multiple skeletal malformations on prenatal ultrasound or at post- Approximately half of all the fetal arrhythmia is supraventricular
mortem external inspection was highly indicative of a diagnostic FPSS tachycardia (250 7 300 beats per min). The most common cause of its
(p50.001). occurrence are formed additional loci conduction system cells of
Conclusion: The majority of the babygrams/FPSS has no contribution different parts of the myocardium, manifested in violation of the
to the diagnostic process. Multiple skeletal malformations on prenatal momentum for re-entry type. Much less (2%) SVT observed anomalies
ultrasound or post-mortem external inspection are indicative for a of the heart structure. In 40% of cases of heart failure accompanied by
diagnostic FPSS, and this should be the main selection criterion. SVT in the fetus. The drug of choice for treatment of CBT is digoxin,
while in 40% of cases, complementary therapy with amiodarone, or
flekanid or sotalolol. Atrial flutter (TP - 250 7 500 beats per min),
Keywords: Fetal, babygram, skeletal survey, postmortem, dysplasia
often accompanied by atrioventricular block (AVB), is 21% of total FA.
In the absence of fetal heart failure digoxin use. In the case of fetal
hydrops joined (7% of cases) shows the use of flekanida, procaina-
mide or amiodarone (for efficacy - more than 80%). Non-immune fetal
hydrops requires a long-term therapy, and the required thorough
dynamic monitoring of the fetal condition. Atrial premature beats
(EP), often arising from structural abnormalities of the heart,
prognostically favorable and does not require any special adjustment.
122 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Progression of the disease (in the form of sustained ventricular Improving antenatal diagnosis and the early detection through
tachycardia, and sometimes more than 200 beats per min). Observed newborn can improve the outcome.
with fetal distress syndrome (combined with a decrease in the basal
rate variability) and horionamnionite (with accompanying fever Keywords: Congenital cardiopathy, epidemiology, newborn
pregnant).
Conclusion: We showed a serious gap in the knowledge of the nature
of occurrence of the FA, thus there is no universal classification
dysrhythmia fetus without designated single optimal treatment
strategy. Further study on the FA should be focused on a detailed
study of the etiopathogenesis of "functional" HRDF using modern 472 (CASE REPORT)
research methods, which will work out the optimal obstetric tactics
and reduce perinatal losses, in particular when the functional Neonatal pulmonary hemorrhage
arrhythmias.
and hypothyroidism
Keywords: Fetal arrhythmia, perinatal outcomes
R Sacy, Y. Nassif, D. Hamod, and M. Khoury
Pediatric department, Saint-George University Medical Center,
University of Balamand, Beirut, Lebanon
464
Epidemiology of congenital heart Introduction: This is a 2 months old boy, born preterm (35 weeks) by
C-section, for pre-eclampsia, product of IVF, transferred to our
disease among neonates in a hospital for tracheostomy. He was born with a good APGAR, with
birth weight of 2600g, with normal neonatal screening at birth.
Tunisian neonatal unit of a At day 15 of life, baby was found to have cold extremities with
tertiary care hospital decrease PO intake, so he was admitted to a peripheral hospital at day
17 for hypothermia, hypotonia, pallor and dehydration, and found to
have peripheral and perioral cyanosis. Patient intubated, and upon
J. Mathlouthi, N. Mahdhaoui, M. Bellalh, H. Ayech, suctioning from endotracheal tube, he was found to have fresh blood.
S. Nouri, and H. Seboui Clinical cases and summary results: Case observation of one patient
with abnormal presentation.
Department of neonatology, Farhat Hached university Hospital, Clinical Cases or Summary Results: Labs revealed low Hemoglobin and
Sousse, Tunisia low platelet count, diagnosed of having septic shock and pulmonary
hemorrhage, so he was given ionotropes, hydration, and covered with
Introduction: Congenital heart diseases (CHD) occur during the Amikacin, Cefotaxime, and Ampicillin. Chest XR showed bilateral
development of the heart during embryonic life. They have an pulmonary infiltrates. Echocardiography showed PDA with L-R shunt
incidence of 6 to 8 for 1000 live births. Early diagnosis is essential in and pulmonary hypertension, so started on Sildenafil. Patient had
order to improve prognosis. failure to extubate (Several trial done), so transferred to our ICU for
Objective: To study the epidemiological and clinical features of CHD in tracheostomy and further workup of pulmonary hemorrhage.
our level 3 universitary maternity, identify the diagnostic difficulties Endocrinology workup done for suspected hypothyroidism, TSH
and evaluate the therapeutic opportunities and outcome of our was 103 microU/ml, with FT4: 0.43 ng/dl, so patient diagnosed with
patients. hypothyroidism, and started on Levothyroxine. Repeat levels in 2
Materials and methods: Retrospective study including CHD diagnosed weeks showed TSH 0.47 microU/ml and FT4 2.30 ng/dl, and
prenatally or postnatally among the neonates admitted in our ultrasound of thyroid showed normal thyroid size, homogenous
department during the time period between 1 January 2003 and 31 and normal echo texture, measuring 1, 108cm on right, and
December 2010. 0.80.o,84cm on left. We also ruled out autoimmune hypothyroidism:
Clinical cases and summary results: During the study, were enrolled Anti thyroglobulin Ab (0.58IU/ml) and microsomal Ab (0.22 IU/ml)
181 neonates with CHD, (overall incidence of 1.91%). CHD was normal. Neonatal screening repeated on neonatal blood and was
diagnosed during first 3 days after birth in 54.7% and before the end normal. Patient was successfully extubated, and discharged home on
of first week in 64.1% of cases. Diagnosis was suspected prenatally in Levothyroxine, with follow up TSH and FT4 to be done in 2 weeks.
only 16 patients (8.8%). 159 patients were symptomatic at birth. Follow up on 2 years period shows improvement and was lost at
Symptoms were mainly: presence of an isolated murmur in 39% of seen.
cases, cyanosis associated with a murmur in 23.3% of cases, isolated Conclusion: We report a case of baby presenting at neonatal period
cyanosis in 17.6% of cases and respiratory distress signs in 9.4% of with unusual presentation of hypothermia and pulmonary hemor-
cases. Cardiac ultrasound allowed diagnosis in 179 patients. Non- rhage with normal neonatal screening, diagnosed later with
cyanotic heart diseases with left-right shunt were the most frequent hypothyroidism of unknown etiology (Which might be transient).
(45.3%). Cyanotic heart anomalies due to right to left shunt were Keywords: Neonatal pulmonary hemorrhage, hypothyroidism
present in 28.7% of cases. Obstructive heart diseases observed in
19.9% of the cohort, were dominated by coarctation of the aorta
(6.07% CC) and right heart obstructions were dominated by
pulmonary stenosis (4.97%). Complex heart malformations repre- 474 (CASE REPORT)
sented 6.1% of CHD and were dominated by the single ventricle
(4.97%). CHD was isolated in 128 cases. Chromosomal anomalies were Fetal cholelithiasis; diagnosis and
found in 34 patients. They were dominated by 21Trisomy. A genetic
syndrome was present in 5 patients. 85 newborns received medical prognosis
treatment, 14 underwent interventional catheterization and 36
patients underwent surgery. The outcome was favorable in 43 O. Tosun1 and E. Mungen2
patients, 71 patients died and 67 were lost follow up.
1
Conclusion: CHD is a common congenital anomaly. Its incidence varies Balmumcu Policlinic, Gumussuyu Military Hospital, Istanbul, Turkey
due to different factors like method of detection by a neonatologist. and 2Obstetrics and Gynecology Dept, GATA Haydarpasa Training
Hospital, Istanbul, Turkey
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 123
1
Paediatric Dept., Faculty of Medicine - Fluminense Federal
Introduction: Gallbladder can be better identified sonographically University, Rio de Janeiro - Brazil, and 2Centro de Diagnóstico por
after the 20 weeks of gestation(1). However, cholelithiasis can be Imagem CDP - Rio de Janeiro - Brazil
detected after 30 weeks(2). Although estrogen is charged(1), the
etiology has not been fully elucidated. Cholelithiasis is observed three Presenter: Adauto Dutra
times more frequently in male fetuses (2) and visualized as single,
Introduction: An epidemic wave of zika virus infection is happening in
multiple and diffuse foci (1). Although it is speculated that it may be
Brazil and the number of cases of microcephaly was increased in the
assosiated with the anomalies such as IUGR, tetralogy of Fallot,
some time. The purpose of this communication is to alert the several
trisomy 21 and gastroschisis in literature (3), prognosis of the isolated
regions of the world that are infested by Aedes aegypti about the
cases is good. Use of ursodeoxycholic acid has been reported to have
possible relation between prenatal infection by zika virus and
positive contribution to the prognosis (1). We aim to discuss the
microcephaly in the fetus, with serious nervous system anatomical
importance of imaging the gallbladder, especially in the 3rd trimester
alterations.
through our case.
Clinical cases and summary results: Since October 2015 until April
Clinical cases and summary results: A 24-year-old, primigravida patient
2016, the Ministry of Health of Brazil registered 7,228 new cases of
was referred to our center with the pre-diagnosis of intrauterine
microcephaly in the country. Of these, 3,710 cases are under
growth retardation (IUGR). Fetal measurements were around 32
diagnostic investigation, 2,320 subjects were discarded as to the
weeks of pregnancy in ultrasonographic scan at 37 weeks of
diagnosis of microcephaly, 1,198 confirmed cases. Were already
gestation. All other fetal wellbeing parameters were normal and
recorded 251 deaths and, in 194 cases, laboratory confirmation for the
multiple echogenic foci were detected at level of fetal liver (Figure 1).
virus zika. In figure 1, a newborn of pregnant with zika virus infection
In Doppler examination, it was observed that the focus was
with microcephaly.
independent from the portal vein and completely filled the
Conclusion: A new intrauterine infectious congenital disease is present
gallbladder. Induction of labor was planned at 38 weeks of gestation
and needs major investigation.
with the diagnosis of fetal cholelithiasis and IUGR. Cesarean section
was performed due to induction failure and a 2380-gram male infant Keywords: Microcephaly, preganancy, zika virus
was born with Apgar scores of 9/9, respectively. At 2 days of age, ‘‘the
largest one being 2 mm, multiple echogenicity in the gallbladder
lumen’’ was observed in the baby’s ultrasound scan. The baby was
discharged with ursodeoxycholic acid (10 mg/kg/dose) treatment on
postpartum 6th day. On follow up, at 1 month of age, the resolution
was observed on baby’s ultrasound scan and treatment was
terminated.
Conclusion: Cholelithiasis is observed at the rate of 0.45 to 1% in the
3rd trimester ultrasound scans(3,4). It is speculated that estrogen may
have a role on etiology in literature(1). Cholelithiasis can be visualized
in different forms. Liver calcifications, calcified liver masses and
meconium peritonitis are observed in differential diagnosis. Prognosis
is generally good(2). Detection of gallbladder associated pathologies
in the 3rd trimester screening is important in terms of prognosis.
Keywords: Cholelithiasis, gallbladder, ultrasound, 3rd trimestr

525 (CASE REPORT)

Prenatal diagnosis of thanato-
phoric dysplasia and other diag-
nostic modalities
522 (CASE REPORT)
Fetal microcephaly and prenatal E. Kalafat1, D.C. Katlan1, C.D. Durmaz2, T. Tuncalı2,
O. Uyguner3, V. Karaman3, B. Berker1, and F. Söylemez1
zika virus infection: a possible 1
Ankara University Faculty of Medicine, Department of Obstetrics
relation? and Gynecology, Ankara, Turkey, 2Ankara University Faculty of
Medicine, Department of Medical Genetics, Ankara, Turkey, and
Adauto Dutra1, Cristina Ortiz1, Renata Nogueira2, and
3
Istanbul University Faculty of Medicine, Department of Medical
Heron Werner2 Genet
124 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Keywords: Thanatophoric dysplasia, prenatal diagnosis, genetics

Presenter: D. C. Katlan
Introduction: Thanatophoric dysplasia (TD) is the most common lethal
form of skeletal dysplasia with a prevalence of 51 in 10.000 births. 592
Diagnosis is usually made in second trimester when deformities
associated with TD become obvious.
Fetal supraventricular tachycar-
Clinical cases and summary results: A 46-year-old multiparous woman, dia in a triplet pregnancy
married to a 56-year-old male, with no living off-spring was referred
due to short humerus detected at mid-trimester scan. Sonographic
scan performed at our institution during 26th gestational week (GW) A. Safont, M. Donázar, B. Gastón, J. Barrenetxea,
revealed extreme rhizomelic shortening of extremities, large bipar- M. Urtasun, S. Garcı́a, N. Abian, and C. Larrañaga
ietal diameter for gestational age, abnormal gyration of occipital lobe,
Obstetrics and Gynecology Dept., Complejo Hospitalario de Navarra.
hypoplastic thorax, all of which were suggestive of TD. The couple
was counseled about the diagnosis and lethal prognosis of the Pamplona. Navarra. Spain
condition. Upon request of family, pregnancy was terminated at 26th
GW and postmortem examination was in accordance with ultrasono- Presenter: Andrea Safont
graphy findings. Postmortem radiographs revealed bowed humerus
Introduction: Fetal arrhythmias complicate 1-2% of pregnancies.
and femur that are characteristic of Type I TD. A skin biopsy was taken
Supraventricular tachycardia (SVT) is the most common fetal
from left fetal axilla and fibroblast cultures were made. Sequential
tachycardia (90% of cases). A variety of approaches have been
genetic analysis of cultured fibroblasts revealed a missense mutation
reported to manage fetal SVT: observation alone, delivery and
of c.742C4T at Exon 7 of FGFR3 gene, which is a common mutation
postnatal management, in utero therapy via maternal administration
for TD Type I (Figure). Culturing and sequence analysis were all
of drugs, and in utero therapy via direct fetal injection. The goal in
completed within 2 weeks and couple were counseled for future
managing fetuses with tachyarrhythmia is prevention or resolution of
pregnancies. Recent advances in prenatal diagnosis of TD include use
hydrops since the mortality rate of fetuses with arrhythmias and
of SNP microarrays for faster turn-over times and use of cell free fetal
hydrops is over 50 percent. Based on its safety profile and efficacy,
DNA (cffDNA) for non-invasive screening of TD. SNP microarrays allow
digoxin is the initial drug of choice, either administered orally or
for confirmation of diagnosis within a week. Although clinical
intravenously to the mother or, if unsuccessful, via direct intramus-
research is very limited, cffDNA allows for non-invasive confirmation
cular fetal injection.
of TD when used in conjunction with ultrasound.
Clinical cases and summary results: We present a case of fetal
Conclusion: TD is a common skeletal dysplasia with characteristic
supraventricular tachycardia in a trichorionic triamniotic pregnancy.
ultrasound findings. Narrow thoracic circumference and absence of
Fetal arrhythmia of the third fetus was detected at 31 + 6 weeks of
growth in the proximal extremities after first trimester should prompt
gestation presenting supraventricular tachycardia with 1:1 conduc-
sonographers to suspect TD.
tion rate with a fetal heart rate of 260 bpm, with the presence of
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 125
hydrops (including ascites, pleural and pericardial effusion). In utero Conclusion: Late CMV infected children present mild clinical symp-
drug therapy was initiated with oral flecainide and digoxine. After toms at birth. From our results, we conclude that late infected
12 hours of treatment digoxin level was 0,9 ng/mL and on ultrasound children show significantly less sequelae, although mild audiological,
ascites had increased. Intravenous digoxin therapy was initiated. The visual en neurodevelopmental sequelae are described in the
mother presented two episodes of palpitation with cardiovascular literature. When amniocentesis after maternal primary CMV infection
stability and normal electrocardiogram daily control (except of digital appears negative, mothers can be reassured, but correct counseling
typical downsloping ST depression). After 3 days digoxin level was and intensive neurosonographic follow-up remains important.
1.3 ng/mL and sustained tachycardia remained, so flecainide was Keywords: Congenital CMV infection; CMV; pregnancy; amniocentesis
increased. After 3 more days of treatment with digoxin levels 1.7, 1.8
and 2.3 ng/mL the third fetus presented intermittent tachycardia
around 220 bpm with periods of normal fetal heart rate. Hydrops had
been resoluted. At this point (33 + 2 weeks) delivery was indicated via 615
cesarean section. At birth the newborn presented supraventricular
tachycardia that reverted with adenosine. Flecainide was indicated as Multiple fetal anomalies with a
chronic therapy but he presented a bad toleration to it with recurrent
paroxysmal supraventricular tachycardia episodes with wide QRS
normal karyotype: a case report
complex. Digoxin was initiated with favorable outcome.
Conclusion: In utero therapy via maternal administration of digoxin N. Sahin Uysal1, C. Gulumser1, Z. Yilmaz Celik2, and
and flecainide to treat fetal supraventricular tachycardia with hydrops F.F. Yanik1
was effective to resolve hydrops and stabilize the fetus before birth.
1
The two other fetuses tolerated the treatment with no complications Obstetrics and Gynecology Department, Division of Perinatology,
as well as the mother. At birth supraventricular tachycardia was Baskent University Faculty of Medicine, Ankara, TURKEY, and
treated with adenosine and flecainide for chronic treatment with bad 2
Medical Genetic Department, Baskent University Faculty of
toleration from the patient, so digoxin treatment was initiated with Medicine, Ankara, TURKEY
favorable outcome.
Keywords: Fetal supraventricular tachycardia, triplet pregnancy, Presenter: Filiz F. YANIK
digoxine, flecainide, hydrops
Introduction: Here we report a fetus with a normal karyotype, having
multiple congenital anomalies diagnosed in the 1st trimester.
Clinical cases and summary results: A 29-year-old woman, gravida 1,
607 was referred to our clinic for chorionic villus sampling (CVS) due to
fetal cystic hygroma, at the 13th week of gestation. The ultrasono-
Congenitally infected cmv fetuses graphic examination of the fetus was consistent with a cystic
hygroma 10 milimeters in thickness behind the neck. The integrity
following first trimester maternal of the vertebral column and abdominal wall was disturbed. Upper
and lower extremities were anomalous. CVS was perfomed to exclude
infection: neonatal and short- aneuploidy. Aneuploidy screening with Quantitative Fluorescence
term outcome Polymerase Chain Reaction (QF-PCR) was normal. After counseling
based on the ultrasonographic findings, the family opted for
pregnancy termination at the 14th gestational week. Hypomelia of
S. Vanwinkel, B. De Keersmaecker, R. Devlieger, the right upper extremity and both lower extremities, amelia of the
G. Naulaers, and L. De Catte left upper extremity, oligodactily of the toes, scoliosis of the vertebral
column, cystic hygroma behind the neck, imperforate anus,
Department of Obstetrics Gynecology, University Hospitals of Leuven, ambiguous genitalia, gastroschisis were verified with postpartum
Leuven, Belgium autopsy. Karyotype analysis was reported as 46,XX.
Conclusion: First trimester ultrasonography is a valuable tool, not only
Presenter: Sanne Vanwinkel for aneuploidy screening via evaluation of nuchal translucency, nasal
bone, ductus venosus doppler and tricuspid regurgitation, but also
Introduction: Objective: To document the course of neonatal and for the screening of structural defects. Fetal karyotype may be normal
short-term outcome in infants of patients with first trimester primary in some cases with multiple fetal anomalies. Chromosomal microarray
CMV seroconversion and subsequent amniocentesis. The primary goal analysis is a promising method to be used routinely in the future for
was to assess the residual risk of adverse outcome in pregnancies the evaluation of such cases.
with negative amniocentesis for CMV.
Materials and methods: We conducted a retrospective cohort study on Keywords: Multiple fetal anomalies, First trimester ultrasonography,
all primary CMV seroconversions discovered in pregnancy from Chromosomal analysis
November 2006 to July 2015. Pregnancies were included in cases of
seroconversion before 14 weeks of gestation and if subsequent
amniocentesis for PCR CMV occurred after 21 weeks of gestation. To
retrieve the neonatal and short-term infant outcome, a questionnaire
was sent to the patients and the referring physicians. Primary focus
was on the auditive, visual, neuromotor and cognitive impairment.
The study was approved by the ethical board.
Clinical cases and summary results: The study group included 198
pregnancies. In 44 cases amniocentesis revealed a positive PCR for
CMV (early infected group), in 7 cases amniocentesis was negative
and neonatal CMV screening appeared positive (late infected group)
and 147 children were not CMV infected (control group). CMV
infected children appeared significantly more frequently symptomatic
at birth. In later life, the prevalence of hearing impairment (12,2%),
visual impairment (14,6%), motor deficit (24,4%) and behavioral
problems (7,3%) was significantly higher in the early infected group.
No late CMV infected children showed short-term symptoms.
126 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

fetus and history of preeclampsia are risk factors(1,4). It begins with

nonspecific symptoms such as abdominal pain, nausea, vomiting,
jaundice(4). Other liver pathologies excluded, 6 and more Swansea
criteria are used for diagnosis(4) although liver biopsy is the gold
standard(1). Early diagnosis is important due to complications such as
bleeding, liver and renal failure, encephalopathy and death(1).
Delivery is the treatment, and cesarean is preferred(1).
Clinical cases and summary results: A 31-year-old, primigravid woman
was admitted to the clinic with complaints of nausea, vomiting, fever,
and epigastric pain lasting for 2 days at 34 weeks of gestation. The
patient had a history of increased risk double test, amniocentesis
reported as normal and increased uterine artery resistance the 2nd
trimester sonography. 2-weeks retardation in fetal measurements and
increased echogenicity on the patient’s liver was observed in
ultrasound scan of normotensive patient. Patient’s laboratory tests
were repeated. ‘‘In the liver parenchyma, hyperechoic areas with
geographic contours showing patchy style distribution’’ was evalu-
ated in favor of hepatosteatosis in radiology consultation.
Leukocytosis, increases in aminotransferase and APTT levels were
observed in the laboratory findings(Table 1). The patient was
620 evaluated as AFLP after gastroenterology consultations and cesarean
section was performed. A female baby weighting 1700 g with Apgar
Acute fatty liver of pregnancy; score of 7/8, was delivered. The baby was followed-up in the neonatal
intensive care unit, whereas the mother was followed-up at the clinic.
importance of early diagnosis The renal system findings of the patient were normal and transfusion
of blood products was not required. Laboratory findings showed a
O. Tosun trend of improvement from postoperative day 2. The patient and the
baby were discharged on postoperative day 14.
Balmumcu Policlinic, Gumussuyu Military Hospital, Istanbul, Turkey Conclusion: Observed in the late 3rd trimester, AFLP is a liver
pathology of great importance as it is life-threatening(1). It is rarely
Presenter: Oktay Tosun seen and etiology is not fully elucidated yet(1). The process beginning
with nonspecific symptoms such as nausea and vomiting, can be
Introduction: Acute fatty liver of pregnancy (AFLP) is a life-threatening finalized with a dramatic end such as encephalopathy, multiple organ
entity observed in the 3rd trimester at a rate of 1/7000-16000(1). failure and death (1,4). Therefore, early diagnosis and intervention are
Although abnormal b oxidation of fetal fatty acids is blamed, etiology important for the avoidance of such complications.
is not fully elucidated(2). AFLP is characterized by microvesiculer
steatosis(3). Being primigravida, multiple pregnancies, carrying a male Keywords: Acute fatty liver of pregnancy, 3rd trimestr, fatty acid
oxidation disorder

PREOP D1 OP D POSTOP D1 POSTOP D2 POSTOP D4 POSTOP D14

3
WBC (x10 /uL) 13.3 16.8 12.7 13.8 9.87
HGB (g/dL) 13.9 13.5 13.8 13.1 15.4
HCT (%) 39.9 36.7 38.4 39.3 42.8
˚
PLT (x10/uL) 153 123 111 126 437
GLUCOSE (mg/dL) 85 68 50 76
UREA (mg/dL) 14 11 14 13 19
CREATININ (mg/dL) 0.68 0.68 0.68 0.63 0.75
ALT (U/L) 97 283 307 256 117 32
AST (U/L) 86 244 349 202 52 27
APTT (sec) 46.1 51.6 45.5
PTZ (sec) 12.8 12.6 11.9

SPOT URINE TEST:

PROTEIN: + 
KETONE:  ++

Anti HAV IgM (S/CO) 0.18 Negative

Anti HAV IgG (S/CO) 0.37 Negative
HBsAg (INDEX) 0.38 Negative
Anti HBs (IU/mL) 46 Positive
Anti Hbc IgM (S/CO) 0.03 Negative
Anti Hbc IgG (S/CO) 0.06 Negative
Anti HCV (INDEX) 0.56 Negative
EBV VCA IgM (INDEX) 0.04 Negative
EBV VCA IgG (INDEX) 1.85 Positive
Anti CMV IgM (INDEX) 0.13 Negative
Anti CMV IgG (AU/mL) >250.0 Positive

Blood Culture Negative

Urine Culture Negative
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 127
prior to the pregnancy. In the ultrasound carried out at 27 weeks the
643 presence of a congenital diaphragmatic hernia was suspected by the
apparent communication between the thoracic and the abdominal
Coarctation of the aorta in the cavity and the presence of a homogeneous mass in the right chest.
The amniocentesis, at 28 weeks, revealed a normal male karyotype,
newborn 46,XY. The MRI showed a bulky right diaphragmatic hernia containing
the right lobe of liver. The existence of a hernia sac was suspected by
J. Methlouthi, N. Mahdhaoui, A. Wardeni, M. Bellaleh, H. the presence of great amount of fluid. This defect resulted in a left
mediastinal shift and marked decrease of right lung volume. Due to
Ayech, S. Nouri, and H. Seboui. the possible need for postpartum surgery the patient was transferred
Neonatology Department, F.Hached University Hospital, Susah, to a tertiary center. She delivered vaginally at 37 weeks, a male with
2860g and Apgar index of 8/9. Reduction of the herniated viscera and
Tunisia
closure of the diaphragmatic defect was performed in the seventh
day of life and the child has been discharged after one year.
Presenter: J.Methlouthi Conclusion: MRI has great value in the evaluation of the type of hernia,
Introduction: Coarctation of the aorta represents 5-7% of all the contents of the hernia, and the effect of these contents on
congenital heart diseases. Early, at best, prenatal diagnosis permits adjacent structures. This information is important for prenatal
to improve prognosis. The objective of this study is to analyze counseling and perinatal planning. Although disease severity in
epidemiological, clinical, therapeutic aspects as well as outcome of patients with right-sided lesions appears to be more severe as liver
the constrictions of the aorta in neonatal period. herniation, the presence of a hernia sac is considered by many
Materials and methods: We conducted a descriptive study, enrolling all surgeons to be associated with less severe disease, as in this case.
the patients with constriction of the aorta diagnosed and confirmed Keywords: Congenital diaphragmatic hernia, MRI, prenatal diagnosis
in prenatal or neonatal period, over 12 years, in the department of
neonataology of Farhat Hached university hospital (Susah).
Clinical cases and summary results: Twenty seven newborns had a
constriction of the aorta representing 6.47% of congenital cardiac 703
malformations with an incidence of 0.16% alive births. Diagnosis was
suspected in prenatal period in only one case. Clinical features Neonatological aspect of conge-
suggestive of a congenital heart disease were mainly circulatory
insufficiency features or respiratory symptoms not explained by a nitalcytomegalovirus infection
pulmonary cause. Cardiac ultrasound allowed making the diagnosis of
the constriction in 23 newborns. The preoperative mortality rate was
-clinical study
of 35% and was in relation with the cardiac malformation in 71.4% of
cases. Twenty neonates survived and underwent surgery. Post Vladan Stefanovic1, Svetlana S. Stefanovic2, and Vladana
operative mortality rate was of 35% with a total mortality of 51.8%. Stefanovic3
The rate of coarctation relapse among survivors was 30.8%.
1
Conclusion: Prognosis of the constrictions of the aorta in neonatal Health Care Centar Novi Sad, 2Medical faculty,Institute for childrens
period remains reserved in our department. It could be improved and youth health care of Vojvodina, and 3Institute for Students
thanks to the progress of diagnostic and therapeutic means Health Care Novi Sad
Keywords: Newborns, Aorta coarctation, diagnosis, treatment
Presenter: Svetlana S. Stefanovic
Introduction: Timing for diagnosis is one of the most important factors
To recognize congenital CMV without previous information about
693 (CLINICAL CASE) mother’s infection is very difficult but yet possible for experienced
Right congenital diaphragmatic clinical neonatologist. Clinical signs are very discrete- pale or
jaundiced skin color, skin rash, reduced fatt tissue, reduced birth
hernia with sac: two unusual weight and length, mycrocephalia, hepatomegalia,poor feeding,
hypotonia, lack of spontaneous motility, lethargic behavior.
features of this defect Materials and methods: AIM of the study was to find out the most
frequent clinical signs that were recognized at first clinical assessment
Rodrigues C.1, Martins M.1, Reis I.1, Monteiro S.2, of newborns during 10 years period at our neonatal department.
Clinical cases and summary results: There were 27 neonates with
Pinto A.1, and Teles T.1 congenital CMV infection, the most characteristic signs were - SGA in
1
Centro Hospitalar de Entre o Douro e Vouga, EPE and 2Hospital São 100%, neonatal jaundice (88,88%) and hypotonia (85,18%). The
João, EPE leading clinical problem that induces their hospitalization was poor
feeding and poor gaining on weight (74,07%).
Conclusion: It is of great importance to recognize discrete signs of
Presenter: Rodrigues C
illness as they can lead to proper DD and if congenital CMV is
Introduction: Congenital diaphragmatic hernia is a developmental diagnosed,then modern therapeutic approach and follow up together
discontinuity of the diaphragm that allows abdominal viscera to with stimulative treatment can prevent serious neurological problems
herniate into the chest. It is a rare condition that occurs in and psychomotor retardation.
approximately 1 in 2200 live births.
Keywords: Citomegalovirus, pregnancy, fetal and neonatal infection
Herniation usually occurs on the left; right-sided diaphragmatic
hernias occur in only 10 to 15% of cases. An estimated 15% of
intrapleural hernias are surrounded by a hernia sac, which is
composed of parietal pleura and peritoneum. The presence of a sac
is associated with a better prognosis than classical CDH.
Clinical cases and summary results: We report a case of a 32 years-old
primipara with history of a uterine malformation - complete
bicorporeal uterus with double cervix and normal vagina - diagnosed
128 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

708 (CASE REPORT) 738

RH isoimmunization in the Abdominal malformations and
second trimester - a case report prenatal ultrasonography
M. Martins1, F. Santos2, V. Ferreira1, C. Pina1, C. Costa1, A. Beke, F. R. Eros, I. Szabo, A. Harmath, J. Jr., and Rigo
and T. Teles1 1st Department of Obstetrics and Gynecology, Semmelweis
1
Entre Douro e Vouga Hospital Center and 2Nélio Mendonça University, Budapest, Hungary
Hospital.
Presenter: Artur Beke MD PhD
Presenter: Matilde Martins Introduction: Showing a prevalence rate of 0.2-0.3%, abdominal and
Introduction: Maternal Rh (D) alloimmunization occurs when a abdominal wall malformations discovered in newborns are regarded
woman’s immune system is sensitized to fetal Rh(D)-positive red relatively rare. The aim of this study is to examine the efficacy of
blood cells, stimulating the production of anti-D antibodies. Rh(D) prenatal ultrasound diagnostics in detecting abdominal and abdom-
positive fetuses/neonates of these mothers are at risk of developing inal wall malformations.
hemolytic disease of the fetus and newborn, which can be associated Materials and methods: In this study, we have processed the prenatal
with serious morbi-mortality. In the subsequent pregnancies, fetal sonographic and postnatal clinical and fetopathological details of 240
anemia is usually even more severe and earlier in gestation. Therefore, abdominal and abdominal wall abnormalities in 216 fetuses with
Rh(D) typing and an antibody screen should be performed at the first abdominal and abdominal wall anomalies according to EUROCAT
prenatal visit. The test most used and accurate for determining recommendations over a 7 years period at the 1st Department
antibody titers is the indirect Coombs test. If a critical titer is reached, of Obstetrics and Gynecology. The patients were divided into three
Doppler velocimetry of middle cerebral artery peak systolic velocity is groups; Group I.: prenatal sonography and postnatal/fetopathological
performed to identify fetuses that may be severely anemic. examinations yielded fully identical results. Group II.: postnatally or
Clinical cases and summary results: C.C.S., 33 years old, O Rh (D) post abortion detected abdominal and abdominal wall changes were
negative, was referred at 30 weeks’ gestation to our Gestacional partially discovered in prenatal investigations. Group III.: prenatal
Diabetes appointment, and a positive indirect Coombs test at 24 sonography failed to detect the abdominal and abdominal wall
weeks’ gestation (1/8) was documented; the indirect Coombs test in malformations identified in postnatal or fetopathological
the first trimester was negative. It was’t identified any sensitizer examinations.
situation that could explain this result. She had received anti D Clinical cases and summary results: Prenatal sonographic diagnosis
prophylaxis after an uncomplicated first pregnancy twelve years ago and postnatal or fetopathological results completely coincided in
(newborn O Rh (D) positive). The father is B Rh (D) positive. The 60.2%, i.e 130/216 of cases in postnatal or fetopathological
determination of the fetal Rh(D) type was positive. Serial maternal examinations in cases of abdominal and abdominal wall abnormal-
indirect Coombs titers were done and critical level was reached at ities. In 31/216 cases (14.4%) discovery was partial, while in 55/216
30 + 2 weeks’ gestation (41/16). Middle Cerebral Artery Peak Systolic (25.5%) no abdominal or abdominal wall malformations were
Velocity (MCA-PSV) Doppler screening was performed once a week till detected prenatally. Isolated abdominal and abdominal wall abnorm-
36 weeks in order to identify signs of fetal anaemia (see table 1).Due alities occurred in 130 cases, in 93 of which (71.5%) the results of
to stable MCA-PSV values, cephalic presentation and no other signs of prenatal ultrasonography and postnatal or post abortion examina-
hydrops fetalis, a labor induction will be performed at 38 weeks tions showed complete coincidence. In 20 cases (15.4%) the discovery
gestation (10/05/16). was partial, and in 17 cases (13.1%) the diagnoses were different.
Conclusion: Among the more than 50 different antigens capable of Abdominal and abdominal wall abnormalities were found to
causing maternal alloimmunization and fetal hemolytic disease, the represent part of multiple malformations in a total of 70 cases as
Rhesus (Rh) blood group system is the most common. This case is an follows: prenatal diagnosis and the postnatal/fetopathological find-
example that in patients who have become sensitized, a good ings completely coincided in 28 cases (40%), in 11 cases (15.7%) there
screening, a accurate diagnostic and a close follow-up to recognize was a partial match, and in 31 cases (44.3%) the diagnoses were
hemolysis or anemia, have led to a dramatic decrease in perinatal different. In 16 cases chromosomal aberration was associated with the
morbidity and mortality rates. abdominal and abdominal wall abnormalities, 6 cases of trisomy 18, 6
cases of trisomy 21, and 4 cases of trisomy 13 has occurred.
Keywords: Rh isoimmunization; indirect Coombs test; MCA-PSV Conclusion: In approximately half of the cases, postnatally/fetopatho-
Doppler logically diagnosed abnormalities coincided with the prenatally
discovered fetal abdominal developmental disorders. The results
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 129
have confirmed that ultrasonography plays an important role in
diagnosing abdominal malformations but it fails to detect all of the
758 (CASE REPORT)
abdominal developmental abnormalities. Jarcho-Levin syndrome and its
Keywords: Abdominal developmental disorders, Prenatal sono-
graphic diagnosis, Efficacy of ultrasound
association with neural tube
defects
740 K. E. Karasahin, S. Bodur, U. Keskin, A. F. Cicek, and
M. Ulubay
Congenital heart desease and
Department of Obstetrics and Gynecology, Gulhane Military Medical
genetic Academy, Ankara, Turkey

N. Kasdallah1, D. Fallah1, H. Ben Salem1, H. Kbayer1, Introduction: Jarcho-Levin syndrome was first described by Jarcho
K. Ben Ameur2, K. Monastiri2, Blibech1, and M. Douagi1 and Levin, in a Puerto Rican family at 1938 (1). It is a congenital
disorder consisting of various vertebral formation and segmentation
1
Resuscitation and Intensive Care Unit of Neonatology. University defects (hemivertebrae, vertebral fusion, scoliosis) accompanying to
Military Hospital of Tunis, Tunisia and 2Department of Medical and asymmetrical costal/rib anomalies (2). Even though there have been
Intensive Care of Neonatology. University Hospital Fattouma far more than 130 cases reported in the literature until now, in most
Bourguiba, Monastir, Tunisa of the cases, the diagnosis is made post-natally and the prenatal
diagnosis has only been rarely reported. Here we report a case of
Presenter: K. Ben Ameur 2 Jarcho-Levin Syndrome in which neural tube defect was the main
clinical manifestation rather than classical findings of the syndrome.
Introduction: BACKGROUND AND AIMS Along with the case presented here, we would like to discuss the
Congenital heart disease (CHD) are the most common type of birth association between neural tube defects and Jarcho-Levin
defect and result in significant mortality worldwide. The etiology of syndrome.
the majority of these anomalies remains unknown, but genetic factors Clinical cases and summary results: A 32-year-old patient presented
are being recognized as playing an increasingly important role. at 21 weeks of gestation with a diagnosis of neural tube defect. She
AIM: To highlight the role of genetic in CHD and to describe the reported a previous pregnancy resulted in normal infant, delivered
genetic syndrome involving CHD. vaginally. There was no family history of congenital anomalies,
Materials and methods: STUDY DESIGN: A 14-year retrospective hereditary disease or consanguinity. The sonographic images
descriptive study. SETTING, SUBJECTS: We identified newborns with revealed vertebral disorganization (kyphoscoliosis and shortened
CHD supported in Resuscitation and Intensive Care Unit of spine), throcalumbal meningomyelocele (20 mm), asymmetrical
Neonatology of Military Hospital of Tunis between 2002 and 2015. deformed thorax, enlarged lateral ventricles and single umbilical
MAIN OUTCOMES AND MEASURES: We studied perinatal database, artery. The couple was counselled about the severity of the findings
clinical and paraclinical features, especially genetic study. affecting the neural tube and elected termination of the pregnancy.
Clinical cases and summary results: We identified 145 newborns with The post-abortion pathologic evaluation of the female fetus
CHD, 21 (14.45%) were associated with chromosomal abnormalities. It revealed pathologic findings indicative of Jarcho-Levin Syndrome
was number abnormalities in 17 of 21 and structure ones in 4 of 21. as follows: short neck, short spine, short thorax, enlarged thoracic
Trisomy 21 was the most frequent chromosomal anomaly (13/21), diameter, agenesis of the right kidney. Radiological findings were
followed by Trisomy 18 (4/21). Antenatal diagnosis was performed for absence of the ribs on the left side of the thorax and vertebral
eight fetuses. For the others cases, diagnosis was done in the early fusion defects.
neonatal period. Atrioventricular septal defects were the most Conclusion: We suggest that obstetricians give appropriate attention
frequent CHD associated with chromosomal abnormalities (7/21), for correct differential diagnosis even on cases with severe neural
especially with Down syndrome (7/13). We identified two cases of tube defects that are incompatible with life and would lead to
Tetralogy of Fallot associated with Di-George Syndrome (transloca- termination of pregnancies. Jarcho-Levin syndrome should be
tion 22 q11), one case of Williams-Beuren syndrome (7q11.13 suspected when prenatal ultrasonographic examination reveals
microdeletion), and one case of polymalformative syndrome with findings of neural tube defects, especially meningomyelocel adjacent
7q deletion. to findings of thoracic or costal deformities, in nations originating
Otherwise, CHD was a part of syndromic entity with possible genetic from Mediterranean basin.
determinism in five cases: Dandy Walker Syndrome (2 cases), VACTERL
Syndrome (one), Pierre Robin Syndrome (one case) and a case with Keywords: Jarcho-Levin syndrome, neural tube defects,
nonspecific polymalformative Syndrome. Seven of 21 newborns meningomyelocele
needed resuscitation with respiratory assistance. Eleven of the 21
newborns dead. CHD and/or severe malformative syndrome was the
direct cause of death for ten over eleven newborns.
Conclusion: Antenatal diagnosis is still insufficient in our context,
especially for CHD. That may led to the birth of severely, malformed
neonates with ethic problem of palliative resuscitation until a clear
diagnosis. Genetic counseling is necessary if genetic anomaly is
found, but not always easy because of clinical variability of some
syndromes.
Keywords: Congenital heart disease, genetic, infant, newborn
130 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 131
Clinical cases and summary results: Their neonatal health problems in
FETAL DISEASE - 765 the group of IUGR were: pathological jaundice 72%, neonatal
Chromosomal abnormalities in infection 20%, severe perinatal hypoxia with Apgare score 3–5 in
the first minute of life 8%. SGA group was caracterized with
fetuses with an aberrant right intrauterine infection CMV 8%, hypotuntritia neonati 64%, ultrasound
verification of prenatal hypoxemia and/or subarrachnoidal hemor-
subclavian artery rahge 33%.
Conclusion: It is very important to recognize neonates small for their
gestational age and with intrauterine growth retardation at birth and
A. Karavida1, A. Zavlanos1,2,3, J. Papoulidis2, A. Gerede3, to carefully observe them in the first weeks of life as the consequences
S. Chousmekiari3, D. Aivazi3, D. Tsirkinidou3, and of their pathologic nutrition and oxygenation will certainly appear, so it
A. Athanasiadis1,2,3 is better to solve the problem as early as possible.
1
Prenatal Diagnostic Center of Thessaloniki, Thessaloniki, Greece,
2
Keywords: Neonates, SGA, IUGR, neonatal outcome
Access to Genome, Genetic Laboratories, Thessaloniki, Greece, and
3
1st Dpt of Obstetrics and Gynecology of Aristotle University of
Thessaloniki,Thessaloniki, Greece
108
Introduction: The objective of this study was to assess the frequency
of associated chromosomal abnormalities, including Di George
Disparities in the risks of term
syndrome, in fetuses with an aberrant right subclavian artery (ARSA).
Materials and methods: This is a retrospective study. All patients
small for gestational age birth
whose fetus had an ARSA diagnosed by ultrasound performed during among immigrant and native
the 2nd trimester of pregnancy were included.
Clinical cases and summary results: Between March 2008 and April women in the republic of Korea
2016, an ARSA was diagnosed in 44 fetuses. All fetuses underwent
amniocentesis (100%). ARSA was an isolated finding in 40/44 cases
I. Song1, M. Kim2, H. Kim1, E. Choi1, S. Shin1, E. Kim1, and
(90.9%). No chromosomal abnormalities were found in 43/44 fetuses
with an isolated or non ARSA (97.8%). One fetus, that had additionally H. Kim1
a mild ventriculomegaly had a VOUS, 22q22.1q11.21 deletion. 1
Department of Pediatrics, Seoul National University Hospital, Seoul,
Conclusion: In our series the presence of ARSA was not associated
Republic of Korea and 2Public Health Medical Service, Seoul National
with a chromosomal abnormality. Thus, this information must be
included while counseling for an invasive procedure. University Hospital, Seoul, Republic of Korea

Keywords: ARSA, chromosomal abnormalities, Di George syndrome Introduction: The Republic of Korea (Korea) has experienced a steady
increase in the number of births from immigrant women over the last
20 years, accounting for a substantial proportion of total births (4.3%).
However, little is known about birth outcomes of immigrant women
FETAL GROWTH RESTRICTION - 021 in Korea.
Fetal growth restriction and Materials and methods: This study compared Korean birth data from
immigrant and native women, and explored the factors that affected
neonatal outcome birth of small for gestational age in term infant (SGA) among
immigrant women. A total of 68 074 singletons from immigrant
women and 1 644 956 singletons from native women during 2010–
S. Stefanovic1, V. Stefanovic2, and V. Stefanovic3 2013 were examined using the National Birth Registration Database.
1
Medical Faculty, Institute for Children’s and Youth Healthcare, Adjusted proportions were calculated for the occurrence of SGA, and
subgroup analyses were performed according to maternal age, parity,
University of Novi Sad, Novi Sad, Serbia, 2Institute for Student
and birth region. The birth outcomes of the immigrant group to a
Healthcare of Novi Sad, Medical Faculty, University of Novi Sad,
vulnerable group in Korea were compared. Multivariable logistic
Medical Faculty, Novi Sad, Serbia, and 3Healthcare Centar of Novi regression analyses were also used to evaluate the associations of the
Sad, Novi Sad, AP Vojvodina, Serbia factors with birth outcomes among immigrant women.
Clinical cases and summary results: Immigrant women exhibited
Introduction: Modern medical literature is dealing with the problem of significant higher adjusted proportions for SGA (6.4% versus 5.7%,
neonatal outcome and further psychomotor development, especially p50.001). The results of the stratified analyses revealed that
of neurocognitive functions in children born as small for their primiparous immigrant women had significantly higher proportions
gestational age. Epigenetic studies all over the world reveal almost of SGA, compared to native women. Among immigrant women, male
the same percentage of SGA in similar developed countries. Although infant, maternal ages (over 35), parity (primipara), and economic
good social, economic and medical care is assumed to be at a high status of the mother’s original country were independently associated
level in European countries, the percentage of SGA is about 3–5% in with SGA.
otherwise healthy newborn population. The aim of our study was to Conclusion: This study has provided evidence regarding the disparities
investigate neonatal outcome in term newborns with intrauterine in the risks of SGA among immigrant women and native women in
growth retardation who were hospitalized at our department. They Korea. These data will be necessary to develop comprehensive
were coming to our hospital both from delivery rooms and from policies that can reduce health disparities and support the successful
home, after discharge from Vojvodina, northern province of Serbia, settlement of immigrants in Korea.
inhabited with 2 million people.
Materials and methods: Prospective study was held in our department Keywords: Small for gestational age, Intrauterine growth retardation,
during a three month period (Sept- Dec 2016.). IUGR was declined by immigrant, disparity
neonate’s antropometric measures toward gestational age, sex and
pondural index lower than 2.5 or for SGA between 2.5–3 but with BW
under 2700 g and BL under 49 cm eg under 3%. Incidence of IUGR and
SGA among our patients was as high as 25%.
132 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Introduction: The incidence of multiple gestation has increased as a

188 result of assisted reproductive techniques. It is known that multiple
Correlation between fetal growth gestations imply an increased risk of both maternal and fetal
complications. Some pathologies such as hyperemesis, preeclampsia
restriction and the maternal or gestational diabetes are more likely in this type of gestation.
Furthermore, the risk of intrauterine growth restriction, stillbirth and
inflammatory changes induced preterm labor is considerably higher than in single pregnancies. We
present a case of quadruple gestation and its clinical evolution.
by smoking throughout gestation Clinical cases and summary results: 32 year-old woman (G2P0A1) with
secondary infertility, who got a quadruple pregnancy after fertility
treatment (artificial insemination). After objectifying evanescent twin
S. Sabra, A. Martinez, A. Gracia, E. Mazarico, E. Gratacos,
and performing embryo reduction in week 13, the gestation became
and M. Gómez diamniotic dichorionic. Normal first trimester screening. A discor-
BCNatal-Barcelona, Hospital Sant Joan de Deu, University of dance between estimated fetal weights of 29% was observed in 16
weeks ultrasound, rising to 46% in week 19, with normal doppler
Barcelona, Spain
ultrasound in the first twin and presence of redistribution in the
second twin. A complete study and amniocentesis were made
Introduction: It is evident that cigarette smoke induces immunologic because of early onset selective intrauterine growth restriction.
changes mainly anti-inflammatory properties. During gestation, Normal morphology of both fetuses in 20 weeks prenatal diagnostic
smoking changes the proportion of lymphocytes and natural killer ultrasound. The second twin died at 24 weeks of gestation. The
cells, suggesting that smoking affects several immune parameters. patient was admitted at 28 weeks of gestation for close monitoring of
However, there are no data investigating immune changes induced the fetus, affected by intrauterine growth restriction with doppler
by maternal smoking throughout gestation. In addition, maternal alteration (absence of diastole in umbilical artery and redistribution).
smoking is associated with multiple adverse outcomes icluding fetal Serial ultrasounds and velocimetries were performed during admis-
growth restriction (FGR), nevertheless the mechanism is still sion. Fetal lungs were madurated and magnesium sulfate was
unknown. Therefore, we hypothesize that, cigarette smoke compro- administered for fetal neuroprotection. Reverse flow in umbilical
mises the maternal immune system and hence increases their artery was objectified at 30 + 3 weeks of gestation. That was the
susceptibility to have growth restricted fetuses. indication to end the pregnancy by caesarean section.
Materials and methods: Retrospective study was conducted in Hospital Conclusion: Serial ultrasound evaluation of fetal growth, biophysical
Sant Joan de Deu, Spain. Patients were divided into smoking (n=309) profile and doppler velocimetry is essential to distinguish between
and nonsmoking mothers (n=476) with singleton pregnancies. Data constitutionally small fetuses and those who are affected by
of maternal leukocytes and its subtypes both in absolute values and intrauterine growth restriction. The second group is associatd with
percentages in the three trimesters of gestation and perinatal poorer perinatal outcome. Detecting them is clinically relevant as it
outcomes were collected. represents an opportunity for preventing cases of intrauterine fetal
Clinical cases and summary results: Our results are consistent with death, perinatal brain injury and severe intrapartum fetal distress.
the negative correlation between maternal smoking and FGR. We
detected consistent increase in leukocytes, neutrophils and lympho-
Keywords: Fetal growth restriction, multiple gestation, Doppler
cytes (absolute values) among smokers in comparison to nonsmok-
ing mothers throughout gestation. Our analysis has showed an
increase in the maternal leukocytes and its subsets both in the
smoking mothers and mothers who delivered FGR neonates 268
compared to the control group. In addition, our data showed a
rise in the maternal HCT, MCV, leukocytes and lymphocytes Trends of low birth weight
(absolute values) in mothers with FGR neonates compared to
those with normal fetal growth.
newborns and its risk factors
Conclusion: Our data is in consistent with others regarding the ability
of cigarette smoke to interfere with the immune system although the
among timely birth
mechanism by which cigarette smoke alters immunity is not
completely understood. Also, our results suggest that smoking I. Zile1,2, I. Ebela1, and I. Rumba-Rozenfelde1
influences the maternal immune system and consequently the 1
Faculty of Medicine, Department of Paediatrics, University of Latvia,
physical growth, development of the fetus and the outcome of
Riga, Latvia and 2The Centre for Disease Prevention and Control,
pregnancy is affected in susceptible mothers.
Riga, Latvia

Introduction: The main cause of neonatal low birth weight (LBW) is

230 (CASE REPORT) prematurity and intrauterine growth restriction which is a major
neonatal health issue. The LBW most often associated with fetal
Selective intrauterine growth intrauterine growth retardation which is most often from a variety of
restriction in multiple gestation: placental problems, as well as other maternal and newborn health
problems.
according to a clinical case Objective: To examine trends and assess the risk factors for at-term
small for gestational age newborns.
Materials and methods: Data from population-based Medical Birth
B. Gastón, J. Barrenetxea, B. Pérez, N. Abián, A. Safont, Register were used. All timely live births (37th gestational week
M. Donázar, S. Garcı́a, and C. Larrañaga (GW)) with low (2499g) birth weight (BW) (n=3972) from 2000 to
2013 were included in the data analysis. Low birth weight rates
Ginecologı́a y obstetrı́cia, Complejo hospitalario de Navarra, (LBWR) and adjusted OR were calculated. Multiple regression model
Pamplona, Navarra, España adjusted for mother age, delivery complications and perinatal period
conditions.
Clinical cases and summary results: 17.5% (n=696) were multiple births.
The average mothers age is 27.5 years (SD ± 6.3), BW - 2292.5g
(SD ± 188.6) and GW - 38.3 (SD ± 1.2). Newborns with LBW more often
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 133
from 2nd delivery (SD ± 1.4) and 3rd pregnancy (SD ± 2.2). Average Outcome resulted 1257g ± 370. Perinatal deaths resulted around
period (2000 - 2013) LBWR is 14.4 per 1000 timely birth (95% CI 13.9 - 11%. Deaths and Severe Morbidity resulted significantly related to
15.0). Slight decrease, an average 0.2 cases (p 50.01) per year was Gestational Age (LR 1.18 up to 2.82, p = 0.001) and Fetal Weight (LR
observed. The higher odds of LBW was associated with intrauterine 181 486.6, p = 0.001). According to Caplan Meier Analysis, at our
growth restriction (ORadj=29.6, 95% CI 26.8-32.8, p50.001), pre- Institution, for gestational age below to 31wGA, findings conferred an
eclampsia (ORadj=2.1, 95% CI 1.9-2.5, p 50.001), hypertension 31-fold increased risk of adverse perinatal outcome, OR 31 (95% CI,
(ORadj=1.2, 1.1-1.4, p50.01) and maternal smoking during pregnancy 30.1-31.8, p50.0001).
(ORadj=3.0, 95% CI 2.7-3.2, p 50.001). Short-term perinatal outcomes Conclusion: Perinatal outcome in preterm IUGR fetuses, is related
such as birth defects (ORadj=1.4, 95% CI 1.2-1.6, p50.001) and certain significantly with gestational age and weight at delivery.
conditions originating in the perinatal period (ORadj=7.4, 95% CI 6.9-
8.0, p 50.001) were observed for LBW newborns. Keywords: Arterial Doppler, IUGR, preterm fetuses
Conclusion: It is necessary to identify pregnant women with risk
factors such as preeclampsia, hypertension, smoking during preg-
nancy and others to decrease the condition of small for gestational
376
age. Special attention must be given to health education to change
knowledge and attitude of antenatal care importance and maternal Value of cerebroplacentar ratio in
smoking during pregnancy.
fetal surveillance
Keywords: Low birth weight, intrauterine growth restriction, risk
factors C. A. Ionescu1, I. Popescu1, M. Dimitriu1 E. Bratila1,
C. Coroleuca1, and L. Ples2
1
Dept Obstetrics Gynecology, Clinical Emergency Hospital Sf
Pantelimon, University of Medecine Carol Davila, Bucharest,
Romania and 2Dept Obstetrics Gynecology, Clinical Emergency
337
Hospital Sf Ioan, University of Medecine Carol Davila, Bucharest,
The role of gestational age and Romania

fetal weight in perinatal out- Introduction: The value of cerebroplacental ratio (CPR), or index, in the
comes among IUGR preterm prediction of fetal distress is a theme extensively researched
nowadays. The degrees of fetal blood flow redistribution is
fetuses quantifiable through the ratio between medium cerebral artery flow
(pulsatility index or resistance index) and umbilical artery flow
(pulsatility index or resistance index) also known as cerebroplacental
E. Prifti, R. Moisiu, A. Alikaj, A. Hoxha, E. Tushe, E. Roshi, ratio.
and E. Pupi7 Materials and methods: After researching the PubMed, Uptodate si
Wiley databases and analyzing the relevant clinical studies and
High Risk Pregnancy Department, Paediatric Unit, University Hospital
rewievs we chose to take into consideration only the results of the
‘‘Koco Gliozheni’’, Tirana, Albania clinical studies from 2014–2015. We conducted a retrospective cohort
study over a period of 2 years (2014–2015) by enrolling cases from
Introduction: Intrauterine growth restriction is a major factor of Saint Pantelimon Emergency Hospital.
perinatal morbidity and mortality. If IUGR fetuses are preterm, timing Clinical cases and summary results: Recent studies show that CPR can
delivery is the most challenging process, from one side to avoid be used in order to predict negative fetal outcomes as placental
the complications from iatrogenic prematurity, and the other side insufficiency and fetal hypoxia - being able to identify fetal growth
avoiding complications of hypoxia and acidosis from placental restriction, regardless of fetal size. Still, there are studies that show
dysfunction. Our aim was to assess the role of gestational age and that CPR is a poor indicator for negative fetal outcomes and is not to
weight at delivery of IUGR preterm fetuses with placental dysfunction be used a screening method. During the last 2 years 224 cases of
and providing data for perinatal outcome regarding this population, decreased CPR have been diagnosed in our hospital. Among these, a
helping clinicians and parents for better timing delivery at our number of 58 (25,89%) newborns were considered SGA or suffering
Institution. from IUGR while 136 (60,71%) newborns were AGA. Outcomes
Materials and methods: Prospective observational study, during years concerning this group are as following: in 98 (43,75%) cases Apgar
2010–2014 in University Hopsital of Obstetric-Gynecology ‘‘Koco scores 5/= 7, 50 (22,32%) newborns needed prolonged treatment
Gliozheni’’, in pregnant women with unique fetus, between 26.0wGA- and were hospitalized for more than 15 days while 38 (16,96%)
36.6wGA, with intact membranes, Estimated Fetal Weigh in ultra- newborns needed special care and were admitted into NICU,
sound5p. 10th, and at least one abnormal Arterial Doppler up to 6 (2,67%) newborns died during hospitalization.
three days before delivery: Umbilical Artery: DUPI 4 p.95th, Conclusion: Even though there are extensive studies on the matter of
AEDF(intermittent), REDF, Mean cerebral Artery MCAPI5p.5th, IC the CPR value as an indicator of fetal and neonatal prognostic, result
p5p.5th. After delivery, we collected data about Adverse Perinatal are yet controversial, suggesting the need for further, wider studies.
Outcome as a complex outcome of perinatal mortality and severe
morbidity: HIV (intraventricual hemorrhage), LP (periventricular Keywords: Fetal growth restriction, cerebroplacentar ratio, fetal
leucomalacia), EN (necrotizing enterocolitis), BD (bronchopulmonary morbidity
dysplasia), sepsis.
Clinical cases and summary results: Our study included 91 cases. For all
the subjects: Mean Gestational Age during diagnosis was 33wGA
± 2.1, Estimated Ultrasound Mean Fetal Weight was 1471g ± 368,
Mean Gestational Age during delivery was: 33.0wGA ± 2.1, Mean
Neonatal Weight was:1477g ± 360. Mean Gestational Age with
Perinatal Favorable Outcome resulted 33.7wGA ± 1.8, Mean
Neonatal Weight with Favorable Outcome resulted 1591g ± 298,
Mean Gestational Age with Adverse Perinatal Outcome resulted
31.8wGA ± 2.0, Mean Neonatal Weight with Adverse Perinatal
134 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

(IL-1, IL-6 , IL-10, IL-12) in blood serum with the help of ELISA method
418 in II and III trimester of gestation.
Risk factors of IUGR in a level III Clinical cases and summary results: We recorded higher levels of
angiogenic factors (VEGF-A, EGF, PGF, ET-1) and cytokines (TNF-a, IL-1,
maternity center from Romania IL-10, IL-12) in pregnant women with female fetuses in the II and III
trimester of both physiological and complicated pregnancy. There is a
certain ratio of the absolute levels of VEGF-A, EGF, PGF, ET-1, TNF-a,
S. I. Scripcariu1,3, A. Avasiloaiei2,3, and M. Stamatin2,3 IL-1, IL-6, IL-10, IL-12 for each trimester in the dynamics of
1
Ist Obstetrics and Gynaecology Unit, "Cuza Voda" Clinical Hospital of physiological and complicated pregnancy, depending on the fetus
Obstetrics and Gynaecology, Iasi, Romania, 2Neonatology Unit, "Cuza sex.
Conclusion: We determined significant differences in the parameters
Voda" Clinical Hospital of Obstetrics and Gynaecology, and 3"Grigore
of endothelial factors and cytokines in pregnant women with male
T Popa" University of Medicine and Pharmacy, Iasi
and female fetuses both with physiological and complicated
pregnancies, indicating on different ways of initiation and regulation
Introduction: Intrauterine growth restriction (IUGR) represents a major of these systems, determined by fetus sex.
and silent cause of various morbidity and mortality for the fetal and
neonatal population and it is defined as a fetal failure to achieve its
Keywords: Fetus sex, pregnanacy, angiogenic factors, cytokines
ideal potential of growth. The objectives of this study were to
determine the incidence and morbidity of IUGR infants, to identify risk
factors and complications and to differentiate IUGR from small for
gestational age (SGA) infants. 425
Materials and methods: This is a retrospective study on 326 SGA
infants of which 252 with SGA with history of IUGR and 58 with SGA Peculiarities of blood coagulation
without history of IUGR, as ascertained by placement on Lubchenco’s
intrauterine growth charts. The following parameters were evaluated: in pregnant women depending
gestational age, birth weight, length, head circumference, weight
index, risk factors, complications and outcome during hospitalization. on the sex of the fetus
Clinical cases and summary results: The incidence of IUGR during two
years (2013–2014) was 15.74%. The newborns with IUGR had a mean T. L. Botasheva, E. A. Kapustin, N. V. Palieva,
gestational age of 36.52 weeks (26–42w) and a body weight on
average 1961.94 grams (500–2700g). The newborns had conflicting
V. V. Barinova, A. V. Hloponina, and L. V. Kaushanskaya
anthropometric parameters when placed on Lubchenco’s growth Rostov Scientific-Research Institute of Obstetrics and Pediatrics,
charts. Risk factors were identified as maternal in 72% of newborns, Rostov-on-Don, Russia
fetal in 21% and placental in 13% of cases. Only the maternal risk
factors can be consider for IUGR. The hematologic and metabolic
Introduction: The study of coagulation system disturbances in
complications were the most frequent and gestational age is a
pregnant women remains relevant because of its pathogenetic
significant influence on the occurrence of complications.
‘‘involvement’’ in placental insufficiency formation. The fetal gender is
Conclusion: There are significant difficulties in placing IUGR newborns
a genetically determined factor, which influences the character of
on classical growth charts. Specific growth curves are necessary for
gestation and the outcome of labor. However, peculiarities of
individual countries.
women’s coagulation system depending on the fetal gender still
remain unexplored.
Keywords: IUGR, intrauterine growth restriction, SGA, small for Materials and methods: To study peculiarities of the hemostasis
gestational age, risk factors system we examined 360 pregnant women with physiological
pregnancy: 187 pregnant women with male fetuses and 173 pregnant
women with female fetuses. Thrombin time, prothrombin time,
423 prothrombin index, international normalized ratio and activated
Peculiarities of angiogenic factors partial thromboplastin time were estimated, soluble fibrin monomer
complexes, fibrinogen, clotting time, D-dimer level, platelet count
and cytokines in the physiological and hematocrit volume were determined. Women at the age from 18
to 27, who were pregnant and gave birth for the first time, who had
and complicated pregnancy, uncomplicated gestation and no extragenital pathologies, were
included in the study.
depending on the sex of the fetus Clinical cases and summary results: In dependence on the term of
gestation, some components of the hemostasis were very active in
T. L. Botasheva, V. A. Linde, N. V. Ermolova, N. V. Palieva, mothers of boys: statistically significant higher values of D-dimer in
O. D. Sargsyan, and V. V. Barinova case of male fetuses (32.9% and 48.5% higher), prothrombin time in
the 1, 2 and 3 trimesters (10.2%, 2.8% and 8.8% higher correspond-
Rostov Scientific-Research Institute of Obstetrics and Pediatrics, ingly) and platelets in the 3 trimester (6.6% higher). According to the
Rostov-on-Don, Russia results of the correlation analysis it was revealed that in mothers of
male fetuses the interconnections between the prothrombin and
Introduction: Objective. To study the peculiarities of angiogenic thrombin time, the level of fibrinogen became stronger, while in
factors and cytokines system in women in the dynamics of mothers of girls the inverse relationship was determined. The most
physiological and complicated pregnancy in dependence on fetal sex. favourable outcomes of labor and normal state of newly born babies
Materials and methods: We studied 390 women with physiological were 1.8 times more often in mothers of girls, while mothers of boys
pregnancy (group 1), including 203 women with a male fetus and 187 had birth difficulty in a larger number of cases (44%). A larger number
with female fetuses, and 345 women with placental insufficiency and of the newly born babies belonging to the male gender (6.9%) had
fetal growth retardation (group 2), including 176 women with male low indices according to the Apgar score as compared with the
fetuses and 169 pregnant women with female fetuses. We alternative gender (3.8%).
determined the levels of vascular endothelial growth factor-A (VEGF Conclusion: The higher activity and the integration of vascular-
- A), epidermal growth factor (EGF) , placental growth factor (PGF), thrombocytic and plasmatic components of the hemostasis system
endothelin-1 (ET-1) , tumor necrosis factor-a (TNF -a), and interleukin increasing over time in the mothers of boys makes it possible to
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 135
consider that male fetal gender as an additional risk factor of
dysfunctional disturbance in the coagulation system in the 2nd and
442
3rd trimesters of pregnancy. Vitamin D and intrauterine
Keywords: Pregnancy, sex of the fetus, hemostasis system growth restriction
I. Ignatko, A. Strizhkov, M. Mirushchenko, E. Timohina,
and P. Budanov
I. Sechenov First Moscow Medical State University
439
Early predictors of fetal growth Introduction: IUGR is defined as the pathological inhibition of
intrauterine fetal growth and the failure of the fetus to achieve its
retardation syndrome growth potential. Fetal growth is known to be an important predictor
of pregnancy outcome. Research in this area is trying to find
predictive parameters, which would lead to a better management of
A. Strizhakov, E. Timochina, and N. Yakushina the condition. One of the biochemical predictive markers is vitamin D
I. Sechenov First Moscow Medical State University in maternal serum. Vitamin D deficiency also associated with an
increased risk for preeclampsia and IUGR.
Materials and methods: We studied 92 pregnant women with data on
Introduction: The fetal growth retardation (IUGR) has the largest share vitamin D (25(OH)D) in first trimester. Then we estimated birth weight
in the structure of causes of perinatal morbidity and mortality, in this cohort. We analyzed the relationship of vitamin D and birth
reaching 40%, and reproductive losses and costs of complex weight. Data analysis was performed with «Microsoft Excel» (2011)
treatment of children with IUGR, cause considerable social and and Factor-Nauka-Meditsina
economic damage. Clinical cases and summary results: The median plasma vitamin D level
Materials and methods: To study the prediction of FGRPatients and among patients with IUGR was 33.14% less than those patients
methods: a prospective analysis of pregnancy in 150 women with the who exhibited normal growth at delivery (IUGR 19.37 ± 1.75 ng/mL
syndrome of fetal growth retardation (IUGR). As markers of FGR used versus normal 28.973 ± 2.15 ng/mL, p=0.002). Infant birth weight
vascular endothelial growth factor (VEGF) and its receptor - VEGF-R. In with low level of vitamin D was 2502.74 ± 31.74 g versus normal
patients with FGR II level of VEGF in the blood significantly higher 3524.21 ± 109.82 g (p=0.001). Infant birth leight with low level of
compared with uncomplicated pregnancy: at time of 16–22 weeks - vitamin D was 47.77 ± 0.26 cm versus normal 52.37 ± 0.43 cm
on 90.5%, from 23 to 36 weeks has been a sharp increase in VEGF (p=0.001). Level maternal serum vitamin D in first trimester of
levels. pregnancy is a high risk for IUGR. Our results also suggest that
Clinical cases and summary results: In the third trimester of VEGF insufficient vitamin D was associated with reduced fetal growth.
concentration reaches its maximum value and exceeds the physio- Conclusion: We found that insufficient vitamin D status had an adverse
logical indicators at 193.1%. In severe FGR VEGF levels in the blood at influence on other measures of fetal growth (birth weight and
16–22 weeks 209.3%, and 23–29 weeks - 246.7% at physiological length). But vitamin D status hadn’t the insufficient predictive value
above. In the third trimester, the rate of increasing the level of VEGF alone. In further studies we tried to improve the prediction of IUGR by
FGR III level is significantly reduced in terms of 30–36 weeks. It as 50% combining Doppler indices with biochemical and clinical parameters.
higher than the physiological values, but it is 2 times lower than the
FGR II degree in the same period. When FGR III level, critical and
Keywords: Fetal growth restriction, Vitamin D
severe fetal hypoxia, there is a tendency to a decrease in VEGF levels.
Thus, determination of VEGF in women with FGR may be the earliest
marker of fetal hypoxia and severe FGR: values 67.12 ± 6.5 pg / ml at
16–22 weeks and 121 pg/ml at 23–29 weeks, show at the risk of the
critical state of the fetus with a sensitivity of 83%, specificity 95%. In 446
the study of VEGF-R1 was a high sensitivity to pathological processes
in the placental system: its level rose several times in pregnancy and
Changes in antenatal doppler
the subsequent development of preeclampsia and FGR. In patients hemodynamics and clinical
with FGR II degree increase in VEGF-R1 has noted with 16–22 weeks. -
36.8%, and the term of 23–29 weeks - by 196.1%. In the III trimester at consequences of altered brain -
FGR II level of VEGF-R1 reaches values 320% higher than those
obtained with uncomplicated pregnancies. VEGF-R1 concentration at pilot study
FGR severe already on the term of 16–22 weeks was 316.5% higher. At
23–29 weeks the average level of VEGF-R1 has increased and reached Tunescu Mihaela, Gabriela Olariu, Maria Tara*, and
maximum values. Sebastian Olariu*
Conclusion: Thus, it becomes evident the important role of determin-
ing the VEGF-R1 to predict FGR development. According to the results *Municipal Emergency Hospital Timisoara / Maternity Odobescu,
of our study, the values of VEGF-R1 7.0 ± 0.7 ng/ml at 23–29 weeks Timisoara, Romania
indicate a high risk of FGR Article II, values of VEGF-R1 9.48 ± 0.8 ng/
ml at 16–22 weeks and 11.1 ± 1.34 ng/ml in 23–29 weeks indicate a
Introduction: Preterm fetuses with early IUGR have a higher
high risk of severe IUGR with a sensitivity of 81%, specificity - 97%.
probability of in utero death, a true (veritable) recognition of
antenatal fetal growth restrictions help prevent or decrease neonatal
Keywords: Inrauterine growth retardation, vascular endothelial mortality and morbidity
growth factor Materials and methods: The study will include all infants with early
IUGR born 32 weeks of gestation, with changes on umbilical artery,
middle cerebral artery and ductus venous and clinical consequences
of altered brain hemodynamics (Doppler on anterior cerebral artery
and pericaloas artery and cerebral oxygenation indices obtained by
INVOS).
136 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Clinical cases and summary results: A prospective study initiated since

January 2016 - aims to track the time of extraction of a premature 524
IUGR with gestational age 32 weeks considering changes in
antenatal doppler on umbilical artery, middle cerebral artery and
The role of modification of cho-
ductus venous following immediate consequences on this category of
newborns.
lesterol of amniotic fluid in the
Conclusion: Cerebral hemodynamics changes can persist after birth development of fetal hypotrophy
which involves a different attitude on the monitoring and clinical
management of brain PM with IUGR compared to premature without as a factor of the ‘‘strategy of
IUGR.
survival’’
Keywords: IUGR, doppler, premature
V.A. Linde, T.N. Pogorelova, N.A. Drukker, I.I. Krukier, O.A.
Durnitsyna, and A.A. Grigoryan
501 Rostov Scientific-Research Institute of Obstetrics and Pediatrics,
Arterial doppler in iugr preterm Rostov-on-Don, Russia

fetuses, data regarding an obser- Presenter: V.A. Linde

vation study in uhog ‘‘Koco Introduction: Objective. Studying the role of changes in cholesterol of
amniotic fluid (AF) in the development of the fetal growth restriction
Gliozheni’’ (FGR) with the account of a transport function of a-fetoprotein (AFP).
Materials and methods: In 34 women, whose pregnancy was
Enkeleda Prifti1, Nikita Manoku1, Alketa Hoxha2, complicated by the FGR in weeks 28-35 and in 19 women with the
physiological pregnancy the content of free cholesterol, LDL
Arian Alikaj1, and Enver Roshi3 cholesterol (LDL-C), HDL cholesterol (HDL-C), AFP in AF obtained in
1
High Risk Pregnancy Department, University Hospital of Ob-Gyn the first period was determined using kits by Randox (Germany).
‘‘Koco Gliozheni’’, Tirana, Albania, 2NICU, Paediatric Dept, University Clinical cases and summary results: The obtained results indicate a
sharp decrease in the content of free cholesterol in AF (by 2.24 times)
Hospital of Ob-Gyn’’Koco Gliozheni’’, Tirana, Albania, and 3University
and of AFP by 2 times as well as an increase of LDL-C by 1.5 times and
of Medicine, Dept. of Public Health
HDL-C by 3 times as compared with the control values.
The revealed changes in the content of free cholesterol, LDL-C and
Presenter: Enkeleda Prifti HDL-C in AF make it possible to consider the levels of lipid-carrying
Introduction: Our objective of this study was describing multivessel molecules and protein that form active receptor absorption of fatty
Doppler of UA and MCA in preterm hypotrof fetuses, in correlation to by cells to be the adaptive ones. The increase of LDL-C reduces the
Perinatal Adverse short Outcome. We also intended to provide data fluidity of plasma membrane of cells changing the function of
for the perinatal outcome at our Institution as Third Level of Care, in integral proteins in it. The decrease in the transport of cholesterol by
order to offer an integrated management of IUGR preterm fetuses, AFP is a factor, which retards embryonic cytokinesis that causes the
according to the level of NICU. FGR. If LDL perform solely a transport function for cholesterol,
Materials and methods: Prospective observational study, 2010 - 2014, delivering it to peripheral cells to form a membrane, HDL transfer a
in pregnant women with unique fetus, between 26-37wGA, with larger quantity of different components of shells, which apparently
intact membranes, with Estimated Fetal Weigh in ultrasound5p.10th, allows maintaining a certain level of the formation of tissues of the
and at least one abnormal Arterial Doppler up to three days before developing fetus.
delivery: DUPI 4p.95th, AEDF(intermittent), REDF, MCAPI 5p.5th; ICP Conclusion: Changes in the content of free cholesterol, LDL-C and
5p.5th. After delivery, we collected data about Adverse Perinatal HDL-C in AF and in the metabolism of AFP, which ensures the
Outcome as a complex of perinatal deaths and severe morbidity: modification of transport of free cholesterol to a fetus, is a kind of a
Intraventricular Hemorrhage (HIV), Periventricular Leucomalacia PVL, regulation mechanism of the cholesterol metabolism by fetus as a
necrotizing enterocolitis NEC, bronchodisplasia BD, sepsis S. factor of the ‘‘strategy of survival’’.
Clinical cases and summary results: Our study included 91 cases. The revealed peculiarities of the change of lipid components make it
Regarding to Doppler parameters: AEDF, DUPI 4p.95th, MCAPI possible to control and to influence certain stages of embryogenesis
5p.5th, there were not significant changes in presence according to with the purpose of prevention of the FGR.
groups of wGA (26-366/7wGA). There is a predominance of presence Keywords: Fetal growth restriction, amniotic fluid, cholesterol,
of REDF in early groups of wGA: {28-29wGA, 30-31wGA, (p=0.001)}; a-fetoprotein
while ICP 5p.5th being more present after 34wGA (p=0.01).
Regarding Perinatal Outcome, the absence of End Diastolic Flow in
UA (AEDF +REDF), was significantly associated with Adverse Outcome
OR 4.18, 95%CI (1.44-12.7)}, with REDF related more significantly
(p 0.0001). Although, a positive correlation of presence of MCAPI
5p.5th with Adverse Outcome, we didn’t find it significant {OR=2.13,
95% CI (0.73-6.77)}. Also we didn’t find any correlation between
presence ICP5p.5th and Adverse Perinatal Outcome {OR = 0.5, 95%CI
(0.18-1.4)}.
Conclusion: In IUGR preterm fetuses, the absence of end diastolic flow
(AEDF+REDF) was significantly associated with adverse outcome.
Clinical managing of preterm hypotrof fetuses, must integrate
Doppler evaluation with fetal wellbeing tests, and timing delivery
must be according to the level of local Intensive Care Unit.
Keywords: Arterial Doppler, IUGR, preterm
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 137

563 605
Association between perinatal Antenatal ultrasound monitoring
smoking exposure, maternal per- and prediction of perinatal out-
ipheral leukocytes subpopula- comes in the early and late onset
tion’ changes throughout of fetal growth retardation
gestation and low birth weight
I. Safonova1 and G. Grebinichenko2
infants 1
Kharkiv Medical Academy of Postgraduate Education, Kharkiv
regional perinatal center, Kharkiv, Ukraine and 2SI ‘‘Institute of
S. Sabra, J. Sabria, A. Martinez, A. Gracia, E. Mazarico, P.
Pediatrics, Obstetrics & Gynecology of National Academy of Medical
Prieto, E. Gratacos, and M. Gómez
Sciences of Ukraine’’, Kyiv, Ukraine
Obstetrics and Gynecology Dept., BCNatal, University of Barcelona,
Barcelona, Spain Presenter: I. Safonova
Introduction: To differentiate late onset FGR and SGA fetus is a
Presenter: Sally Sabra common but challenging clinical task for fetal-maternal medicine
Introduction: Perinatal maternal tobacco exposure is a well-known specialists. The objective of the study was to explore the value of
major risk factor of fetal growth restriction. However, the exact ultrasound (US) fetal biometry and Doppler monitoring in the
mechanism is still unknown. During gestation, few studies noted diagnosis of early and late forms of intrauterine growth retardation
changes in the proportion of lymphocytes in the peripheral blood of (IGR) and small for gestational age (SGA) fetus, as well as in predicting
smoking mothers in the second trimester. Nevertheless, there are no perinatal outcome.
data investigating changes in the leucocyte subpopulations in Materials and methods: We studied the results of Doppler monitoring
maternal peripheral blood induced by tobacco exposure throughout and clinical perinatal catamnesis of 204 fetuses, which had estimated
pregnancy in correlation with neonatal birth weight.Objectives: To weight (EW) at the antenatal stage below the 10th centile, and 100
evaluate the perinatal smoking exposure influence on leukocyte fetuses with the EW above the 10th centile. Fetuses with EW below
subpopulations’ changes in the maternal peripheral blood and its the 10th centile were subdivided into two subgroups: 141 - with
correlation with intrauterine fetal growth. diagnosis established for the first time before 34 GW, and 63 -
Materials and methods: Retrospective study was conducted in Hospital diagnosed after this term. Only singleton pregnancies participated in
Sant Joan de Deu, University of Barcelona. Patients were divided into the study. Doppler monitoring included assessment of umbilical
three groups depending on smoking status and neonatal birth artery, uterine arteries and fetal middle cerebral artery flow. Postnatal
weight; appropriate for gestational age (AGA) nonsmokers versus low results were classified as follows: adverse general postnatal outcome
birth weight (LBW) smokers and nonsmokers. Data from maternal (GPO) meant perinatal or infant death; adverse clinical postnatal
peripheral blood analysis including leukocytes and its subtypes both outcome (CPO) meant severe neonatal morbidity.
percentages and absolute values in the three trimesters of gestation Clinical cases and summary results: Adverse GPO and CPO in group
were collected. with EW below 10th centile occurred 11.7 times more often than in
Clinical cases and summary results: Our data have shown significant group with normal gestational fetometry (p=0.02). Postnatal outcome
increase in the maternal peripheral major leukocyte subpopulation’ in fetuses with EW below 10th centile diagnosed after 34 GW had a
among the LBW smoker group throughout gestation. Also, we wide variability - from extremely unfavorable GPO and CPO up to
detected a significant increase in leucocytes, neutrophils, eosinophils constitutionally low weight at full clinical wellbeing. Rate of true IGR
and lymphocytes absolute values throughout gestation among the and adverse GPO was higher in subgroup where low EW was
LBW smokers on comparison to the AGA nonsmoking group. diagnosed before 34 GW, than in cases, first diagnosed after 34 GW (p
Conclusion: Our data reinforce the strong association between 50.05). In studied cohort fetal weight percentile estimation allowed to
maternal tobacco exposure and LBW, however; our novel results diagnose true early IGR with an accuracy of 71% and true late IGR
suggest a correlation between the triad: maternal smoking, LBW and with an accuracy of 45%. True late IGR was confirmed in 24/63 (38.1%)
peripheral maternal immune cells. The maternal inflammatory of fetuses with EW below the 10th centile after 34 GW. The best
changes noted in the first trimester throughout gestation suggest a quality of true early IGR diagnosis (area under ROC-curve 0.9902) was
prior maternal immune system triggering. observed with application of integrated US monitoring, and the worst
one (the area under ROC- curve 0.4012) with only percentile
Keywords: Maternal Smoking, peripheral leukocytes, low birth fetometry assessment after 34 GW.
weight infants Conclusion: Differential diagnosis between true late IGR and SGA is
extremely difficult. In early onset IGR the prediction of perinatal
outcome may be based on estimated fetal weight evaluation and
Doppler monitoring, whereas in late onset form of IGR the prediction
of perinatal risk degree on the basis of both US fetometry and
Doppler monitoring can be considered as uncertain.
Keywords: Pregnancy, fetus, ultrasound, fetal growth retardation,
perinatal outcome
138 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Introduction: There is strong evidence that omega-3 fatty acids have a

707 beneficial effect on human body. The most crucial docosahexaenoic
Diagnosis of preeclampsia by acid (DHA) is a component of cell membranes. It is well established
for now that its prenatal supplementation has a great influence on
decresed fetal movements proper development of nervous system, perinatal outcomes and
mental functions in early childhood. The results of recent studies
conducted in groups of adults suffering from cardiovascular diseases
M. Urtasun, S. Garcı́a-Francés, A. Safont, M. Donazar, suggest that its supplementation plays a role in secondary prevention
B. Pérez, N. Abian, B. Gastón, and C. Larrañaga of heart diseases and strokes.
Our aim was to investigate whether prenatal DHA supplementation
Servicio de obstetrica y ginecologı́a, Complejo Hospitalario de affects: fetal weight gain, vascular flow improvement expressed in
Navarra, Pamplona, Navarra, España Doppler ultrasound parameters, mode and time of delivery in
pregnancies complicated by growth restriction.
Presenter: Maitane Urtasun Materials and methods: This is a retrospective study of a 78 singleton
pregnancies complicated with intrauterine growth restriction hospi-
Introduction: Preeclampsia is a multi-system disorder characterized by talized in Department of Obstetrics and Perinatology Jagiellonian
the new onset of hypertension, proteinuria or end-organ dysfunction University between I and IX 2014. 35 women were administered DHA
after 20 weeks in a previously normotensive woman. They are at (DHAgroup) at the minimum dose of 500mg and 43 were not
increased risk for maternal-fetal mortality and morbidity. The (0group). Ultrasound examinations were performed to measure
incidence is 4.6%. Abnormalities in the development of the placental estimated body weight (EFW), pulsatility index for umbilical artery
vasculature can result in placental underperfusion, hypoxia and (PI UA), mid-cerebral artery (PI MCA) and cerebro-placental ratio (CPR)
ischemia. It may lead to release of circulating antiangiogenic factors on admission and after 7 days in both groups.
that can cause maternal systemic endothelial dysfunction resulting in Clinical cases and summary results: There were no statistically
the clinical manifestations, and fetal growth restriction and oligohy- significant differences in patients’ age, gestational age, fertility
dramnios. The definitive treatment is delivery to prevent complica- rate, frequency of comorbidities, medications intake, mode of
tions, timing of delivery is based upon gestational age, the severity of delivery and indications to cesarean section (CC) between two
preeclampsia, and maternal and fetal condition. groups, although women in DHAgroup more likely underwent CC
Clinical cases and summary results: A 29 + 3 weeks pregnant arrived at (82,86% vs 74,42%, p40,05) and delivery was 4 days earlier (pw
the emergency room by decreased fetal movements during the last 36 + 6 vs. 37 + 3, p40,05). In DHA group EFW increase after 7 days
four days. The fetus was diagnosed with intrauterine growth was higher (117g vs 98g) and correlated with gestational age at
restriction and the patient presented high levels of blood presure, birth more strongly (p50,05). In DHAgroup changes in PI UA and PI
so income was decided to study FGR and preeclampsia. Study of MCA increase CPR value moderately and strongly (p50,05), there
infections and thrombofilias was performed. We diagnosed a severe was no such strong correlation in 0group. In DHA group CPR
preeclampsia, and iniciated treatment with oral nifedipine, thanks to increase is bigger when primary CPR is lower (p50,05) and it is not
she stayed normotense. We stablished daily fetal monitoring by serial happening to 0group.
ultrasound velocimetries. At week 31 + 3 had an unsatisfactory fetal Conclusion: In pregnancies complicated with growth restriction DHA
monitor and an ultrasound with redistribution, so urgent caesarean supplementation increases CPR via its influence on blood flow in
section was decided, with neuroprofilaxis. A 1,040gr girl was born, umbilical artery resulting in moderate decrease of PI UA value. EFW is
with artery pH 7.16 and Apgar 9/10. She entered in neonatology statistically higher when correlated with gestational age at birth. DHA
service with good clinical evolution, being discharged with 48 days intake doesn’t affect mode or time of delivery and has no side effects.
and 2135 gr. The mother has satisfactory evolution too.
Conclusion: Serial ultrasound evaluation of fetal growth, behavior, and Keywords: Docosahexaenoic acid, fetal weight,cerebro-placental
Doppler velocimetry represent the elements of fetal assessment. ratio
The goal is to identify fetuses at highest risk of in utero demise and
neonatal morbidity and thus may benefit from preterm delivery.
Doppler velocimetry of the umbilical artery is recomended for
monitoring pregnancies with suspected growth restriction. Delivery FIRST TRIMESTER SCREENING AND
prompted by abnormal Doppler ultrasonography reduces perinatal PREVENTION STRATEGIE - 059 (CASE REPORT)
death.
The role of prenatal ultrasound in
diagnosing craniosynostosis,
724 Crouzon syndrome: a case report
Effects of docosahexaenoic acid
I Putri, and KWS Tan
supplementation on doppler flow
Obstetrics and Gynaecology Department, The Calvary Hospital,
parameters and birthweight in Canberra, Australia
pregnancies affected by growth
Introduction: Crouzon syndrome, one of the best known of many
restriction craniofacial syndromes, is an autosomal dominant disorder character-
ized by craniosynostosis, prominent eyes, and midfacial hypoplasia
due to abnormal development and premature fusion of the skull. This
M. Radon-Pokracka, H. Huras, A. Lachowska, M. Nowak,
is attributed to mutations in the fibroblast growth factor receptor 2
and P. Ossowski gene (FGFR2). Crouzon syndrome is one of the rarest condition
Dept of Obstetrics and Perinatology, University Hospital in Krakow, affecting 16 in 1 000 000 newborns, however it is the most common
craniosynostosis syndrome.
Krakow, Poland
Clinical cases and summary results: We report a 39 year old woman,
G3P1, with a previous history of termination of pregnancy for a
Presenter: M. Radon-Pokracka trisomy 18 fetus, a previous first trimester miscarriage and a normal
birth of a 2 year old child. She underwent first trimester screening
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 139
which was low risk and had a normal 20 week fetal morphology Materials and methods: Prospective study which included pregnant
survey. A third trimester ultrasound was performed at 35 weeks for women who underwent to first trimester ultrasound, between
evaluation for fetal growth which identified severe craniosynostosis. January and December 2015, and which was calculated the risk of
The features included frontal bossing, scaphocephaly and cloverleaf early pre-eclampsia based on maternal characteristics, biophysical,
skull appearance, possibly associated with genetic/syndromic dis- sonographic and biochemical markers. The aim of the study is to
orders. Following counselling with maternal fetal medicine and compare the group characteristics with increased risk with other
craniofacial surgeon, who discussed implications of findings for the pregnant women.
fetus, a decision was made to terminate the pregnancy. This was Clinical cases and summary results: The sample comprised 610
approved by the termination review committee. A stillborn was pregnant women submitted to screening of preeclampsia, mean
delivered at 35 + 6 weeks gestation for medical interruption of age of 29.9 years. The estimate of early risk of preeclampsia
pregnancy. Postmortem genetic examination has shown that the demonstrated increasingly in 39 pregnant women, 13 for early
fetus had an FGFR3 Ala391 Glu mutation which is characteristic of preeclampsia risk calculation 41/100, 17 major risk factor and 9 by
Crouzon Syndrome. The frequency of Crouzon syndrome is approxi- conjugation of minor factors. The analysis of the two groups for
mately 1 in 25,000 births. Although transmission is through carrying out the t test for independent samples showed statistically
autosomal dominance, 30–60% of cases are from parents without a significant differences for the following variables: age (p= 0.028), body
family history. It is important to make a differential diagnosis with mass index (p= 0.001), systolic blood pressure (p50.001) and pressure
similar cranioencephalics characteristics like Carpenter, Apert, Pfeiffer diastolic blood pressure (p= 0.011), No significant differences in PAPP-
and other syndromes. Prenatal suspicion of Crouzon syndrome needs A values and IPmAU were found.
to be referred to geneticist and a paediatric craniofacial surgeon to Conclusion: The first trimester preeclampsia screening allows early
plan for the remainder of the pregnancy. identification of a pregnancy at high risk for preeclampsia,
Conclusion: Craniosynostosis is very rare and has a bad prognosis particularly taking into account the particular characteristics of this
for fetus. Genetic testing is required to exclude any genetic population, increasing the likelihood of a better prognosis for
conditions or syndromes. The importance of prenatal surveillance is pregnancy.
important in detecting any presence of any associated structural
abnormalities. Keywords: First trimester preeclampsia screening

Keywords: Crouton syndrome, craniosynostosis

177
Screening of pregnant women in
169 the first trimester: risk factors for
Early preeclampsia screening - preterm delivery
evaluation of the factors that
M. Bogavac1, A. Jakovljevic2, Lj. Stanisic3, and
influence increased risk Z. Novakovic4
1
A. Correia, M. Bóia, S. Pedrosa, F. Leitão, R. Neto, Clinical Centre of Vojvodina, Department of obstetrics and
M. Almeida, and S. Neto gynecology, University of Novi Sad, Medical faculty, Novi Sad, Serbia,
2
Clinical Centre of Vojvodina, Centre for Laboratory Medicine,
Obstetrics and Gynecology Dept., Centro Hospitalar Baixo Vouga, University of Novi Sad, Medical faculty, Novi Sad, Serbia, 3Primary
Aveiro, Portugal Helathcare centre Novi Sad, Serbia, and 4University of Novi Sad,
Medical Faculty, Novi Sad, Serbia
Introduction: Preeclampsia is a very variable heterogeneous syndrome
of unknown etiology that affects about 4.6% of all pregnancies. It is Introduction: Etiology of preterm delivery is very complex and still
the major maternal and perinatal morbidity being associated with unknown. There are numerous risk factors related with possible
long-term complications either to the mother or to the child. The initiation of preterm contractions and preterm delivery. Some of
preeclampsia screening aims to identify as soon as possible the group important factors are used these days in screening of pregnant
of pregnant women at high risk of enabling the prophylactic women who are in risk of preterm delivery.
administration of acetylsalicylic acid low dose, increased monitoring
of pregnancy and early diagnosis of the disease signs. Keywords: Aim of the study: Aim of this study was to determine how
life style, life habits and laboratory markers of infection which are
140 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

monitored during pregnancy, can be used in screening of pregnant repeated. No discrepancy was seen between the results of both
women for occurrence of preterm delivery. techniques. Fifty six samples showed normal patterns, three sample
Materials and methods: Study is conducted in Clinical centre of showed trisomy 21, successfully detected by both techniques and
Vojvodina, Department of Gynecology and Obstetrics in Novi Sad. one sample showed normal pattern by QF-PCR but could not be
Protocol was approved by Ethical board of Medical Faculty, University compared to the cytogenetics due to culture failure, the pregnancy
of Novi Sad and Ethical board of Clinical centre of Vojvodina (Novi outcome of this case was a normal baby.
Sad). Study concluded total 100 pregnant women gestational age Conclusion: Our study concluded that QF-PCR is a reliable technique
between 11 and 14 weeks of gestation (WG) which are recieved on for prenatal diagnosis of the common chromosomal aneuploidies. It
Clinic for conducton of screening test on chromosomal abnormalities has the advantages over the cytogenetic culture of being faster with
of fetus. All pregnant women agreed to participate in research by the results appearing within 24–48 hours, simpler, doesn’t need a
signing written consent. Pregnant women are divided in two groups: highly qualified staff, less prone to failure and more cost effective.
study group (n=60) and control group (n=40). All women were
followed up till the end of pregnancy with special reference to the Keywords: QF-PCR, chromosomal aneuploidies, prenatal diagnosis
week of pregnancy completion and delivery method.
Clinical cases and summary results: Pregnant women of study group
were average age 33.4, while women of control group were age 29.3
which is statistically significant difference (p 50.0046). Both groups
had same number of smokers in study group (49%), and in control
group (35.34%), however this period of smoking (values are expressed 212 (CASE REPORT)
in years) was statistically significantly higher in study group 11.8 ± 4.2
in correlation to the control group 8.2 ± 5.13, (p 50.04). Also, Early ultrasound screening for
statistically higher number of pregnant women of study group lives
in the city 74% in correlation to the pregnant women of control fetal malformations in the second
group 36% (p 50.03). As for laboratory markers, values of CRP and
fibrinogen were higher in study group, while the values of leukocytes pregnancy after combined
were approximately equal in both groups.
Conclusion: Results of research points to the importance of choice and
modality treatment for hodgkin’s
following of risk factors for ocuurrence of preterm delivery to be
implented in first trimester and they include general maternal factors
disease: a case report
among which are emphasized bad habits and monitoring of
parameters of infection. G. Bushinoska-Ivanova1, J. Ivanov2, and T. Sotirova3
1
UK JZU Gynecology-Obstetrics Clinic Skopje, Macedonia, 2Clinical
Keywords: First trimester screening, risk factors, preterm delivery Hospital Acibadem Sistina, Skopje, Macedonia, and 3Haemathology
Clinic Skopje, Macedonia

Introduction: Therapeutic progress in HD has led to a high rate of cure,

but at the expense of some side effects. Abnormalities reported so far
are: cardiac toxicity, pulmonary toxicity, endocrinal failure, second
184
cancers and congenital malformations. Although several studies
QF-PCR as a rapid technique for reported in the literature showed no or slightly increased risk of
congenital abnormalities among newborns of women previously
routine prenatal diagnosis of fetal treated for Hodgkin’s disease compared with the general population,
abnormalities do occur and sometimes they are very odd and difficult.
aneuploidies
Keywords: Materials and method: We report a case of female patient,
1 1 2 2 25 years old, Macedonian, presented with Hodgkin’s disease, subtype
S.H. Atef , S.S. Hafez , N.H. Mahmoud , and S.M. Helmy nodular sclerosis, stage IIIA. The patient received chemotherapy
1
Clinical Pathology Department, Ain Shams University, Faculty of according to ABVD protocol-6 cycles. Thereafter she received mantle
field radiation with 3600 cGy. She was followed for the next 36
Medicine, Egypt, and 2Prenatal Diagnosis and Fetal Medicine
months and than she become pregnant.
Department, National Research Center, Cairo, Egypt
Keywords: Clinical Cases of Summary Results: Ultrasound confirmed a
Introduction: The most common chromosomal abnormalities identi- normal fetus in first pregnancy during controls. A normal female baby
fied at birth are aneuploidies of chromosome 21, 18, 13, X and Y. was born with Caesarean Section at term. Clinical assessment in the
Prenatal diagnosis of fetal aneuploidies is routinely done by follow-up period showed normal development. Also the mother was
traditional cytogenetic culture, a major drawback of this technique assessed regularly and was free of disease. The next pregnancy
is the long period of time required to reach a diagnosis. In this study occurred 87 months after completion of treatment. At 13th
we evaluated the QF-PCR as a rapid technique for prenatal diagnosis gestational week ultrasound assessment revealed malformations
of common aneuploidies and induced abortion was suggest.
Materials and methods: This work was carried out on Sixty amniotic A male fetus with malformations on the head such as proboscis,
fluid samples taken from patients with one or more of the following cyclopia and omphalocele on the front abdominal wall containing
indications: Advanced maternal age (3 case), abnormal biochemical liver and small bowels was found. After induced abortion the autopsy
markers (6 cases), abnormal ultrasound (12 cases) or previous history report from the Institute of Pathology was: male fetus with
of abnormal child (39 cases). Each sample was tested by QF-PCR and malformations on the head like proboscis and cyclopia (one eye
traditional cytogenetic. Aneuploidy screenings were performed beneath proboscis), and omphalocele on the frontal abdominal wall
amplifying four STRs on chromosomes 21, 18, 13, two pseudoauto- containing liver and small bowels. Other findings were normal. The
somal,one X linked, as well as the AMXY and SRY, markers were patient has been followed-up regularly until now. She is disease free,
distributed in two multiplex QFPCR assays (S1 and S2) in order to with no more pregnancies.
reduce the risk of sample mishandling. Conclusion: We consider this case important in bringing the potential
Clinical cases and summary results: All the QF-PCR results were late side-effect that should be alert for the risk of congenital
successful, while there was two culture failures, only one of them was abnormalities in newborns of women previously treated for Hodgkin’s
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 141
disease, especially with combined modality treatment, and should Introduction: The objective of the study was to compare fetal hepatic
check for them during pregnancy, at birth, in early childhood or in flow at the 1st trimester scan and establish a possible marker for
adulthood. Treatment with chemotherapy, radiation therapy or both abnormal fetal growth.
may have adverse effects on germ cell survival, fertility and health and Materials and methods: Methods: 346 patients that attended the
congenital abnormalities. Outpatient Clinic in The 1st Department of Obstetrics and Gynecology
of the Medical University of Warsaw had a 1st trimester ultrasound
scan with the assessment of the risk of chromosomal abnormalities
Keywords: Ultrasound screening, congenital abnormalities,
according to the Fetal Medicine Foundation. During the scan the
Hodgkin’s disease
nuchal translucency, nasal bone, flow across the tricuspid valve and
the flow across the ductus venosus were assessed. An additional
marker - the flow across the hepatic artery - was also assessed.
Clinical cases and summary results: Results: Out of the 346 patients,
the outcomes of 241 were obtained. The patients were divided into
three groups: 1 - the first group included babies that were below the
318 11 percentile (n-23), 2 - the second group included babies between
Iodine replacement in pregnancy, 11 and 89, 3 (n-188) - the third group included babies above the 89th
percentile (n-30). The PSV of the hepatic artery for the 1st, 2nd and
is it necessary? 3rd group was 10.92, 10.35 and 10.1 respectively. The PI of the hepatic
artery for the 1st, 2nd and 3rd group was 2.29, 2.36 and 2.46
respectively. The differences were not statistically significant.
K. Koyuncu, B. Turgay, T. Yuce, M. Seval, and F. Soylemez Conclusion: Hepatic artery flow does not seem to be a marker for
Obstetrics and Gynecology Dept., University Hospital of Ankara, abnormal fetal growth.
Ankara, Turkey
Keywords: Hepatic artery flow, feral growth, first trimester screening
Introduction: To assess iodine status in early pregnancy and its
correlation with maternal TSH levels.
Materials and methods: This was a hospital-based, noninterventional, 553
retrospective, cross-sectional, cohort study. A total of 440 pregnant
women were recruited between June 2015 and November 2015 in
Perspectives, preferences and
their first trimester visit. All of the patients were using iodised salt.
Urinary iodine concentration (UIC) and thyroid function were assessed
needs regarding early prediction
at first trimester visit. UIC was measured using colorimetric method of preeclampsia in dutch preg-
based on Sandell-Kolthoff reaction. Thyroid hormones and TSH and
T4 were measured by chemiluminescence immunoassays. nant women: a qualitative study
Clinical cases and summary results: In the pregnant women providing
a urine sample UIC was below 150 mg/l in 86% of the women. The
mean UIC was 82,23 (1–450) mg/l, indicating insufficient iodine intake.
N. Crombag1, M. Lamain - de Ruiter, A. Kwee1,
The mean TSH level was 1,5 (0,01–14,74) and mean T4 levels was P. Schielen2, J. Bensing3,4, G. Visser1, A. Franx1, and
13,99 (7.09–23,7). 12.7% had subclinical hypothyroidism or isolated M. Koster1
hypothyroxinaemia based on serum TSH and FT4 levels. 1
Conclusion: Our study shows that iodine deficiency (ID) is a serious Department of Obstetrics, University Medical Center Utrecht,
problem among pregnant women in Ankara despite of mandatory Utrecht, the Netherlands, 2Centre for Infectious Diseases Research,
iodine salt use. It is known that iodine supplementation enhances Diagnostics and Screening (IDS), National Institute for Public Health
neurodevelopment scores and psychomotor performance. We and the Environment (RIVM), Bilthoven, The Netherlands, 3Utrecht
suggest that iodine should be a part of routine laboratory evaluation University, Faculty of Social and Behavioural Sciences, The
at the first prenatal visit iodine because it is most important in early Netherlands, and 4The Netherlands Institute for Health Services
pregnancy. Pregnant women with ID should receive 100–200 mg/d of Research Utrecht, The Netherlands
I-containing supplements in addition to iodised salt.
Presenter: N.Crombag
Keywords: Iodine deficiency, TSH, T4
Introduction: In the Netherlands only quarter of women take part in
first-trimester combined testing. As risk identification is an essential
element of antenatal care and research on its improvement is
ongoing it was of our interest to investigate attitudes of Dutch
pregnant women with regards to innovations in prenatal screening. In
particular, preeclampsia screening. Prediction models may improve
403 risk selection by early identification and leaves room for preventive
The fetal hepatic artery flow at measures, but potential drawbacks and ethical concerns are related to
the false positive and false negative results.
the first trimester scan and fetal Therefore the aim of this study was to explore Dutch pregnant
women’s perceptions, preferences and needs regarding the predic-
growth tion models for first-trimester screening for preeclampsia.
Materials and methods: To explore pregnant women’s perception,
R. Brawura-Biskupski-Samaha, D. Bomba-Opoń, preferences and needs, ten focus groups (of which five with
primiparous and five with multiparous women) were conduc-
S. Kozłowsk, M. Lipa, and M. Wielgoś ted(n=45). Six focus groups were conducted in urban regions and
1st Department of Obstetrtics and Gynecology Medical University of four in rural regions. All focus group discussions were audio taped
and content analysed.
Warsaw
Clinical cases and summary results: Women in this study had a positive
attitude towards first trimester screening for preeclampsia using
prediction models. Reassurance when determined as low-risk was a
142 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

major need for using the test. Self-monitoring, early recognition and
intensive monitoring were considered benefits of the prediction model
in case of a high-risk. Women acknowledged that high-risk determina-
tion could cause (unnecessary) anxiety, but it was expected that
personal and professional interventions would level out this anxiety.
Conclusion: Women in this study had positive attitudes towards
preeclampsia screening. Self-monitoring, together with increased
alertness of healthcare professionals, would enable them to take
active actions to potentially improve pregnancy outcomes. Therefore,
identification of women at high-risk offers opportunities for preven-
tion, early recognition and treatment. This differs greatly from the
attitude on Down syndrome screening in the Netherlands.
Keywords: Preeclampsia screening, prenatal screening

559
First trimester fetal morfology
P. Dimcev and K. Trajkova
720
Acibadem Sistina Hospital, Skopje, Republic of Macedonia
Hyperemesis gravidarum is
Presenter: Pavle Dimcev
related to urinary iodine
Introduction: First Trimester screening for chromosomal abnormalities
is widespread tool for early detection problems in fetal well being. excretion?
But not only for chromosomal abnormalities, advanced ultrasound
machines allows, almost complete evaluation of fetal morphology till B. Turgay, K. Koyuncu, M. Seval, and F. Söylemez
14 week of gestation.
Moreover, huge part of the anomaly scan in 20 weeks is moved at Gynecology and Obstetrics Dept., University Hospital of Ankara
First Trimester University, Ankara, Turkey
Materials and methods: Our data is presenting period between
January 2011 and December 2015 .In this period in our hospital 1786 Presenter: Batuhan Turgay
patients were examined. The average gestational age was 12.3(11.3 -
13.6). Singleton pregnancies were 1532, twins 254. Average maternal Introduction: The aim of this study to identify the effect of iodine
age, 31.4, over 35 years of age 360 patient. status on hyperemesis gravidarum.
Clinical cases and summary results: In last few years we are trying to Materials and methods: This retrospective cohort study was under-
incorporate in First Trimester ultrasound examination all recommen- taken in Ankara University Hospital, Ankara, July 1, 2015 and February
dations published in ISUOG White Journal, published in February 1,2016. Urinary concentrations of iodine were measured at the initial
2013, (ISUOG Practice Guidelines: performance of first-trimester fetal obstetrical visit. Iodine status was measured using colorimetric
ultrasound scan). method based on Sandell-Kolthoff reaction. 437 pregnant women
This work is presenting anomalies that we have found in last five who visited Ankara University Hospital consecutively were included
years as a part of First Trimester Screening. study. Hyperemesis gravidarum was estimated with clinical symptoms
In this period we detected: 2 AV defect of the hearth (both were and ketonuria.
Down,s) 2 megacistis, 1 holoprosencephaly (Tr. 18), 1 omfalocellae, 3 Clinical cases and summary results: Among 437 eligible women, 11.2%
anancephaly, 1 spina bifida with abnormal plsterior fossa(abnormal was diagnosed as hyperemesis gravidarum. 40 (9.1%) of the patients
IT) was hospitalized. In the first trimester, 380 women had lower urinary
Conclusion: Despite modest number of patient, this data is trying to iodine excretion (5 150 mg/l) which indicates iodine deficiency. In our
present current state of practice in Macedonia according First population, the rate of hyperemesis gravidarum was 9.5% in iodine
Trimester Screening. deficiency group and %22.8 in iodine sufficient group. The rate of
These should be first published work in Macedonia which are trying hyperemesis gravidarum was statistically significantly lower in women
to meet modern principles of FTS (ISUOG fetal ultrasound Practice with iodine deficieny (P50,05).
Guidelines: performance of first-trimester scan). Conclusion: Urinary iodine excretion was inversly correlated with
hyperemesis gravidarum in pregnancy in our study. Future prospec-
Keywords: FTS, nuchal, abnormalities tive studies are needed to investigate the relationship.
Keywords: Urinary iodine excretion, hyperemesis gravidarum
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 143

INDUCTION OF LABOUR - 061 077

Induction of labour- is it Failure of cervical ripening
influenced by fetal gender? following PGE2 vaginal insert -
Antonakou1, M. Souma1, E. Tsourlou1, what to do next?
M. Bouroutzoglou1, and D. Papoutsis2
1
A. Mohr -Sasson1,2, O. Sindel1,2, R. Rahamim Suday1,2,
Alexander Technological Educational Institute of Thessaloniki, A. Kalter-Farber1,2, R. Mashiach1,2, E. Schiff1,2, Y. Yinon1,2,
Thessoloniki, Greece and 2Royal Shrewsbury and Telford Hospitals
M. Dulitzki1,2, E. L. Sivan1,2, and S. Mazaki-Tovi1,2
NHS Trust, Shrewsbury, UK
1
High Risk Unit, Department of Obstetrics and Gynecology, The
Introduction: According to the World Health Organisation more than Chaim Sheba Medical Center, Tel Hashomer, Israel and 2Sackler
25% of all pregnant women will undergo an induction of labour, with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
the percentage rising up to 40% in some developed countries. This
study was designed to explore the effect of the fetal gender on the Introduction: Failure of cervical ripening following sustained-release
success of labour induction done for all indications and to investigate PGE2 vaginal insert is a common clinical challenge. Yet, what is the
whether other factors might affect the outcome of the induction optimum method of induction of labor after failure of PGE2 is
process. uncertain. The aim of this study was to determine success rate of
Materials and methods: This was a retrospective study of women induction of labor using Foley transcervical balloon (FTB) versus
having had an induction of labour at the largest public maternity second treatment with PGE2 vaginal insert, following failure of
hospital located in Athens Greece for the study period of January- cervical ripening with vaginal insert.
December 2012. Data concerning the socio-demographic status of Materials and methods: A retrospective cohort study of all pregnant
women, antenatal and intrapartum complications, the outcome of the women admitted to a single tertiary care center between June 2012
induced labour and neonatal data were all recorded. Ethical approval to October 2014 for induction of labor. Inclusion criteria included
was granted for the purposes of the study from the hospital’s Ethical gestational age 424 weeks, cephalic presentation, intact membranes,
Committee. Multivariable analysis was used in order to determine and an unfavorable cervix (Bishop score 56). Foley catheter was left
independently associated factors with the likelihood for caesarean for 12 hours if not expelled spontaneously. PGE2 was left for 24 hours
section (CS). if there was no commencement of labor. Successful induction is
Clinical cases and summary results: We identified 360 women having defined as a vaginal delivery within 24 to 48 hours of induction of
had induced labour over the 1-year study period with a mean age of labor. Second line treatment after failure of first PGE2 vaginal insert
30.0 years (SD=5.4 years). In the total sample, 33.1% had a CS delivery, was left for physician discretion. Non-parametric statistics, as well as
8.9% had an instrumental vaginal delivery and 57.9% had a normal regression were used for analysis.
vaginal delivery. The maternal characteristics were similar in the two Clinical cases and summary results: During the study period 1162
sub-groups of women according to the fetal gender. Also, the mean women were admitted for induction of labor with either FTB (852,
gestational age and the presence of antenatal complications were not 73.3%) or PGE2 vaginal insert (310 26.7%). Failure (non-delivered after
associated with fetal sex. We found a significantly greater rate of CS 24 hours) was reported in 322 (37.8%) in the FTB versus 162 (52.2%) in
delivery women having delivered in male infants in comparison to the PGE2 group (p 50.001). Regression analysis revealed that earlier
those with female infants (39.4% versus 25.5%, p = 0.006). The birth gestational week (p=0.04) and the use of PGE2 (p=0.001) were
weight was significantly greater in male neonates as compared to associated with higher failure rate. Among 162 patients treated with
female neonates (p=0.033). After adjusting for several confounding PGE2 as first line and did not deliver after 24 hours, 14 had
factors, multiple logistic regression analysis showed that the fetal spontaneous rupture of membranes, 15 had stripping and 42 were
gender was independently associated with the odds of CS delivery in still in active labor however didn’t yet deliver. The remainder
and determined that there was an almost two-fold increased risk in 91(56%) patients with PGE2 failure, were allocated to either second
the case of male neonates [OR 2.04 (1.11–3.76) p = 0.022]. trial of PGE2 treatment (n= 58, 63.7%) or FTB (n=33, 36.3%). Failure
Conclusion: We have shown that the male fetal gender is an rate was higher in the PGE2 (43/58, 74%) than in the FTB group (20/
independent risk factor that affects the success rates of induced 33, 60.6%) however these findings were not statistically significant
labour. This finding should be taken into consideration by the health (p=0.23). There was a trend towards shorter insertion-to-delivery
professionals when planning to induce labour. interval with FTB compared to PGE2 (p=0.07).
Conclusion: Despite a statistical trend, induction of labor with Foley
Keywords: Induction of labour, fetal gender transcervical balloon was not superior to second dose of PGE2 vaginal
insert for induction of labor following failure of cervical ripening with
PGE2 vaginal insert. This finding may be helpful for patients and
physicians alike.

Keywords: PGE2, Foley transcervical balloon, induction of labor

Table 1. Regression Analysis FTB versus PGE2.

95% CI
Lower Upper p
Age 1.01 0.99 1.04 0.29
BMI 1.04 1.01 1.07 1.01
Parity 0.61 0.53 0.71 0.00
Pregnancy Week 0.90 0.99 1.85 0.03
Group 1.98 1.49 2.63 0.00

BMI = Body Mass Index

144 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

spontaneous onset of labour within 24 hours of assumption (47.5%),

Table 2. Regression analysis - failure compared to success in PGE2 the remnantes were planned to received pharmacological induction.
induction of labor. Therefore, pharmacological labour induction was required for 18
women in Castor Oil (45%) and for 36 in Control group (p50.001).
95%CI Prostaglandins was the most frequent method used. No significant
differences were found in oxytocin augmentation between the
Exp B Lower Upper p groups. Operative deliveries occurred in 11 cases in Castor Oil (27%)
vs 17 cases in Control group (42.5%) (p50.02*). Caesarean section also
Age 1.01 0.96 1.06 0.6
Parity 0.72 0.53 0.98 0.04 was significantly lower in Castor Oil than in controls (8 vs 15 cases,
PV 0.76 0.47 1.23 0.26 p50.03). As far the side effects is concerned 4 women assuming
Effacement 0.99 0.98 1.01 0.47 Castor Oil referred not severe nausea and diarrohea No fetal or
neonatal adverse events were observed.
Conclusion: Accordingly with previous studies also our report suggest
that Castor Oil assumption after the 39 week of gestation was able to
favour spontaneous onset of labor without maternal and fetal/
neonatal side effects. In the half of the women treated the labour
119 onset within 24 hours. Moreover, the group of women submitted to
pharmacological induction because of failure of Castor Oil effect
Castor oil for induction of labour: experienced a lower rate of operative delivery and caesarean section.
Even if further studies are needed in order to clarify the optimal time,
a retrospective study dosage of Castor Oil administration and mechanism underlying its
effects on uterine activity, we purpose such method as a non-
I. Neri, G. Dante, and F. Facchinetti pharmacological approach to labour induction also in view of the
strong association between prostaglandins and oxytocin administra-
Mother-Infant Department, University of Modena and Reggio Emilia, tion and operative delivery and caesarean section.
Italy
Keywords: Non-pharmacological labour induction, castor oil
Introduction: Pharmacological labour induction with prostaglandins
gel, oxytocin infusion and mechanical methods, such as membrane
sweeping, amniotomy and trans cervical Foley balloon are associated
to fetal and maternal complications and more frequent operative
delivery and caesarean section (CS). Often the midwives recom-
mended near term the assumption of Castor Oil in order to avoid or 283
reduce pharmacological labour induction. A national survey of herbal
preparations reported that Castor Oil was prescribed by 93% of 500 PGE2 cervix ripening in patients
American College of Nurse-midwives interviewed. The United States
Food and Drug Administration categorized Castor Oil as a ‘generally
with previous caesarean birth. Is
recognized safe and effective over-the-counter laxative’. However the
mechanisms underlying the pharmacological effects of ricinoleic acid
it safe? Is it worth?
remain elusive, in particular its effect on initiating labour is not well
understood. The aim of the present study is to investigate safety and O. Sanz, B. Royo, I. Krasteva, B. Azcona, A. Fernandez, and
efficacy of Castor Oil to induce labour in a sample of women referred M.P. Martinez
by a midwife-led unit.
Materials and methods: A retrospective observational case control Obstetrics and Gynaecology Dept., Reina Sofia Hospital, Tudela,
study was conducted over five years, (February 2009 - February 2014) Spain
at the midwife-led unit of the University Hospital of Modena. Such
unit, opened in 2006, offered care to women carrying a single, Introduction: The use of PGE2 is initially contraindicated in patients
uneventful pregnancy classified at low-risk according to NICE with prior caesarean delivery. Nevertheless is a common method of
guidelines on intra-partum care. The inclusion criteria for Castor Oil cervix ripening in term labour induction. The obstetric results
assumption were: gestational age of 39–41 weeks, premature rupture (caesarean rate) and complications are evaluated in this study,
of membranes (PROM) between 12 and 18 hours, absence of comparing patients with and without previous caesarean section.
spontaneous labour over 41 + 4 weeks of gestation or amniotic fluid Materials and methods: Descriptive study that includes the cases with
index 4, Bishop Score lower than 4. The exclusion criteria were: term labour induction with vaginal PGE2. The use of PGE2 to ripening
onset of sporadic uterine activity, application of non pharmacological the cervix is indicated in Bishop under 6. The obstetric outcome and
methods as coitus, nipple stimulation, laxatives, other herbal complications have been compared between the patients with or
preparations or acupuncture in the last 24 hours. Forty women without previous caesarean, and into that group between the
meeting the inclusion criteria were invited to assume 60 ml of Castor patients with or whithout previous vaginal delivery.
Oil and then compared to 40 women showing same characteristics Clinical cases and summary results: 100 patients required labour
which received no intervention and considered as Control group (C). induction with vaginal PGE2 in our hospital during 2015 (11.6%). The
Antenatal follow-up was offered similarly in both groups. Data were caesarean rate in this gruop was 24%. In the previous caesarean
collected and analyzed with IBM SPSS Statistics software v19.0. Chi- delivery group the caesarean rate was 38.46%. In the previous
squared was used to compare categorical variables. For age and caesarean group without previous vaginal delivery the caesarean rate
gestational age at delivery comparisons we used Student t-test. All was 55.5%. A only mayor injury was reported during a caesarean in
data are reported as mean ± standard deviation or number with % in the last group (bladder injury). None was reported during the labour
brackets. P value less than 0.05 was considered as threshold for or vaginal birth. The time lapse between the PGE2 insertion and the
statistical significance. birth was similar in both groups.
Clinical cases and summary results: Gestational age at delivery was Conclusion: The use of PGE2 is initially contraindicated (technical
lower in Castor Oil respect to Control group (287.8 ± 6.0 vs CG 298.8 sheetdata) in patients with previous caesarean section. The study
± 3.9, p=0.08). In Castor Oil group 19 women experienced a results show that it is safe. On the contrary, the caesarean rate in
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 145
patients with previous caesarean section without a prior vaginal birth 578
is 55.5%. Is it a good result? Should we program an elective caesarean
in these cases? To perform a clinical decision we need to know the A slow, customized induction of
current evidence in addition to our own results.
labor using vaginal dinoprostone
Keywords: PGE2, previous caesarean, labour induction and misoprostol
A. Laoreti1,2, P. Antonazzo1,2, and I. Cetin1,2
1
Unit of Obstetrics and Gynecology, Department of Biomedical and
Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital ‘‘L. Sacco’’,
552
University of Milan, Milan, Italy, and 2Centre for Fetal Research
Induction of labour, two years of Giorgio Pardi, University of Milan, Milan, Italy

experience at faro’s hospital Presenter: A. Laoreti

Introduction: The goal of labor induction is to achieve vaginal delivery
F. Vilela, A. Edral, R. Martins, and A. Pacheco in the setting of various conditions that may adversely affect
Obstetric Dept, Faro Hospital, Faro, Portugal maternal-fetal well-being. Labor induction has increased in recent
years with a concomitant rise in CS rates. Recently, nomograms for
individualized counseling of women with antepartum risk factors,
Presenter: Fernanda Vilela
new algorithms for management of induced labor and new
Introduction: Induction of labour is a common practice and one of the formulations, such as misoprostol vaginal insert, have been intro-
most important obstetric interventions. It is undertaken when duced to improve the response to the cervical ripening and finally the
continuing with pregnancy is associated with more maternal and CS rate. However, studies generally do not consider the possibility
fetal risks than delivery. Furthermore before induction of labour we that longer times are necessary in specific conditions. Here we
have to weight the risks of fetal prematurity. present a case of customized labor induction in which we reviewed
Induction of labour is associated with higher maternal and fetal risks. the concept of failure and we continued the process using
Therefore, it is important to establish specific indications for this dinoprostone and misprosostol.
intervention. The success of induction of labour depends on many Clinical cases and summary results: A 28 years old white woman,
factors namely maternal parity and bishop score. According to WHO primigravida, overweight (pregestational BMI=28.4) was hospitalized
the incidence of labour induction is rising. In developed countries the at 39.3 wks of gestation for planned labor induction due to
proportion of term induction of labour can be as high as one in four gestational hypertension in good pharmacological compensation.
deliveries. Fetal growth was normal at regular ultrasound scans. Obstetric
Materials and methods: This retrospective study evaluates the evaluation evidenced a Bishop Score (BS)=2 and a cervical ripening
indications and methods of induction of labour and the main was preferred, using Dinoprostone vaginal insert. 24 h later, whereas
obstetric outcomes at Faro’s Hospital during 2013 and 2014. The data the BS unchanged, it was administered a second dose of dinopros-
was analysed in Excell and SPSSvs 10. tone. 52 h later, the BS was unchanged, and induction of labor
Clinical cases and summary results: This study verified that 23,3% continued with i.v. oxytocin, starting at a rate of 8 mU/min and
(n=1035) of the deliveries were induced. Nulliparous women (65,5%) adjusting every 30-40 minutes, with a maximum infusion rate of
had higher rates of dystocic deliver (51,7%, p50,05), namely c-section 36 mU/min. The infusion with oxytocin was carried out for 9 h,
(76,9%, p50,05). The percentage of women with previous c-section without any response in terms of uterine contractions, and
was 22,1%. modifications of BS. After this period, considering the good maternal
The main indications for induction of labour were prolonged and fetal conditions, the induction process was temporary inter-
pregnancy (33,86%), premature rupture of membranes (16,7%), rupted. 96 h later, we restarted labor induction using misoprostol
diabetes (10,8%), oligoamnios (8,2%), fetal growth restriction (8%) vaginal insert. 21 h after the placement of misoprostol, a spontaneous
and hypertensive disorders (6,2%). Vaginal prostaglandins were the rupture of membranes and the beginning of labor occurred. It was
most used method of induction. There was no relationship between performed epidural analgesia. The labor continued regularly, resulting
the method of induction and mode of delivery or newborn outcome. in a vaginal birth of a male newborn, weighing 3420 g in good
We verified 56,2% eutocic deliveries eutocic, 29,6% c-sections (similar general condition. Overall, vaginal delivery occurred 124 h after the
to the total rate at our hospital) and 14,19% vaginal instrumented start of induction. Mother and child were discharged on third day
births. In this study we demonstrated that woman with previous c- postpartum.
section had higher rates of distocic delivery (67,5%, p50,05) however Conclusion: Our case presents a model of slow labor induction,
the cesarean rate was similar (p7 at 98,7% of the newborn. suggesting the possibility of proceeding with customized induction
Conclusion: Labour induction is a common obstetric intervention mode, in order to reduce induction failure and, in turn, CS rate. To our
associated with risks for mother and fetus, At this study we verified knowledge, this is the first case in which dinoprostone and
that almost 23,3% of the deliveries in our hospital are induced. The misoprostol are associated in a sequential process of induction of
literature describes higher c-section rates associated with induction of labor. Further trials are needed to assess whether this choice may be
labour but our study demonstrated no difference. In obstetric care is particularly useful in specific subgroups at increased risk of induction
essential to evaluate the indications, methods and mode of delivery failure.
from induction of labour to improve medical approach and outcomes.
Keywords: Induction of labor, dinoprostone, misoprostol, induction
Keywords: Induction, labour, delivery failure
146 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

622 681
Misoprostol vaginal insert com- Induction of labour: a theorical
pared with misoprostol oral for cost evaluation of a new protocol
induction of labour
Z. Luengo, P.H. Crispı́n, C. Cabrera, N.M. Barrios, and MB.
K. Redling and I. Hoesli Adiego
University Hospital Basel, Departement of Obstetrics and Antenatal Obstetric & Gynecology Department, University Hospital Fundación
Care, Basel, Switzerland Alcorcón, Madrid, Spain

Presenter: Katharina Redling Presenter: Zhenia Luengo

Introduction: Misoprostol in an administration of 50mg orally is Introduction: Induction of labour is the technique to stimulate uterine
recommended for induction of labor (IOL) in women with an contractions leading to delivery before the spontaneous onset of this.
unfavourable cervix, although not licensed for this indication. In We can do the induction of laboUr with or without cervical ripening,
September 2014 the 200mg Misoprostol vaginal insert (MisodelÕ ) was which is the use of pharmacological agents, mechanical or other
launched in Switzerland and is licensed for induction. Our aim was to agents to soften, efface and dilate the cervix. An induction is
compare the efficacy and safety of Misoprostol vaginal insert and oral considered appropriate if: This is according to the wishes and the
Misoprostol. autonomous consent of the mother. The indication should be
Materials and methods: We retrospectively identified 100 patients who compelling, informed, discussed (methods, risks, success rate) and
have been induced with Misodel (VI) and compared them with 100 documented consent. Optimizes the fetal-maternal outcomes (includ-
patients, induced with Misoprostol oral (O) (50mg every 4-6 h, max. ing psychological well-being). It is accepted when the risks of
200mg). Primary outcome were time until delivery, secondary continuing the pregnancy to the mother or fetus, exceeds the risks of
outcome the mode of delivery, occurrence of polysystoly, and induction. It is based on scientific evidence and is cost-effective.
neonatal adverse outcome. We included women with a singleton Materials and methods: Until 2014, labor inductions in our center were
term pregnancy over 36 + 0 weeks of gestation, a Bishop Score 4 performed with dinoprostone vaginal devices and oxytocin. Based on
and a BMI 50kg/m2. the evidence available, our new protocol, introduced by the end of
The study has been approved by the local ethical committee (EKNZ). 2015, contemplates the use of pharmacological and mechanical
Clinical cases and summary results: Both groups were similar agents, taking into account the history patient, the admitting
regarding age of the mother (VI 31.10y ± 5.56, O 31.16y ± 5.45), diagnosis and BISHOP, considering the rupture of membranes and
BMI (VI 30.39kg/m2 ± 5.41, O 30.12kg/m2 ± 5.92), gestational age at the presence of streptococcus group B. The algorithm used to choice
the beginning of the induction (VI 40.4w ±1.3w, O 40.4 w ± 1.07w). the method of induction is summarized in Figure 1. To implement the
Time from the beginning of induction to delivery was significantly new protocol, a cost evaluation was conducted. We determined to
shorter in the VI group (20.86 h ± 19.93h) compared to the O group each patient, for whom labor induction was indicated during 2014,
(49.91 h ± 41.6h, p50.001). Mode of delivery overall was not which would be their method under the new protocol. From this, we
significantly different, but more Cesarean sections for failure of calculated a theoretical cost and performed a comparative evaluation
induction were performed in the O group (15 vs 4). Polysystoly respect real 2014 spendings.
occurred significantly more often in the Misodel group (VI 22.4%, O Clinical cases and summary results: During 2014, 1521 births were
4.7%, p50.001). attended in our hospital, of which 400 had indication for delivery
APGAR score, umbilical cord blood pH and transfer to neonatal care before onset of labor (26.3%). The most frequent indications for labor
unit were not statistically significant. We observed a lesser estimated induction were prelabour rupture of membranes (136 at term and 9
blood loss in the oral Misoprostol group (VI 606ml ± 478ml, O 470ml preterm cases) and post-term pregnancy, which represent 71.5% of all
± 206ml, p50.001). inductions. The unit prices of the different methods correspond to the
Patients with polysystoly in the VI group had a significantly shorter cost of hospital pharmacy, misoprostol: 13 euros (4 tablets of 25mcg);
time of insertion (7.18h vs 9.71h, p=0.001) and a shorter time until vaginal dinoprostone: 44.51euros; Foley catheter: 19.8euros and
delivery (16.02h vs 22.27h, p=0.04) compared to the patients without oxytocin (infusion of 30 mIU/h for 18 hours): 1.59euros. For the cost
polysystoly in the VI group. Maternal BMI, Bishop Score, fetal evaluation, we made for each method the calculation with the
birthweight, and fetal outcome were not statistically significant. highest dose according to our protocol. The indications for labor
Conclusion: In our selected cohort we could confirm the effectiveness induction, induction method, and the real and theoretical cost
of Misodel for IOL. Time to delivery was reduced by more than half according to each protocol are shown in Table 1. Once we had done
from 50 to 21h. However, there was a higher rate of polysystoly in the the comparing of the two protocols costs, the use of the new
Misodel group without an adverse neonatal outcome. Larger protocol involves an overall theoretical savings of 68% (12,026.67
observational trials are necessary to confirm these data. According Euros).
to our experience the selection of patients is very important as well as Conclusion: Labor inductions involve a workload for delivery rooms,
proper surveillance during IOL in order to choose the right moment an increase in medical interventions and an increase in hospitalization
to remove the vaginal insert. costs. The indication should optimize fetal-maternal results, be based
on scientific evidence and be cost-effective. The correct use, based on
Keywords: Induction of labour, Misoprostol, Misodel current evidence, of various methods for induction of labour,
individualizing the treatment for each patient, may involve a
significant saving in hospital costs.
Keywords: Cost evaluation, misoprostol, induction of labour
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 147

698
Predictors of success of the Presenter: C. Sánchez Ajenjo

mechanical cervical ripening with Introduction: Elective transverse cesarean section (TCS) remains as the
main way in most of the Spanish public hospitals to end the gestation
foley catheter in patients with in patients with a previous cesarean delivery (PCD) and postterm
gestation without cervical modifications for fear of breakage of the
previous cesarean delivery and uterine scar. The usual methods with prostaglandins analogs have a
postterm pregnancy breakage rate of 5-10%. The main objective of this study is to
assess the efficacy of the mechanical cervical ripening with Foley
Catheter (FC) in patients with PCD and postterm gestation who want
C. Sánchez Ajenjo, P. Calvo Hoyas, L. Giménez Roca, a vaginal delivery (VD), by the analyses of the variables which can
A. Valle Tejero, VJ. Diago Almela, A. Perales Marı́n, and affect to it.
Materials and methods: Inclusion criteria: Single gestation, gesta-
A. Aguilar Crespo
tional age440 + 6, cephalic presentation and a PCD418 months;
University and polytechnic hospital la fe, Valencia, Spain signed informed consent of VD after TCS. 41 cases enrolled in 2
148 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

years. Bishop Index (BI): 2.4±1.5; Previous Cervical Length:

30.17mm±6.65mm. PCD reasons: Non-Progressive Delivery, Failed Introduction: My Organization runs a Medical Pharmacy College in
Induction or Cephalopelvic Disproportion in 18/41 (43,9%); other India by the name of MAK College Of Pharmacy (http://www.mak-
causes in 23/41 (56,1%). We used a Latex FC FR18 (CovidienÕ ). pharmacollege.com/Collaborating company Biotechnica-pharma)
Vaginal and cervix disinfection, catheter insertion and inflation with Our research demonstrates that our indigenous medicines that are
sterilized water (40-50ml) under ultrasound guidance. Fixation to the made by 1000 years old Herbal and Ayurvedic practice find remedies
inner thigh without tension. A 2h Cardiotocographic Trace and other for Asthma, Tuberculosis, Cancer and various other ailments. Herbal
after 6h. Evaluation after 12h, if BI57, catheter is maintained until medicine is the use of medicinal plants for prevention and treatment
24h. Comparative study and a Logistic Regression with analyzed of diseases: it ranges from traditional and popular medicines of every
variables for achieving or not VD. country to the use of standardized and titrated herbal extracts.
Clinical cases and summary results: 73,2% of 41 patients (30) had Generally cultural rootedness enduring and widespread use in a
achieved labor after cervical ripening and subsequent use of oxytocin. Traditional Medical System may indicate safety, but not efficacy of
19 (46,34%) patients had ended their pregnancy through VD and 22 treatments, especially in herbal medicine where tradition is almost
(53,66%) through TCS. Comparative study of the 2 populations (VD Vs completely based on remedies containing active principles at very
TCS), we didn’t find significant differences in any of the variables: age low and ultra low concentrations, or relying on magical-energetic
(TCS 33.86 ± 3.57; VD 32.63 ± 4.69); BI difference (6.15 ± 2.11; rank principles. In the age of globalization, assessing the ‘transferability’ of
1-10), Neonatal Weight (TCS 3405 ± 431g; VD 3272 ± 668g); previous treatments between different cultures is not a relevant goal for
TCS reason (Non-Progressive Labor/Failed Induction/Cephalopelvic clinical research, but the assessment of efficacy and safety should be
Disproportion Vs Others (Odds Ratio= 1.14 IC 95% (0.3-3.95)). With a based on the regular patterns of mainstream clinical medicine
Logistic Regression any of the variable were included in the equation. Materials and methods: The other black box of herbal-based
About incidences, we didn’t register hyperdynamic o hypertonic treatments is the lack of definite and complete information about
uterus, fetal cardiac frequency alterations, bleeding nor infection the composition of extracts. Herbal derived remedies need a powerful
signs. The all neonates’ Apgar and pH were normal in all cases. and deep assessment of their pharmacological qualities and safety
Conclusion: Mechanical cervix ripening with Foley Catheter in patients that actually can be realized by new biologic technologies like
with previous TCS and GPE is successful in half of the cases. We don’t pharmacogenomic, metabolomic and microarray mythology. Because
have any variable which can predict the ripening result. of the large and growing use of natural derived substances in all over
We didn’t register any maternal, fetal or neonatal complication. the world, it is not wise to rely also on the tradition or supposed
Keywords: Mechanical, Cervix, Ripening, Foley, Catheter, Previous millenarian beliefs; explanatory and pragmatic studies are useful and
Cesarean Section, Induction, Labor, Gestation in Progress of Extension should be considered complementary in the acquisition of reliable
data both for health caregiver and patients.
Clinical cases and summary results: The other black box of herbal-based
017 treatments is the lack of information about the composition of the
Herbal medicine today: clinical remedy. Herbs are natural products and their chemical composition
varies depending on several factors, such as botanical species, used
and research issues chemotypes, the anatomical part of the plant used (seed, flower, root,
leaf, and so on) and also storage, sun, humidity, type of ground, time of
harvest, geographic area; and merchandized products containing on
M. T. Ansari the label the same product varying in their content and concentrations
of chemical constituents from batch to batch; and even the same
Mak College of Pharmacy, Hyderabad, India
manufacturer can merchandize in different periods products
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 149
containing different substances although standardized to achieve a Clinical cases and summary results: The prevalence observed was
high pharmaceutical quality. This variability can result in significant 27.6% when screened by culture, 38.2% by RT-PCR with sip gene and
differences in pharmacological activity: involving both pharmacody- 31.0% by PCR with atr gene. There was a statistically significant
namic and pharmacokinetic issues. Adverse and side effects is another difference between the methods (p 50.001). Of the 195 negative
open problem, because in citizens still prevail the respect for samples tested by culture, 28 were positive for both genes and 6 were
everything that is natural tout court, more as a cultural-fashion- positive for at least 1 gene. The sensitivity and specificity of the RT-
based choice than thinking that the patient is introducing in his/her PCR with sip gene was 90.4% (CI 0.817–0.953) and 82.1 (CI 0.760-
body chemical substances of vegetal origin; not knowing that salicylic 0.869). For PCR with atr gene, the sensitivity and specificity was 71.6%
glucosides and lactonic sesquiterpenes of many Compositae are often (CI 0.605-0.806) and 84.2% (CI 0.784-0.887), respectivelly.
responsible of allergic reactions; that some constituents of plants are Conclusion: RT-PCR with sip gene had a higher sensitivity than
cancerogenic like safrole, bergapten and pyrrolizidines alkaloids. conventional PCR with atr gene. The difference between the 2
Conclusion: Herbal-derived remedies need a powerful and deep methods may be due to the evaluation of 2 different genetic targets.
assessment of their pharmacological qualities and safety issues due to The higher prevalence found with RT-PCR and conventional PCR than
the large and growing use of natural-derived substances all over the with culture suggest the possibility of false positive results. However
world, which cannot rely only on the tradition or supposed such result can represent the finding of non-hemolytic strains,
millenarian beliefs; explanatory and pragmatic studies are useful colonization by few colonies or the fact that the molecular technics
and complementary in the acquisition of reliable data both for health are true-positive and culture is false-negative.
caregiver and patients. Evidence-based medicine (EBM) was first
conceived by Archibald Cochrane as a cultural and methodological Keywords: Streptococcus agalactea, group B streptococcus,
approach to clinical practice to make decisions; based on clinical pregnancy
expertise and the most intimate knowledge of the individual patient’s
clinical situations, it de-emphasizes unsystematic clinical experience
as ground for medical decision-making, and stresses the rigorous
analysis of evidence from clinical research. An important problematic 139 (CASE REPORT)
of EBM is the difficulty to be easily applied in everyday practice.
Congenital rubella infection - a
Keywords: Evidence-based medicine, explanatory trials, herbal case study
medicine, mainstream medicine, physiotherapy, pragmatic trials,
traditional medical system, traditional medicine.
V. Stefanovic1, M. Kolarski2, I. Kavecan2, and
S. Stefanovic2
1
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia and
2
Institute for Child and Youth Health Care of Vojvodina, Novi Sad,
124 Serbia

Comparison of the sensitivity and Introduction: Rubella infection occurring for the first time during
the specificity of two genes in the pregnancy is diagnosed through detecting specific IgM antibodies
after mild febrile status followed by skin rash. Although rubella causes
diagnosis of maternal anogenital a mild acute infection in adults, if it occurs during pregnancy,
especially in the first 12 or last 10 weeks it can cause intrauterine
tract colonization by group b death or preterm birth with severe congenital abnormalities,
anophtalmia, microphtalmia, galucoma, congenital heart defect.
Streptococcus Congenital rubella infection at birth presents itself as SGA, pallor,
jaundice, heaptosplenomegalia, microcephalia, hypotonia, failure to
O.H.M. Feuerschuette1, S.K. Silveira2, L.M. Feuerschuette thrive. After birth, it can be diagnosed either by detecting specific IgM
in umbilical blood or by the PCR method. The most intriguing fact is
Neto3, E. Alves4, J.R. Pereira5, A. Trapani Jr 4, and the ability to recognize this infection even if without any knowledge
A Pógere4 about the mother’s condition during pregnancy, as it is frequently the
1 case at neonatal departments in children’s hospitals. Our case is
Unisul and Hospital Univiversitário/UFSC, Brazil, 2Hospital
indicative and convenient for learning because nowadays rubella
Univiversitário/UFSC and Maternidade Carmela Dutra, Florianópolis,
infections are rare due to immunization, so doctors do not recognize
Brazil, 3Unisul, Tubarão, Brazil, 4Hospital Universitário, Florianópolis, this syndrome, especially when they do not have any contact with the
Brazil, and 5Unisul, Tubarão, Brazil mother or her medical documentation.
Clinical cases and summary results: First baby from the first pregnancy,
Introduction: Sepsis by group B streptococcus (GBS) is the leading mother (age 13), very low social status, GS 36 weeks, meconial
cause of neonatal death. A simple screnning method of maternal amniotic fluid, aspiration of meconium, BW 2250gr BL 45cm/SGA/HC
colonization with high sensitivity and specificity is important to allow 29/microcephalia/, retro and microgenia, microphtalmia culi bil, heart
maternal treatment and decrease neonatal transmition during labor. murmor, palor and jaundice of skin, hypotonia, letargia. Our first
The aim of this study is to compare the sensitivity and the specificity diagnose was that the preterm baby suffers from sepsis, but our lab
of 2 methods for the detection of maternal GBS colonization: real time test showed negative CRP and procalcitonin values, normal level of
polymerase chain reaction (RT-PCR) with sip gene and conventional WBC, anemia and thrombocytopenia, direct hyperbilirubinemia.
PCR with atr gene. Ultrasound of brain with calcifications was the first clue toward
Materials and methods: We conducted a cross-sectional study to diagnosing congenital intrauterine infection and after gaining
evaluate maternal colonization by group B streptococcus of 264 positive specific IgM, we were sure that all these signs were due to
anorectal samples collected from pregnant women between 35 and congenital rubella infection. The mother was never vaccinated and
37 weeks of gestation. We performed culture in Todd-Hewitt medium had rash during this pregnancy that was thought of as an allergic
(reference standard), RT-PCR with sip gene (primer 1 ATC CTG AGA reaction towards food. The mother didn’t want to keep the child as it
CAA CCC TGA CA and primer 2 TTG CTG CTG TTT CTA TTT TCA), and was unwanted and due to the prognosis of a very poor psychomotor
conventional PCR with atr gene (primer 1 CAA CGA TTC TCT CAG CTT development, it was sent to a health care center for social care.
TGT AAR and primer 2 TAA GAA ATC TCT TGT GCG GAT TTC).
150 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Conclusion: This case can be very instructive for parents who do not among six patterns, pattern 1 to 4 were classified as LST 1 to 4. The L.
want to give rubella vaccination to their children as an anti- crispatus predominant group(pattern 1) was classified as LST 1, L. iners
vaccination wave is present nowadays in high developed countries predominant group (pattern 2) was classified as LST 2, L. gasseri
because every unvaccinated girl can have a rubella infection during predominant group (pattern 3) was classified as LST 3, and L. jensenii
pregnancy and then lose her child or give birth to this syndrome. predominant group (pattern 4) was classified as LST 4. Pattern 5 and 6
showed that they had no predominant L. species with predominant
Keywords: Rubella, infection, congenital, syndrome anaerobes. Quantification of G. vaginalis and A. vaginae had no
statistical significance between 2 groups (p value ¼ 0.026, 0.699).
Therefore, 2 groups were classified as LST 5. Five types (4
predominant Lactobacillus species types and a predominant anae-
robe type without predominant Lactobacillus species) were classified.
Conclusion: Five predominant Lactobacillus species types were
identified in the vaginal microbiota of Korean pregnant women. L.
crispatus and L. iners predominant types comprised a large
proportion.

Keywords: Lactobacillus crispatus predominant type, Lactobacillus

iners predominant type, Korean women, pregnant women, vaginal
microbiota

155

Redominant Lactobacillus species

types of vaginal microbiota in
pregnant korean women, quanti-
fication of the five lactobacillus
species and two anaerobes
K. Oh1, J. Kim1, S. Yoo2, Y. Sohn3, C Jin1, Y. Yang1, and
I. Hwang3
1
Department of Obstetrics and Gynecology, School of Medicine, Eulji
University, Daejeon, Republic of Korea, 2Department of Microbiology,
School of Medicine, Eulji University, Daejeon, Republic of Korea, and
3
Department of Laboratory Medicine, School of Medicine, Eulji
University, Daejeon, Republic of Korea

Introduction: The vaginal microbiota is thought to consist of a

community with predominant Lactobacillus species that prevent
genital tract infections. Lactobacillus species of vaginal microbiota
may depend on many conditions such as pregnancy, vaginal
infection, race, and other factors. The five Lactobacillus species,
including L. crispatus, L. jensenii, L. iners, L. gasseri, and L. vaginalis,
have been commonly reported. However, to date, there has been no
study on pregnant Korean women.Therefore, by quantifying five
Lactobacillus species, and two anaerobes using qPCR in pregnant
Korean women, we attempted to identify the predominant
Lactobacillus species types (LSTs) of vaginal microbiota.
Materials and methods: One hundred sixty-eight Korean pregnant
women under antenatal care at Eulji University Hospital and local
clinics were enrolled in the prospective cohort study during
pregnancy (10-14 wks). Vaginal samples were collected with Eswab
for the qPCR and stored in a 80  C freezer. Quantitative polymerase
chain reaction was performed for five Lactobacillus species, and two
anaerobes. To analyze relative abundance, a heat map was created
using the Cluster program and Tree View program of Eisen Lab. Six
pattern were found. By analyzing quantifications of five Lactobacillus
species, and two anaerobes according to six patterns, we tried to
identify predominant Lactobacillus species types.
Clinical cases and summary results: L. crispatus and L. iners were most
commonly found in Korean pregnant women, followed by L. gasseri
and L. jensenii, L. vaginalis was nearly absent. By comparing
quantifications of five Lactobacillus species, and two anaerobes
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 151

164
Diagnosis and management of
157 (CASE REPORT) neonatal urinary tract infections
A rare case of spinal
K. BEN AMEUR1,2, O. MAATOUK1,2, MK. MSALBI1,2,
intramedullary tuberculoma H. BEN HMIDA1,2, A. BEN SALEM3, A. NASR4,
in pregnancy FZ. CHIOUKH1,2, and K. MONASTIRI1,2
1
Departement of intensive care and neonatal medicine, 2Fattouma
A. Trapani Jr, A.T. Gieburowski, R.N. Galluzzo, S.K. Silveira, Bourguiba Teaching Hospital, Faculté de médecine, University of
and O.H.M. Feuerschuette Monastir Tunisia, 3Departement of radiology B, and 4Laboratory of
Biology
Hospital Universitário/UFSC, Florianópolis, Brazil

Introduction: Objective: To describe clinical findings, imaging results

Introduction: Tuberculosis is a chronic infectious disease caused by
and management of neonates diagnosed with urinary tract infection
Mycobacterium tuberculosis and characterized by the formation of
(UTI).
granuloma and rarely of abscess in the infected tissue. Spinal
Materials and methods: Medical records were reviewed for infants
intramedullary tuberculoma is a rare disease usually associated with
diagnosed with UTI in a single neonatal intensive care unit (NICU) in
pulmonary tuberculosis. Common clinical manifestations include
Tunisia over a 6-year period.
variable lower extremity motor and sensory loss, bladder and bowel
Clinical cases and summary results: Thirty nine infants were diagnosed
dysfunction and constitutional symptoms. Typical MRI characteristics
with UTI. Ultrasound screening in pregnancy revealed fetal urinary
are hypo or isointense to spinal cord in T1-weighted sequence with
abnormalities in 8 cases and 2 babies were premies. Mean age at
signs of focal cord expansion and heterogeneous intensity on T2
diagnosis was 9.1 ± 8.8 days. Sex- ratio was 2.9. Fever was the most
usually with central hypointensity and peripheral hyperintensity, but
frequent symptom (64.1%) followed by jaundice (10.3%). In 12.8% UTI
occasionally with central hyperintensity and peripheral hypointense
was done within investigation of an urinary tract malformations. CRP
ring (target sign) depending on the phase of the tuberculoma.
was positive in 46.1% of cases. Escherichia coli (25.6%) and Klebsiella
Clinical cases and summary results: A 34-year-old woman, gravida 3,
pneumoniae (5%) were the most common isolated organisms. One
para 2, was admitted at 30 weeks of pregnancy with progressive
patient had sepsis with the same bacteria. Ultrasonography showed
symmetric weakness and hypoesthesia of lower limbs for 3 weeks and
urinary tract abnormality in 35.9% of patients. Hydronephrosis was
weight loss of 7 kg. After 2 days she developed fever and urinary
the most frequent one (75.6%). A third generation cephalosporin and
retention. M tuberculosis was positive in liquor PCR. Sputum test was
an aminoglycoside was the antibiotherapy used in 82% of patients.
negative as well as HIV test. Thoracic CT scan demonstrated active
Conclusion: Urinary tract infection is one of the most common causes
miliary tuberculosis. Thoracic MRI showed enlargement of the conus
of infection in newborns. A prompt diagnosis and treatment is of
medullaris at T11-T12 level and the presence of a nodular lesion
extreme importance to reduce the risk of renal scarring.
measuring 9 mm, isointense at T1-weighted sequence and with target
sign appearance at T2. Cranial MRI identified 3 nodular lesions located
in the right frontal lobe. She developed hepatotoxicity with Keywords: Neonates, Urinary tract infection, antibiotherapy
antituberculous chemotherapy that required modification of the
treatment. The fetus developed IUGR and oligohydramnios. Her labor
was induced at 38 weeks of gestation. She gave birth to a healthy
baby with 2245g, Apgar score 7 and 9. She had a progressive
improvement of her neurologic deficit.
Conclusion: The recognition of extrapulmonay tuberculosis in
pregnancy may be delayed because the clinical manifestations are
insidious and may be confused with symptoms of pregnancy. Spinal
intramedullary tuberculoma has a good prognosis when diagnosed
and treated at an early stage but neurologic sequelae may remain.
152 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

317 320 (CASE REPORT)

Sensitivity of real-time polymer- Rare picc line complication,
ase chain reaction in the diagno- placed in the umbilical vessel
sis of colonization by group B A. Onnela
Streptococcus during labor: NICU, U.C.L. Cliniques Universitaires St-Luc, Brussels, Belgium
preliminary results
Introduction: This is a case report of a dysmature baby girl born at 33
O. H. M. Feuerschuette1, S.K. Silveira2, O. Feuerschuette3, weeks, weighing 1050 g (-4 D.S.), with an initially favorable clinical
course without any signs of infection. The pregnancy of the G2P1
L. M. Feuerschuette Neto3, D. J. Trevisol3, E. Alves4, mother is complicated by pre-eclampsia and fetal growth retardation.
J. R. Pereira3, and A. Trapani Jr4 Because of prematurity and extreme dysmaturity, PICC line use is
1 needed. The picc line is placed initially by the umbilical vessel up to
Unisul and Hospital Universitário/UFSC, Tubarão, Florianópolis
diaphragmatic level, the position controlled by an X-ray. On D6, the
Brazil, 2Hospital Universitário/UFSC and Maternidade Carmela Dutra,
X-ray shows the catheter in a lower position directed to the right lobe
Florianópolis, Brazil, 3Unisul Tubarão, Brazil, and 4Hospital of the liver.
Universitário/ UFSC Florianópolis, Brazil Clinical cases and summary results: On D6, the baby presents apneic
spells with inflammatory syndrome and low platelet count. She is
Introduction: Sepsis by group B streptococcus (GBS) is the leading transfered to a third level NICU after receiving first antibiotics. The
cause of neonatal death. Because colonization is intermittent and PICC line is taken out. The ultrasound shows an anechogenic
over 60% of deaths occurs in newborns of pregnant women with formation with irregular contours in the right lobe of the liver
negative screening, diagnostic methods used in the bedside may corresponding to an abcess in the segment VIII. On D8, deterioration
decrease neonatal transmission, allowing the selection of patients for with development of RDS and more severe inflammatory syndrome.
antibiotic use. The objective of this review is to determine the Treatment consists of antibiotics, initial fluid replacement therapy,
sensitivity of real time polymerase chain reaction (RT-PCR) in the several platelet transfusions, endotracheal intubation and mechanical
diagnosis of maternal colonization by GBS in the anogenital tract of ventilation (D8-D14) and a right laparotomy (D8) with a punction and
laboring women. aspiration of the abcess. The bacteriological cultures show
Materials and methods: We performed a systematic review according Staphylococcus epidermidis in both the blood culture done by the
to the Cochrane Library review protocol and Strome-ID. Studies in catheter and in the perioperatory aspirate of the abcess. Progressive
English language were searched in MEDLINE, PubMed, Cochrane, recovery after the laparotomy, the antibiotic treatment stopped on
LILACS and Scielo without date restriction. We included papers that D22 and the baby is discharged on D25. The size of the lesion
used RT-PCR and culture collected from the anogenital tract of diminishes without any complications.
laboring women as the reference standard. Two indepent reviewers Conclusion: This case report shows a rare complication of a picc line in
selected 333 studies, evaluated data and assessed quality acording to a secondary false position in the umbilical vessel causing a septicemia
the criteria previously defined for inclusion and exclusion. and liver abcess due to Staphylococcus epidermidis. It illustrates the
Clinical cases and summary results: 14 studies were included (total of importance of the follow-up of the position of central lines.The use of
6870 laboring women). We found a sensitivity of 88.3%. picc line in the umbilical vessel should be very carefully controlled.
Conclusion: The sensitivity of 88.3%, despite close is lower than
recommended by the Centers for Disease Control and Prevention to Keywords: PICC line, complication hepatic abcess
be accepted as a screening method. New diagnostic methods or
improvement in methods evaluated are needed.

Keywords: Streptococcus agalactiae, PCR

328 (CASE REPORT)
A preventable reason of mortality
in neonatal period: congenital
Rubella syndrome
B. Sanlidag1, C. Dalkan2, A.B. Hocaoglu3, and N.B. Onder3
1
Pediatric Department, Near East University, Nicosia, Cyprus,
2
Pediatric Department, Division of Neonatology, Near East University,
Nicosia, Cyprus, and 3Pediatric Department, Division of Allergy and
Immunology, Near East University, Nicosia, Cyprus

Introduction: Rubella is one of the most teratogenic intrauterine viral

infections. The commonest findings are heart defects, cataracts, low
birth weight, hepatosplenomegaly and microcephaly.1 Universal
screening and follow-up of vaccination for women at childbearing
age is highly recommended.
Clinical cases and summary results: A 37 week term male baby was
born with prenatal oligohydramnios and intrauterin growth arrest.
Mother was not immunised with Measeles-Mumps-Rubella (MMR) and
serology for Toxoplasma-Rubella-Cytomegalovirus-Herpes (TORCH)
was screened at 8th week of gestation. Both Rubella Ig M and Ig G
were negative. There was no history of fever or rash during
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 153
pregnancy, but the mother had aseptic arthritis during gestation.
Positive findings on physical examination were low birth weight (1785 Introduction: In spite of advances in neonatal intensive care practice,
grams 510th percentile), height was 40 cm (510th percentile), head neonatal sepsis remains one of the major cause of mortality and
circumference was 29 cm. morbidity in the neonatal population. More than half of neonates
Conclusion: In conclusion, unlike CMV and HSV infections, CRS is a admitted to neonatal intensive care units (NICUs) carry a diagnosis of
preventable reason of mortality and morbidity in newborns. So suspected sepsis. The gold standard for diagnosis of Neonatal sepsis
screening and vaccination strategies against Rubella for women at is positive blood culture, which is positive in only 50-80% at best,
childbearing age should be considered. however negative blood culture does not rule out the disease.
Objective of this study is to get an overview of the burden of bacterial
Keywords: Congenital Rubella sepsis in the newborn population in NICU Dubai hospital. The focus
was concentrated mainly on the pathogens mostly implicated,
incidence of early and late onset sepsis and meningitis, antibiotics
347 sensitivity patterns, associated mortality and morbidity.
Materials and methods: The present study is retrospective observa-
Clinical and epidemiological tional study done in tertiary referral center NICU in Dubai hospital,
UAE. All the neonates with positive blood culture enroll in this study.
profile of patients with The study conducted over the period of 36 months from January 2013
to December 2015. Data collection was done for the incidence in
chorioamnionitis different weight and gestational age groups, pattern of pathogens,
age of onset, associated mortality, percentage of meningitis in culture
I. Ortiz-Trujillo, L. Martinez-Sanchez, F. Hernández- positive neonates and drug susceptibility pattern. Statistical analysis
Restrepo, D. Gallego-Gonzalez, E. Sánchez-Dı́az, and was performed by calculating the number and mean from the total
number of NICU admissions during the 36 months of study period.
C. Agudelo-Vélez Clinical cases and summary results: Between January 2013 to
Grupo Biologia de Sistemas, Escuela de Ciencias de la Salud, Facultad December 2016, 1247 babies admitted in our NICU. 123 infants had
one or more episodes of blood culture proven sepsis. The sepsis rate
de Medicina, Universidad Pontificia Bolivariana, Sede Central
was 9.8 % during this period. Out of 123 blood culture positive cases
Medellı́n, Medellı́n, Colombia
25 (20%) were term while 98 (80%) were preterms. The incidence of
sepsis is more in babies below 30 weeks (70%) .The mean age at time
Introduction: Chorioamnionitis, is a pregnancy infection, causes of sepsis is 14 days and mean birth weight is 1300 grams. Late onset
different fetal and maternal symptoms. Streptococcus agalactiae sepsis was 69% while 31% were early onset sepsis. Majority of sepsis
present in the normal vaginal microflora of some women, favouring was caused by Gram positive organisms ( 63.4%). Among Gram
its abnormal multiplication during pregnancy, causing perinatal positive organisms, Staphylococcus epidermidis was the most
morbidity and mortality. Objective. Describe the clinical and common pathogen while GBS incidence was minimum. Gram
epidemiological profile of the patients with diagnosis of clinical negative organism accounted for 28.45% of sepsis and Klebsiella
chorioanmionitis. pneumonia (65.7%)was most common pathogen.18.6% of sepsis were
Materials and methods: Descriptive, cross-sectional study. The caused by ESBL Klebsiella pneumonia and E Coli. 7.3% of sepsis are
population was patients with diagnosis of clinical chorioanmionitis. caused by Candida species with 70% of them by Albican. CSF analysis
The information was taken from the medical records. The research done in 32 cases and 4 cases of meningitis were confirmed by positive
was approved by the Ethics Committee. We used the program SPSS Õ culture. One case was caused by multidrug resistant Flavobacterium
version 17.0 (SPSS Inc, Chicago, Illinois, USA) for the information Indologenes. The identifiable risk factor in this extreme preterm twin
analysis, descriptive statistics were used. included precipitous delivery in the bathroom. The case fatality rate of
Clinical cases and summary results: 78 patients in total with clinical sepsis among VLBW infants was 7.3%. Infants with EOS had a much
chorioamnionitis, with a mean age of 26.3 ± 5, 8 years old, the 69.2% higher fatality rate than those who had LOS (15% versus 3.5%).ESBL
primigravid women. 2.6% of women had positive culture for Klebseila Pneumonae was the prominent pathogen among fatal EOS.
Streptococcus agalactiae in urine sample during current pregnancy Majority of sepsis caused by ESBL organism were sensitive to
and 30.7% had received some kind of antibiotics during current Meropenem.
pregnancy. The 57.7% had 37 to 40 weeks of gestation in the current Conclusion: The sepsis rate in our unit is 9.8%) and the sepsis related
pregnancy it was calculated more frequently by ultrasound (66.7% in mortality rate was 7.3%.Only 5 cases of GBS reported during study
first quarter, 11.5% in the second and 1.9% in the third). In a 60.3% period and all are early onset. One case of Meningitis was caused by
way of termination of pregnancy was vaginal and a 35.9 percent were flavobacterium indologenes, a rare and unusual organism. ESBL and
caesarean section. Among the women in the study, a 30.8% had fungal sepsis incidence were 18.6% and 7.35 %respectively. Majority
premature rupture of membranes. of organisms showed resistance to commonly used antibiotics. In
Conclusion: The chorioamnionitis continues to be an important cause resource poor countries, however, the availability of alternative
of antibiotic use during pregnancy or labour and the decision to do a antibiotics is limited. There is need for studies looking at simple and
caesarean, with highest percentage in pregnancies-preterm and sustainable interventions to reduce the burden of neonatal infection.
preterm premature rupture of membranes. Possible strategies to be considered might include intrapartum
antibiotic prophylaxis, implementation of simple infection control
Keywords: Chorioamnionitis, Streptococcus agalactiae, pregnancy methods such as hand washing and promotion of clean deliveries,
complications, infectious restriction of antibiotics use, and rationalization of admission to and
discharges from neonatal units.

348 Keywords: EOS (Early onset sepsis),LOS(Low onset sepsis), meningi-

Pattern of neonatal sepsis in tis, ESBL(Extended Spectrum Betalactamase)GBS (Group B
Streptococcus)
Dubai hospital
A. Khan
Department Of Neonatology, Dubai Hospital, Dubai Health
Authority, Dubai, UAE
154 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

loss, hyponatremic dehydration and hyperkaliemia. Increased plasma

360 (CASE REPORT)
aldosteron levels are found. Primary PHA1 is a hereditary disease
Detection of M. pneumoniae DNA caused by mutations in mineralocorticoids receptor gene while
underlying pathogenesis of secondary PHA1 is still unclear.
in cerebrospinal fluid (CSF) in a Secondary PHA1 is transient, usually presents in first tree months
and is most often associated with urinary tract infection (UTI) and/or
neonate with an acute bilateral urinary tract malformations. Treatment of UTI completely reverses all
stroke: a coincidental event or biochemical abnormalities in majority of patients. We present our
patient with secondary PHA1 due to urinary tract infection and
causal relationship? obstructive uropathy.
Clinical cases and summary results: The male patient was born at term
after an uneventful pregnancy with a birth weight of 4200 grams. He
S. Kunzmann1, R. Wössner1, C. Willaschek2, and presented at 4 weeks of age with a two-week history of poor feeding,
J. Wirbelauer1 and failure to thrive. At admission his weight was 10 g below his birth
1
weight. His initial blood chemistries showed marked hyponatremia
Children’s Hospital, University of Würzburg, Germany and and hyperkalemia, urea was elevated. Creatinine was normal (Table 1)
2
Caritas-Hospital, Bad Mergentheim, Germany as were parameters of infection. He received intensive intravenous
rehydration with gradual correction of serum sodium. We started an
Introduction: While neurological complications of Mycoplasma (M.) empiric antibiotic therapy for UTI as his urinalysis showed pyuria. Urine
pneumoniae infection (e.g.: meningitis, encephalitis, myelitis, cere- culture revealed 1M colonies/cc of Escherichia coli. His blood cultures
bellar syndrome) are well described in children and adults, the role of remained sterile. Renal ultrasound (US) showed moderate bilateral
M. pneumonia infection in neonates is less defined, especially in the dilatation of renal pelvis with hyperechogenic debris. Serum sodium,
pathogenesis of perinatal stroke. potassium and urea levels normalized within a few days of therapy, he
Clinical cases and summary results: A boy was born at 40 weeks of started to breastfeed normally. Plasma aldosterone obtained at the 5th
gestational age by caesarean section after an unremarkable day after admission was elevated (Table 1), 17 OH progesteron was
pregnancy with an Apgar Index of 9/10/10. At the first day of life normal. One month after dismissal his aldosterone levels were normal,
he had several generalized tonic-clonic seizures, which could be he gained more than 1200 g. At 4 months his renal US and US voiding
managed with an anticonvulsant therapy (phenobarbital). The cystourethrography were completely normal.
neurological examination and the EEG were normal. MR images Conclusion: Severe hyponatremic dehydration with hyperkalemia is a
showed a large bilateral infarction in the right and left middle cerebral severe condition in neonatal period that requires prompt treatment.
artery (MCA) territory. MR angiography was normal. M. pneumonia Our patient presented with salt wasting crisis requiring aggressive
DNA was detected in CSF by positive polymerase chain reaction. CSF fluid therapy. Investigations revealed UTI with bilateral dilatation of
leucocytes count was 17/ml, glucose level 43 mg/dl, protein level collecting system and markedly elevated aldosterone level. Successful
215 mg/dl and erythrocyte count 6,930/ml. The serum titer of therapy lead to resolution of all electrolyte and hormonal abnorm-
antibodies to M. pneumoniae was not elevated. Other causes of alities. Clinical course and laboratory results were consistent with
neonatal stroke (e.g. cardiac embolism, vascular risk factors, carotid secondary form of PHA type 1.
artery dissection, thrombostasis or metabolic abnormalities) were not
evident. Systemic inflammation parameters were normal. After the Keywords: Neonate, aldosteron, electrolyte disbalance, uroinfection
detection of M. pneumonia DNA in the CSF a clarithromycin therapy
was initiated for 21 days. On discharge from the hospital after 28 days,
the patient had no clinical irregularities. At a follow up 3 months later,
the boy was well-being with normal statomotoric development so far.
To date, only in a few cases stroke due to M. pneumoniae infection has
been reported with or without CSF pleocytosis. To the best of our
knowledge, this association has not been described so far in a
neonate.
Conclusion: Although the cause of the stroke remains unclear in this
newborn, central nervous system infection with M. pneumonia has to
be considered as a possible cause of neonatal stroke. Future targeted
search to M. pneumoniae in CSF of newborn with strokes could help
to find out, whether our observation is a coincidental event or a
causal relationship.

Keywords: Stroke, newborn, Mycoplasma

385 (CASE REPORT)

Secondary
pseudohypoaldosteronism type 1
A. Stepišnik1 and I. Cetin-Lovšin2
1
Paediatric Dept., General Hospital Izola, Izola, Slovenia and
2
Neonatal Dept., General Hospital Izola, Izola, Slovenia

Introduction: Pseudohypoaldosteronism type 1 (PHA1) is a rare

disorder caused by aldosterone resistance with subsequent defective
transepitelial sodium transport. Affected patients develop severe salt
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 155

396 400
Role of polymorphism of genes of Respiratory viruses in neonates
TNF-A in miscarriage of infectious
T. Carrion1, F. Aliaga2, and M. Ruiz2
genesis 1
NICU, Clinica Rotger, Palma, Spain and 2Microbiology Dept., Clinica
Rotger, Palma, Spain
M. A. Levkovich, V. A. Linde, V. O. Andreeva, and
D. D. Nefedova Introduction: The burden of respiratory viruses in neonates has not
Rostov Research Institute of Obstetrics and Pediatrics, Rostov-on-don, been clearly studied in our country. The aim of this study was to
Russia determine the overall distribution of respiratory viruses in Neonatal
Intensive Care Unit (NICU) hospitalized neonates with acute lower
respiratory tract infections (ALRI).
Introduction: Medical and social significance of the problem of
Materials and methods: From January to December 2015 69
abortion, its impact on women’s reproductive health puts scientific
individuals younger than one month old were hospitalized with
and clinical research in this area in a number of the most important
ALRI in our unit. All these cases were included in the present study.
tasks of modern medicine. In recent years, urogenital infection is a
Viruses were identified with the molecular test FTD Respiratory
major trigger of early reproductive losses. According to modern
pathogens 21 (Fast-Track Diagnostics), a multiplex reverse transcrip-
concepts the stages of implantation and development to pregnancy
tion polymerase chain reaction (RT-PCR). Only nasopharyngeal
are cytokine-dependent processes, and the level of gene expression
aspirates were used as sample. This protocol included a culture for
of cytokines depends on the allelic variant of a gene in the
the commonly associated bacterial pathogens.
genotype.TNF-a is an important regulatory molecule, which mediates
Clinical cases and summary results: The 46.38% (32/69) of the samples
the inflammatory response and is involved in the process of uterine
were negative. The 53.62% (37/69) of neonates had positive results for
contraction.
at least one viral type, among them RSV A/B, Rhinovirus and
Keywords: Objectives: Analysis of the frequency distribution of Enterovirus were the most common infections with a 14.49% (10/69) ,
genotypes 308G/A and 238G/A gene of TNF-a in miscarriage and 13.04% (9/69) and 10.14% (7/69) respectively. The 83.78% (31/37)
urogenital infections. were informed as monoinfection, with only one of the target viruses.
Materials and methods: Were examined in 67 pregnant women. The 66.68% (4/6) of the co-infections had VRS A/B as the main
Gruppe I (n=48) comprised pregnant women with miscarriage in the pathogen. Only the 4.41% (3/68) of the cases showed positive result
first trimester and verified urogenital infection. The control group for the bacterial culture with a negative RT-PCR. The 41.18% (28/68)
consisted of 19 patients with physiological pregnancy. The definition were positive for the RT-PCR and negative for the culture. Moraxella
of allelic variants of the genes TNF-a was performed using PCR and catarrhalis and Haemophilus influenzae were present in the 45.45 %
subsequent restriction analysis of test-systems for molecular-genetic (5/11) and 27.27% (3/11) respectively.
analysis developed by Gosniigenetika (Russia). Conclusion: RSV A/B and Rhinovirus were the most common viral
Clinical cases and summary results: In the study of polymorphism etiology in neonates with lower respiratory tract infections. The early
308G/A gene TNF-a revealed that in group I compared with control detection of a viral respiratory tract infection could be useful to
group, the frequency of genotype G/A was met significantly more reduce the use of antibiotics. New molecular assays based on (RT-
often (p 50.01), and genotype G/G gene TNF-a was significantly less PCR) are now being used for clinical practice. These tests can provide
(p 50.01). In addition, it was found that in group I the frequency of faster results, even in hours after sample collection. Molecular
allele A was significantly higher than in the control group (2=10.96 techniques can confirm a suspected infection of viral origin.
when p=0.002). The odds ratio is statistically significant at the 5%
level because the confidence interval does not include 1 (OR=0.15, Keywords: NICU, ALRI, FTD, RT-PCR
CL=0.05-0.45, OR=0.20, CL=0.07-0.54). There were no significant
differences in the distribution frequency of the polymorphism
238G/A gene TNF-a between the patients I and the control group.
Polymorphism of genes encoding expression of TNF-a may lead to
increased production of proinflammatory cytokines, differentiation
towards Th1, are unfavorable for pregnancy. 405
Conclusion: Therefore, the studies of genes controlling intercellular
interactions during pregnancy makes it possible to determine the Evaluation of factors associated
nature of the response of the immune response and its intensity. In
carriers of the allele A of a gene TNF-a the risk of miscarriage in with the occurrence of sepsis in
urogenital infection is higher, and the G/G genotype is protective,
which contributes to more favorable course of pregnancy.
infants of very low birth weight in
Polymorphism 308G/A gene TNF-a may be genetic markers of the
risk of miscarriage in urogenital infections.
a neonatal intensive care unit in
cyprus
Keywords: Miscarriage, infections, TNF-a
T. Papadouri1, C. Karaoli1, S. Nicolaou1, and
V. Raftopoulos2
1
Neonatal Intensive Care Unit, Archbishop Makarios III Hospital,
Cyprus and 2Health Management Department, Open University
Cyprus

Introduction: Neonatal septicemia is one of the major causes of

morbidity and mortality in very low birth weight (VLBW) infants.
156 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Aim: To investigate the incidence, causes, predictors, and outcomes prophylaxis was observed. The most common clinical presentation
of septicemia in a neonatal intensive care unit in Cyprus in a cohort of was respiratory distress which was presented in 110 (63%) patients
very low birth weight infants. followed by poor feeding in 80 (46%), lethargy in 55 (31%), apnea in
Materials and methods: A retrospective study of all infants with birth 43 (25%), hypothermia in 32 (18%), jaundice in 26 (15%), and shock in
weight of 1.500 g who were admitted in a neonatal intensive care 5 (3%) patients. No neonatal death due to early onset sepsis occurred
unit in Cyprus in June 2011- June 2012 was performed. Data on the in this study.
maternal prenatal history, delivery and neonatal course, including Conclusion: In our study GBS was the commonest organism of EONS,
detailed information on episodes of microbiologically verified and had shown good sensitivity to Ampicillin. The combination of
septicemia were collected on predefined forms. Ampicillin and Gentamicin was effective against all strains for GBS and
Clinical cases and summary results: Of the 89 infants of very low most strains of E. coli. Based on our data Ampicillin and Gentamicin
birth weight, who were hospitalized in the NICU during that period combination should remain to be the first choice of empiric antibiotic
21 septicemia episodes occurred for 17 infants (19%). Staphylococcus treatment for EONS. Periodic evaluation helps in implementation of a
coagulase negative was the main pathogen (76.1%) isolated from the rational empirical treatment strategy and limit antibiotics resistance.
positive blood cultures. Neonates with blood-culture proven sepsis
were lower gestational age and birth weight than the others and with
Keywords: Newborn, early onset sepsis, antimicrobial sensitivity
an increased rate of chorioamnionitis during the pregnancy. 75% of
the VLBW newborns with sepsis were ventilated during their
hospitalization in the NICU and in 82.4% of those had inserted
central venous vascular catheters The mean duration of hospitaliza-
tion in septic infants was 74.8 days.
Conclusion: In this study, the prevalence of sepsis in neonates VLBW
admitted in a NICU in Cyprus was very low, as septicemia occurred for 426
19% of the infants. Major risk factors were the chorioamnionitis and
the presence of central vascular catheters. The main pathogen of
Lotus birth: simply a placenta
neonatal sepsis in the unit was the staphylococcus coagulase- ritual or a dangerous choice in
negative.
the childbirth experience? A case
description and considerations
422 from the neonatologist’s point of
Identification of bacterial patho- view
gens and their antimicrobial sus- N. Todisco, V. Della Monica, A. Plantulli, and A. Criscuolo
ceptibility of culture proven early Maternal-Infantile Department, University Hospital of Salerno
onset neonatal sepsis "San Giovanni di Dio e Ruggi d’Aragona", Salerno, Italy

Introduction: Considerations around the placenta in childbirth

A. Bystricka, M. Nassib Raya, M. Qadir, and J. Khan experience has been since ancient Greek medicine. Among different
cultures until us spiritual and ancestral elements are available in the
NICU, Al Rahba Hospital, Abu Dhabi, United Arab Emirates
midwifery practice-oriented or birth unassisted choice. Women
included in the home-birth setting, that in many cases had birthed
Introduction: Neonatal sepsis remains one of the leading causes of in hospital previously, haven’t a preexisting protocol in the placenta
neonatal mortality and long term morbidity among term and preterm management so they need to make a decision about placenta
infants. The aim of this study was to calculate the incidence of destination. On the other hand, placenta as an integral part of the
bacterial pathogens of EONS and their antibiotic susceptibility to birthing experience culminate in placenta rituals including placenta
commonly used antibiotics. burial, placentophagy and lotus birth.
Materials and methods: This study was conducted at NICU of Al Rahba Materials and methods: The lotus birth practice consists in missed
hospital in UAE, from Jan 2011 to Jun 2013. EONS was defined as severance of the umbilical cord after the birth of baby then wrapping
isolation of a bacterial pathogen from blood culture drawn within 7 the placenta in a breathable cotton piece kept near the newborn until
days of birth. A total of 175 neonates were included from all the cord dries and breaks on it own. In spite medical disposal this
gestational age with suspected sepsis, either on clinical presentation, practice tributes to placenta spiritual significance as something
history of prolonged rupture of membranes (more than 18 hours), or belonging to the baby and to the birthing mother, contrary to any
suspected chorioamnionitis. Neonates with gross congenital anoma- evidence of medical benefit for the newborn.
lies were excluded from the study. Empirical antibiotic treatment with Clinical cases and summary results: A male baby of 2850 gr at 41 wks
Ampicillin and Gentamicin was started as a first line. Demographic was hospitalized in our NICU Division after 30 hrs from home-birth.
data, clinical manifestation, microbial pathogens and their antibiotic Mother, without appearance of risk factors during pregnancy,
susceptibility were collected and analyzed. independently opted for lotus-birth after two previous hospital
Clinical cases and summary results: A total of 29% (51 out of 175) high birth. At admission we found: hyporeactivity and hypotonia, severe
risk newborns had culture proven sepsis with an incidence of 13.7 per hypoglycemia, cyanosis, ARDS signs, dehydration. Umbilical cord was
1000 live births. The mean age of neonates at time of presentation unexcided and still kept on with placenta. For all these reasons the
was 2.3 ± 4.0 days and mean age at admission was 0-2 days. 70 % of baby was intubed then assisted in SIMV mode. After umbilical cord
infants presented within the first 48 hours of life. The most common cutting, umbilical vein was withdrawn and rapidly started antibiotic
organisms isolated were Streptococcus agalactiae (68%, 9.1 per 1000 (amoxicillin/clavulanate) and fluid administration. Hypoglycemia was
live births) followed by Escherichia coli (17%, 2.4 per 1000 live births), restored by repeated 10% glucose i.v. bolus. Cause high total bilirubin
CONS (9%) and others (6%) (such as Klebsiella, Pseudomonas, and hematocrit (about 70%) exchange transfusion was moreover
Enterococci). All of GBS isolates were sensitive to Ampicillin. Among carried out. During the following days we admistered a second
E. coli isolates, 1 out of 9 (11.1 %) was resistant to Ampicillin and antibiotic (gentamicin) and fresh frozen plasma respectively for sepsis
Gentamicin. No increase in the incidence of EONS caused by and impaired hemocoagulation. Finally after 20 days of
Ampicillin resistant E. coli following intrapartum antibiotic
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 157
hospitalization, most of them because relapsing hypoglycemia, the Nevertheless high mortality rate remains to indicate need to forward
baby returned to home whitout none damage reported. progress in knowledge of this diseas.
Conclusion: We can conclude that if the placenta represents a key site
of spiritual meaning for some birthing women, none ritual practice Keywords: Congenital tuberculosis, newborn, preterm
seems to be sufficiently safe without a real preventive fully informed
campaign that explains benefits (few) and risks (many) implied in this
particular birth choise.

Keywords: Placenta, home birth, childbirth, lotus birth

466 (CASE REPORT)

427
CMV transmission in seropozitive
pregnancy caused worse effects
Neonatal vertical transmitted
than expected
tuberculosis in a couple of
preterm twins M. Güngör1, K. Yümlü2, A. Afşin Kundak2, G. Nadir
Köken1, D. Baskın Embleton3, Ç. Özdemir4, and
N. Todisco, V. Della Monica, A. Plantulli, and A. Criscuolo S. Kundak5
1
Maternal-Infantile Department, University Hospital of salerno Department of Obstetrics and Gynecology, Division of Perinatology,
"San Giovanni di Dio e Ruggi d’Aragona", Salerno, Italy Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar,
Turkey, 2Department of Pediatrics, Division of Neonatology, Faculty
Introduction: Tuberculosis remains an unresolved health global of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey,
3
problem as such still recognized by WHO. Some forms that differ Department of Pediatric Surgery, Faculty of Medicine, Afyon
from the classic pulmonary expression are poorly object of Kocatepe University, Afyonkarahisar, Turkey, 4Department of
attention and underestimated on general people. Congenital Pathology, Faculty of Medicine, Afyon Kocatepe University,
infection by vertical transmission is a rare modality reported for Afyonkarahisar, Turkey, and 5Dr. Behçet Uz Pediatric Diseases and
only 358 cases until 1995 and another 18 cases from 2001 to 2005. Surgery Training and Research Hospital, Department of
This form is responsible of high mortality (over 60%) and morbidity Dermatology, _Izmir, Turkey
in neonatal period. Clinical findings in newborn often are non
specific including distress and sepsis-related aspects. Must be
remembered that tuberculosis in pregnancy is responsible of Introduction: Congenital CMV infection risk is only about %1 in infants
recurrent abortions, stillbirths, PROM and preterm labour. born to mothers who have circulating CMV antibodies. Preexisting
Guidelines for management of borns from infected mothers maternal antibody to CMV is the most important protective factor
represent still a controversial issue. against congenital CMV infection. Generally , congenital infection due
Materials and methods: Key points in diagnosis making remain to recurrent maternal infection are less severe
Cantwell’s criteria and finding of Mycobacteria by examination of the Clinical cases and summary results: The pregnant women referred for
placenta (tuberculosis must be considered in the differential consultation because of possible CMV infection at 5 weeks 4 days.
diagnosis of all cases of acute chorioamnionitis). Infection in the The obstetrical history of the mother is gravida 1, para 0, abortus 1.
foetus can be transmitted from the maternal circulation through the The mother was apparently immunocompetent and had no clinical
placenta or by aspiration and swallowing of infected amniotic fluid symptoms due to CMV infection. We have tested CMV IgG, CMV IgM
during the perinatal period. Treatment with isoniazid, rifampicin, and CMV IgG avidity. The results were CMV IgG pozitive, CMV IgM
ethambutol and kanamycin (or amikacin) for the first two months of negative and high IgG avidity. Family was given information based
life, then followed by isoniazid and rifampicin usually represents initial on these results. The same pregnant women was admitted to our
pharmacological therapy. perinatal medicine department with symptoms of fetal distress at
Clinical cases and summary results: We present our case consisting in 37 weeks and 4 days. Cesarean delivery was performed immediately,
two 27 wks preterm twins (birth weight 950 gr and 980 gr) from because of nonreassuring fetal status. Baby was born with 1800 gr
mother in treatment for miliary tuberculosis. Mother’s anamnesis birthweight, APGAR score:6 within 5 minutes of birth and required
revealed a long infertility story ended whit a medical induced admission to neonatal intensive care unit. Clinical findings in the
pregnancy needing of steroid therapy before and during gestational symptomatic neonate were petechia, purpura, small size for gesta-
period. At birth both babies presented severe RDS treated whit tional age and also laboratory findings included thrombocytopenia.
mechanical ventilation (SIMV) and surfactant. Fluids, inotropes, fresh The infant died from severe end-organ disease 3 days later. Diagnosis
frozen plasma, amoxicillin/clavulanate where the first pharmacologi- of congenital infection was based on the detection of CMV DNA in
cal approach, integrated by isoniazid in second day of life. In the fetal tissue biopsy by polymerase chain reaction.
following period we can isolate Mycobacterium tuberculosis by Conclusion: Although most infants are asymptomatic at birth due to
gastric aspirate in only one child, cerebrospinal fluid specimens recurrent maternal infection, nonprimary CMV infection caused
resulted negative. After informed parental consent we began in the mortality in our case. Counselling and management of CMV
first week whole specific therapy (isoniazid, rifampicin, ethambutol seropozitive pregnant women is a complex issue. Because lack of
and pyrazinamide) still in course. Unfortunately, examination of the interventions to chance prognosis, screening of CMV infection seems
placenta resulted prevented from its early fixation process. At the to be not appropriate.
moment we are following therapy and all the other needs (the same
of every other VLBW preterm) attending to patients’ assistance and Keywords: CMV, pregnant women
follow-up.
Conclusion: Congenital tuberculosis in newborn infants by mother
suffering from the same illness remains a rare diagnosis and,
consequently, non entirely at golden standard above all for loss of
attention towards an overlooked disease and for a difficult diagnosis
making. Likewise, guidelines for treatment of the newborn delivered
to infected mothers result variable and without uniform consensus.
158 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

children. RS virus infection are manifests primarily as bronchiolitis

468 (CASE REPORT) and/or viral pneumonia.
Materials and methods: 50 preterm infants with clinical manifestations
Recent parvovirus b19 infection of bronchiolitis or pneumonia were examined in RS markers of
infection by immunochromatographic rapid trial of the nasopharynx.
in late pregnancy Half of the children surveyed were found RS antigen.
Clinical cases and summary results: We have established risk factors:
Ž. Žegarac1, Ž. Duić1, S. Stasenko1, and A. Borovečki2 premature birth, Down syndrome, congenital heart defect, bronch-
opulmonary dysplasia, multiple pregnancy, congenital immunodefi-
1
Department of Obstetrics and Gynecology, Merkur University ciency, lack of breastfeeding.The peak incidence accounted for the
Hospital, Zagreb, Croatia and 2Department of Clinical Pathology and winter. The risk of infection was inversely proportional of gestational
Cytology, Merkur University Hospital, Zagreb, Croatia age.
In infants with RS-viral infection observed the following symptoms:
Introduction: A 28-year-old (G4 P3) was admitted in labor to the fever, cough; cold; wheezing and wheezing; retraction, cyanosis,
delivery room at the Department of Obstetrics and Gynecology, shortness of breath, reduced hydration, sleep apnea, sepsis.
Merkur University Hospital, Zagreb, Croatia, at 39 + 2 weeks of Radiography of the chest reveals emphysematous changes in the
pregnancy. Initial cardiotocography showed fetal bradycardia (60 lung fields. There have been pockets of focal atelectasis and/or
beats per minute). Ultrasound showed bilateral fetal pleural effusion. infiltration of the lungs.
Meconium-stained amniotic fluid was noted during amniotomy, Laboratory methods: serological - determination of specific antibodies
leading to emergency cesarean delivery. A pale, edematous, and titer in paired blood serum; used for retrospective diagnosis;
stiff fetus with rigid tissue (weight 4150 g; length 52 cm) and no vital virological - is the most accurate, but requires 3–7 days; rapid
functions was delivered. In the pleural effusion, 3870 copies of diagnosis of viral antigen - the fastest; should be used as a screening
parvovirus B19 (B19V) per mL were detected via real-time poly- method for children with risk factors.
merase chain reaction. Blood tests for TORCH infections were Conclusion: The clinical course of RS-virus infection in newborns is
negative. Maternal serum was also negative for B19V IgG and IgM. fairly nonspecific. For a quick and accurate diagnosis must be guided
Clinical cases and summary results: B19V usually causes a mild, self- by objective data, instrumental and laboratory examination methods
limiting, and exanthematous disease in childhood and intrauterine with mandatory consideration of risk factors RS viral infection in
fetal death in pregnant women with primary infection.Infection newborns. Immunochromatographic rapid test is a quick and
usually takes place through respiratory droplets but the virus can also accessible method for diagnosing RSV in children. Early diagnosis
be transmitted by blood and vertically from mother to fetus. will allow the maximum applied early stages of infection prevention
Transmission to the fetus occurs in one- third to one-half of cases and efficient treatment of sick newborns.
of maternal infection, with a 10% risk of adverse fetal outcome. Keywords: RS viral infection, newborns
Infection risk decreases with advancing gestational age. In the first
trimester, B19V causes spontaneous abortion in approximately 30% of
cases; in the second trimester, non-immune fetal hydrops and/or fetal
death occurs in 12% of cases; in the third trimester, fetal death occurs 513
in approximately 7% of cases. The highest rate of fetal hydrops is seen
if maternal infection occurs between 17and 24 weeks of gestation. In A chance turning out foetal
cases of maternal infection, viremia peaks approximately 1 week after
infection. Vertical transmission occurs 1-3 weeks after maternal hydrops as single finding of
infection, which indicates that fetal infection occurs during the
maternal peak viral load. The interval between B19V infection and
unsuspected primary syphilis
development of fetal hydrops commonly ranges from 2 to 6 weeks. infection in a young pregnant
B19V IgM antibodies become detectable in maternal serum 7-10 days
after infection. Levels peak at 10-14 days and decrease within 2-3 woman
months. The level of IgG antibodies increases more slowly and
plateaus 4 weeks post-infection. The serologic window?when levels of
B19V IgG and IgM are still negative is 7 days.
N. Todisco, A. Plantulli, A. Criscuolo, and V. Della Monica
Conclusion: B19V can cause late intrauterine death, and potential Maternal and Infantile Care Department, University Hospital of
maternal cases must be carefully evaluated to optimize fetal Salerno ‘‘San Giovanni di Dio e Ruggi d’Aragona’’, Salerno, Italy
outcome.
Presenter: N. Todisco
Introduction: The congenital syphilis rate, declined in the late 1990s,
473 has risen somewhat and CDC has reported a recent increase to 10.1
Clinical course and diagnosis cases per 100.000 live births in 2008 (incidence rate being 8.2 cases
per 100.000 live births in 2005) due to lack in prenatal mother’s
respiratory syncytial viral infec- health care (none screening for syphilis often are assessed during
pregnancy). Transmission of congenital infection occurs, most
tion in newborns frequently, to transplacental diffusion at any stage of pregnancy
and more likely it becomes in case of mother’s primary or secondary
syphilis (until 100%). If not recognized congenital syphilis may result
O. Laksha and Ye. Shunko
in stillbirth (30-40% of all cases), non immune hydrops, preterm
Hospital Maternal and Child Welfare, National Medical Academy of delivery.
Postgraduate Education, Kyiv, Ukraine Materials and methods: Treponemal infection assessment include
more specific but also more expensive FTA-ABS and TP-HA test that
poorly correlates with disease-activity (remaining positive for life) and
Introduction: Respiratory infections in infants - an actual problem of
therefore not indicated for screening. Non treponemal VDRL reaction,
modern perinatal medicine in Ukraine. Respiratory syncytial virus
which measures anti-cardiolipin antibodies, gives quantitative results
(RS-virus) infection is a major cause of perinatal and infant mortality
and can represent an helpful disease-activity indicator and useful
the leading cause of lower respiratory tract in infants and young
during screening and follow-up phases. Screening tests for syphilis
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 159
should be performed in all pregnant women at first prenatal visit and 560
at 28-32th gestational week. Because neurosyphilis may occur at any
disease stage, tests should be done also on cerebrospinal fluid. Finally Prevention of hiv vertical trans-
IgM test by immunoblot or ELISA assay in newborn is indicated in
case of congenital infection. mission in a tertiary care hospital
Clinical cases and summary results: We describe the case of a VLBW 30
wks preterm male baby who born by cesarean section in urgency
in Portugal
cause unaspected hydrops diagnosed in course of an occasional US
scan. None screening for syphilis was previously carried out in the S. Alves1, M. Marinho2, M. Carrilho2, and A. João3
mother, an apparent healthy young pregnant of 20 yrs at her first 1
pregnancy. At birth was found: low weight (1250 gr); severe RDS Peadiatric Dept., Centro Hospitalar Vila Nova de Gaia/Espinho, Vila
and non immune hydrops with significant hepatomegaly (figure) so Nova de Gaia, Portugal, 2Obstetrics and Gynaecology Dept., Centro
needing of primary reanimation and early IPPV ventilation with Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal,
surfactant replacement. Fluids, glucose, inotropes, and antibiotics and 3Neonatology Dept., Centro Hospitalar Vi
followed as starting rescue and stabilization therapy, integrated by
infusion of platelets and blood cells coexisting severe anemia and Presenter: Sérgio Alves
thrombocytopenia. During followed days, infectious panel revealed
positive VDRL and FTA-ABS and afterwards IgG and IgM positive Introduction: Pediatric human immunodeficiency virus (HIV) infection
treponemal immunoblot assay. Therapy including G-Penicillin at is a worldwide issue, associated with premature mortality and
50.000 units/kg every 4 hours for 10 days was administered, itself morbidity. Extensive research and established guidelines have
followed by a subsequent cycle of Mycafungin (4 mg/kg for day for contributed to reduce vertical transmission (VT), which is now a rare
20 days) cause a systemic candidiasis central catheter and antibiotic occurrence in Portugal. However antiretroviral therapy (ART) use
therapy related. Finally, at 58th day of life and weighting 2150 gr, our during pregnancy has generated several questions regarding fetal
patient was discharged and addressed to follow-up for transient mild toxicity. This study aims to describe the practices of prenatal and
direct-hyperbilirubinemia due to hepatic involvement during fetal life. postnatal care in reducing HIV VT and to study adverse outcomes in
Parents were also treated with G-Penicillin healthy resulting when newborn’s follow-up in a tertiary care Hospital.
followed-up. Materials and methods: We retrospectively reviewed data on all
Conclusion: Non immune-type hydrops from infectious disease patients born to HIV infected mothers between 2004 and 2015 in
happens in about 8% of all cases, including in this rate various Centro Hospitalar Vila Nova de Gaia/Espinho and analyze multiple
congenital infectious origin. In case of sexually transmitted spiroche- variables including prematurity, low birth weight (LBW), HIV vertical
tal agents illness sometimes may result totally undiagnosed because transmission and long-term neurodevelopment and growth.
unsuspected, expecially in a silent pregnancy as above described. This Clinical cases and summary results: A total of 83 patients born to 71
condition represents a severe risk factor for foetal survival itself and, women were included. Median gestational age at delivery was 39
at the same, for mother’s health moreover affecting for the future weeks, with 18.3% prematurity documented. We recorded statistically
fertility of the couple. significant differences between rates of prematurity in mothers who
smoked (RR 3.7, p=0.04), consumed alcohol (RR 10.5, p=0.03) or drugs
Keywords: Congenital syphilis, prematurity, neonatal hydrops (RR 3.7, p=0.04) during pregnancy. LBW was identified in 24% of
births. Viral load, maternal ART and co-infections were not associated
with increased risk of prematurity or LBW. Perinatal death occurred in
1 case of extreme prematurity. Optimal compliance regarding
neonatal prophylaxis with ART was obtained in all patients. All
infants were exclusively formula-fed. VT occurred in one case, with no
prenatal vigilance, accounting for an overall VT rate of 1.2%.
Neurodevelopment delay at 18 months was reported in 12% of
cases, with higher risk related to younger maternal age (p=0,017) and
alcohol exposure (p=0,045). Referral to child protection organizations
occurred in 12% of the patients.
Conclusion: An adequate prenatal, perinatal and infant care can
reduce HIV vertical transmission rate to almost zero. In our study,
adverse outcomes seemed to be related with an unfavorable social
environment rather than with the use of ART in pregnancy and
infancy. These findings highlight the importance of a close clinical
and psychological follow-up of HIV infected mothers in order to
prevent not only HIV vertical transmission but also other undesirable
events like prematurity or LBW.
Keywords: HIV, Vertical Transmission, Prematurity, Low birth weight

565
Two cases of hydrops fetalis
caused by parvovirus b19 with
different perinatal outcomes
Presenter: Marina Artsiusheuskaya

Introduction: Hydrops fetalis is a serious condition which can cause

perinatal morbidity and mortality and is defined as the accumulation
160 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

of abnormal fluid in different fetal compartments. Parvovirus B19 is cefotaxime followed by ciprofloxacin. Prophylaxis was established, to
the most important infectious cause of nonimmune fetal hydrops her husband, son and newborn. After four days she went home with
(NIFH). The main problem in parvovirus’ NIFH is timely diagnosis that good evolution.
allows providing treatment measures and decrease perinatal mortal- Conclusion: The main preventive strategy to intramniotic infection is
ity. There is no official registration of parvovirus infection in Belarus administration of antibiotics to women with PPROM. Neisseria
although its laboratory diagnosis for patients with rash and fever was meningitidis is the leading cause of bacterial meningitis, with a
organized in the National laboratory for measles and rubella. Recently mortality rate of 15% without antibiotics treatment. The clinical
serological and molecular testing for the cases of NIFG has also manifestations can be quite varied, from transient fever and
started in this laboratory. We present two cases of NIFH caused by bacteremia to fulminant disease. There are three syndromes:
parvovirus B19 with favorable and unfavorable outcomes. meningitis alone, meningitis with meningococcemia, and meningo-
Clinical cases and summary results: A 29-year-old woman, gravida 1, coccemia without clinical evidence of meningitis.
para 0, first and second screening’s results were normal. At the 25
weeks of gestation she had flu-like symptoms with arthralgia. The
fetal ultrasound at 28 weeks of gestation showed ascites, hydro-
pericardium, hydrothorax and tissue edema. Parvovirus B19 DNA and 567
specific IgM were revealed in mother’s serum. Because of increasing
of fetal disorders, at 31 weeks of gestation a female infant was
Placental cryptococcus infection:
delivered by cesarean section. She suffered from anemia, asphyxia,
respiratory distress syndrome, pneumonia. Single transfusion of
a rare cause of second trimester
packed red blood cells and treatment of ventilatory disorders were loss in a woman without
successful. Hypoplasia of tooth enamel was found with no other
abnormalities up till 3 years of age. immuncompromise
A 25-year-old woman, gravida 1, para 0, first and second ultrasound
screening’s results were normal. She had a mild flu-like symptoms
M. Kiseli1, E. Akincioglu2, G.S. Caglar1, A.Y. Gursoy1,
without fever at 26 weeks of gestation. In two weeks fetal movements
disappeared and ultrasound examination confirmed antenatal fetal A.B. Durmus1, E.G. Pabuccu1, H. Dogan2, and R. Pabuccu1
death. At autopsy swelling of placenta, anemia of fetal internals and 1
Department of Obstetrics and Gynecology, Ufuk University, Faculty
excessive fluid accumulation in the peritoneal and pleural cavities
of Medicine, Ankara Turkey and 2Department of Pathology, Ufuk
were revealed. Parvovirus B19 DNA was detected in women serum
University, Faculty of Medicine, Ankara Turkey
and autopsy of the placenta and fetus internals.

Presenter: Mine Kiseli

Introduction: Placental infections have been implicated in 10-25% of
566 second trimester pregnancy losses. Many infectious agents such as
Chorioamnionitis by bacteria, spirochetes, protozoa, viruses and fungi have been reported
as possible causes. Bacterial infections are most commonly encoun-
meningococcus tered in etiology whereas fungi are rarely reported. Candida species
are more frequently reported in placental fungal infections which are
associated with intrauterine device or immune supression.
M. Urtasun, S. Garcı́a-Francés, A. Safont, M. Donazar, B.
Cryptococcal infection of the placenta is a very rare pathologic
Pérez, N. Abián, B. Gastón, and C. Larrañaga entity. To our knowledge there are three cases of cryptococcal
Servicio de obstetricia y ginecologı́a, Complejo Hospitalario de placental infection and fetal loss reported up today, where two of
these cases were immunocompromised. Here we present the second
Navarra, Pamplona, Navarra, España
case of placental cryptococcus infection and fetal loss without
immunocompromise.
Presenter: Maitane Urtasun Clinical cases and summary results: Thirty-year-old woman at 17 weeks
Introduction: The incidence of intramniotic infection is 2-4%, main risk of gestation (G5P4), admitted to the hospital with nausea and
factors: prolonged labor or membrane rupture, multiple vaginal vomiting. The ultrasonography reveaed 17 weeks of live fetus with
examinations, nulliparity, previous IAI, meconium, internal monitor- echogenities in the amniotic fluid. Her history revealed three vaginal
ing, genital tract pathogens. Diagnosis criteria: maternal fever 438 C births and one cesearean section. On third day of admission, vaginal
plus one: maternal leukocytosis, maternal or fetal tachycardia, uterine bleeding started. Thereafter, a test (Placental Alpha Microglobulin-1
tenderness or foul odor of the amniotic fluid. Maternal complications: protein) was performed to confirm amniotic fluid leakage.
labor abnormalities, uterine atony, postpartum hemorrhage, endo- Termination was decided at the 12th day of the follow-up with the
metritis, sepsis, coagulopathy and respiratory distress syndrome. Fetal family’s consent due to clinical chorioamnionitis. Macroscopic
outcomes: death, asphyxia, neonatal sepsis, septic shock, pneumonia, evaluation of the terminated fetus was normal. Placental tissue was
meningitis, intraventricular hemorrhage, cerebral damage. Broad 10 cm in diameter and disc shaped where histopathology showed
spectrum parenteral antibiotics should be given as soon as posible, presence of active chronic chorioamnionitis and large necrotic areas
but can only be considered cured after delivery. in the decidual tissues. On the necrotic decidual areas, multiple
Clinical cases and summary results: A pregnant of 36 + 2 weeks came spherical shaped (5-10 micron in diameter, narrow based and
to our emergency department by fever without focus to two days. encapsulated) microscopic colonies of encapsulated budding yeasts
The examination was normal 126/60, 39̄ C. The cardiotocographic morphologically consistent with Cryptococcus sp were seen.
monitoring had a tachycardia and early decelerations with non These yeasts were positive with Mucicarmine, Gomori Methenamine
painful contrctions. In the blood analysis: leukocytosis with left shift, Silver (GMS) and Periodic Acid Schiff + Alcian Blue (PAS+ AB) stains
elevated CRP and negative procalcitonin. We collected urine and (Figure 1).
blood cultures. Because of the suspicion of chorioamnionitis, we start Conclusion: Cryptococcosis, an opportunistic infection, causes cuta-
antibiotic therapy with ampicillin and gentamicin and end the neous, pulmonary or meningitis, especially in immune suppressed
pregnancy with oxytocin. With antipyretics fever and tachycardia patients. Pregnant women also might have tendency for this rare
improve. We indicated an urgent cesarean section because of variable infection, as pregnancy is a state of subtle immunosuppression. In
decelerations with pH of 7,21. A girl was born, with artery pH 7.23, conclusion, we present an uncommon case of a pregnant woman
and Apgar 6/10. A positive blood culture for Neisseria meniningitidis without any other immunocompromising conditions whose initial
was noticed in postpartum. We started antibiotic treatment with
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 161

manifestation of cryptococcosis was preterm prelabor rupture of (p=0,020); disturbed vaginal pH in 21 versus 10 (p=0.010) and
membranes and chorioamnionitis. positive KOH test in 10 of the first group. GV was isolated in 10 versus
2 women (p=0,024).
Keywords: Cryptococcus, placental infection, pregnancy loss, fungi Conclusion: The signs of BV were more frequently registered among
women with PL. Disturbance of the vaginal mulleu and BV may play
causative roles in spontaneous abortion and PL. Beside many
conducted studies, the role of BV in pregnancy is still not clearly
576 defined. Since these are easily preventable risk factors, the additional
Relationship of bacterial vagino- researches may be of great assistance for prevention of this unwanted
pregnancy outcome. These are preliminary results from the ongoing
sis with pregnancy loss before study with a larger number of participants.

24th week of gestation Keywords: Pregnancy loss, bacterial vaginosis, vaginal pH,
Gardnerella vaginalis
K. Trajkova, P. Dimcev, G. Petrovska, and S. Drakulevski
Acibadem Sistina Hospital, Skopje, Republic of Macedonia
583
Presenter: Kornelija Trajkova Bullous impetigo in a level III
Introduction: Bacterial vaginosis (BV) is extremely prevalent vaginal neonatal intensive care unit
condition among pregnant women. It has been related to many
complications of pregnancy including preterm labor and delivery,
premature rupture of the membranes, spontaneous abortion and
J. Fonseca, C. Baptista, and A. João
pregnancy loss (PL). The early pregnancy loss is the most common Paediatric Department of Centro Hospitalar Vila Nova de Gaia/
complication of early pregnancy with rate of 10-20%. Beside the Espinho, Vila Nova de Gaia, Portugal
chromosomal abnormalities as the most common risk factor, maternal
risk factors include genital infections and BV. The objetive was to
analyze the correlation of screening tests for BV as well as Presenter: Jacinta Fonseca
microbiologically proven Gardnerella vaginalis (GV) with PL before Introduction: Bullous impetigo (BI) commonly affects neonates but
24th week of gestation. can also occur in older children and adults. It is caused by toxin-
Materials and methods: A study of 72 women with pregnancy before producing Staphylococcus aureus and is a localized form of
24th gestational week, divided in two groups: 36 women with PL Staphylococcal Scalded Skin Syndrome. BI often presents during the
versus 36 women with normal pregnancy. All women were screened first 2 weeks of life with flaccid, transparent, sub corneal bullae, which
for BV: vaginal secretion analysis using Amsel criteria, measurement of may be single or clustered. Systemic symptoms are rare. The
vaginal pH (cut off value of 4.5) and amine test with 10%KOH. Vaginal diagnosis is usually clinical. There is no standard treatment for
and cervical swabs were taken for microbiological analysis using impetigo. Uncomplicated impetigo needs only topical antibiotics and
Nugent score. cleaning the affected area. Systemic therapy should be considered for
Clinical cases and summary results: Among 36 women from each those with more extensive or systemic disease. The purpose of this
group, normal finding is registered in 12 versus 22 in the control study was to describe the clinical features of BI in neonates.
group; positive swabs and/or screening tests in 24 versus 14
162 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Materials and methods: Retrospective study of the clinical files of 87 mg/L within 24 hours. Lumbar puncture and CSF studies were
newborn admitted in a level-3 neonatal intensive care unit (NICU) conducted and Cefotaxime was added to her antibiotic regimen. On
between January 2000 and December 2015, with a diagnosis of BI. the third day placental swab culture results revealed E corrodens++
Clinical cases and summary results: BI was diagnosed in 47 newborns (sensitive to Cephalosporins) on both the foetal and maternal surfaces
admitted to NICU; 57.4% (n=27) female. The delivery was vaginal in of the placenta. Her blood and CSF cultures were negative. She
59.6% (n=28); 21.2% (n=10) were born in another institution and received a total of 10 days Benzylpenicillin and 7 days Cefotaxime and
10.6% (n=5) had previous neonatology admittance. The median age subsequent clinical course was uneventful.
of the appearance of the lesions was 6 (IQR 5-9.5) days of life and the Conclusion: E corrodens is a rare cause of early-onset neonatal sepsis.
median age of admittance to the NICU was 9 (IQR 6.5-11.5) days of Our patient presented with culture negative sepsis following preterm
life; 74.5% (n=35) had multiple lesions; None of the newborns delivery at 24 + 6 weeks gestation and the successful outcome was
presented systemic symptoms or a positive septic screen; 97.9% supported by the timely placental swab culture report and
(n=46) underwent systemic antibiotic treatment and 85.1% (n=40) appropriate antibiotic use. Published literature of perinatal and
underwent an initial course of intravenous antibiotic; the median neonatal E corrodens infections is reviewed and the choices available
number of intravenous treatment was 2 (IQR 1-4) days. Topical to enhance the identification of causative agents for early neonatal
treatment was administered on 68.1% (n=32). The median number of sepsis discussed.
lenght of stay was 4 (IQR 3-5) days and the total systemic antibiotic
treatment time was 10 (IQR 10-10) days. On follow-up no complica- Keywords: Eikenella corrodens; neonatal sepsis; placental swab;
tions were reported. perinatal infections; chorioamnionitis
Conclusion: In our review no newborn presented disseminated lesions,
signs of systemic disease or a positive septic screen. Therefore, the
topical antibiotic treatment alone in an out-patient regime could have
been the first line of treatment, with reappraisal of the newborns in
611
an appointment shortly afterwards. Admittance and systemic Nosocomial sepsis in VLWB. an
antibiotic treatment should be reserved for newborns that present
more extensive lesions or systemic manifestations, as described in the epidemiological study from the
literature.
‘‘Grupo de Hospitales Castrillo’’
Keywords: Bullous impetigo, newborn, treatment
B. Fernandez Colomer, GD Coto Cotillo, and members of
Grupo de Hospitales Castrillo
608
Neonatology Service. University Hospital Central of Asturias, Oviedo,
Perinatal infections by eikenella Spain
corrodens: highlighting the Presenter: B. Fernandez Colomer
merits of placental swab culture Introduction: Nosocomial sepsis (NS) is a serious problem in very low
through case analysis and a lit- birth weight babies (VLBWB) and a leading cause of neonatal morbidity
and mortality. Their high frequency is related to the immaturity host
erature review defenses, frequent exposure to invasive diagnostic and treatment
procedures and prolonged hospital stay of these babies.
Objetive: to assess the epidemiology of nosocomial sepsis (Late-onset
A. Garvey1, J. Powell2, B. Murphy3, N. O’Connell2, sepsis) in very low birth weight babies (VLBWB) in our country (Spain).
M. Imcha4, and R. Philip1 Materials and methods: From 2006 the neonatal services of 40 acute-
1 care teaching hospitals in Spain (‘‘Grupo de Hospitales Castrillo’’)
Division of Neonatology, Department of Paediatrics, University carries out a prospective surveillance of the epidemiology of
Maternity Hospital Limerick, Ireland, 2Department of Clinical nosocomial sepsis in VLBWB. We present the results from 2006 to
Microbiology, University Hospital Limerick, Ireland, 3Department of 2014.
Pharmacy, UL Hospitals, Limerick, Ireland, and 4Department of Clinical cases and summary results: There were 5,082 episodes of NS
Obstetrics & Gynaecology, University Maternity Hospital, Limerick, among 17,009 admissions (29.9%) in the study period, with 11.3
Ireland episodes per 1,000 patient days. Between 2006 and 2014 the
incidence decrease from 30.3% to 26.4%. 3,270 of 5,082 NS (64.3%)
Presenter: Dr Aisling Garvey were caused by Gram-positive bacteria with S. epidermidis (48.3%) as
the most common gram-positive isolated. Gram-negative bacilli were
Introduction: Ekinella corrodens (E corrodens) is a gram negative rod responsible of 28.4% of cases with Klebsiella spp (10.5%) as the most
which is known to be associated with human gastrointestinal and common isolated pathogen. Candidemia occurred in 365 cases (7.2%)
respiratory tracts. Case reports have described an association of E with a significant decline during the study period from 10.8 to 4.1%.
corrodens infection and obstetric complications such as preterm C. albicans (3.0%) and C. parapsilosis (2.6%) were the most common
labour, chorioamnionitis and cases of early neonatal mortality. We Candida species. Four o more risk factors were present in 90.8% of
describe a case of E corrodens in-utero foetal infection detected by a cases. Catheter-related sepsis occurred in 42.2% of cases. The
positive placental swab culture influencing antimicrobial manage- mortality rate was 9.2% with significant differences among Gram-
ment of an extremely low birth weight (ELBW) baby with clinical positives (3.3%), Gram-negatives (20.1%) and Candida (19.6%). The
features of sepsis soon after birth. most common combination of initial empirical antibiotic therapy was
Clinical cases and summary results: A baby girl born was at 24 + 6, by vancomycin-amikacin (37.7%). Median length of antibiotic therapy
emergency LSCS due to preterm breech in labour and her mother had was 10.0 days (10 for gram-positive, 11 for Gram-negative and 21 for
a previous foetal loss at 21/40 gestation associated with acute, severe Candida spp).
chorioamnionitis. She conceived approximately one month after the Conclusion: 1) In our country, the incidence of NS in VLBW is high, but
above described event. On the day after delivery in the current similar to other series reported.
pregnancy, mother became unwell with CRP reaching 310 mg/L. Baby 2) Gram-positive are the most common pathogens isolated; S.
had clinical features suggesting sepsis, a septic work up was epidermidis caused 48.3% of NS
performed and was commenced on IV Benzylpenicillin and 3) The incidence of Candidemia showed a significant decline during
Gentamicin. Her initial CRP was 25 mg/L and subsequently rose to the study period.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 163
4) Catheter related sepsis occurred in 42% of cases.
5) Gram-negative bacilli were responsible for 61% of deaths.
Presenter: Nailya Rahimova
Keywords: Nosocomial sepsis, Late-onser sepsis, VLBWB
Introduction: Congenital infection pathology among newborns is one
of the most complex and important medical and social problems in
modern pediatrics and neonatology. According to some authors, fetal
650 infections are developed in 27.4-36.6% of live-born children and
newborns infection pathology is the primary cause in mortality
Intra-amniotic infection with can- patterns, causing between 11 and 45% of deaths.
The aim of this study is detection of association of SNPson the
dida albicans in a patient pre- promoter regions of Interleukin-6 (IL-6), Interleukin-10 (IL-10) and
senting with cervical insufficiency Interleukin-18 (IL-18) genes with prenatal infections in newborns, as
well as to establish the interrelation of the allelic gene variants with
their production levels.
S.H. Yang, D.W. Hwang, J.W. Park, K.C. Chun, Y.A. Kim, Materials and methods: In order to determine the effect of nucleotide
and J.W. Koh polymorphisms on IL-6, IL-10 and IL-18 genes 50 newborns with
congenital infection were investigated by verified enzyme immu-
Department of Obstetrics and Gynecology, Inje University College of noassay analysis and polymerase chain reaction. Screened group
Medicine Ilsan-Paik Hospital, Gyeonggi, Korea included 76 newborns without any sign of infection. Measurement of
IL-6, IL-10, IL-18 proteins was performed by standard method of solid
Presenter: SH Yang phase (‘‘sandwich’’ option) of the EIA (enzyme immunoassay) using
diagnostic test kits by Vektor-Brest (Novosibirsk). IL-6, IL-10 and IL-18
Introduction: Intra-amniotic infection (IAI) is a major cause of genes polymorphisms (at -174, -572, -597; -819,-592 and -656, -137,
significant maternal and fetal morbidity and mortality and is +105 positions, respectivily) were detected by PCR amplification and
recognized as an important etiologic factor for preterm delivery. restriction analysis(PCR-RFLP).
Although Candida albicans(CA) is frequently recovered from the Clinical cases and summary results: The role of nucleotide polymorph-
vagina during pregnancy, it rarely creates chorioamnionitis and IAI. ism, located in promotor regions of IL6, IL-10 and IL18 genes, in the
We present a case of IAI caused by CA presenting cervical genesis of infectious diseases in newborns was determined as a result
insufficiency and treated by liposomal amphotericin B. of the completed research. Direct correlation between allele variants
Clinical cases and summary results: A 40-year-old multigravida was of IL6, IL-10 and IL18 genes and production of these cytokines is of
referred at 21 weeks’ gestation for management of cervical particular interest. Predictable increase in cytokine production in
insufficiency Emergent cerclage was performed successfully. At initial infected newborns confirms functional significance of point muta-
amniocentesis, amniotic fluid (AF) WBC count was 0/ml. A few days tions in the genesis of perinatal infections. In other words, cytokine
later, it was reported that CA was recovered. The patient wanted to gene polymorphism signifies susceptibility to various types of
continue the pregnancy and liposomal amphotericin B started to be infections at the time shaping up individual cytokine profile and
administered. Serial amniocentesis was conducted weekly and AF varying the level of expression of final proteins. Generated data
WBC counts were 950, 20, and 2/ml, respectively. AF culture was enable us to use the results of measurement of IL6, IL-10 and IL18
negative since 3rd amniocentesis. After two consecutive negative gene polymorphism as a predicator of congenital infections.
results in AF culture, antifungal agents were stopped. On 27 + 3 Conclusion: The increase in the frequency of occurrence of G allele in
weeks, emergent cesarean section was performed due to clinical the promoter region of the gene IL-6 at -174, -572 positions of IL-10
chorioamnionitis and previous history of cesarean delivery. A 1,200- gene in positions -819, -592 and IL-18 at -656 position and nucleotide
gm male infant was delivered but expired at two days of age because substitution in other positions revealed in IL-6, IL-10, IL-18 genes
of severe respiratory distress and sepsis. Cord blood culture at birth indicates the importance of point mutations in the development of
was positive for E.coli and placental pathology revealed severe acute intrauterine infections.
chorioamnionitis and funisitis.
Conclusion: The present case showed that despite negative culture Keywords: Interleukin-6 gene Polymorphism, Interleukin-10 gene
results for fungi after antifungal agent treatment, another pathogen Polymorphism, Interleukin-18 Gene Polymorphism, Single Nucleotide
such as bacteria could ascend into amniotic cavity via weakened Polymorphisms, Perinatal infections, newborns
membranes. In such situation as IAI with fungi in previable period,
physicians may offer either termination of pregnancy or close
surveillance for IAI with not only the initially detected pathogen
but also various those which were not recovered from initially
717
retrieved AF. Fetal ultrasound findings in zika
infection. Preliminary report in a
654 colombian selected population
Role of single nucleotide poly-
J. Sanin-Blair1,2, A. Cumplido3, J. Gutierrez-Marin1,2,
morphisms of the interleukin M. Campo-Campo2, R. Garcia-Posada2, A. Londoño2,
genes on the development of A. Arango-Gomez1,3, and B. Aristizabal-Bernal4
1
perinatal infections among Medicina Fetal. Medellin, Colombia, 2Maternal-Fetal Medicine Unit.
Universidad Bolivariana. Medellin, Colombia, 3Female ultrasound
newborns Unit. Ser Mujer. Sincelejo, Colombia, and 4Molecular Genetics
Research unit. Unigem. Medellin, Colombia
N. Rahimova, and N. Guliyev
Presenter: JOSE SANIN-BLAIR
Scientific Research Institute of Paediatrics named after K.Y. Farajova
Introduction: There is an increasing epidemiologic, clinical and
(Azerbaijan, Baku)
pathologic evidence between Zika virus infection during pregnancy
164 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

and adverse pregnancy and birth outcomes, including microcephaly, Presenter: Alina Popescu
placental insufficiency and brain abnormalities. Multiple studies are Introduction: Since 1992, Clinical Hospital of Obstetrics and
underway to estimate the risk of Zika virus in pregnancy, but it is Gynecology ‘‘Prof. Dr. Panait Sı̂rbu’’ Bucharest was the medical unit
important to recognize that microcephaly caused by viral destruction to consult, record and monitoring pregnancies, births and mis-
of brain tissue is likely to be part of a spectrum of neurological carriages associated with transmited diseases- including HIV positive
damage and the frequency of malformations may underestimate the patients- from Bucharest and surrounding counties. The hospital had
proportion of cases affected. The objective of this preliminary report the necessary professional expertise and hospital networks. In time,
was to report the frequency of abnormal fetal ultrasound findings and within the ‘‘Prof. Dr. Panait Sârbu’’ Clinic, we had systematized and
describe the abnormal findings in a selected population with proven implemented obstetrics protocol for prevention of HIV prevention of
Zika infection in different trimesters of pregnancy vertical transmission’s infection.
Materials and methods: This was a descriptive prospective study based Materials and methods: The aim of this protocol was to decrease HIV
on three reference fetal medicine units of two cities in Colombia vertical transmission rate from 30-35%, value from year 2000, to 2-3%
(Sincelejo and Medellin). All the patients have confirmed Zika which represent European developed countries rate. Starting from the
infection in differents gestational ages and went for detailed primordial objective to decrease mother-to-child vertical transmission
ultrasound and Doppler exam and follow up. In cases with suspected rate, we established the cesarean section as the method of delivery
anomalies, Amnio for Zika PCR was done and ultrasound re- for all HIV positive women, at 37-38 weeks, on intact membranes,
evaluation at least for two examiners effected. outside labor. The result: it was a significant decrease of the number
Clinical cases and summary results: 74 pregnant women’s with Zika of HIV positive babies.
infection were followed or referred at the centers with a media of 25 Clinical cases and summary results: Between 2007-2011 the results
gestational weeks at first detailed ultrasound. Median age was 23 were most encouraging, with a 0 rate of vertical HIV transmission
years. Most of the patients had a Zika infection in the first trimester through cesarean section, and an 23.63% transmission HIV for vaginal
(52/74). Abnormal central nervous system findings were found in 6 deliveries.
patients, Zika PCR in amniotic fluid was detected in all cases. In these Conclusion: Attentive monitoring of pregnancies and colaboration
6 cases, 5 of them had the infection in the first trimester of pregnancy with Infectious Diseases specialist, caesarean section deliveries,
and 1 at 21 weeks of gestational age. Periventricular calcifications, complex antiretroviral therapy for both mother and child and
lissencephaly, and subependymal cysts were common findings in all weaning were main means through which a spectacular decrease in
cases. Microcephaly (53SD) was also a common finding between 26 HIV vertical transmission had been achieved.
and 30 weeks of pregnancy. No cases of persistent oligoamnios,
persistent fetal Doppler alterations or fetal anemia was founded. Keywords: HIV infection, cesarean section, antiretroviral therapy
Conclusion: In these selected population, Zika infection in the first (ART), weaning
trimester was associated with severe central nervous system
abnormalities detected later in pregnancy. Use of Doppler to detect
placental insufficiency was not helpful in this population, but our Zika
cases in the third trimester were limited 741
Keywords: Zika, ultrasound, Doppler Incidence of hospitalization for
acute respiratory syncytial virus
bronchiolitis in the first year of
age in a third level hospital. Have
the preterm infants more risk?
R. Martı́n Masot, L. Serrano López, J.M. Osorio Cámara,
and J.A. Hurtado Suazo
Paediatric Dept. Neonatology Dept. University Maternal Hospital
Virgen de las Nieves, Granada, Spain

Presenter: R. Martı́n Masot

Introduction: Respiratory syncytial virus (RSV) has consistently been
noted to be the most important cause of lower respiratory tract illness
and bronchiolitis in infants under one year of age. These infections
may be severe in selected high-risk populations: Preterm infants with
or without chronic lung disease. Acute bronchiolitis is the main cause
729 of hospitalization in children under one year of age. This study aimed
to evaluate in a Spanish cohort the rate of hospitalization for RSV
HIV pregnant women manage- bronchiolitis in children under one year of age stratified according
gestational age at birth. The secondary aim was to determinate the
ment. 11 years experience in incidence and risk factors of severe bronchiolitis induced by RSV
clinical hospital ‘‘Prof. Dr. Panait during the first year of life.
Materials and methods: Descriptive study of retrospective cohort. The
Sarbu’’ study population was the newborn in a Spanish third level hospital
for 2013 to 2015, stratified according gestational age (preterm and
term) cross math with a cohort of infants under one year of age
Popescu, Mitran, and Georgescu hospitalized for RSV bronchiolitis in that years. The infants were
selected after revision of the hospital discharge codes with a primary
Clinical Hospital of Obstetrics Gynecology ‘‘Prof. Dr. Panait Sarbu’’,
diagnosis of RSV bronchiolitis or RSV infections. We collected the
Bucharest, Romania following data: demographic and epidemiologic, underlying condi-
tions, comorbidities, diagnostic tests, treatments, invasive and non-
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 165
invasive mechanical ventilation and outcomes of disease severity echogenicity and cystic lesion in the left parietal periventricular white
parameters: Intensive care unit admission, length of stay and matter. At 4 days, the infant presented intestinal perforation and signs
mortality. of sepsis. Ileostomy was necessary. Due to a suspicion of candida
Clinical cases and summary results: Between 2013 to2015, 10.603 infection, cultures from central and non-sterile body sites were taken
infants were born. 8%(861)were premature infants (537wga), of these, and fluconazole therapy was initiated at 4 DOL. Serum BDG increased
67%(582) were late preterm (34-36 + 6wga), 12%(102) born between to 5,230 pg/ml (normal 580 pg/ml). A Candida albicans species was
32-33 + 6wga and 10%(91) born before 28wga. In that years, 376 rapidly isolated from ascitic fluid puncture, urine, blood culture and in
infants under one year of age were hospitalized due RSV acute all samples from non-sterile sites. Renal ultrasound and echocardio-
bronchiolitis, from them, 91% were term infants and 8,2% were graphy were normal, but ocular examination revealing hyalitis. CUS at
preterm infants. (Table 1) Compared the RSV bronchiolitis hospitaliza- 10 day showed increased echogenicity with moderate ventricular
tion in preterm infants with term infants, there were no statiscally dilatation. At the same time, EEG was abnormally discontinuous. On
significant difference (p=0,92). Attend the rate of RSV bronchiolitis day 18, serum BDG was still very high (45,230 pg/ml). Lumbar
hospitalization in late preterm infants compared with preterm infants puncture was then performed and revealed 203 leukocytes, protein:
534wga, there were no statiscally significant (p=0,23). Regarding 1.22 g/l, glucose: 1.4 mmol/l and chloride: 124 mmol/l; CSF BDG level
length of stay, preterm infants had longer hospital stays compared 1247 pg/ml. Treatment with micafungin was then prescribed. On day
with term infants. There was statiscally significant (P=0,04). The 35, serum BDG decreased significantly and CUS showed regression of
admission to Intensive care unit and the needed of mechanical brain lesion. EEG had returned to normal. All cultures were negative.
ventilation due to severe RSV bronchiolitis there were no statiscally The hospital outcome was favorable.
significant between preterm and term infant. Conclusion: We reported here, regression of brain lesions during
Conclusion: Respiratory Syncytial Virus acute bronchiolitis is a treatment of neonatal candidiasis with mycafungin. The very severe
common cause of hospitalization in preterm and term infants along and extensive white matter lesions observed on the initial CUS
the first year of age. The rate of hospitalization were similar in preterm suggested very early onset of infection, possibly in utero. After
and term infants. There were no difference in rate of hospitalization antifungal therapy with mycafungine, these lesions had regressed. To
between late preterm infants and very preterm infants. The length of improve the prognosis, the initial antifungal therapy strategy when
stay were longer in preterm infants. HCME is suspected should include a fungicidal molecule such as
liposomal amphotericin B or echinocandins.
Keywords: Respiratory Syncytial Virus, Bronchiolitis, preterm infant,
hospitalization Keywords: HCME, premature infant, echinocandins, beta-D-glucans

INTRAPARTUM SURVEILLANCE - 024

Does the morphological classifi-
cation of the decelerations on the
ctg trace matter? Analysis of 500
cases
J. Yanju1, V. Lowe1, A. Archer1, A. Gracia Perez-Bonfils2,
757 (CASE REPORT)
and E. Chandraharan1
Regression of infectious-sus- 1
St George;s University Hospitals NHS Foundation Trust, London, UK,
pected brain lesion in a prema- and 2Institut Marquès. Barcelona, Spain

ture infant during treatment of Introduction: Cardiotocograph (CTG) guidelines produced by the
invasive candida infection with National Institute of Health and Care Excellence (NICE) in the UK
classifies atypical (or ‘non-reassuring’) variable and late decelerations
echinocandins as ‘abnormal features’ and recommends intervention if these
decelerations persist for 50% of uterine contractions over the
preceding 30 minute period. However, variable and late decelerations
S. Goudjil1, G. Kongolo1, C. Chazal1, A. Leke1, and represent a fetal baro and chemo-receptor reflex mechanisms to
T. Chouaki2 compensate for ongoing intrapartum mechanical (i.e. umbilical cord
1 compression) and/or hypoxic (i.e. utero-placental insufficiency) to
NICU, University Hospital of Amiens Picardie, Amiens, France and protect the fetal myocardium by a reflex reduction in the myocardial
2
Laboratory of Mycolgy, University Hospital of Amiens Picardie, workload as to preserve its energy balance. Our objective was to to
Amiens, France determine the association between ‘variable’ and ‘late’ decelerations
and the perinatal outcomes (i.e. Apgar Scores, Umbilical cord arterial
Introduction: Neonatal candidiasis in critically ill premature infants is pH at birth and admission to the neonatal unit, in the presence of a
associated with significant morbidity and mortality. Hematogenous stable baseline fetal heart rate and reassuring variability.
Candida meningoencephalitis (HCME) may contribute to a poorer Materials and methods: A retrospective analysis of 500 CTG traces was
neurologic outcome. Imaging and cerebrospinal fluid (CSF) para- carried out and the perinatal outcomes in the presence of ‘variable’
meters are not sufficiently sensistive diagnostic tests to be reliable. and ‘late’ decelerations were determined in the presence of a stable
We report the case of a patient with cerebral lesion highly suggestive baseline fetal heart rate and reassuring variability after obtaining
of HCME given the context of candida sepsis. approval from the Research and Audit Office. Perinatal outcomes
Clinical cases and summary results: A male infant was born at 26 weeks (umbilcial arterial cord pH, Apgar Scores and admission to the
with a birthweight of 920 g. Tracheal ventilation was necessary. neonatal unit) were determined.
Broad-spectrum antibiotic with third-generation cephalosporin was Clinical cases and summary results: Compared with the group with no
administered due to suspected bacterial infection. At 1 day of life decelerations, presence of variable or late decelerations on the CTG
(DOL), cranial ultrasonography (CUS) was performed and showed Trace was not associated with poor perinatal outcomes (Apgar Score
166 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

55 at 1 and 5 minutes, cord arterial pH of 57.0 or admission to presence of a catecholamine surge (i.e. increase in the baseline fetal
neonatal unit) if the baseline fetal heart rate and variability were heart rate in response to repetitive variable or late decelerations),
normal. Poor perinatal outcomes were observed only when variable there was no cases of metabolic acidosis at term or neonatal
and late decelerations were associated with a reduced baseline admissions, if the baseline variability was maintained.
variability.
Conclusion: Our study confirms that presence of late and variable Keywords: Catecholamine response, fetal tachycardia, cardiotoco-
deceleration in the a stable baseline fetal heart rate and reassuring graph, evolving hypoxia
variability on the CTG trace is associated with normal umbilical arterial
pH at birth and good perinatal outcomes. Therefore, additional tests
of fetal wellbeing such as fetal scalp blood sampling (pH or lactate) is
not indicated in the presence of a stable baseline fetal heart rate 028
and reassuring variability. Clinicians need to take action to relieve the
ongoing stress to the fetus by intrauterine resuscitation to negate In term, uncomplicated
the need for fetal baro- or chemo-receptor response to reduce the
workload of the myocardium. pregnancies, can intrapartum
Keywords: Cardiotocograph, baseline variability, perinatal outcomes
fetal compromise be predicted by
the cerebroplacental ratio (CPR):
a prospective observational
cohort study
025
A. Page1, K. Roelens2, E. Roets3, I. Dehaene4, and
Is the fetal ‘catecholamine G. Page5
response’ to evolving intrapar- 1
University Hospital of Ghent, Ghent, Belgium, 2University Hospital of
tum hypoxia really harmful? Ghent, Ghent, Belgium, 3University Hospital of Ghent, Ghent,
Belgium, 4University Hospital of Ghent, Ghent, Belgium, and
5
Jan Yperman Hospital, Ypres, Belgium
E. Chandraharan1, A. Gracia Perez-Bonfils2, and J. Yanju1
1
St George’s University Hospitals NHS Foundation Trust, London, UK, Introduction: We aim to investigate the predictive value of the
and 2Institut Marquès, Barcelona, Spain cerebroplacental ratio (CPR) doppler flow evaluation in the last month
of pregnancy, during routine prenatal follow-up, in identifying fetuses
Introduction: Catecholamine response is an essential aspect of at risk of intrapartum compromise.
physiological response to a gradually evolving intrapartum hypoxic Materials and methods: In a prospective multicentre cohort study over
stress. Catecholamines help to increase the circulation to the placenta a 1-year period, 400 consecutive term pregnancies will be included in
and to the vital organs via fetal tachycardia and peripheral both a secondary and tertiary referral center. The umbilical artery
vasoconstriction to increase systemic blood pressure to increase the pulsatility index, middle cerebral artery pulsatility index and CPR will
pressure head. In addition, catecholamines help in the re-distribution be recorded during routine prenatal follow-up at 36, 38, 40 and
of the oxygenated blood from the non-essential organs to central beyond weeks of gestational age.
organs so as to protect the central organs (brain, heart and adrenal Doppler parameters will be converted to centiles, adjusting for
glands) from hypoxic and ischaemic injury as well as provide energy gestational age. Labor will be managed according to local protocols,
substrate through glycogenolysis. while the data of the doppler examinations remain blinded for the
Our Objective was to determine the relationship between fetal obstetricians, and intrapartum and neonatal outcomes will be
catecholamine response (i.e. evolving fetal tachycardia) and perinatal recorded.
outcomes. Clinical cases and summary results: We aim to present the interim
Materials and methods: A retrospective analysis of 500 CTG traces with results of this study (started in october 2015) after the first 8 months
a progressive increase in the baseline fetal heart rate in response to a of inclusion. The association between low CPR ratio’s and the need for
gradually evolving hypoxia (i.e. with preceding variable or late instrumental or operative delivery for fetal compromise durante partu
decelerations) was determined after obtaining permission from the will be statistically analysed.
local Research and Audit Office. Perinatal outcomes in fetuses with Conclusion: We hypothesize that fetuses with a low CPR would be at
catecholamine response was compared with fetuses with no increased risk of compromise during labor, leading to the probability
catecholamine response of evolving intrapartum hypoxic stress. of a high risk labor and delivery, necessitating additional monitoring
Clinical cases and summary results: In the presence of evolving and supervising of labor by experienced obstetricians.
baseline tachycardia (i.e. 410% increase from the initial heart rate),
both 1 minute and 5 minute Apgar scores were significantly lower but Keywords: Cerebroplacental ratio, doppler, intrapartum fetal
the umbilical arterial pH at birth was normal. A greater tachycardic compromise
response was seen amongst babies of higher birth weight possibly
reflecting larger adrenal glands. Similarly, there was a significant
increase in the incidence of ‘late decelerations’ (poor placental
function) without tachycardia (stronger vagal tone) amongst fetuses
441 weeks. Overall, tachycardia lasting for more than 20 minutes was
associated with a lower 1 minute and 5-minute Apgar scores.
Conclusion: Increased likelihood of lower Apgar Scores at 1 minute
and 5 minutes when the tachycardic response persisted for more than
20 minutes was most likely due to the catecholamine induced re-
distribution of oxygenated blood from fetal muscles, skin and lungs,
leading to pale skin, poor muscle tone and poor respiratory effort at
birth leading to lower Apgar Scores. Our results show that even in the
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 167

082 side effects. Lately, a new noninvasive device, electrohysterography

(EHG), that measures the electrical activity of the uterine muscle, was
The length of active phase and introduced as an alternative for the determination of contractions
(Nemo Healthcare’s, PUREtrace). The aim of this study was to determine
second-stage labor the validity and safety of this novel technology.
Materials and methods: A prospective preliminary study including ten
Selahattin Kumru1, _Ilkay Boz1, Aysu Koptur1, and parturient women in first or second phase of labor. Uterine activity
Mehmet Ziya Fırat2 was determine in each participants by both IUPC and EHG.
Monitoring was held until the time of delivery of the fetus.
1
Faculty of Nursery, Akdeniz University, 2Faculty of Medicine, Akdeniz Exclusion criteria included non-vertex presentation, skin disease. To
University, and 3Faculty of Agriculture, Akdeniz University evaluate the uterine contraction detectability of the different
noninvasive methods in comparison to IUP the contractions
consistency index (CCI) was calculated.
Introduction: The labor is managed based on the labor curve and the
Clinical cases and summary results: Ten women were included in the
phases of labor, which were first described by Friedman in 1954.
analysis: 4 nulliparous and 3 multiparous women. The average
This study aims to use the partograph among the Turkish women
gestational age was 38.2 weeks. All patients were treated with pitocin
to (a) assess birth curves, (b) define the phase duration of the labor,
after insertion of IUPC and had epidural analgesia. Seven women had
and (c) identify the factors that affect the labor.
spontaneous vaginal delivery, 2 had vacuum extraction due to NRFM
Materials and methods: This study was used a retrospectively
and one woman had an urgent Cesarean delivery due to non
descriptive and cross-sectional survey design. The partographic
reassuring fetal monitoring and was diagnosed with uterine rupture.
records and files of 496 women, who had vaginal birth in singleton
Interestingly, in this case both IUPC and EHG showed no uterine
with vertex presentation were examined.
activity. In 3 women the EHG registration was not interpretable due to
Clinical cases and summary results: The mean duration for active phase
the lack of experience of the operating team. All 6 remaining women
is 6.44 ± 3.84h and 4.37 ± 3.43h in nulliparous and multiparous
had CCI above 0.92 and 4 of them above 0.96 suggesting closely
women. This study demonstrated that the duration of active phase
approximation to that calculated from the intrauterine pressure
had lasted significantly longer than the Friedman’s study. The
catheter signal.
nulliparous length of the second stage labor was higher in Turkish
Conclusion: Electrohysterography may provide noninvasive and safe
women than the multiparous women in the Friedman’s study.
means of assessing uterine contractions, comparable with IUPC.
However, the multiparous length of the second stage was not
Optimal training of the operating team will allow better assessment
significantly different than the Friedman’s group. Also, the nulliparous
of its accuracy and might lead to less invasive procedures in delivery
length of the second stage lasted significantly longer for the infants
room, minimizing potential complications.
with a length 450 cm than the infants with a length 49cm. Last, the
study demonstrated that the longer gestational age among the
nulliparous women was an effective variable for the significantly Keywords: Tocometry, Intrauterine Pressure Catheter,
prolonged (1.29 times longer) active phase. Electrohysterography
Conclusion: This study has provided valuable information about the
normal length of labor in Turkish women. In Turkish women, the Table 1. Contraction consistency index (CCI).
active phase of labor lasts longer than the broadly accepted duration.
Number of Contractions Contractions
Keywords: Active phase, second stage, labor, partograph, Turkish Patient in IUPC (n) in EHG (n) CCI
women, vaginal birth
1 - - NI
2 - - NI
3 - 13 UR
4 81 81 1
5 - - NI
087 6 43 40 0.96
A novel non-invasive technology 7
8
35
74
40
79
0.93
0.96
for contraction monitoring in 9
10
49
37
52
39
0.97
0.92
parturient women - can it replace NI- Not interpretable, UR- Uterine rupture
invasive intrauterine pressure
catheter?
A. Mohr-Sasson1,2, O. Moran1,2, A. Kalter-Farber1,2, 121
B. Lemmens3, K. Thijssen3, R. veroegop3, E. Sivan1,2, Can we define a critical cut-off
S. Mazaki-Tovi1,2, and I. Hendler1,2
1
value of PH for the prediction of
Obstetrics and Gynecology Department, The Chaim Sheba Medical
Center, Tel Hashomer, Israel, 2Sackler Faculty of Medicine, Tel Aviv
adverse neonatal outcome?
University, Tel Aviv, Israel, and 3Nemo Healthcare, Eindhoven, The
Netherlands D. Yohay, T. Silberstein, B. Aricha-Tamir, S. Yaniv-Salem,
B. Hamou, D. Elharar, I. Idan, Z. Yohay, and E. Sheiner
Introduction: Monitoring of uterine wall activity using tocometry is
occasionally cumbersome due to maternal obesity or technical Soroka Medical Ceter, Beer-Sheva, Israel
difficulties. Currently, the only available alternative, the invasive
intrauterine pressure catheter monitor (IUPC) cannot be used in patient Introduction: To examine the association between arterial cord pH
with intact membranes and is associated with several complications and value and adverse neonatal outcome in term deliveries, and to
168 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

evaluate whether a critical cut-off value of pH can be defined for the 127
prediction of adverse neonatal outcome.
Materials and methods: The study population included 653 term Arterial cord PH is a better
deliveries (37 weeks gestation and above). Deliveries occurred in a
tertiary medical center, where arterial cord pH is routinely taken after predictor of low apgar scores at
birth. Composite adverse neonatal outcome was defined as a low
5-minute Apgar less than 7, admission to neonatal intensive care
1 versus 5 minutes
unit (NICU), prolonged neonatal hospitalization or post-partum
death.Receiver operating characteristic (ROC) curve analysis was D. Yohay, T. Silberstein, B. Aricha-Tamir, S. Yaniv-Salem,
used to describe the relationship between different values of arterial B. Hamou, D. Elharar, I. Idan, Z. Yohay, and E. Sheiner,
cord pH and the composite outcome.
Clinical cases and summary results: A significant linear association was Soroka Medical Center, Beer-Shave, Israel
documented between arterial cord pH and composite adverse
neonatal outcome. Using a receiver operating characteristic (ROC) Introduction: To examine the association between arterial cord pH
curve analysis, the area under the curve was 0.683 (95% CI 0.64-0.72, value and low Apgar scores in term deliveries, and to evaluate
p50.001, Figure). However, using pH57.2 as a predictive value for whether pH is a better predictor of abnormal Apgar scores in 1 or
adverse neonatal outcome, the sensitivity was only 62%, (with a 5 minutes.
specificity of only 68%). Likewise, pH value 57.0 had a sensitivity of Materials and methods:The study population included 653 term
only 14% (despite a specificity of 99.8%) in the prediction of deliveries (37 weeks gestation and above). Deliveries occurred in a
composite adverse neonatal outcome. tertiary medical center, where arterial cord pH is routinely taken after
Conclusion: Although low arterial cord pH is associated with adverse birth. Receiver operating characteristic (ROC) curve analysis was used
neonatal outcome, there is no clinical cutoff value of pH that can be to describe the relationship between arterial cord pH in the prediction
practically used for the prediction of composite adverse neonatal of 1 and 5 minutes Apgar scores lower than 7.
outcome. Clinical cases and summary results: A significant association was
documented between arterial cord pH and Apgar scores less than 7 in
1 and 5 minutes. Using ROC curve analysis, investigating the
association between pH and Apgar scores at 1 minute 57, the area
under the curve was 0.811 (95% CI 0.76-0.85, p50.001, Figure 1a),
i.e. good accuracy. Another ROC curve analysis investigated the
association between pH and Apgar 5 minute 57. The area under
the curve was 0.763 (95% CI 0.63-0.88, p50.001, Figure 1b), i.e. only
fair accuracy.
Conclusion: In our population, arterial cord pH is a better predictor of
low Apgar scores at 1 versus 5 minutes.

214
Way of delivery as a reson for
birth trauma
G. Bushinoska-Ivanova1, J. Ivanov2, and L. Hoxha3
1
UK JZU Gynecology-Obstetrics Clinic Skopje, Macedonia, 2Clinical
Hospital Acibadem Sistina, Skopje, Macedonia, and 3PZU DONA,
Skopje, Macedonia

Introduction: The aim of this study was to prove the connection

between the birth trauma and the way of delivery.
Materials and methods: 9496 newborns, term 8630 (90.88%), praeterm
866 (9.12%), who were born at Special Hospital for Gynecology and
Obstetrics -Mother Theresa,Skopje, Macedonia, during the period of
tree years (2009-2011), were studied retrospective. We analyzed the
method of delivery: vaginal (spontaneous and with intervention) and
cesarean and the type of birth trauma. 7699 (81%) of newborns were
born by spontaneus vaginal method,135 (1.42%) were born vaginal
with intervention and 1662 (17.5%) were born with cesareum section.
Clinical cases and summary results: The incidence of birth trauma in
the whole group (9496 newborns) was 5.72% (544). In a group of
newborns with spontaneous vaginal delivery 6% (462) were with birth
trauma. In a group of a newborns with vaginal delivery with
intervention 37% (50) were with birth trauma. In newborns with
cesareum section 1.92% (32) with birth trauma. From 9496 newborns:
Intracranial hemorrhage (ICH) were 0.85% (81), term 0.7% (61),
praeterm 2.3% (20). Cefalhaematoma 2.54% (242), term 2.6% (225),
praeterm 2% (17). F-ra claviculae 1.94% (185), term 2.1% (181),
praeterm 0.5% (4). Paresis plexus brachialis 0.23% (22), term 0.23%
(20), praeterm 0.23% (2). Paresis N.Facialis 0.11% (11), term 0.1% (9),
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 169
praeterm 0.23% (2). F-ra Femoris 0.01% (1), term newborn. Oedema
223
cerebri 0.02% (2), term newborn 0.01%(1), preterm 0.1%(1).
Conclusion: Obstetric techniques of delivery, like the methods of Fetal heart rate monitoring cate-
Bracht, vacuum extraction, forceps and extraction are connected with
increase of incidence of birth trauma. This is pointing us to the risk of gory 3 during the 2nd stage of
the use of vaginal obstetrics intervention, and to avoid them when
ever it is possible. labor is an independent predictor
Keywords: Birth trauma, way of delivery
of fetal acidosis
D. Yohay, T. Silberstein, B. Aricha-Tamir, S. Yaniv-Salem,
216 (CASE REPORT) B. Hamou, D. Elharar, I. Idan, Z. Yohay, and E. Sheiner 9
The status of knowledge and Soroka Medical Ceter, Beer-Sheva, Israel

performing nonpharmacological Introduction: To determine whether fetal heart rate (FHR) monitoring
categories during the 1st and 2nd stage of labor can predict arterial
methods in labour pain manage- cord pH 57.2.
ment of midwives and nurses Materials and methods: A case control study was conducted including
653 consecutive term deliveries (37 weeks gestation and above) that
work in delivery rooms were divided according to fetal pH7.2 (n=315) and fetal pH47.2
(n=338). Deliveries occurred in a tertiary medical center, where arterial
cord pH is routinely taken after birth. Intrapartum FHR monitoring
Y. Yesil, F.S. Sen, M. Cömert, H. Ozturk Can, and categorization was defined according to the ACOG committee
N. Tuna Oran guidelines by 2 obstetricians. Multivariable models were constructed
to control for confounders, FHR categorizations were entered as
Ege University Faculty of Health Science, Midwifery Department, Dummy variable.
Izmir, Turkey Clinical cases and summary results: A significant association was
observed between category 2 and 3 during the 1st stage of labor and
Introduction: Giving birth is one of the most painful actions and the pH7.2 (Table, model 1). However, while controlling for FHR category
stress related to uncontrolled pain while delivery has bad effects on 3 at the 2nd stage of labor, 1st stage categorization lost its association
mother, fetus and newborn’s health. To prevent these effects, some with pH 57.2 (Table, model2).
nonpharmacological methods are performed to overcome labour Conclusion: FHR monitoring category 3 during the 2nd stage of labor
pain. For pain management by midwife/nurse, the midwife/nurse is an independent predictor of fetal acidosis as expressed by arterial
should be qualified in pain management in labour and delivery. The cord pH57.2.
aim of this study is to estimate the level of knowledge in
nonpharmacological in labour pain management and delivery of Keywords: FHR monitoring categories, 2nd stage of labor, fetal
midwives/nurses work in delivery rooms and the status of performing acidosis, arterial cord PH
these methods.
Clinical cases and summary results: In this descriptive study, it was
aimed to assess the level of knowledge and the status of performing
nonpharmacological methods in labour pain management and
delivery of midwives/nurses work in delivery room, and also to
guide ingoing training programmes. Due to excess in the numbers of
midwives/nurses work in delivery room, only five hospitals in Izmir
and 60 volunteer midwives/nurses were included in this study. The
average age of participants was found as 35.31 ± 6.84, the average
of years of working was found as 14.3 ± 8.40 and the average of years
of working in delivery room was found as 7.25 ± 7.08. Besides, it was
found that 55 midwives and five nurses were working in delivery
room and 66.7% of them were graduated from college. 70% of
midwives/nurses were defined that they were informed about in
labour pain management,. 41% of them defined that the reason of
not performing nonpharmacological methods was finding themselves 249
inadequate even they were trained in labour pain management. Also
it was found that 88.3% of participants knew movement and
Effect of hyoscine butyl-N-
changing position as one of the nonpharmacological methods the
most, and 61.7% of them performed this method.
bormide (BUSCOPAN) on cervical
Conclusion: According to the results of this study, it is defined that the dilation during first stage of
level of knowledge of midwives/nurses in labour pain management is
high, but the status of performing these methods are insufficient. labour in term multiparus and
Moreover, it is recommended that training programmes about pain
management in labour should be arranged for the midwives and primiparous women
nurses work in delivery room, and these subjects should be included
in educational programmes before graduation. P. Zubor1, A. Gondova1, S. Krivus1, M. Zibolen2,
P. Kasajová1, and J. Danko1
Keywords: Labour pain, nonpharmacological methods, midwife
1
Department of Obstetrics and Gynecology JLF UK and UNM, Martin
and 2Neonatologic clinic JLF UK and UNM, Martin
170 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Introduction: Prolonged labor is the important risk factors for perinatal ultrasound and a biophysical profile of 8/8. Two days later she
compromise and adverse perinatal outcome (e.g. obstructed labor, the returned because of no fetal movements since discharge. Fetal heart
risk of uterine rupture, postpartum hemorrhage, puerperal sepsis, rate tracing revealed a spontaneous deceleration lasting 4 minutes
neonatal injury, infection and asfyxia). Various drugs have been tried to with slow recovery, maintaining variability. On ultrasound no fetal
hasten cervical dilatation in aim to minimise maternal or perinatal movements were seen, and she was admitted to the labor ward for
mortality and morbidity. Thus, we aimed to determine whether continuous monitoring. Two hours later tracing became sinusoidal,
hyoscine butyl-N-bromide (HBB) shortens the stages of labor, and how and she was submitted to an emergency C-section with delivery of a
it impact on maternal and/or neonatal complications. Additionally, we 2800gr markedly pale newborn with 1, 5 and 10 minute Apgar of 1, 5
have pointed on its good analgesic effect against labor pain. and 8 respectively, and respiratory depression responding to bag and
Materials and methods: A retrospective study of 541 cases were mask ventilation. Intra-operatively no signs of placental abruption or
included of primigravidae or multigravidae with gestational age of 37 anomalies were detected. Cord blood gas pH was 7.13. Immediate
to 42 weeks with full term with single foetus, vertex presentation and hemoglobin was 3.0g/dL, recovering to 16g/dL after 2 unit transfu-
no major antenatal complication of women in labour. Women were sion. Kleihauer-Betke test was positive, with an estimated volume of
studied and divided into 2 groups. Cases (n=320) - labour accelerated transfusion of 80mLs.
by hyoscine butyl-N-bromide received 20-40 mg (1ml) i.v./i.m. in the Conclusion: Although rare, FMH should be suspected in a woman
active phase of labor and control group (n=221) without buscopan complaining of reduced fetal movements with non-reassuring CTG
during the first stage of labor. The effects of hyoscine in shortening trace. The majority of cases are idiopathic, severity will depend on
labor time, perinatal complications and neonatal Apgar score was rate and rapidity of transfusion. The triad diminished fetal move-
compared and results were adjusted for parity. Pain scores were ments, sinusoidal trace and hydrops should raise suspicion.
assessed at baseline and two hours later, and as a need for epidural Recognition and prompt intervention are key in order to avoid
analgesia. negative outcomes. Tests that detect fetal hemoglobin in maternal
Clinical cases and summary results: Mean duration of the first stage of circulation, such as the Kleihauer-Betke, may aid in diagnosis.
labor in primiparous cases versus primiparous controls was 190.4 ±
125.8 and 241.6 ± 115.1 minutes and for multiparous women was in
Keywords: Feto-maternal hemorrhage, Kleihauer-Betke test
cases 140.3 ± 105.3 minutes and 176.3 ± 74.2 minutes in no-hyoscine
group, respectively. The difference between the groups was highly
significant (p 50.01). There were no differences in the duration of the
second and third stages of labour. Frequency of cesarean section,
postpartum haemorrhage and mean of neonatal Apgar score at
minutes 1 and 5 were not different in all studied groups. No serious
285
adverse events were seen between the groups. Pain relief of 31.3% in Effect of electronic fetal monitoring
primiparous and in 26.8% in multiparous women was noted on visual
analog score with the use of HBB, as well as lower demand for EDA. (EFM) education program on EFM
Conclusion: Injection of hyoscine in active phase of labor can be
effective in significantly shortening of labor without any adverse effect interpretation skills of students
on mother and fetus and effectively hastened the rate of cervical
dilatation. G. Daglar, G. Demirel, H. Guler, and Z.B. Yurtsal
Keywords: Labor, pain control, dilatation augmentation Midwifery Department, Faculty of Health Sciences, Cumhuriyet
University, Sivas, Turkey

Introduction: Application to correct body part and correct trace

272 (CASE REPORT) interpretation are highly important in the emergence of benefits of
electronic fetal monitoring (EFM) such as the reduction of intrapartum
Massive idiopathic fetomaternal deaths. Implementation and interpretation of EFM are performed by
health professionals especially by nurses/midwives. However, mid-
hemorrhage - a happy ending wifery and nursing degree programs does not have the aim of gaining
a qualification in EFM. Inadequacy of midwifery students’ in this issue
I. Lobo Antunes, C. Tomás, I. Gomes, J. Curado, who will work in obstetrics services increases insufficient monitorings,
wrong assessments and intervention possibilities. Monitoring and
J. Metello, and J. Saraiva interpretation errors endanger the fetal health. For this reason, this
Obstetrics and Gynecology Department, Hospital Garcia de Orta, study aims to evaluate EFM knowledge and interpretation skills of
Almada, Portugal midwifery students’ by educating them about EFM.
Materials and methods: The sample of the research planned as an
Introduction: It is physiologic for small amounts of fetal blood to enter
intervention study is consisted of voluntary 4th grade students
maternal circulation during pregnancy, however, larger volumes
studying between 2014-2016 years. Data were collected by pre-test
causing significant fetomaternal hemorrhage (FMH) can have
(14 questions containing theoretical information, 10 trace paper),
catastrophic consequences. They can be spontaneous or due to
post-test (the same as the pre-test), Trace Interpretation Skills Criteria.
trauma. Transfusions 420ml/kg are considered massive, due to the
Students also interpreted 10 more trace papers except that they
significant fetal and neonatal morbidity and mortality. The most
interpreted in pre and post tests. At the end of the evaluation done
common presenting symptom for massive FMH is decreased fetal
by ‘‘Trace Interpretation Qualification Criteria’’, students who correctly
movements, fetal heart rate may show a sinusoidal pattern.
interpreted 8 (80%) and more trace papers were considered as
Treatment depends on gestational age at diagnosis, after 32 weeks
successful. Analysis of the data was tabulated by using average,
immediate delivery should be the course of action. We present a case
standard deviation, percentage, paired t-test in SPSS (22.0) package
of spontaneous massive FMH, with antenatal signs of compromise
program. Statistical significance was accepted as p 50.05.
and a newborn with severe anemia who, due to prompt recognition
Clinical cases and summary results: All the 4th grade students
and delivery, had a positive outcome.
participated in the study are female students (100%) and their
Clinical cases and summary results: 25-year old RG, Gravida 2 Para 1,
average age is 22.56 ± 2.11. The difference between student’s scores
had an uneventful pregnancy followed by her primary care doctor,
they got before EFM education and after EFM education was found to
third trimester ultrasound showed normal fetal biometry. At 34 weeks
be statistically significant (p 50.05). While students’ point distribution
RG presented to our emergency room with reduced fetal movements.
was 55.29 ± 11.17 before EFM education, after education it was found
Fetal heart rate monitoring was reassuring, with fetal movements on
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 171
to be 76.15 ± 6.72. When trace interpretation qualification criteria are Whether one system is superior to the other in predicting fetal
examined, 96.1% of students’ in determining basal/basic heart rate, acidemia remains unknown.
94.2% of them in assessing the long and short term variability, 87.4%
of them in detecting accelerations and 80.6% of them were found to Keywords: Electronic fetal monitoring, fetal heart rate classification
be sufficient in assessing decelerations and contractions. 80.6% of systems, validity, acidemia
midwifery students’ have been successful in EFM education.
Conclusion: In accordance with these results, it can be said that, EFM
education significantly increased the theoretical knowledge of
students’ and improved their trace interpretation skills.

Keywords: Education program, Electronic Fetal Monitoring, Student,

Trace interpretation

374
Diagnostic accuracy of the FIGO
3-tier and the 5-tier fetal heart
rate classification system in the
detection of neonatal acidemia
Martı́ Gamboa S, Redrado Giménez O, Ruiz Sada J,
Rodrigo Rodrı́guez M, Rodrı́guez Lázaro L, Lapresta
Moros M, Pascual Mancho J, and Castan Mateo S
Obstetrics Dept, Miguel Servet University Hospital, Zaragoza, Spain
(All authors)

Introduction: The use of electronic fetal monitoring (EFM) is

ubiquitous. However, despite numerous attempts, the obstetric
community has been unable to reach a broad consensus on a
standardized approach to the management of most fetal heart rate
(FHR) patterns. In 2007, Parer and Ikeda described a five categories
complex system based on 134 possible fetal heart rate patterns. In
2015, a three categories system was proposed by the FIGO
Intrapartum Fetal Monitoring Expert Consensus Panel. The objective
of this study is to determine which system presents more validity for
fetal acidemia detection
Materials and methods: We conducted a one year retrospective case-
control study of all singleton, non-anomalous gestations delivered at
 37 week with neonatal acidemia, defined as an umbilical cord gas
pH7,10 and base excess (BE) 58 mmol/L. A sub-analysis was
performed in those fetus with pH7 and BE512mmol/L. Neonates
in the control group were matched to each neonate in the case group
in a one-to-one fashion using the subsequent delivery matched by
gestational age. The primary exposure was 30 minutes of EFM
immediately prior to delivery, interpreted by two obstetricians,
blind to clinical and outcome data. Both reviewers categorized EFM
patterns into three and five categories systems. Relative risks, 95%
confidence intervals and test characteristics for acidemia were
calculated. 502
Clinical cases and summary results: During the period of study 3490
women met inclusion criteria, of these, 102 delivered an acidemic Electrohysterography compared
fetus (Figure 1). There were no meaningful differences in maternal
demographics between the neonates in the case group and those in
to external tocodynamometer
the control group (n=100). More than 77% of tracings classified as
normal where green or blue, according to 5-tier system. 59.2% of
and intra-uterine pressure
pathological tracings were orange or red, although there were also catheter
blue and yellow tracings within this category. According to validity of
both systems, Orange, Red and combination of both categories
presented a lower sensitivity and a higher specificity in acidemia M.W.C. Vlemminx1,2, K.M.J. Thijssen1,2, and S.G. Oei1,2
detection, compared to the Pathological category (Table 1). However, 1
Department of Obstetrics and Gynecology, Máxima Medical Center,
based on the Youden index, both systems had a similar validity for
Veldhoven, the Netherlands, and 2Department of Electrical
detecting mild (FIGO: 0.26, Parer: 0.24) and severe acidemia (FIGO:
0.45, Parer: 0.42). Engineering, Eindhoven University of Technology, Eindhoven, the
Conclusion: The FIGO 3-tier and the 5-tier systems were similar in fetal Netherlands
heart rate interpretation and validity for fetal acidemia detection.
Presenter: Marion Vlemminx
172 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Introduction: Monitoring uterine activity is one of the main

intrapartum measurements during high-risk childbirth. The fetal 535
heart rate is evaluated in relation to uterine contractions. And uterine
activity is monitored in order to detect tachysystole. Unfortunately,
Monitoring contractions: which
current uterine monitoring techniques have major drawbacks. The
sensitivity of the external tocodynamometer (TOCO) is low and
method do pregnant women
influenced by maternal movements or obesity. The alternative is an prefer?
invasive intra-uterine pressure catheter (IUPC), which is the gold
standard but carries some rare but serious risks. Electrohysterography
(EHG), reporting the electrical activity of the uterus, is a promising K.M.J. Thijssen, MD1, M.W.C. Vlemminx, MD1, and
new method. The objective of our W3-study is twofold: to validate S.G. Oei, MD PhD1,2
EHG by comparing this method to IUPC and to compare EHG with 1
Department of Obstetrics & Gynaecology, Máxima Medical Center,
TOCO.
Materials and methods: We performed a prospective observational Veldhoven, The Netherlands, and 2Faculty of Electrical Engineering,
study of pregnant women during term labor at the Máxima Medical Eindhoven University of Technology, Eindhoven, The Netherlands
Center, Veldhoven, The Netherlands. The pregnant women were
simultaneously monitored with three different uterine monitoring Presenter: Kirsten Thijssen
techniques: IUPC, EHG and TOCO. We aimed for a two-hour
measurement during the dilation and/or expulsion phase, with a Introduction: In most countries the standard method for uterine
minimum of 30 minutes. Afterwards, contractions were automatically monitoring during labor is the external tocodynamometer (TOCO).
detected using a computer-based algorithm. We considered contrac- The intra-uterine pressure catheter (IUPC) is only used on strict
tions as consistent when the peak of the contraction in EHG or TOCO indication. Recently, a new non-invasive uterine monitoring techni-
was within 30 seconds from IUPC. Our primary outcome parameter que has become available: electrohysterography (EHG), measuring
was the sensitivity of EHG and TOCO, with and without maternal the electrical activity of the uterus. In our W3-study, we compared
obesity. EHG to both IUPC and TOCO during term active labor. The study
Clinical cases and summary results: A total of 48 term pregnant women design allows the evaluation on patient preference, since the women
with a singleton in cephalic presentation have been included from were exposed to all three methods simultaneously, which is very
July 2014 till September 2015. One patient was excluded because the unique. As a secondary objective we studied which method women
duration of the measurement was insufficient (530 minutes). There prefer and which aspects are most important.
were no dropouts due to technical problems. The sensitivity of EHG Materials and methods: Women in labor were monitored with IUPC,
was significantly higher compared to TOCO: respectively 87% versus TOCO and EHG for about two hours. The EHG-system (NEMO
66%, p50.001. On average, the EHG method registered 2.6 contrac- Healthcare, Eindhoven, The Netherlands), consists of a PUREtrace-
tions per hour more compared to IUPC (p50.001) and 3.2 per hour device and a patch that was placed on the maternal abdomen after
more than TOCO (p50.001). The false positive and false negative skin preparation. The obstetrician inserted the IUPC and the nurses
contraction ratio was significantly lower in EHG than in TOCO. Finally, placed the TOCO. Post-partum, the participants filled out a
the sensitivity of EHG was not influenced by maternal obesity (88% questionnaire about which technique was preferred and what
versus 84%, p=0.374). TOCO did show a significant decrease of aspect of uterine monitoring was valued as most important.
sensitivity in case of maternal obesity (73% versus 51%, p=0.001). Furthermore, participants completed continuous scale questions
Conclusion: EHG has a high sensitivity for contraction detection during from 0 (not bothering at all) to 100 (very bothering) for each
term labor and performs significantly better than TOCO. Maternal technique regarding positioning, presence during labor and removal.
obesity does not influence the EHG performance while TOCO shows a Values were expressed as median [25% quartile - 75% quartile].
significant decrease in sensitivity. EHG does monitor more contrac- Boxplots and the Friedman-test were applied for statistical analysis.
tions than IUPC. It is yet unclear if these ‘‘contractions’’ are technical Clinical cases and summary results: From July 2014 till September
artefacts or actual contractions, i.e. that EHG is more sensitive than 2015, 48 women participated in the W3 trial at Máxima Medical
IUPC. In conclusion, EHG can improve fetal monitoring non-invasively. Centre, Veldhoven, The Netherlands. 79% indicated to prefer EHG,
19% IUPC and 2% TOCO. From the continuous scale questions (0 - 100
Keywords: Electrohysterography, uterine monitoring, external toco- corresponding to not bothering at all and very bothering, respec-
dynamometer, intra-uterine pressure catheter tively), ‘‘placement of EHG’’ was scored low 2.1 [0.0-4.8])*, compared
to TOCO 8.5 [2.1-25.5] and IUPC 30.2 [7.5-52.5], p50.001. For
‘‘presence of the device during labor’’, patients were more bothered
by TOCO 36.5 [9.9-61.3], than by IUPC 6.5 [0.0-44.2]. Although seven
(14,6%) patients reported minor irritation of the skin after preparation
and one patient developed an allergic reaction, EHG scored lowest
regarding presence throughout labor: 2.1 [0.0-6.8] on our continuous
scale, p50.001. TOCO scored best regarding ‘‘removal of equipment’’,
but differences were not significant, p= 0.147. Patients reported both
safety and mobility during labor as the most important factors for
uterine monitoring techniques.
Conclusion: This is the first study evaluating patient satisfaction of
uterine monitoring techniques. Women strongly preferred EHG over
TOCO and IUPC. EHG was considered as the most comfortable
method regarding both placement and presence during labor.
Women may have been positively influenced, being aware that EHG
was the newly introduced method, but the results seem evident. As
safety and mobility are important factors, patient satisfaction could
be further improved by introducing wireless EHG in future.
Keywords: Electrohysterography, uterine activity monitoring, patient
preference
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 173

MATERNAL PSYCHIATRIC DISORDERS AND Romania, 3Department of Psychiatry, University of Medicine and
PREGNANCY - 140 Pharmacy of Craiova, Romania, 4Department of Diabetes, Nutrition
and Metabolic Diseases, Clinical Emergency Military Hospital’’ Stefan
The influence of the environ- Odobleja’’, Craiova, Romania, 5Department of Obstetrics and
mental origin in mental illness in Gynecology, University of Medicine and Pharmacy’’ Carol Davila’’,
Bucharest, Romania, and 6Department of Obstetrics and Gynecology,
perinatal period University of Medicine and Pharmacy of Craiova, Romania

V. Gheorman1, C. Berceanu2, M. Pı̂rlog3, V. Calborean4, Introduction: The perinatal period is a special time both for pregnant
women as for her family. Many psychiatric symptoms are correlated
E. Bratila5, and V. Gheorman6 with the mode of delivery.
1
Resident Physician in Psychiatry, PhD Student, University of Medicine Materials and methods: We included in our study a number of 8.784
pregnant women hospitalized at Craiova County Emergency Period
and Pharmacy of Craiova, Romania, 2Department of Obstetrics and
between 1.07.2010 and 30.06.2013.
Gynecology, University of Medicine and Pharmacy of Craiova,
Clinical cases and summary results: Only 15 women from the whole
Romania, 3Department of Medical Sociology and Behavioral number of 8.784 pregnant women presented psychiatric symptoms.
Sciences, University of Medicine and Pharmacy of Craiova, Romania, According to the mode of delivery, we found 11 pregnant women
4
Department of Cardiology, Clinical County Emergency Hospital of who delivered by caesarean intervention and just 4 women who
Craiova, Romania, 5Department of Obstetrics and Gynecology, delivered by psysiologically way. We tried to structure our research for
University of Medicine and Pharmacy’’ Carol Davila’’, Bucharest, each year of study and we have seen that on every year we cand
Romania, and 6Department of Obstetrics and Gynecology, University observe a higher incidence of psychiatric symptoms at women who
of Medicine and Pharmacy of Craiova, Romania delivered by caesarean operation.
Conclusion: We observed some correlations between the caesarean
intervention and the incidence of mental illness after delivery. It is well
Introduction: The number of mental illness in perinatal period is known that caesarean like every surgical intervention generates higher
bigger in last period of time. We admint that pregnancy represents a stress, increasing the emotional lability and the depressive idea.
high-risk period for new episode of mental disease or for relaps of Unfortunatly, it is difficult to define strong correlations between
preexisting mental illness. caesarean intervention and psychiatric diseases according that our
Materials and methods:We realized both a prospective as retrospective study included a small group of patient. However, we considered that a
study about pregnant women who were hospitalized and who connection between caesarean intervention and mental diseases exists.
delivered between 1.07.2010-30.06.2013 in Craiova County
Emergency Hospital.
Keywords: Caesarean intervention, stress, depression
Clinical cases and summary results: In this period of time we registered
8.784 pregnant women. After our analysis we found a number of 15
pregnant women who presented mental illness during the pregnancy
after delivery. From these, 11 women were coming from urban
environment and just 4 women were coming from the country side.
142
We structured our research per year and we showed that in every year The influence of the education
the number of patients with mental illness coming from urban
environment was higher comparing with the patiens who came from level at pregnant women with
the country side.
Conclusion: We can observed a very low number of pregnant women psychiatric symptoms
with mental illness. From 8.784 preganant women we found only 15
patients with psychiatric disease. One explanation can be the fact that V. Gheorman1, A.L. Chiriţă2, C. Berceanu3, R.C. Pană4,
our study was develop in a Department of Obstetrics and it is difficult
for doctors who are not psychiatrist to separate the physiological
E. Bratila5, and V. Gheorman6
changes specific for perinatal period by pathological mental 1
Resident Physician in Psychiatry, PhD Student, University of Medicine
symptoms. Probably, the stress factors like social problems, family and Pharmacy of Craiova, Romania, 2Department of Psychiatry,
relations and stressfull city life,are the most important risk factors for University of Medicine and Pharmacy of Craiova, Romania,
mentall illness at pregnant women from urban environment. 3
Department of Obstetrics and Gynecology, University of Medicine
and Pharmacy of Craiova, Romania, 4Department of Obstetrics and
Keywords: Pregnancy, environmental origin, mental illness
Gynecology, University of Medicine and Pharmacy of Craiova,
Romania, 5Department of Obstetrics and Gynecology, University of
Medicine and Pharmacy’’ Carol Davila’’, Bucharest, Romania, and
6
Department of Obstetrics and Gynecology, University of Medicine
and Pharmacy of Craiova, Romania
141 Introduction: The paper is about both a prospective as a retrospective
analysis of pregnant women with mental diseases hospitalized in
Correlations between the mode Craiova County Emergency Hospital.
We tried to show how the education level influences the incidence of
of delivery and mentall illness in psychiatric symptoms at pregnant women.
perinatal period Materials and methods: We studied a number of 8.784 of pregnant
women. The period of the study was 1.07.2010-30.06.2013. We
develop the research in the Department of Obstetrics of Craiova
V. Gheorman1, C. Berceanu2, A.L. Chiriţă3, County Emergency Hospital.
L. M. Gheorman4, E. Bratila5, and V. Gheorman6 Clinical cases and summary results: Only 15 pregant women presented
psychiatric diseases. We divided the group of study by two criteria:
1
Resident Physician in Psychiatry, PhD Student, University of Medicine the year of hospitalization and the education level. According to the
and Pharmacy of Craiova, Romania, 2Department of Obstetrics and level of education 7 (0.08%) patients had graduated the college,
Gynecology, University of Medicine and Pharmacy of Craiova, 6(0.07%) had graduated the high school and 2 (0.02%) had graduated
174 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

just the elementary school. The distribution according to the year of participate but their birth experience was before 2005. We even
hospitalization was as follows: received requests to participate from other countries.
Between 1.07.2010-30.06.2011 registered 2 cases(0.07%) of pregnant Conclusion: None as yet. We hope this will be the first time women
women who graduated the college, 2 patients(0.07%) who graduated themselves will report the reasons they believe their birth was a
the high school and only one patient who graduated just the traumatic event and what they think could have been done to
elementary school. prevent this. Hopefully we can use this information to prevent some
Between 1.07.2011-30.06.2012 were 2 cases(0.07%) of pregnant of these experiences in future.
women who graduated the college, 3 patients(0.11%) who graduated
the high school and only one patient(0.03) who graduated just the Keywords: PTSD, traumatic experiences, chilbirth, causes, prevention
elementary school.
Between 1.07.2012-30.06.2013 we found 3 cases(0.11%) of pregnant
women who graduated the college, one patients(0.04%) who
graduated the high school and none patient who graduated just 258
the elementary school.
Conclusion: After our analysis of pregnant women with mental illness Effects of coping with stress
according to education level we can say that the incidence of
psychiatric symptoms is higher at the patients with a higher level of training on pregnant women’s
education comparing with the others. depression, stress and coping
Keywords: Education level, pregnancy, depression with stress levels
Ş. Ertekin Pinar, Ö. Duran Aksoy, G. Dağlar, Z.B. Yurtsal,
and B. Cesur
Department Of Midwifery, Faculty Of Health Sciences, Cumhuriyet
154 University, Sivas, Turkey
Traumatic experiences associated
Introduction: Pregnancy is the period when significant biopsychoso-
with childbirth: the teach study cial changes experienced and the period existing high risk of
encountering many factors that can create anxiety and stress.
M. Hollander1, J. van Dillen2, E. de Miranda3, and Identification of depression, stress and coping strategies and
prevention initiatives made by health care professionals in this
C. Stramrood4 period are important. The research was conducted to examine the
1
Obstetrics and Gynaecology Dept., Radboud University Medical effects of coping with stress training on pregnant women’s
Centre, Nijmegen, the Netherlands, 2Obstetrics and Gynaecology depression, stress and coping with stress levels.
Materials and methods: Randomized controlled study’s sample is
Dept., Radboud University Medical Centre, Nijmegen, the
consisted of 202 pregnant women (study: 103, control: 99). Planned
Netherlands, 3Midwife, PhD, researcher, Academic Medical Centre,
stress and coping training was given to pregnant women in the study
Amsterdam, the Netherlands, and 4Obstetrics and Gynaecology group with standard care application in a home environment and
Dept., University Medical Centre, Utrecht, the Netherlands standard care was applied to pregnant women in the control group.
Pregnant women in study and control groups were visited four times
Introduction: Childbirth can be a traumatic event for many women. in their homes, forms were repeated in monitorings. Data were
Around 30% of new mothers refer to the birth as a trauma, and 1-3% collected by Personal Information Form, Beck Depression Inventory
of them fulfill criteria for post partum PTSD. Although many risk (BDI), Perceived Stress Scale (PSS) and Stress Coping Scale (SCS). In
factors for the development of PTSD after birth have been described data analysis, percentage distribution, Chi-square and t-tests were
in literature, no study has ever examined which factors the women used. The statistical significance level was assumed as p 50.05.
themselves identify as cause of their trauma and how they think this Clinical cases and summary results: In both groups of pregnant
could have been prevented. women, there was an average decline of points in the BDI during the
Materials and methods: An online questionnaire was shared on social monitoring period and after a month of training, avarage points of
media networking sites like twitter and facebook, and posted on sites the study group was found to be significantly lower than the control
for women with traumatic birth experiences, women who want other group (p 50.05). PSS points of the pregnant women was found to be
than recommended birth care, and women who have suffered from lower in study group, one and two months after training, their
HELLP or severe pre-eclampsia. Inclusion criteria were a self described average points were found to be significantly lower than the control
traumatic birth experience in the last 10 years, age over 18 and good group (p 50.05). A month or two after training, from sub-dimensions
knowledge of the Dutch language. The responders were presented of SCS, self-confidence and social support search approaches and one
with questions about their background, the specifics of the birth, month after training, optimistic approach average scores of women in
which aspects they found most traumatic, and if they think there was study group were found to be significantly higher than the ones in
anything their care provider or they themselves could have done to control group (p 50.05).
prevent it. They were also asked if this was discussed post partum, if Conclusion: As a result, BDI and PSS average scores of women in
any treatment had been offered, and were given a full PTSD study group were low in monitorings after stress and coping training.
questionnaire. Increase was determined in self-confidence, optimism and social
Clinical cases and summary results: Results to follow, questionnaire support search approaches from sub-dimensions of SCS.
closes at the end of March, data will follow in April. However, the
response so far has been overwhelming. In the first 48 hours over Keywords: Pregnancy period, depression, stress, stress coping
1500 questionnaires have been filled out. Many comments were strategies
received of women who reported they thought they had dealt with
their trauma, but found themselves crying while filling out the
questionnaire. Many women lamented that they wanted to
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 175

263 322
Postpartum depression: what Anxiety and perceived stress,
about the fathers? strong predictors of postpartum
depression. unclear role of
S. Culotı̀ and J. Gaugue
Child and Youth Clinical Psychology Unit, University of Mons
oxytocine
(UMONS), Mons, Belgium
D. Marı́n-Morales1, C. Peñacoba-Puente2,
Introduction: The perinatal period offers suitable conditions to M. Losa-Iglesias2, I. Corral-Liria2, and F. Pacheco-Ardila1
develop psychiatric disorders. So far, most of the research focus on 1
Obstetric Dept., Fuenlabrada Universitary Hospital and 2Health
the mother’s well-being. However, men can also suffer from
Sciences Dept., Rey Juan Carlos University
psychiatric disorder such as postpartum depression. This phenom-
enon is known to be associated with maternal depression (Goodman,
2004) and can have consequences on the child’s development Introduction: Great amount of research has found multifactorial causes
(Ramchandani et al., 2005). Despite the growing interest regarding for postpartum depression. Different studies have shown that anxiety,
the father’s well-being, a lack of focus on a global perception of the stress or neuroticism have been associated to PPD. Nevertheless, new
paternal experience in the francophone population, particularly in investigations have evidenced that hormonal factors as oxytocine
Belgium, still remains. Therefore, the aim of our study was to examine could be associated to depressive symptoms during puerperium. The
the prevalence of depression and anxiety and to evaluate the aim of this study is to analyze the influence of anxiety and perceived
dimensions of self-esteem, social support and coping strategies stress on PPD in puperperal women, and the mediation effect of a
among fathers. biological variable such as oxytocine
Materials and methods: Fathers were assessed at 5 days of postpartum Materials and methods: A longitudinal correlational and prospective
in a Belgian hospital (Hainaut, Wallonia). The Edinburgh Postnatal design was performed with two measures: one day after childbirth
Depression Scale (EPDS-10, Cox et al., 1987) was used to assess and four months after childbirth. A blood test was done with women
symptoms of depression. The prevalence of anxiety was determined consent between 24 and 36 hours after childbirth, to measure serum
with the Hospital Anxiety and Depression Scale (HADS, Zigmond & oxytocine. Furthermore, anxiety was evaluated. At fourth month of
Snaith, 1983). Self-esteem, social support and coping strategies were puerperium, women were contacted to measure depressive and
respectively measured with the Self-Esteem Inventory (SEI, anxiety symptoms, and perceived stress. Edinburg Postnatal
Coopersmith, 1984), the Social Support Questionnaire (SSQ6, Depression Scale (EPDS) was used for depression, State-Trait Anxiety
Sarason et al. 1987) and the Coping Inventory for Stressful Inventory (STAI) was used for anxiety, and Perceived Stress Scale (PSS)
Situations (CISS, Endler & Parker, 1990). Sociodemographic variables to measure perception of stress. The final sample was composed by
were also taken into account. 57 mothers.
Clinical cases and summary results: 66 French speaking fathers (mean Clinical cases and summary results: The bivariate correlational analysis
age: 32,68 years, SD: 5,36) completed the questionnaires. 16,7% of showed a possitive association between depression and trait anxiety
them are depressed and 36,4% suffer from anxiety. 15,2% of the at 24 hours (0.377, p 50.001), state anxiety at fourth month (0.780, p
fathers also seem to have a low self-esteem. Scores on the EPDS, 50.001), trait anxiety at fourth month (0.777, p 50.001) perceived
HADS and SEI are significantly correlated. We can therefore assume stress (0.820, p 50.001) , and oxytocine ((0.358, p=0.006). A regression
that there is a significant number of subjects who suffer from analysis was performed, indicating that state anxiety and perceived
psychological distress. Many fathers (63,6%) preferentially resort to stress predicted depressive symptoms (corrected R2=0.707, F=46,04, p
avoidance strategies when faced with a stressful situation. The results 50.001), without significant mediation of oxytocine.
concerning social support showed that our subjects have a sufficient Conclusion: To suffer anxiety and stress symptoms seems to increase
number of people on whom they can rely on in their life and an depressive symptoms, however there’s no clear influence of oxytocine
adequate social satisfaction. Some variables seem to be protective in initial postpartum on depression afterwards. An evaluation of
factors against the psychological distress such as conjugal status, anxiety and stress during postpartum is needed to prevente or
vaginal birth and the availability of social support while socio- improve mood disorders.
professional categories and coping strategies focused on emotion
and distraction act as vulnerability factors. Keywords: Anxiety, stress, postpartum depression, oxytocine,
Conclusion: Our results are globally consistent with previous research childbirth
conducted in other countries but we found higher rates of anxiety
and depression in our sample. Therefore, these results highlight the
importance of paying attention to the fathers given the implications
for family health and well-being. Further research in this area will be
carried out in a PhD thesis.
380
Keywords: Postpartum depression, family health, fatherhood
Depress and anxiety in pregnant
women
S. Ledesma, S. Taravillo, M. Garcia, M. Valverde, M. G.
Nogales, A. B. Leal, and L. Calvo
University Hospital of Aranjuez, Madrid, Spain

Introduction: The pregnancy is high demending period of time for

women’s psysically and psychologically.Motherhood is very reward-
ing but also very complex the psychological point of view. Pregnancy
is related with many psychological effects inducing anxiety and
176 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

depression. It is characteristic for pregnant woman to present physiological parameters showed that psychosocial stress affects
susceptibility, and mood swings that can accentuated with small not only the social sphere, but also the somatic sphere of pregnant
proportion adversed events. Depression, anxiety, and stress, are mice. After the dams had given birth, they were isolated from the
psychological conditions than can affect the mother as well as the ultrasonic waves. In the experimental group it was recorded only one
fetus in short and long term. The knowledge of the emotional case of severe maternal aggression toward the offspring: one litter
changes of future mothers are important for health care professionals. was completely eaten by the lactating dam at the age of 2 weeks.
It is essential to performe appropriate messures to avoided negative Young offspring were tested for behavioral deficits using three
consequences. standardized behavioral assays (open field, forced swimmed test, new
Materials and methods: We performed across sections study including object recognition test). The offspring showed no differences in the
254 pregnant women with non-pathological pregnancies followed in forced swim test as well as in the parameters in the open field - such
hospitals of Madrid. Two validates scales (Zung Depression Scale and as the travel distance, vertical activity, visits to the center. However,
Beck Anxiety Questionnaire) were used to assess anxiety and during the new object recognition test recognition index was found
depression in the population studied. to be decreased in the male offspring of the dams who were under
Clinical cases and summary results: ultrasound. The marked decline of the index was found in the group
Objetive: To assess psycho-emotional changes in pregnant women of males born from stressed mice (p 50.001).
with non-pathological gestations. Conclusion: This fact may indicate that the changes caused by the
Methods: We performed across sections study. psychosocial stress may have adverse impact on the further
Including 254 pregnant women with non-pathological pregnancies development of the offspring (its cognitive development).
followed in hospitals of Madrid.
Two validates scales (Zung Depression Scale and Beck Anxiety Keywords: Stress, pregnancy, neuroendocrine regulation, ultra-
Questionnaire) were used to assess anxiety and depression in the sound, cognitive disorders, animal model, mice
population studied.
Results: 31,9% of pregnant women had symptoms of depression, and
19,3% presented anxiety disorders.
Self-esteem problems prior pregnancy planning, previous antidepres-
sant treatments, family history of depression, changes in sleep
patterns and lack of emotional support were risk factors for 471
depression and anxiety
Conclusion: Psychoemotional, disords as anxiety and depression can Postpartum depression, mother-
be present during pregnancy. The evaluation of the emotional status
of pregnant women is a pending activity for health care providers. It is infant bonding and postpartum
very important to detect risk factor for psychological pathology in
pregnat women to prevent adverse consequences coping strategies in mothers of
newborns admitted to the neo-
Keywords: Pregnancy, depression, anxiety, mood profile of
pregnancy natal unit
440 E. Capdevila1, G. Lasheras2, R. Porta1, B. Farré-Sender2,
and JM. Farré2
The effect of psychosocial stress 1
Department of Pediatrics, Hospital Universitario Dexeus. Barcelona,
on pregnancy and the further Spain, and 2Department of Psychiatry and Psychology, Hospital
Universitario Dexeus. Barcelona, Spain
development of the offspring
Introduction: One of the most stressful concerns for the mother is the
(the example of an experimental health of her offspring, particularly when admission to the neonatal
model) unit (NU) is needed after birth. The stress coping strategies (SCS) can
determine the mother’s adaptation and perception of stress,
influencing the appearance of the postpartum depression (PPD)
A. Strizhakov, V. Chekhonin, V. Florova, P. Budanov, and and the mother-infant bonding.
E. Zubkov The objectives of the study were:
 To determine, at 6 weeks postpartum, the presence of PPD and
I.M. Sechenov First Moscow state Medical University mother-infant bonding disorders in a population of mothers whose
infants were admitted to the NU in the first days after birth.
Introduction: There can be drawn a parallel between the psychosocial  To analyze the SCS and its correlation with PPD and bonding
stress and the action of ultrasonic waves of variable frequencies disorders.
(UWVF) on mice. It was proved, that the continuous presence of the Materials and methods: In a prospective study, mothers whose infants
UWVF on the animal model for 21 days leads to the development of a had been admitted to the NU after birth for a period longer than
depressive-like state. 24 hours were recruited. Those who accepted received by e-mail, at 6
Materials and methods: The aim of our study was to investigate the weeks after delivery, a link to complete on line 3 validated
effects of continuous action of ultrasonic waves of variable questionnaires: the Edinburg Postnatal Depression Scale (Cox J et
frequencies on the pregnant mices and the further development of al, 1987) for PPD detection, the Parental Bonding Questionnaire (PBQ)
the offspring. The experimental group of mouse dams underwent the (Bronckington et al, 2006) to evaluate the bonding disorders, and the
continuous action of ultrasonic waves of variable frequencies during Coping Strategies Questionnaire (Tobin et al, 1989) to evaluate the
pregnancy (17 days). The control group was bred up in the standard SCS to manage stress.
conditions. Clinical cases and summary results: A total of 155 mothers were
Clinical cases and summary results: During the pregnancy there was recruited and accepted to participate during the newborns admission.
no difference in behavioral tests (open field test, social interactions From those, 68 (43,8%) completed the questionnaire on line at 6
test) between the control and the experimental groups of the weeks after delivery.
pregnant mice. The evaluation of higher nervous activity and
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 177
The prevalence of suspected PPD was 17,6%. None bonding disorder delivered of a male infant with a birth weight of 4,110 g and 52 cm
was found in the whole population. The model of multiple logistic in length, Apgar 10/10 by spontaneous vaginal delivery at 40 + 1 week
lineal regression for the independent variable PPD, demonstrate five of pregnancy.
items that were related with coping strategies: problem solving, social Conclusion: Successful pregnancy after liver trasnsplantation is
support, self-criticism, cognitive restructuration and social isolation possible.The majority of pregnant liver recipients do not develop
(Table 1). These five factors are responsible for the 40,8% of the graft dysfunction, especially if they become pregnant when the graft
outcome PPD. function is stable. Every pregnancy in patients with previous
Conclusion: The prevalence of PPD in mothers of newborns admitted transplantation should be closely monitored, offered multidisciplinary
to NU was similar than in general population. The mother-infant approach to pregnancy care, and accompanied by high compliance
bonding was not affected, probably in relation to the practices of the and motivation on the part of the pregnant patients.
NU, like kangoroo mother care, enhancing mothers to stay beside
their infants, empowering them and inviting them to take an active
role. Some SCS can explain a higher rate of PPD in the first 6 weeks.
We suggest than the PPD could be prevented in mothers of sick 597
babies.
Keywords: Bonding. Postpartum depression. Coping strategies
Psychopatological traits in preg-
nancy: the importance of an early
screening
M.L. Crosta1, A.M. Strangio1, B. Salvati1, S. Di Pietro1,
A. Serio2, S. De Carolis2, and L. Rinaldi1
1
Institute of Psychiatry, Catholic University of the Sacred Heart,
Rome, Italy, and 2Department of Obstetrics and Gynaecology,
Catholic University of the Sacred Heart, Rome, Italy

Presenter: L. Rinaldi
Introduction: Pregnancy is a crucial event in a woman’s life. It is a
delicate time that can result in the development or onset of
psychopathology. We conducted this study of pregnant women
with no obvious psychiatric symptoms to investigate the presence of
psychopathological traits, in order to demonstrate the importance of
an early screening. Finding mental changes and their treatment
548 during gestation allows the prevention of more serious diseases
Pregnancy and delivery after liver (Post-partum Depression and Puerperal Psychosis) or organic and
mental diseases in the fetus.
transplantation Materials and methods: Our sample made up of 38 pregnant women
(middle age 32.9 ± 5.61) recruited from the Department of Obstetrics
and Gynaecology, Gemelli Hospital, Rome, between January and July
S. Stasenko, Ž. Žegarac, and Ž. Duić 2014. Psychiatric assessment, socio-demographic, psychosocial and
anamnestic variables were recorded on the basis of a psychiatric talk,
Department of Obstetrics and Gynecology, University Hospital
a non-standardized questionnaire and a psychometric assessment:
Merkur, Zagreb, Croatia EDI (Eating Disorder Inventary), BSQ (Body Shape Questionnaire),
ORTO-15 (Orthorexia), BDI (Beck Depression Inventory), SCL-90-R
Presenter: S. Stasenko (Symptom Check List-90-Revised). Moreover we sistematically
recorded anthropometric newborn data and any childbirth
Introduction: We present a case of a successful pregnancy and delivery
complications.
in a 30-year-old liver transplant recipient who conceived sponta-
Clinical cases and summary results: 63% of the women had a
neously 2 years posttransplantation.
pathological score, specially in BDI (31,6%) and in the subscale
Clinical cases and summary results: The patient was diagnosed with
‘‘maturity fear’’ in EDI (44,7%) emphasizing the evolutionary crisis
Wilson disease when she was 15 years old . In 2001, she delivered a
presenting in this period. We detected elevated scores also in most of
male infant weighing 3,500 g and 52 cm long, and in 2003 had a
the subscales of SCL-90-R (somatization, depression, anxiety and sleep
therapeutic abortion at 12 weeks’ gestation for portal hypertension.
disorders). Correlation of Pearson highlights a statistically significant
She conceived spontaneously 2 years posttransplant. She was
association between the BMI before pregnancy and the smoking
followed on an out-patient basis (12 clinical and 6 ultrasonographic
status during pregnancy and some subscales in EDI, BSQ and SCL-90-
examinations during pregnancy) and was admitted to the hospital for
R. They probably represent compensatory mechanisms to manage a
work-up at 22, 28, and 39 weeks’ gestation. During pregnancy she
new condition. We also observed that women with psychopatholo-
was administered cyclosporine in a dosing regimen of first 150 mg 0,
gical traits who reported higher scores in SCL-90 had complications
150 mg, and then 150 mg, 0, 175 mg for immunosuppression.
during childbirth, such as a slow descent of fetus and consequent an
Cyclosporine whole-blood trough levels were monitored regularly,
operative vaginal delivery. This underlines that maternal anxiety
and were found to be within the normal therapeutic range. The
affects the course of pregnancy and childbirth, and consequently the
results of all biochemical tests during pregnancy were normal, except
physical and mental development of the child.
the platelet count, ranging from 49 to 85 x109/L. Thrombocytopenia
Conclusion: The presence of psychopathological traits, detected in our
had been also present before pregnancy, probably as a consequence
research, shows the importance of an early screening, as part of a
of spleen enlargement. Abdominal ultrasonography showed normal
multidisciplinary approach to the welfare of pregnant women, to
blood flow through the portal vein and other hepatic vessels, and an
allow psychological support and prevent the onset of post-natal
enlarged spleen 180x160 mm in size with a venous convolute in the
diseases.
hilus. Ultrasound of the fetus was normal, with fetal growth and
development appropriate for gestational age. The patient was Keywords: Psychiatric disorders, pregnancy, early screening
178 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Conclusion: The particularity of our case results from many aspects:

714 the schizophrenia in pregnancy and a pregnancy with potentially
Schizophrenia and recurrent complications. The medical history of the patient with two fetal
abandons adds a new issue. There is a more important issue
pregnancies outcomes (Case concerning the fact that there is no regulation that allow termination
of pregnancy in such conditions.
report)
L Ples1,2, RM. Sima1,2, A. Ricu2, I. Sosievici2, and C. Moisei2 MISCELLANEOUS – 001
1
The ‘‘Carol Davila’’ University of Medicine and Pharmacy, Bucharest
and 2‘‘Bucur’’ Maternity, ‘‘St. John’’ Hospital, Bucharest, Romania
Effects of maternal asthma on
pregnancy, delivery and fetal
Presenter: R.M. SIMA
outcomes: a retrospective cohort
Introduction: Schizophrenia is among the most disabling and
economically catastrophic medical disorders, ranked by the World study
Health Organization as one of the top ten illnesses contributing to the
global burden of disease. Schizophrenia occurs throughout the world.
M. Nojomi1, A. Vaezi2, L. Haghighi3, and
The overall prevalence of schizophrenia approaches 1 percent. The
incidence is about 1.5 per 10,000 people. Slightly more men are F. Beigmohammadi4
diagnosed with schizophrenia than women (on the order of 1.4:1), 1
Community and Preventive Medicine Department, 2Community and
and women tend to be diagnosed later in life than men. There is also
Preventive Medicine Department, 3Obstetric & Gynecology
some indication that the prognosis is worse in men. Characteristics
Department, and 4Community and Preventive Medicine Department
of schizophrenia typically include positive symptoms, such as
hallucinations or delusions; disorganized speech; negative symptoms,
such as a flat affect or poverty of speech.
Clinical cases and summary results: We present the case of 35 years of Introduction: Asthma is a common problem around the world with a
age woman who was admitted several times in our hospital. Her prevalence of 1–18%. This common disease could affects women
medical history revealed schizophrenia, but she refused the during pregnancy too with different complications. This disease was
psychiatric treatment. We report this case because of the social, known as the most common chronic problem during pregnancy. The
medical, economical and ethical issues. This patient had a normal aim of current study was to determine pregnancy, delivery and fetal
vaginal delivery 3 years ago. The new-born was healthy and the outcomes of maternal asthma in a cohort of women.
mother abandoned him into the hospital. One year later she referred Materials and methods: Using a retrospective cohort design data of
to our unit with a pregnancy at term without prenatal care. She had a 580 pregnant women were gathered form a large and teaching
breech vaginal delivery and the new-born was also abandoned. This hospital in Tehran, Iran. The medical records of pregnant women who
year the same patient came into our hospital for abdominal pain. The had attended to hospital between 2009 to 2011 was assessed.
ultrasound examination diagnosed a 14 weeks of gestation twin Pregnancy, delivery and fetal outcomes of maternal asthma as an
pregnancy. More accurate examination revealed that both fetuses exposure was evaluated. Data of delivery and fetal outcomes was
present features suggestive for trisomy 21. The issue is that a genetic gathered by observation and medical records of women. Multiple
diagnosis cannot be performed because the public health insurance logistic regression and adjusted odds ratio (OR) was used to assess
does not cover those tests. The question is: how to manage this the independent effect of asthma on outcomes.
situation? There are some ethical issues to be dealt with concerning Clinical cases and summary results: 274 patients (47.2%) were
the patient capacity to understand the condition of the fetuses and asthmatic and 306 patients (52.8%) were non-asthmatic. Basic and
the outcome, who will support the burden that two babies with demographic variables had a same distribution across two groups.
disabilities and special care needs implies, how to decide for a women Maternal asthma had an adjusted effect on gestational diabetes
that has no discernment. (OR=2.64), gestational hypertension (OR=3.79), cesarean delivery (OR
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 179
= 2.68), small for gestational age (OR= 2.86), premature rupture of
membrane (OR=2.18), preterm delivery (OR=1.74), abnormal vaginal Serum bilirubin (mg/dL)(Mean ± SD)
bleeding (OR=3.75), and low birth weight (OR=1.78) significantly (p
Groups 48 hours 96 hours
50.05 for all associations).
Conclusion: Majority of pregnancy, delivery and fetal outcomes (just Group 1(N=92) 11.48 ± 4.29 11.40 ± 3.87
for fetal death, abortion, placenta previa and placenta abruption) Group 2(N=92) 10.37 ± 3.45 10.52 ± 3.50
were significantly associated with maternal asthma. The largest effect p value 0.054 0.106
of maternal asthma was on gestational hypertension and abnormal
vaginal bleeding respectively.

Keywords: Maternal asthma, fetal outcomes, delivery outcomes,

pregnancy 031 (CASE REPORT)
Neonatal bradycardia and
transient QTC
008 T. Carrion, F. Garcia, and J. Ferrer
Revisiting abo incompatibility as Nicu, Clinica Rotger, Palma de Mallorca, Spain

a risk factor for significant Introduction: A male full-term neonate of one day of age was
hyperbilirubinemia admitted to NICU with bradycardia. He was born by cesarean section
for poor variability of fetal heart tones and nonprogression of labor.
Apgar 8/9. Parents were healthy. There is no a family history of long
P. Batra, R. Khurana, and M. M. A. Faridi QT syndrome.
Clinical cases and summary results: Physical Examination: T C.: 36,9  C
Division of Neonatology, Department of Pediatrics, University College
RR, 82/min HR, 44 bpm BP: 77/41 mmHg TAM: 41 mmHg SpO2:96% in
of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi - 110095,
room air. Weight: 3.335g length:46 cms head circunferance: 36 cms.
India On physical examination, the baby was awake, crying, and vigorous.
There were no dysmorphic facial features.There were mild intercostal
Introduction: ABO haemolytic disease is a major risk factor for retractions, but the lungs were clear to auscultation. The heart rate
hyperbilirubinemia requiring readmission. American Academy of was bradycardic with strong pulses. The remainder of the examina-
Pediatrics and National Neonatology Forum of India recommends tion was normal.
clinical and biochemical monitoring of these babies for hyperbilir- Diagnostic Studies: A completed blood count revealed 11.000 WBCs/
ubinemia, leading to prolonged hospitalization and economic mm3 (37% segmented neutrophils, 48% lumphocytes, 10% mono-
burden. But, very few studies have compared bilirubin levels in cytes) hemoglobin, 15.5 mg/dl and platelets, 225.000 mm3.Serum
neonates with and without ABO incompatibility setting. chemistry values included sodium, 144 mmol/L; calcium 8,5 mg/dL,
Materials and Methods: This was an observational cohort study that Serum alanine and aspartate amonitranferases were normal.
included 34 weeks neonates, born to O positive mothers and having Troponine was 74.03 ng/L. TSH: 12.57 uU/mL, T4: 2,52 ng/dL. Anti
blood group ‘A’ or ‘B’ versus those with blood group ‘O’(92 in each Ro/SSA) 2.8 u/mL, Anti La (SSB) 2.8 U/mL. ANA: negative. Chest X -ray
group). Direct Coombs’ test was done with cord blood. Serum was normal. The ECG recordings had a long QT interval (QTC=
bilirubin, hematocrit, peripheral smear examination and reticulocyte 0.5 seconds) in the setting of a second degree AV block.
count were done at 48 ± 2 hours of age. Serum bilirubin and Echocardiography showed an anatomy and fuction normal. Genetic
hematocrit were repeated at 96 ± 2hours. Primary objective was to testing was normal. His parents were under study but theirs ECG were
compare mean serum bilirubin levels at 48 and 96 hours of age also normal.
between neonates with and without ABO incompatibility setting. Treatment: The baby was treated at 5 days of age with beta-blocking
Secondary objectives were to compare hematocrit, Coombs positivity, (propanolol 3mg/Kg/d) . He didn’t need insert a pacemarker and are
reticulocyte count, peripheral smear findings, and number of babies doing well at home with apnea monitor.
requiring phototherapy and exchange transfusion in these groups. Discussion: It is important to recognize prolonged QT-interval because
Clinical cases and summary results: Mean Serum bilirubin levels in both it is a potentially lethal condition, implicated in the pathogenesis of
groups at 48hours (11.48 ± 4.29 versus 10.37 ± 3.45; p value 0.054) sudden infant death syndrome in approximately 10%. The diagnosis
and 96 hours (11.40 ± 3.87 versus 10.52 ± 3.50, p value 0.106) were of prolonged Qtc is based on clinical history, ECG findings and family
comparable (Table 1). Mean hematocrit levels were also comparable. history.
Mean reticulocyte count of babies with ABO incompatibility was Conclusion: Prolongation of the QT interval in neonates may be
significantly higher (3.56 ± 1.20 versus 2.70 ± 1.10; p value 50.01). transient or may represent an early form of the long QT syndrome
Direct Coombs’ test was positive in two babies who underwent and the length of the QT interval may provide data on prognosis:
exchange transfusion. those with a Qtc less than 0.50 second returned to normal; those with
Conclusion: As there is no increased risk of hyperbilirubinemia in a QTC greater than 0.60 second were associated with severe
neonates with ABO incompatibility setting, policies regarding arrhytnmias. He is controlled for sinus dysfunction and atrial
prolonged hospitalization of these neonates need to be revised to extrasystole
promote early discharge.
Keywords: Bradycardia, transient QTC
Keywords: ABO incompatibility, hyperbilirubinemia
180 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

047 055
Our experience with gestational Trends in incidence rates of large
diabetes after implementation of size at birth, Brazil, 2001-2013
IADPSG criteria
A. A. Cunha2, M. I. Nascimento1, C. L. F. Oliveira3,
I. Djakovic1, V. Gall1, M. Markus Sandric2, and V. Kosec1 A. A. Moura3, C. Lopata3, D. F. Pereira3, L. S. Silva3, and
1
M. J. S. Mattos3
Clinical Department of Gynecology and Obstetrics, Sestre milosrd-
1
nice University Hospital Center, Zagreb, Croatia and 2National Center Instituto de Saúde Coletiva, Universidade Federal Fluminense,
for External Evaluation of Education, Zagreb, Croatia Niterói, RJ, Brasil, 2Hospital Maternidade Terezinha de Jesus,
Secretaria de Estado de Saúde, Mesquita (RJ), Brasil, and 3Faculdade
Introduction: The growing incidence of obesity and carbohydrates Medicina, Universidade Federal Fluminense, Niterói (RJ), Brasil
metabolic disorders represents a special problem in pregnant women
and influences gestational diabetes incidence. The aim of this Introduction: Birth weight at delivery 4000 g is associated with
retrospective study is to evaluate the type and frequency of GD immediate adverse outcomes for babies and mothers, including
complications after implementation of new diagnostic criteria for dystocias, fractures, injuries, intensive care hospitalizations and
gestational diabetes at our department. surgical interventions. Later, these babies have a higher risk of
Materials and Methods: We compared our experiences in 2005, 2006 developing obesity, type 2 diabetes and other chronic diseases.
and 2007 when we used World Health Organization criteria for GD This study aimed to estimate incidence rates of babies with birth
with results in 2012, 2013 and 2014 when we diagnosed gestational weight of 4000 g or more and analyze trends from 2001 to 2013, in
diabetes according to the IADPSG criteria. Results were statistically Brazil, by using time series model.
analyzed by SPSS 15.0 for Windows, T-test and Chi-square test. Materials and methods: In Brazil, DATASUS - Department of
Clinical cases and summary results: We have found significant Informatics of the Unified Health System - is the official source
diference in birth weight between all studied years (F=4.151, df=6/ about all Brazilian live births. The data are provided by SINASC (Live
1851 p50.01) and significant diference between 2005-2007 group and Births Information System) and was consulted for getting total of live
2012-2014 group (t=2.18, df=1639, p=0.03). There was no significant births, considering all gestational ages and 37 or more gestational
diference in mode of delivery between years (2=9.65, df=6, p=0.140) weeks, occurred from 2001 to 2013. Microsoft Excel Program was
and two diagnostic criteria groups (2=0.048, df=1, p=0.826). We have used to calculate rates and produce trend graphic for all gestational
found significant diference in number of hypertrophies between all ages and to full-term births. Time series were analyzed using Prais-
studied years (2=28.10, df=6, p50.01) and between two diagnostic Winsten auto-regression. The Annual Percent Changing - APC and
criteria groups (2=20.590, df=1, p50.01). Chi-square test showed that 95% Confidence Interval (CI) were estimated using logarithmic
there is a significant difference in incidence of gestational diabetes transformation of rates and STATA Statistical Package
between 2011, 2012, 2013 and 2014 (2=377.03, df=3, p50.01). Clinical cases and summary results: On these 13 years, 38 343 116
Conclusion: Significant differences is found in incidence of hyper- babies were born alive in Brazil, being 1 977 745 with birth weight of
trophy and newborns overweight, whereas no difference in the mode 4000 g or more. The average annual incidence rate of large babies
of delivery is found in studied groups. Recorded increase in the was 55.6 by 1000 live born. The higher rate occurred in 2001 (55.2 by
incidence of gestational diabetes is repercussion of better diagnostic. 1000 live born) and the lower rate occurred in 2003 and 2013 (49.4 by
An early detection and treatment of GD has reduced the adverse 1000 live born). The visual inspection of plotted data shows a
consequences for both mother and newborn. decreased trend from 2005 to 2013 (Image). The Annual Percent
Changing (APC) was of 0.62% with 95% confidence interval
Keywords: Gestational diabetes, IADPSG criteria, hypertrophy, mode stastistically significative (1.218%, 0.009%). The analizes of
of delivery babies born with gestational age 37 weeks (1 919 987 out of 34
833 194 live born) showed the average annual incidence rate of 55.1
by 1000 and reducing trends of large size at birth, but APC (0.43%,
95% CI: 0.97%, 0.11%) was not stastistically significant.
Conclusion: Although the analysis of all newborns shows a significant
decrease of large size at birth rates, data restricted to full-term births
were not statistically significant. These findings suggest a non-optimal
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 181
prenatal care in Brazil with a higher risk of perinatal complications
095
and of development of disease related to large size at birth.
Effect of two different bathing
Keywords: Fetal macrosomia, time series studies, prenatal care
methods on crying duration and
physiological measurements in
newborns
S. Yalnizoglu Caka1 and D. Gozen2
1
Pediatric Nursing, University of Sakarya, Sakarya, Turkey and
2
Pediatric Nursing, University of _Istanbul, _Istanbul, Turkey

Introduction: Bathing the newborn is an important part of nursing

interventions in terms of hygienic, aesthetic, socio-cultural and
personal benefits. Today, the results of several studies relating to
the newborn bath time and method are being discussed. The
temporal and procedural mistakes in bathing may adversely affect
newborns’ physiologic-autonomic signs such as body temperature,
086 oxygen saturation and heart rate (HR). This study was designed as
Detection of a universal fetal DNA randomised controlled, experimentally to determine the effects of
swaddle bathing (SB) and tub bathing (TB) applications on crying time
marker RASSF1A by RT-PCR: and physiological measurements (body temperature, Oxygen satura-
tion, HR) of newborns.
reassurance to NIPD Materials and methods: The population of the study consisted of
newborns who were born on 38 weeks of gestation and met the
R. Ahmad Rather1, S. Chandra Saha1, and V. Dhawan2 sampling criteria in _Istanbul University Cerrahpasa Faculty of Medicine
Hospital between June and August 2015. The sample group consisted
1 of 80 newborns (40 SB group and 40 TB group) by using randomized
Department of Obstetrics and Gynaecology, Post Graduate Institute
of Medical Education and, Research (PGIMER), Chandigarh, India and controlled method. Newborns’ body temperature, HR, Oxygen
2
Department of Experimental Medicine and Biotechnology, Post saturation and crying duration were compared between both
groups at before, immediately after and 10 minutes after bath.
Graduate Institute of Medical, and Education and Research (PGIMER),
Clinical cases and summary results: As a result of the study, it was
Chandigarh, India
determined that there was significant difference within-group and
between groups when the vital signs were evaluated in the
Introduction: Noninvasive prenatal diagnosis (NIPD) using cell-free immediately after and 10 minutes after bath (p50.05). Crying time
fetal DNA (cffDNA) from maternal plasma is routinely performed to were evaluated, there was found statistically significant difference
detect alloimmunization and fetal aneuploidies in women. The between the groups in the advanced level (p50.001).
necessity of a control or a fetal marker for extraction of cffDNA is Conclusion: It was found that both bath methods had decrease on
imperative for NIPD. This study was taken to facilitate a modified body temperature and that the SB method affected crying time,
protocol to detect fetal DNA marker RASSF1A using a real-time oxygen saturation and heart rate of infants compared to TB and thus
polymerase chain reaction (rt-PCR). caused infants to relax.
Materials and methods: Maternal plasma samples from pregnant
women (n=30, mean gestational age 18 ± 2 weeks) were collected for
Keywords: Newborn, bath, swaddle, physiological measurements,
the isolation of cffDNA. From 200 ml of plasma, cffDNA was extracted
crying
using QIAamp DNA Blood Mini Kit. Samples were analyzed in
triplicate with no digestion, a methylation-sensitive digestion, and a
methylation insensitive-digestion, and then subjected to real-time
PCR analysis of RASSF1A.
Clinical cases and summary results: RASSF1A was detectable in all 096 (CASE REPORT)
undigested samples (100%) demonstrating that total cffDNA had
been extracted successfully. For the methylation-sensitive digest, 2 Uterine vascular malformations
(6.6%) samples had no detectable hypermethylated RASSF1A,
indicating no cffDNA in the sample and 28 (93.3%) had one or after pregnancy
more replicates positive for RASSF1A indicating the presence of a
cffDNA in the sample. For the methylation-insensitive digest, 28 E. De Bel and R. Stadshouders
samples (93.3%) were negative for RASSF1A indicating complete
restriction digestion and 2 samples (6.6%) had 1 replicate positive for Gynaecology and obstetrics, University hospital Ghent, Ghent,
RASSF1A indicating that restriction digestion was incomplete. Belgium
Conclusion: This modified rt-PCR assay for RASSF1A could be valuable
for NIPD, for use as a universal fetal DNA marker.
Introduction: We have three recent cases of patients with heavy blood
loss after a pregnancy, due to an uterine vascular malformation. We
Keywords: Cell-free Fetal DNA, noninvasive prenatal diagnosis, real- describe their clinical pattern, diagnosis en therapy.
time polymerase chain reaction, plasma Clinical cases and summary results: We describe a ‘real’ arterioveneus
malformation with succesful embolisation. There is also a case with
pseudo-aneurysm with spontanous resolution and a intramural
myoma that presents as a arterioveneus malformation.
Conclusion: Uterine vascular malformations are abnormal hypervas-
cular regions in the endometrium, with the presence of turbulent
182 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

flow. There is a low prevalence and the clinical presentation can be 165 (CASE REPORT)
variable. There is an congenital etiology (embyronic) or it can be
acquired after an uterine trauma. Making a diagnose and the
differentiation is often hard. The need and the way of treatment Antenatal Bartter syndrome: a
depends on the clinical presentation but also on the underlying
pathofysiology. The purpose of reviewing those three case-reports is case report
to give an overview of uterine vascular malformations after a
pregnancy, their possible presentations and the need for treatment, Chioukh Fz1,2, Ben Ameur K1,2, Ben Hmida H1,2, and
with implication in the clinical practices.
Monastiri K1,2
1
Keywords: Uterine vascular malformations Department of Intensive Care and Neonatal Medicine, Fattouma
Bourguiba Teaching Hospital, Tunisia, and 2Department of Radiology
B, Laboratory of Biology, Research Unit 01/UR/08.14, Faculté de
Médecine, University of Monastir, Tunisia
135 (CASE REPORT)
Introduction: Antenatal Bartter syndrome is a rare autosomic recessive
Delivery and postpartum man- tubulopathy (1/100 000 births) characterized by idiopathic hydram-
nios in mother leading to premature delivery, and elevated levels of
agement of a patient with pompe amniotic chloride. Postnatally newborns suffer from recurrent
episodes of severe dehydration and electrolyte imbalance which
disease, case report and review of can lead to fatal outcome.
the literature Clinical cases and summary results:: A six-month-old female was
admitted in our intensive care unit for dehydration and staturo-
ponderal delay. She was the second child of third degree
K. Koyuncu, B. Turgay, R. Aytaç, and F. Söylemez consanguineous parents. In family history there is a maternal niece
treated for a Bartter syndrome with deafness. Pregnancy was
Obstetric and Gynecology Dept., University Hospital of Ankara, complicated by hydramnios at 26 WG. The patient was born at
Ankara, Turkey the term of 36WG by vaginal delivery. Physical examination
showed poor weight gain (1500g for 6 months), cranial circumference
Introduction: Pompe disease (PD) is an autosomal-recessive disorder 30000 mIU/L). A bilateral sensorineural hearing loss at 70 DB was
caused by acid alpha-glucosidase deficiency due to mutations in the detected, Molecular biology is ongoing (mother and child). The
GAA gene. Adult patients are affected by limb-girdle muscular patient received intravenous fluid replacement at 200 ml/kg/day with
weakness and respiratory insufficiency. There is a little knowledge hypokalemia correction, ibuprofen at the dose of 30 mg/kg/day and
about pregnant women with PD. These patients should be Aldactone dose 2 mg/kg/day. Actually, she is 9 months old the last
considered as high risk pregnancies.Herein we present postpartum biological test was correct and she had a good weight gain.
hemmorhage management of a cesarean delivery of a patient with Conclusion: Antenatal Bartter syndrome is characterized by severe
PD who choose to interrupt enzyme replacement therapy during polyhydramnios in mother leading to premature delivery. This
pregnancy. premature newborn had severe manifestations of polyuria, recurrent
Clinical cases and summary results: A 38-year-old primiparous woman dehydration, and electrolyte derangements. Antenatal diagnosis is
at week 38 of gestation was admitted to our department for delivery. possible by amniocentesis and should be performed for heterozygous
She only had motor deficiency on her proximal leg muscles. After the mother’s or those who already have an affected child.
diagnosis of PD, enzyme replacement therapy (ERT) was initiated.
Pregnancy was uncomplicated and fetus was appropriate for Keywords: Bartter syndrome, polyhydramnios, hypokalemia
gestational age. The patient discontinued ERT at the very beginning
of her pregnancy because of fear of any adverse fetal effects. At 38 5
weeks, elective cesarean section was performed under regional
anesthesia because it was risky as the patient might not be able to be
extubated due to limited diaphragmatic and intercostal muscle
strength. As glycogen may be stored in the myometrium and impede 166 (CASE REPORT)
with its ability to contract, it was considered of utmost importance to
follow up vaginal bleeding and vital signs. In order to prevent Hypercalcemia induced by
postpartum hemorrhage, oxytocin infusion at a rate of 100 mU/min
was given for 16 hours continuously. Methylergonovine was pre- hypersensitivity to vitamin D:
scribed 0.2 mg IM three times a day and after 24 hours 0.125 mg orally
every 8 hours for the next 3 days. Preoperative Hb was 12.8 gr/dL and
a neonatal case
decreased to 10.4 gr/dL 6 hours postpartum. Patient was admitted to
the ICU for 12 hours postpartum. The following 3 days were Fz. Chioukh1,2, K. Ben Ameur1,2, H. Ben Hmida1,2, and
uneventful until discharge at the same day. K. Monastiri1,2
Conclusion: In our quite uncomplicated case of pregnancy in a patient
1
with a diagnosis of PD, we aimed to stress out postpartum Department of intensive care and neonatal medicine, Fattouma
management with all preventive measures needed to be taken to Bourguiba Teaching Hospital, Monastir, Tunisia, and 2Research Unit
avoid the possibility of uterine bleeding and postoperative infection. 01/UR/08.14, Faculté de Médecine, University of Monastir, Monastir,
Although anticoagulation medication had not been used in our Tunisia
patient due to early ambulation, the tendency of increased
intravascular coagulation in these immobilized patients should be
Introduction: Vitamin D supplementation for the prevention of rickets
taken into consideration. We did not observe any postoperative
is one of the oldest and most effective prophylactic measures in
complications with this approach.
pediatrics. Idiopathic infantile hypercalcemia (OMIM#143880) or
Hypercalcemia induced by hypersensitivity to vitamin D is rare, and
Keywords: Pompe disease, cesaerean section, postpartum can be fatal. Clinical manifestation is characterized by failure to thrive,
managment vomiting, dehydration, and nephrocalcinosis.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 183
Clinical cases and summary results: A twenty four-days-old male was Conclusion: Our aim here was to evaluate the antepartum and
admitted for severe dehydration. He was born by cesarean section for postpartum results of a pregnant woman with chronic idiopathic
preeclampsia at 34 WG and was hospitalized in our unit for 10 days. leukocytosis in pregnancy where the immune function exhibits
The newborn received a single dose of 200 000 IU of vitamin D3 changes. We think that when the results of the two pregnancies are
(VitD3 BONß) for 6 month by 15 days of age. He was asymptomatic examined in this rarely seen case.
until 22 days old when he developed hypotonia and vomiting.
Physical examination showed a severe dehydration, hypotonia and Keywords: Leukocytosis, white blood count, low molecule weight
hypotension. Laboratory tests showed a major hypercalcemia heparin
(4.70 mmol/l) with high urinary calcium (Cau/creat.U 40.3)and low
phosphoremia (1.51 mmol/l), PTH was at 5 pg/ml, high vitamin D3 at
29.720 nmol/L, and 1,25-dihydroxyvitamin D3 at 442 pmol/l.
Abdominal ultrasound showed bilateral nephrocalcinosis grade III.
Our patient received an intravenous hydration, and corticosteroids
(Hydrocortisone 3mg/kg/day) to control hypercalcemia. Outcome was 201
good: normalization of serum calcium, urinary calcium level regress
and the baby has progressive weight catch. To confirm genetic Pregnancies and deliveries in
involvement we underwent a molecular analysis of CYP24A1 gene.
Conclusion: Hypersensitivity to Vitamin D is a rare disease that can be migrant women: the experience
life threatening and require urgent and appropriate care. Selective
occurrence of toxic effects in some individuals can be explained by a in an Italian region
genetic sensitivity to intrinsic vitamin D.
V. Viola, L. Fatigoni, L. Minelli, and M. Chiavarini
Keywords: Neonatal hypercalcemia, dehydration, hypersensitivity to
vitamin D Department of Experimental Medicine, Public Health Section,
University of Perugia, Italy

Introduction: The social disadvantage of immigrant women and the

difficulties of access to services result in worse outcomes in terms of
health, so the aim of this study is to evaluate the access to services
175 and maternal-child health of immigrant women in Umbria.
Materials and methods: The data was obtained from a population
Course of chronic idiopathic based study using routine maternity discharge data. This study
consists of 7310 women who delivered in Umbria, an Italian Region,
leukocytosis in pregnancy during 2014. Indicators such as access to services during pregnancy
(WHO indicators as first visit and visit’s number, ecograph’s number
U. Keskin1, A. Saygı2, F. Kıncı1, S. Sayın3, U. Fidan1, and and invasive prenatal diagnosis), Pomi indicator (presence of trusted
M. C. Yenen1 person), mode of delivery and neonatal outcomes (duration of
pregnancy, birth weight, need of intensive care and stillbirth) in
1
Gülhane Military Medical Academy and Medical School, Obstetrics relation to citizenship’s mother are studied. Logistic regression
and Gynecology Department, Etlik, Ankara, Turkey, 2Etimesgut models were used to analyse the magnitude of citizenship’s mother
Military Hospital Obstetrics and Gynecology Department, Etimesgut, with respect to indicators.
Ankara, Turkey, and 3Gülhane Military Medical Academy and Clinical cases and summary results: - 23% of childbirths is represented
by foreign women (over 50% of which come from Romania, Albania
Medical School, Hematology Department, Etlik, Ankara, Turkey
and Morocco) and the fertility rate (the average number of children
per woman) among foreign residents is 1.63 against 1.27 of Italian
Introduction: Showing a progressive increase during pregnancy, residents - the average age at delivery is 32.7 for Italian residents,
peripheral leukocyte count may rise up to 20.000 - 30.000/mm3 at while it is 29.1 for foreigners and the frequency of mothers aged more
birth. It has been demonstrated that the increase in leukocyte count than 35 is higher among Italian women (37.7% versus 16.5%), the
may be associated with increased estrogen and cortisol levels and a percentage of multiparous mothers is higher among foreign women
‘‘leukocyte activation’’ occurs due to the phenotypic and metabolic than Italian ones (46.1% versus 35.8%). It also highlights, in women
changes in leukocytes. We intended to show in this case report the with foreign citizenship compared to italian women, the critical points
antepartum and postpartum outcomes of a pregnant lady with in the Table1.
chronic idiopathic leukocytosis. Conclusion: The maternal and child health is one of the most critical
Materials and methods: A G2P1 patient who had been diagnosed with areas for which many have stressed the importance of accessibility to
high WBC for a period of approximately 15 years was referred to our social and health services which is largely conditioned by the
hospital due to a WBC of 35*10.e3/ml at gestational week 30.The information and knowledge that foreigners receive and by the quality
peripheral smear perform showed that the leukocyte percentage of relationships with health and social service workers.
distribution was within normal limits. In the flow cytometry that was
carried out to exclude Chronic Lymphocytic Leukemia (CLL), there
Keywords: Immigrant women, access to services, maternal-child
was no finding compatible with that condition. The result of the Ph
health
chromosome analysis was reported to be normal.
Clinical cases and summary results: The patient was diagnosed with
idiopathic leukocytosis. Until the genetic analysis was reported we
started a LMWH therapy. At gestational week 39, she was
administered a cesarean delivery. The JAK2 V617F gene mutation
analysis, turned out to be negative, bone marrow aspiration and
biopsy examination were proposed. The patient did not give
permission. The patient’s WBC was 12*10.e3/ml at postpartum week
6 and 14.8*10.e3/ml at postpartum week 8.
184 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Conclusion: These results suggested that HG may have adverse effects

219 on both mother and baby’s health. Pregnant women with HG should
Hyperemesis gravidarum affects be provided with training and consultancy services and be closely
monitored in terms of anemia and thyroid hormones.
maternal sanity, thyroid (This study was publicated in Archives of Gynecology and Obstetrics
at August 2015, Volume 292, Issue 2, pp 307-312)
hormones and fetal health: a
prospective case control study Keywords: Hyperemesis gravidarum, maternal sanity, fetal health

N. Buyukkayaci Duman1, O. Ozcan2, and M. O. Bostanci3

1
Department of Nursing, Health School, Hitit University, Corum,
Turkey, email: [email protected] of Biochemistry, 227
Medical Faculty, Mustafa Kemal University, Hatay, Turkey, and
3
Department of Physiology, Medical Faculty, Hitit University, Corum, Relationship between antenatal
Turkey
factors and the birth outcome in
Introduction: Hyperemesis gravidarum (HG) is a condition of severe Korean women
nausea or vomiting accompanied by various complications during
pregnancy. In the present study, we aimed to demonstrate the effects
of HG on mother and fetus health H. W. Kim
Materials and methods: Control and case group were arranged from Seoul National University, College of Nursing, The Research Institute
50 healthy pregnant women and 50 pregnant women with
of Nursing Science, Seoul, South Korea
HG.Information about the participant women was gathered with
data collection form and Beck’s Depression Inventory (BDI) and State
Anxiety Inventory (SAI) were administered to the women. Following Introduction: The birth outcomes could be influenced by the many
an abortion or delivery, the data about birth complications and factors during the pregnancy. In Korea, the trends have been shown
neonatal health were collected. All laboratory results (blood count, that increasing the numbers of the women with high risk pregnancy
thyroid hormones, electrolyte values and biochemical parameters) and antenatal depression. This study aimed to identify the role of the
were gathered from the laboratory information system used in the women’s characteristics during the pregnancy including the pre-
hospital. pregnancy affecting the birth outcome among the Korean mothers.
Clinical cases and summary results: It was found that in the case group, Materials and methods: The participants were 255 pregnant women
mean postpartum weight, serum hemoglobin, hematocrit and thyroid who were followed in a prospective study. Of these, 197 cases were
stimulant hormone levels were lower than control group (p 50.01). examined included birth weight, AFGAR scores at 5 minutes,
Conversely, case group women have higher T3 and T4 levels than premature contraction, complication of labor, delivery types and
control group (p 50.01). There was no significant difference between laboratory data for dependent variables. The independent variables
the two groups in terms of intrauterine growth retardation, low birth were that age, BMI, income level, education, antenatal depression,
weight and abortion but it was observed that women with HG had and high risk pregnancy. The relationships between the dependent
often delivered prematurely. The mean scores of BDI and SAI in the and independent variables were analysed using Relative Risk and
case group were higher than those of control group. Adjusted Logistic regression with SPSS/Win.
Clinical cases and summary results: level of antenatal depression was
associated with low birth weight (x2=7.69, p=.010) and high risk
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 185
pregnancy was a predictor of low birth weight (OR=6.98[1.21-40.30]) hypoparathyroidism is not diagnosed during pregnancy, it produces
and baby’s weight (OR=2.12,[1.05-4.28]). Prepregnancy body mass hypocalcemia in the fetus, which is considered the stimulus to
index (BMI) was a predictor of complications in labors (OR=3.59[1.03- increase production of fetal parathyroid hormone (PTH).
12.48]). Clinical cases and summary results: Maternal hypothyroidism treated
Conclusion: Women with antenatal depression, high risk pregnancy, with levothyroxine 25mcg. Vaginal delivery at 36 weeks. At birth, the
prepregnancy BMI more than 23 kg/M2 shuld be carefully monitored newborn presents generalized hypotonia and respiratory depression,
and managed to ensure favorable birth outcomes. requiring IPPV. Apgar 5/7. Weight 2400gr (2 SD), height 45cm (2
SD). Hés admitted in the Neonatal Unit for distress and study of
Keywords: Depression, low birth weight, pregnant women symmetrical intrauterine growth restriction. During the first hours, the
newborn presents respiratory distress and tachypnea (90rpm), weak
cry, yellowing. Associated dysmorphic features: narrow and elongated
thorax, axial hypotonia, intense craniotabes, small petechiae, narrow
palate and face and trunk, so we initiated a study of syndromic
pathology. During the first days, the respiratory distress persists, he
228 needs respiratory support, improving gradually and allowing its
removal week prior to discharge. Analytical study shows:phosphorus
Perception of the human 2.8mg/dL (low), calcium ion 6.02mg/dl and very high levels of PTH
1766pgmL,so that neonatal hyperparathyroidism is suspected. During
papillomavirus and the admission, PTH levels down to normal in the third week,like the
serum calcium and phosphoremia. In the extension study, we request
willingness to prevent HPV a radiological bone series, and we watch a hypoplastic thorax, short
infection of the boys ribs with dysplastic aspect, widespread demineralization, shortening
and bowing of femur, humerus, radius and ulna. Suspecting neonatal
hyperparathyroidism and as extension study thereof, asymptomatic
H. W. Kim maternal hypoparathyroidism is diagnosed so far, with PTH 10.1pg/
mL, Ca ion 4.38mg/dL, phosphorus 4.6mg/dL, FA 149U/L.
Seoul National University, College of Nursing, the Research Institute Conclusion: The patient had diffuse bone disease at birth and severe
of Nursing Science, Seoul, South Korea hypotonia. The diagnosis of neonatal hyperparathyroidism was made
based on an increase in serum PTH in association with radiological
Introduction: The rate of HPV vaccination is low and formal education abnormalities. The transience of the disease is reflected in the
for HPV prevention is not provided to Korean students. This study resolution of laboratory abnormalities at month of life, and bone
explored the perception of HPV and the willingness to prevent HPV lesions at six months. He received treatment with vitamin D 400U / I
infection of Korean boys. day for the first 6 months of life.
Materials and methods: This study explored the perception of HPV and
the willingness to prevent HPV infection of Korean boys. The survey Keywords: Neonatal hyperparathyroidism, maternal hypoparathyr-
design involved 615 Korean boys. Measurements were the levels of oidism, fetal hypocalcemia, parathyroid hormone
the perception of the severity of HPV as a sexually transmitted
infection (STI) and as a cause of cancer, and their willingness to
prevent HPV infection using at least one of four methods toward the
boys and the girls.
Clinical cases and summary results: HPV as an STI in boys (p50.05) and
as a cause of cervical cancer (p 50.05) were associated with 254
minimizing the number of sexual partners toward the boy.
Whereas, HPV as a cause of cervical cancer was associated with Ambiguous external genitalia:
condom use (p 50.05), delaying sexual activity (p 50.05), and
minimizing the number of sexual partners (p 50.05) and HPV as an what might be the reason?
STI in boys (p 50.01) were associated with minimizing the number of
sexual partners toward the girl. A. Campos Martı́nez, A. Montoro Sánchez, R. Pérez Iañez,
Conclusion: Extending the perception of HPV to the girls could
increase the willingness of boys to prevent HPV infection. Boys should
J. Casas Gómez, and A. Rodriguez Leal
be made more aware that HPV causes cervical cancer and is a Paediatric Dept., Motriĺs Hospital, Motril, Granada, Spain
common STI in both sexes.
Introduction: Presence of ambiguous genitalia involves a birth defect
where the external appearance of the external genitalia is not
251 (CASE REPORT) characteristic of the newborn. The are differents causes: decreased
production of fetal androgen, decreased or absent androgen in men,
A curious case of neonatal primary defect in the development of the external genitalia in males
by non-hormonal problems, or partially masculinized genitals due to
hyperparathyroidism: what fetal exposure XX response androgen in utero (congenital adrenal
causes it? hyperplasia or origin of the mother). Triying to discover the cause we
use the clinical history, physical examination and additional tests.
Clinical cases and summary results: Our cause is about a newborn who
A. Campos Martı́nez, A. Montoro Sánchez, P. Cid presented bifid scrotum with testes in bags and peneanoescrotal
Galache, R. Pérez Iáñez, J. Casas Gómez, and S. Broncano hypospadias with micropenis, the remaining normal scan. Personal
Background: Prematurity 35 + 1 weeks dichorionic twin gestation
Lupiáñez
second diamniotic by in vitro fertilization. Cesarean section for breech
Paediatric Dept., Motriĺs Hospital, Motril, Granada, Spain position. negative serologies. Apgar 9/10. Birth weight: 1610 gr. In
abdominal and testicular ultrasound could be seen in bags and
normal morphology, thickened scrotal hydrocele covered. karyotype,
Introduction: The neonatal hyperparathyroidism secondary to mater-
blood count, blood gas and biochemical hormone was requested.
nal hypoparathyroidism is a rare condition. When the maternal
Blood gases and electrolytes were within normal limits, the presence
186 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

of very high levels of Androstenedione (410 ng / ml) and Hormone exams may be necessary for a comprehensive evaluation. Its fatal
antimulleriana (4150 ng / ml), with other hormones in the normal cases are usually secondary to cardiac defects. Prenatal suspicion and
range (testosterone, dihydrotestosterone, 17O Hprogesterona , LH, postnatal confirmation are essential for family follow-up and genetic
FSH, DHEA-S, Estradiol 17B, basal Cortisol (11 deoxycortisol). counseling.
Karyotype 46 XY. With that hormone levels and presentation he
was diagnosed of a probable partial androgen insensitivity syndrome Keywords: Ellis-van Creveld syndrome, chondroectodermal dyspla-
(PAIS). Pending the genetic results for gene mutation in the AR sia, newborn, mutation, prenatal diagnosis
(androgen receptor), responsible for 20% of these cases. The baby
was delivered to sugery unit to monitorised and repair hypospadias
and orchidopexy made in the first year of life, after weekly treatment
with B-HCG intramuscular.
Conclusion: In most cases of ambiguous genitalia, the differential
diagnosis is difficult, given the wide variety in both:the symptoms and
the underlying causes. PAIS is a disorder of sexual development, with
an unknown prevalence characterized by abnormal genital develop-
ment in a 46XY child with normal development of the testes and
partial sensitivity (generally resistance) to the appropriate levels of
androgens for age, presenting highly variable needs genital
appearance and sometimes corrective surgery.

Keywords: Ambiguous external genitalia, PAIS, disorder of sexual

development

257 (CASE REPORT)

Ellis-van Creveld syndrome: case
report
G. N. B. Soledade, T.R.M. Buetto, and G.F. Rodrigues
Neonatal Intensive Care Unit, Hospital São Francisco, Mogi Guaçu,
São Paulo, Brazil

Introduction: Ellis-van Creveld syndrome (EVC) is a rare syndrome

characterized by short limbs and short ribs, postaxial polydactyly,
dysplastic hair, nails and teeth, and congenital heart defects. It was
first described in 1940 and, until the present, about 200 cases have
been reported. Its prevalence is between 1 in 60,000 to 200,000
newborns. Two genes in chromosome 4p16 have been found to be
related to this syndrome. It can be a fatal condition prominently due
to cardiac defects, although some individuals can reach adulthood 259
bearing mental and sexual delays. The diagnosis is essentially based
on clinical features but radiologic and cardiologic evaluation can be
Maternal quality of life in routine
helpful on the screening of complications. Genetic study may also be
performed in order to provide genetic counseling to the families.
labor epidural analgesia versus
Clinical cases and summary results: A girl was born at 35 weeks of labor analgesia on request,
pregnancy from a 32-year-old mother with two previous stillborns
and no living children. The mother had no previous morbidities but results of a randomized trial
developed gestational hypertension. No family history was reported.
Prenatal ultrasound revealed polyhydramnios, fetal growth restriction,
A. A. S. van den Bosch1, M. Goossens2, K. Bonouvrié1,
polydactyly in hands and feet, intraventricular communication and
possible absence of right kidney. The baby was non-vigorous at birth, B. Grimm3, J.G. Nijhuis1, F. J. M. E. Roumen3, and
requiring tracheal intubation at birth room. Apgar score was 2, 6 and M. M. L. H. Wassen3
7 at first, fifth and tenth minutes. At physical examination: rare, brittle 1
hypochromic hair, small, dysplastic nails, enlarged nose, short limbs, Maastricht University Medical Center+, Department of Obstetrics
type III postaxial polydactyly in both hands and both feet, incomplete and Gynecology, GROW School for Oncology and Developmental
syndactyly of left 2nd-3rd toes and right 3rd-4th toes, narrow thorax Biology, Maastricht, The Netherlands, 2Maastricht University,
with short ribs and prominent hypoventilation, lower attachment of Department of Rehabilitation Research & Clinical Psychological
upper labial frenum. Echocardiography confirmed intraventricular Sciences, Maastricht, The Netherlands, and 3Zuyderland Medical
communication, persistent ductus arteriosus and primary pulmonary Center Heerlen-Sittard, Center of Education & Research, CX Heerlen,
hypertension (PPH). Abdominal ultrasound showed hypoplastic right The Netherlands
kidney. The newborn had PPH related complications such as
refractory cardiogenic shock and severe hypoxemia, with fatal Introduction: Maternal quality of life (QOL) is complex, multidimen-
evolution at 19th day. sional, and may be affected by many factors, including childbirth. The
Conclusion: EVC is a rare dysplastic syndrome caused by mutations in maternal QOL has been increasingly recognized as an important
the chromosome 4p16. Its diagnosis is clinical but complementary outcome measure for the evaluation of medical practice. Women’s
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 187
childbirth experience is influenced by many factors, including coping 1
Department of Midwifery, Faculty of Health Sciences, Cumhuriyet
with pain and pain relief during labor. The purpose of this study was University, Sivas, Turkey, 2Department of Nursing, Faculty of Health
to evaluate the changes in QOL from pregnancy to 6 weeks after Sciences, Cumhuriyet University, Sivas, Turkey, and 3Department of
delivery in women who received routine labor epidural analgesia (EA),
Biostatistics and Medical Informatics, Faculty of Medicine,
compared with women who received pain relief on maternal request
Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
only.
Materials and methods: Women delivering of a singleton in cephalic
presentation beyond 36 + 0 weeks’ gestation were randomly allocated Introduction: Gas pains observed specifically among healthy infants of
to routine labor EA or analgesia on request (control group) in one 2 weeks to 4 months of age (infantile colic) affects parent-infant
university and one non-university teaching hospital in The relationship and occasionally put families in tense and stressful
Netherlands. The Short Form health survey (SF-36) was used to situations. It is of great importance for nurses and midwives to
assess women’s QOL before randomization, and 6 weeks postpartum. provide information and assurance to tense and stressed parents with
Data were analyzed according to the intention to treat. respect to the physiology of infantile colic, its effects on the infant,
Clinical cases and summary results: A total of 488 women were and the methods to be used to relieve gas pains either during house
included and ante partum, as well as postpartum SF-36 question- calls or at hospitals. Therefore, the present study was planned with
naires were filled in by 356 (73.0 %) women, where 176 (49.4 %) of the aim of identifying the factors affecting gas pains among infants of
them were allocated to the routine EA group, and 180 (50.6 %) to the 0-4 months of age and the practices used by mothers in this context.
control group. In the control group, 41 (22.8%) women gave birth Materials and methods: The cross-sectional study included volunteer-
without any pain medication. Compared to the QOL during ing mothers (373 people) of 0 to 4 month old infants suffering from
pregnancy, women’s QOL, six weeks after delivery, showed compar- gas pains that applied at the Family Healthcare Centres (Alibaba,
able changes in the routine EA group and the control group. Women Aydogan, etc.) situated in central Sivas between 15.02.2015 and
in the routine EA group had significantly more adverse events related 15.05.2015. Study data were collected through the use of a
to EA, including maternal hypotension, motor blockade, and questionnaire form created by the authors as a result of the review
postpartum urinary retention. This was in comparison to the of the relevant literature. The data were evaluated in the SPSS (22.0)
women who delivered with analgesia and without in the control software package and tabulated through the use of averages,
group, where women who delivered without labor analgesia had standard deviations, percentages, Fisher’s exact test and chi-square
more often a previous vaginal delivery and less frequency an test. Statistical significance was examined at the level of p 50.05.
unplanned cesarean section, but comparable changes in QOL. Clinical cases and summary results: 15.7% and 53.1% of the mothers
Conclusion: Routine administration of EA during labor and pain relief were identified to use baby bottles and pacifiers, respectively,
on request are associated with comparable changes of women’s QOL, whereas 72.4% were found to be consuming flatulent foodstuffs. In
from pregnancy to six weeks after delivery, whereas women in the the first four months, mothers had used medicinal treatment (41%),
routine EA group had more adverse events which were related to EA. herbal teas (25.7%), holding baby in arms (58.2%), blow-drier (13.1%)
Based on the changes in women’s QOL, no preference can be given to and sound of washing machine or vacuum cleaner (23.6%), car rides
routine labor EA, as compared with labor analgesia on request. (28.4%), massaging, back-patting (74%), heat treatment (37%),
frequent changes in position (39.9%), light music (17.1%), and
bathing (11.8%). From amongst the mothers, secondary school
Keywords: Analgesia, childbirth, epidural, labor, quality of life graduates had more recourse to medicinal treatment and use of a
blow-drier, those in the age group of 21-30 years to holding in arms
and sound of washing machine, those living in districts to use of
herbal teas, those living in villages and the city to bathing, and those
that stated they had a stress-free personality to holding in arms and
massaging. The difference among these groups was found to be
statistically significant (p 50.05).
Conclusion: Mothers had utilised a number of different practices to
relieve their infants of gas pains (herbal and medicinal treatment,
back-patting and massaging, use of blow-drier or sound of washing
machine, heat treatment, etc.). The ratios of such practices against gas
pains were affected by certain socio-demographic characteristics
(educational status, age, domicile location, stressful personality).

Keywords: Mother, Infant, Infantile colic

267
Perinatal outcomes from in vitro
fertilization –retrospective cohort
study in latvia
265
Factors affecting infantile colic in I. Zile1,2, I. Jefremova1, A. Villerusa1, and I. Gavare2
infants of 0-4 months of age and 1
Riga Stradin’s University, Public Health and Epidemiology
Department, Riga, Latvia and 2The Centre for Disease Prevention and
relevant maternal practices Control, Riga, Latvia

G. Demirel1, I. Yildiz2, N. Akgun Gundogdu2, and Introduction: Pregnancies that occur after assisted reproduction,
constitute high-risk pregnancies. The multiple births and delivery
A. Doganer3
188 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Figure 1. Flowchart of the participants of the QOL study.

complications are much higher from in-vitro fertilisation (IVF)

pregnancies than the average. In Latvia IVF births have increased Keywords: In-vitro fertilisation, perinatal outcomes, multiple births
from 147 cases in 2007 to 263 in 2014.
Keywords: Objective: To investigate the association with newborns
perinatal risks conceived through in vitro fertilization.
Materials and methods: Data from population-based Medical Birth
Register were used. The analysis includes data on 1674 IVF newborns
and comparative or control group - without IVF - 167,038 newborns 269 (CASE REPORT)
(2007 - 2014). Adjusted Odds ratios (OR) with 95% confidence
intervals (CI) were estimated. Multiple regression model adjusted for
The tricky peripherally central
mother age, multiple births, delivery complications, birth weight (BW)
and gestational week (GW).
catheter in preterm infant
Clinical cases and summary results: The average maternal age of IVF
group was 33.1 years (SD ± 4.9) in contrast without IVF (28.0 M. Ali, P. Gilbertson, and I Khan
(SD ± 5.8)), newborn gestational week respectively 37.5 (SD ± 2.9)
Midyorks Hospital NHS Trust, Wakefield, United Kingdom
and 39.1 (SD ± 1.9). Maternity characteristics showed significant
differences between multiple births - 25.0% with IVF to 1.1% (p
50.001), delivery complications 58.8% to 54.2% (p 50.001), caesarean Introduction: Peripherally inserted central catheters (PICC) are
sections 49.4% to 22.6% (p 50.001), maternal age 35 years 37.7% to frequently inserted in preterm babies for central delivery of total
14.6% (p 50.001), primipara 79.7% to 48.1% (p 50.001). Perinatal parenteral nutrition. We are presenting a case in which the PICC was
factors: certain conditions originating in the perinatal period 35.2% to noted to make a loop on abdominal X ray. On pulling back to adjust
31.8% (p 50.01), low birth weight (2499g) 20.3% to 4.5% (p 50.001), its position, a true knot was noted and it was difficult to remove the
gestationl age (36 GW) 21.6% to 5.4% (p 50.001), stillbirths 1.0% to line. Our line coiled intra-luminally which is very rare, especially in
0.6% (p 50.05), congenital anomalies no differ between groups. The preterm babies.
higher odds of having a multiple birth was in IVF group (ORadj=28.1, Clinical cases and summary results: A 30 + 1-weeks gestation female
95% CI 25.2-31.4, p 50.001), maternal age 35 years (ORadj=7.2, 95% infant was born by emergency caesarean section. She was success-
CI 6.3-8.1, p 50.001), primipara (ORadj=8.5, 95% CI 7.4-9.8, p 50.001), fully recruited in the SIFT trial. She required parenteral nutrition for
delivery complications (ORadj=1.2, 95% CI 1.1-1.3, p 50.05) and which a 2 Fr PICC was inserted in the left saphenous vein on day 2 of
perinatal conditions (ORadj=1.2, 95% CI 1.1-1.3, p 50.05). life. There was difficulty in advancing the line beyond 10 cm when it
Conclusion: IVF children are often born to mothers aged 35 years, was thought to be in the groin but after some perseverance line was
from multiple birth, primipara, by caesarean section. Although the advanced easily to 20 cm. An abdominal x-ray revealed the line
rates of adverse perinatal outcomes of the pregnancies after IVF just making a loop in the abdomen(figure1). The line was pulled back
slightly higher than pregnancies without IVF. 5 cm to adjust its position(figure2) and then a further 5 cm(figure3). At
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 189
this point a true knot was noted and the line was removed without Conclusion: Cordocenteses for diagnostic purposes are rarely
pulling too hard(figure4). It needed a stab incision over the skin at the performed nowadays. However, cordocentesis remains the method
entry point. Bleeding at the exit site was controlled by applying of choice in several situations where intrauterine fetal therapy is
surgicel and pressure. indicated such as immune hydrops and hemolytic anemia.
Conclusion: Knotting is a rare complication of PICC but an important Keywords: Cordocentesis
cause of difficult line removal. It is likely that the line met resistance
more centrally and coiled and the knot probably formed as we pulled
the line back to adjust its position. It is very important to recognise Diagnostic
this complication and not to pull too hard when removing the line as indications hemophilia 11/260
forceful removal can cause venous trauma, line fracture and
embolisation. For more complicated knots surgical approach would Markers of chromosomal abnormalities 51/260
be recommended. 2nd trimester biochemical screening 8/260
Structural abnormalities 48/260
Maternal age 55/260
Cardiac abnormalities 4/260
B-thalasemia 46/260
Infections 1/260
Other indications 13/260
Laboratory failure after amniocentesis 8/260
Therapeutic Rhesus disease 46/52 (88%)
indications Fetal hydrops 6/52 (12%)

298 (CASE REPORT)

A case report of a 21-year-old
pregnant patient with abnormal
karyotype and Bloch-
Schulzberger syndrome diag-
nosed for metachromatic
leukodystrophy
A. Dró_zd_z, M. Sajewicz, and H. Huras
Gynecology and Obstetrics Department, Jagiellonian University
Medical College, Cracow, Poland

Introduction: Bloch-Sulzberger syndrome is an X-linked dominant

inherited and rare genetic disorder with an incidence of 1:50 000-
1:75 000 live female births. Genetic basis of this disease is a mutation
in the NEMO gene which is located in locus 28 of the X chromosome.
293 It is characterised by progressing lesions of different morphology,
which after many years present as hairless, atrophic spots or regions
Cordocentesis with diagnostic of hypopigmentation. Other symptoms observed in these patients
are ocular (strabismus, nystagmus, iris hypoplasia) or neurological
and theurapeutic indications (microcephaly, mental retardation). Incontinentia pigmenti often also
presents with tooth and nail dysplasia.
M. Theodora, V. Maritsa, G. Asimakopoulos, P. Antsaklis, Clinical cases and summary results: 21-year-old patient was admitted to
K. Blanas, M. Sindos, and G. Daskalakis the Clinic of Obstetrics and Perinatology in Cracow because of
hypertension, anhydramnios and rupture of the membranes during her
Maternal Fetal Medicine Dept, 1st Dept of Obstetrics &Gynecology first pregnancy. She was diagnosed with an abnormal karyotype- 45XX
University of Athens, Alexandra Hospital der (13,14) (q10,q10) and Bloch-Sulzberger syndrome in 2008 with the
following symptoms: pigmentation disorders on the left side of the
Purpose: The purpose of this retrospective study is to present the trunk, around the left shoulder, lower and upper limb, bilateral
indications, the demographic characteristics of pregnant women and hypoplasia of the nails, abnormal skull construction, facial dysmorphia,
the outcome of pregnancies which underwent cordocentesis with congenital dysplasia of the teeth, intelectual retardation. During
either diagnostic or therapeutic indications. hospitalization she complaint about blurred vision and headaches.
Materials and methods: In this retrospective study we included 312 After neurological consulatation MRI of the eyes and brain was
cordocenteses done in our department during the period 01/01/2007 ordered. MRI image suggested metachromatic leukodystrophy.
to 01/06/2015. Genetic tests for lysosomal disease were done. Arylsufatase activitiy
Clinical cases and summary results: The mean age of the pregnant level was within normal limits. The deterioration observed in the
women was 32 years (19-42) and the mean gestational age at the imaging examinations is probably related to the progress of Bloch-
procedure was 22 weeks. The main indication for therapeutic Sulzberger syndrome.
cordocentesis was Rhesus immunization and for diagnostic proce- Conclusion: This case presents the issues of pregnancy care for
dures late diagnosis of anatomical abnormalities of the fetus. The patients diagnosed with genetic disorders. Our patient has an
percentage of live births was 97% while the abortion rate was 2.5%. abnormal karyotype and X-linked Bloch-Sulzberger syndrome and
we also suspected an autosomal recessive disease. Patients with
190 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

elevated risk of multiple genetic disorders should be offered a proper

prenatal diagnosis. Appropriate obstretic care should be provided
309
due to a multitude of systemic defects found in those rare diseases. Knowledge levels of pregnants
Keywords: Bloch–Sulzberger syndrome, abnormal karyotype, about vaginal delivery with
prenatal diagnosis
epidural anesthesia
S. Cambaz Ulas, S. Koken, S. Ildan Calim, and H. Demirci
301
Celal Bayar University, School of Health, Midwifery Department,
Childbirth fear of pregnant Manisa, Turkey
women in prenatal period and Introduction: Epidural analgesia provides pregnant women to attend
related factor the delivery process as well as to ease the labor pain. Comfort of
patient and psychological convenience which result of less labor
contribute more satisfied discharging patients from hospital. This
H. Demirci, H. N. Simsek, M. Turemen, and I. Atlig method is the most preferred analghesia method for delivery. This
Midwifery Department, School of Health, Celal Bayar University, research is planned to determine the knowledge level of the pregnant
women who applied to Manisa Maternity Hospital.
Manisa, Turkey
Materials and methods: This resarch is a descriptive study. The sample
size of this study is calculated as n=357 which is minimum sample size
Introduction: Given that childbirth is not a completely controllable in Epi info program with 95 % confidence interval and 5 % margin of
process whose results cannot be entirely predicted, during their error and 50 % unknown prevalance by assumed the monthly
pregnancy most women may experience fear of delivery. Fear of labor average number of pregnant women who applied to Polyclinics of
which is affects the mother, fetus and new born in many ways, leads Manisa Morris Sinasi Maternity Clinic as 5064 in 2014. Data of the
to negativity of relationship between the parents. Fear of birth to be research are collected by survey form with face to face interview
identified by medical staff, determine the level, determine the factors method that was prepared by researchers. Percentage distribution of
cause of fear of labor and planning the appropriate interventions is numbers is used for evaluation of data.
important. This research was conducted to examine fear of childbirth Clinical cases and summary results: Average ages of pregnants
in pregnant and to determine the factors that cause this fear. included in this study is found as 37.15 ± 12.14 and 31,9% of them
Materials and methods: This descriptive and cross-sectional study was are graduated from primary school. Examining of reproductive
conducted in obstetrics and gynecology clinics and NST polyclinics of documentation of the pregnants is shown that 62,7% of them have
Manisa Merkez Efendi State Hospital between 21 and 25 March 2016. previously given birth and 74,3 of them have given vaginal delivery.
Instead of sampling selection, 132 pregnant women who appealed to It’s found that 57,7% of pregnant women haven’t heard epidural
related policlinics that met the criteria for being included in this study vaginal delivery, 72,1% of them have never had information about
were consisted the sampling of the study. Data of the research were this issue. It’s determined that 37,8% of pregnant women know the
collected by using Survey Form and version A of the WIJMA Delivery correct definiton of epidural vaginal delivery. It’s found that 73,1%
Expectancy/Experience Questionnaire (W-DEQ A) (Cronbach alpha, of them don’t know the effects of epidural delivery on mother and
0.89) after permisson of the institute and approval of Ethical 87,7% of them don’t know the effects of epidural delivery on child
Committee. The data obtaining from the Study were evaluated in Conclusion: It’s determined that the knowledge levels of pregnant
SPSS package program by using median, minimum and maximum women about epidural vaginal delivery is very poor.
values with percentage numbers and paired t test.
Clinical cases and summary results: 40.9% of pregnant women are in
Keywords: Epidural analgesia, vaginal delivery, knowledge level
18-24 age group, 26.5% of them are graduated from middle school,
85.6% were hausewife, 75.8% of them have nuclear family. Average
duration of marriage is 3 years and 43.9% of them are in their first
pregnancy. 82.6% of the pregnancies were planned. All multipar
pregnant women were given birth by vaginal delivery. It is observed
that 81.1% of the pregnant women are afraid of delivery. 68.2% of
316
women are stated that they have knowledge about delivery. Psychological support for
Resources, mother, friends, relatives and health staff, respectively.
The mean W-DEQ A score of women was 55.92 ± 22.95 (Min:6 - obstetric professionals: views
Max:116). Statisticall significant difference was found in W-DEQ A
scores in relation to unplanned pregnancy, socioeconomic status, fear from staff
of childbirth, hearing negative stories about labor (p 50.05).
Conclusion: We found that pregnant women had moderate fear of D. Marı́n-Morales1, M. Losa-Iglesias2, I. Corral-Liria2, and
childbirth. In antenatal period, fear of childbirth to be identified by
medical staff, determine the level, determine the factors cause of fear
R. Jiménez-Fernández2
of labor and planning the appropriate interventions is important. 1
Obstetric Department Fuenlabrada Universitary Hospital,
Madridand 2Health Sciences, Rey Juan Carlos University, Madrid
Keywords: Pregnancy, fear of childbirth, wijma delivery expectancy/
experience questionnaire Introduction: Obstetrics professionals sometimes face to critical
incidents, related to severe maternal and fetal outcomes. There are
specific factors in obstetric units that could increase the perceived
threat, leading to psychological and physiological reactions with
potential dangerous consequences for professionals. It’s essential to
manage these stressful events with tools as Critical Incident Stress
Debriefing. A great amount of research defends its positive effect on
personnel.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 191
Keywords: Aims: To perform an adaptation of CISD for obstetric staff group compared to control group there was a significant differences
to manage stress after critical situations. Evaluate professionals in their systolic blood pressure values (p 50.001) and heart rate (p
perceptions about implementing this plan. 50.017).
Materials and methods: A standard protocol in obstetric units is Conclusion: The results revealed that exercise during pregnancy
proposed, with two sessions of one hour, the first one day after the reduced the systolic blood pressure and improves the cardiovascular
event, and the second one week later, with special emphasis in system this may be due to better structural adjustment in epicardial
reaction phase. If required, could be a third session to handle coping arteries. On the other hand the results showed that exercise reduce
resources. For those professionals with psychological symptoms after stress during pregnancy this may be attributed to the fact that
the sessions, a consult with psychology department is suggested. exercise affects the neurotransmitter involved in the stress level and
Clinical cases and summary results: It’s expected that with the reduces the level of stress hormones and muscle tension.
implementation of this protocol, the professional who has experi-
enced a crisis could reduce their stress response, acquire adequate
Keywords: Exercise, pregnancy, systolic and diastolic blood pressure,
coping mechanisms and gain resilience. Midwifes and physicians
heart rate, fasting blood sugar, stress
expressed their intention to accept the protocol due to emotional
impact that involve critical situations
Conclusion: It’s important to offer emocional support during obstetric
adverse outcomes, to reduce symptomatology and to improve
psychological adaptation on professionals. Good acceptance by
336
staff would allow to start this specific protocol for managing Routine use of array comparative
threatening situations.
genomic hybridization analysis in
Keywords: Crisis intervention, coping, resilience psychological,
childbirth
fetus with markers for chromo-
somal abnormalities
V. Gnetetskaya, M. Kurtser, E. Kuznetsova, and
L. Bessonova
334
Genetics center of Mother and Child groups of companies, Moscow,
The effect of eight weeks of Russia
stretching exercises and walking Introduction: This study aims to investigate the possible association
in the third trimester of between different markers for chromosomal abnormalities (ultra-
sound and/or serum biochemical markers, advanced age) and
pregnancy on physiological and pathogenic chromosomal rearrangements including copy number
variants (CNVs) detected by array comparative genomic hybridization
psychological indices of pregnant (aCGH) in pregnant women.
Materials and methods: aCGH was carried out in samples of chorionic
women villi or amniotic fluid from 407 singleton pregnancies for which
chorionic villus sampling at 11-13 weeks’ gestation or amniocentesis
M. Zareai1 and Z. Mokhtar2 at 17-21 weeks’ gestation were performed. The median maternal age
32.4 (17.0-47.0) years, the percentage of women with advanced
1
Department of Midwifery, Jahrom Branch, Islamic Azad University, maternal age - 38.8 %. A customized 60K CGXTM Chip v2 (PerkinElmer
Jahrom, Iran and 2Department of Sport Physiology, Jahrom Branch, by Agilent Technologies, Inc., Finland) was used for the aCGH studies
Islamic Azad University, Jahrom, Iran and the data were analyzed with the use of a Genoglyphix aCGH
software (PerkinElmer, Finland), with data aligned to the Human
Introduction: Pregnancy is one of the most important periods in the Genome release 19 (hg19).
women’s life. Physiological and psychological health of women in this Clinical cases and summary results: All women had sonographically
period has a significant effect on the future life of the pregnant detectable defects or/and biochemical markers or/and advanced
women and their child. The objective of the present study was to maternal age. Numerical (12.0%) and structural (3.4%) chromosomal
evaluate the effect of eight weeks of stretching exercises and walking abnormalities were identified. The most frequent aneuploidies were
on physiological and psychological indices of pregnant women. trisomy of 21 (47%) followed by trisomy of 18 (20%) and monosomy X
Materials and methods: The populations in this study were twenty four (8%). The percentage of the normal and pathological cases for
pregnant women aged between 25-35 years. Women were rando- women younger and over 35 years old was approximately the same.
mized into two groups. The study group exercised under supervision The fetal nuchal translucency (NL) was increased in 33 (20%) cases
for eight weeks (n=16) and the control group followed their routine with aneuploidies and structural rearrangements. High-risk group
life (n=8). The women in the study group and control group had an with biochemical markers revealed aneuploidies and pathogenic CNV
average age of 27.07 ± 6.06 and 26.87 ± 4.70, an average height of in 17 (23%) cases. For confirming structural microscopic and
161.37 ± 5.20 and 157.62 ± 3.46, an average weight of 75.87 ± 9.52 submicroscopic abnormalities (see Table) FISH-analysis with specific
and 61.75 ± 6.92 and an average BMI of 29.20 ± 3.65 and 24.90 ± probes have been used. Microdeletion in DMD gene (see Fig.) (Xp21.1,
2.88, respectively. For all participants the systolic and diastolic blood 45-th - 55-th exons) was confirmed by MLPA.
pressure, mother’s heartbeat and fasting blood sugar were measured Conclusion: Approximately 80% pregnancies with increased fetal NL
in two stages of pretest and post test. Furthermore Cohen perceived or/and biochemical markers or other markers for chromosomal
stress questionery forms were filled by the participants at the abnormalities may not be associated with aneuploidies or pathogenic
mentioned stages. CNVs.
Clinical cases and summary results: Paired t-test, t-test and
Kolmogorov-Smirnov test was used to analyze the data. The results Keywords: Prenatal diagnosis, nuchal translucency (NL), advanced
showed that in the study group there was a significant differences in maternal age, aCGH
systolic blood pressure values (p 50.007), heart rate (p 50.012) and
stress score (p 50.05) before and after exercise. As experimental
192 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

erythema, may hinder the diagnosis of bullous disease if they appear

together and the biopsy sample contains skin lesions.
342 (CASE REPORT) Clinical cases and summary results: We report the case of a black
Eosinophilic infiltrate as a newborn with a history of not classified maternal skin lesions in
the third trimester. At birth has severe cutania dryness and in the
confounder in the diagnosis of following hours, bullous lesions appear progressively all over the
body. A skin biopsy was performed determining the presence of a
neonatal bullous epidermolysis subepidermal blister with inflammatory component and eosinophilic
infiltration. Because of this, the case was oriented as a pemphigoid,
C. Hornos, R. Diez, I. Collazo, J. Barberan, E. Lobera, since the presence of eosinophilic infiltrate in subepidermical blisters
is suggestive of neonatal pemphigoid. Given the suspected diagnosis,
G. Sais, C. Admetlla, and M. Fernández
analysis of antiepidermical antibodies was done to the mother and
Hospital de Mataró, Barcelona, Spain newborn, pending the outcome of the IFD and electronic microscopy.
Antibody testing proved negative. At 12 days of life lesions in oral
mucosa and nail involvement appear. 15 days later, the patient
Introduction: The blistering diseases are a group of disorders
presented a sepsis. Given the persistence of clinical and the diagnosis
characterized by the primary appearance of bullous lesions. Each of
suspiccion of cogenital bullous epidermolysis, the newborn was
them is categorized according to the level of blister formation.
referred to a tertiary care center. The result of the IFD and ME
Hereditary blistering diseases or bullous epidermolysis , are produced
confirmed the clinical suspicion of bullous epidermolysis junctional
by an alteration in the proteins involved in the dermo epidermical
type. The patient died at 2 months of age due to septic meningitis.
junction. Initially biopsy is used to determine the level of injury but
Conclusion: The intent of this event is to reinforce the importance
for a definitive diagnosis it’s required electron microscopy. The
of early diagnosis and treatment at the onset of bullous lesions in
mapping of antigens by direct immunofluorescence (IFD), is a fast
the newborn. Some common skin conditions in newborns as toxic
method for the classification of bullous diseases. It is important to
erythema, may hinder the diagnosis of bullous diseases. As in our
consider that some common skin conditions in newborns as toxic
case, the presence of eosinophilic infiltration and blister level
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 193
determined by biopsy could erroneously guide the diagnosis in Introduction: Gastric rupture is a potential fatal condition occasionally
neonatal period, with the consequent delay in treatment. encountered in adults and neonates but it rarely occurs in children
over 1 year of age. We report a case of gastric perforation in a 3 year
old boy presenting with surgical abdomen and fever and found to
have T cell lymphoma.
343 (CASE REPORT) Clinical cases and summary results: 3-Year-old boy presented with
Breath holding spells in the abdominal pain and distension after 5 days history of fever treated
with NSAIDs. Abdominal ultrasound showed intraperitoneal ascites
neonatal period , a very rare and air-fluid level at the level of the stomach. Abdomen/pelvis
CT-scan showed pneumoperitoneum. Patient underwent urgent
entity laparotomy, gastric perforation was found, repaired and biopsies
were done. On Day 5 post-op, he developed abdominal pain,
tachypnea and desaturation. Abdomen/pelvis CT-scan showed large
C. Hornos, E. Lobera, J. Barberan, R. Dı́ez, and L. Aquino amount of fluid in the peritoneal cavity and thickening of the parietal
Hospital de Mataró, Barcelona, Spain peritoneum. Adhesion within peritoneal cavity can’t be ruled out.
Patient underwent laparotomy, clear fluid was obtained and biopsies
from the liver, omentum and spleen were taken. Pathology of Gastric
Introduction: Breath-holding spells is a common entity described in biopsy showed malignant non-Hodgkin’s T-cell lymphoma. Liver and
4-5% of the paediatric population. It is considered a benign retroperitoneum biopsies showed abnormal T cell lymph proliferation
paroxysmal non-epileptic disorder occurring in healthy children favoring T-cell lymphoma. Chemotherapy was to be started however
from 6 to 48 months of age and only 15% of them start before 6 patient was declared dead at day 12 of admission.
months. The episodes start with an stimulus, such as an emotional Conclusion: Primary gastrointestinal tumors are rare entity in infancy
upset or a minor injury, and consist in breath holding, cyanosis or and childhood and accounts for less than 5% of all pediatric
pallor and sometimes syncope. They do not have pathological neoplasms. Primary non-Hodgkin’s lymphoma (NHL) of the gastro-
consequences and its evolution is benign, with tendency to disappear intestinal (GI) tract is the most common extra nodal lymphoma in
in 3-4 years. There are two clinical forms, cyanotic and pallid. The pediatric age group. Although gastric perforation is a rare entity
cyanotic form could be due to inhibition of respiratory effort, and the in this group, we should consider gastric lymphoma in the differential
pale presentation to an exaggerated vagal reaction, leading to diagnosis of gastric perforation.
bradycardia, which produces cerebral hypo perfusion.
Clinical cases and summary results: We present two cases of cyanotic
breath-holding spells that appeared before the 48 hours of life, which
is a very unusual age for this entity. None anomalies were detected
during pregnancy and labour, and the physical exploration at birth
was normal. They both initiated at 24 and 36 hours of life clinical
episodes compatibles with cyanotic breath-holding spells. In one of
these episodes, the patient presented a decrease in oxygen saturation
down to 70 % with a compained bradycardia , which both recovered
spontaneously . None of the episodes required resuscitation, and in
one of them there was a paternal history of breath-holding spells, but
not in neonatal period. Because of the unusual presentation at this
age, we performed some examinations, including cranial ultrasono-
graphy, blood analysis (with glucose, calcium and electrolytes), blood
culture, ECG and EEG that were all normal. At the moment, they are 3
and 4 months-age, and the episodes are less frequent and with rapid
resolution.
Conclusion: Breath-holding spells presentation in the immediate
neonatal period, like the two cases we present, is very rare, and
there is poor literature on the subject. It is important to make a good
differential diagnosis with other most prevalent entities at that age.
The diagnosis is clinical and once suspected, is recommended to
perform an ECG and rule out anemia, but no more studies are usually
needed, except in neonatal period.

345 (CASE REPORT)

352
Gastric perforation: unusual Women’s knowledge and
presentation of gastric lymphoma opinions about lactational
in pediatric population amenorrhea
R. Hamzeh1, S. Zeidan2, E. Bechara3, D. Hamod4, and
Y. Nassif4 S. Şen1, N. Bolsoy1, Y. Çiçek1, G. Muslu2, and A. Muslu1
1
1 Faculty of Health Sciences, Celal Bayar University, Manisa, Turkey
Pediatric Department, Saint George Hospital University Medical
and 2Fethiye School Of Health, Muğla Sıtkı Koçman University,
Center, 2Pediatric surgery department, Saint George Hospital
Muğla, Turkey
University Medical Center, 3Pediatric Hematology/Oncology
Department, Saint George Hospital University Medical Center, and
4
Neonatology Department, Saint George Hospital University Medical Introduction: Lactational amenorrhea may be used as a very effective
contraceptive method when certain criteria are met. In a conference
Center
194 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

which was held by World Health Organization (WHO) and interna- The data were analyzed by using number and percentage
tional organizations in Bellogo, Italy in August, 1988 it was agreed to distribution.
consider lactation as a potential family planning method in all Clinical cases and summary results: It was determined that pregnant
maternal and child health programs in the developed and developing women that were included in the study had an age average of 26,96
countries. The study was performed to determine knowledge and ± 5,13 and 29,9% were primary school graduates, 97,7% were
opinions of mothers who lived in Manisa city center and had babies of officially married and 81,2% were unemployed. As a result of the
0-6 months about Lactational Amenorrhea as a family planning analysis that was conducted between the socio-demographic
method. variables and viewpoints of pregnant women, a statistically significant
Materials and methods: The study is a descriptive study. Population difference was obtained regarding the working condition of pregnant
was consisted of women (n=5024) who were registered in 11 Family women. Accordingly, it was determined that majority of unemployed
Health Centers affiliated to Manisa City Center and had vaginal and pregnant women wanted to get midwifery service from women
cesarean delivery. Study sample was consisted of 357 women who (97,1%). No statistically significant relationship was determined
were determined via a Sample Formula with a Known Population and between other features.
who accepted to enroll in the study. While data were collected, socio- Conclusion: It could be suggested that almost one fourth of pregnant
demographic features formed by the researchers and a survey form women agree that midwifery service could be provided by male
which contained 33 questions for determining postpartum knowl- midwives, however, almost all of them prefer female midwives when
edge and opinions of women who had babies of 0-6 months about service procurement is in question.
lactation were used. *This study was presented at the 2rd International & 6th National
Clinical cases and summary results: It was determined that 63.2% of Students of Midwifery Congress
women were in an age range of 21-30, averages of their ages were
26.23 ± 5.34 and 36.55 of them were primary school graduate. When
obstetric history of women was examined in the study, it was Keywords: Midwifery, gender, male
detected that babies of 71.7% of women were 1-6 weeks of age and
76.85 of them were amenorrheic and 32.7% of them did not use a
family planning method. It was determined that 74.7% of women
lactated 7-9 times daily, 71.45 of them lactated every time their babies
354
had cried and 97.3% of them lactated at nights. 27.5% of women give
supplementary food. It was revealed that 34.6% of women knew the
The process of growth related to
lactation as a contraceptive method, 39.4% of women who knew the the period of the conquest of
lactation as a contraceptive method learned this information from
their friends and 99.7% of them did not get any information for LAM. autonomy of the child
Conclusion: As a result, it is thought that women know the lactation as
a family planning method but healthcare professionals does not E. Kahhale and C. Poppa
touch on this topic during family planning educations.
Pontificia Universidade Catolica de São Paulo, São Paulo, Brazil
*This study was presented at the 1rd Congres of Aegean Midwifery
and Labor.
Introduction: This paper aims to describe the process of growth
Keywords: Lactational amenorrhea, family planning, lactation related to the period of the conquest of autonomy of the child from
the point of view of Gestalt - therapy through a dialogue with the
maturation theory of D. W. Winnicott.
Materials and methods: This work is the result of a dialogue with the
353 theory of maturation of D. W. Winnicott, from which it was possible to
describe the constitutive basic needs of human subjectivity and care
Viewpoints of pregnant women that meet.
Clinical cases and summary results: To the extent that the basic needs
concerning male midwives in related to the early period of life are met, the baby is the basis for
which may take ownership of their experiences in their contact cycles
Turkey constitute a permeable contact boundary and perform creative
adjustments. When the caregiver is in tune with the baby, it identifies
N. Bolsoy, S. Şen, S. Cambaz Ulaş, and S. Köken the advances in their neuromotor development and realizes that the
baby can not only get to wait to have their needs met, as happens
Faculty of Health Sciences, Celal Bayar University, Manisa, Turkey even to profit from the expected. Thus, the sense of urgency caregiver
to meet the needs of the baby tends to decrease. From this new
Introduction: Profession of midwifery is one of the oldest professions position, the caregiver is able to provide the care (time and space,
of history that started with history of humanity in the world and in our person or object that carries the paradoxical role, limits and
country and has continued as women’s assistance in their deliveries confrontation in a balanced way between indifference and retaliation)
based on the master-apprentice relationship for many years. Long- that meet the basic needs related to the period of child autonomy of
term changes for midwifery are similar in many countries although achievement (ability to move through the cycles of contact with
not synchronized. It is known that some countries also have male autonomy, opening for play and for inter-human contact boundary of
midwives. In Turkey, on the other hand, midwifery is still a women’s the establishment and ability to perform creative adjustments).
profession. Thus, this study was conducted for determining the Conclusion: When all goes well, the child can use throughout their first
viewpoints of pregnant women in the city center of Manisa years of life of the care to meet their basic needs related to the early
concerning male midwives. period of life and the conquest of autonomy. When this is possible,
Materials and methods: This is a cross-sectional and descriptive study. the child appropriates their experiences in their contact cycles, is a
While the target population of the study consisted of 2954 pregnant permeable contact boundary and develops your ability to perform
women, the sample consisted of 384. It was conducted in 3 rural- creative adjustments. Thus, the care that meet their basic needs
urban-slum Family Health Centers that were randomly selected from underpin the process of appropriation of self constituent resources.
Şehzadeler and Yunus Emre districts in the City Center of Manisa. A
questionnaire involving 21 questions was used in the study. The data Keywords: Child development, Gestalt therapy, self support,
were collected by the researchers from pregnant women that had responsibility, guilt, shame
applied to Family Health Centers via face-to-face interview technic.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 195
379 383
Congenital fetal malformations - A complementary treatment in
the importance of in utero perinatology: reflexology
trasport
N. Bolsoy, B. Oğuz, and M. Topaç
M. Resko-Zachara, M. Rutkowska, and E. Sawicka Department of Midwifery, Celal Bayar University, Manisa
Neonatal Intensive Care Unit, Intitute of Mother and Child, Warsaw,
Poland Introduction: Reflexology is a complimentary treatment that uses
compressions and skin contact to help the body release enkephalins
Introduction: The successful outcome of an operation performed on a and endorphins.Thus, the neural transmission of pain messages to the
newborn with congenital anomalies depends not only on the skill of brain is stopped, anxiety and pain levels are decreased, as a result of
the paediatric surgeon but also on that of a large team consisting of a improved lymphatic nerves and blood flow, the excretion of toxins
paediatrician, anaesthetist, radiologist, pathologist, biochemist, from the body is increased. Further assessment of the evidence
nurses, and others necessary for dealing satisfactorily with the relating to the use of reflexology at pregnancy, childbirth, and
newborn infant subjected to surgery. Advances in neonatal intensive postpartum units is needed. This study is designed to evaluate the
care dictate that effective and efficient treatment of the sickest studies in reflexology and related fields systematically.
neonates can only be available by concentrating resources such as Materials and methods: Data is obtained by scanning Medline,
equipment and skilled staff in a few specialist paediatric centres that Pubmed, ScienceDirect, Google Academic, National Thesis center
have responsibilities to a particular region. It is well established that databases in the Celal Bayar University library between January 1 and
the outcome of critically ill neonates is better if they are cared for in April 1 2016. Databases were scanned with ‘‘antenatal, intranasal,
specialised tertiary centres. postpartum, reflexology’’ keywords.
Materials and methods: Gastroschisis - Congenital malformation in Clinical cases and summary results: Nine full texts associated with the
which a defect in abdominal wall allows portions of the abdominal subject were found. Mollart (2003) concluded that reflexology is
contents to herniate outside of the abdominal cavity. During the effective in reducing edema in the feet and ankles during pregnancy.
fourth week of development, the lateral body folds move ventrally Ghaffari and Ghaznein (2010) concluded that it helps reduce fatigue
and fuse in the midline to form the anterior body wall. Incomplete in pregnant women. Close et al (2015) concluded that reflexology can
fusion results in a defect that allows abdominal viscera to protrude help in a back and pelvic pain management in pregnancy. Hanjani
through the abdominal wall. The bowel typically herniates through et al (2014) stated that reflexology shortens the delivery time, reduces
the rectus muscle, lying to the right of the umbilicus. There is no the intensity of labor pain, reduces anxiety levels, contribute to
protective sac covering the intestines. natural childbirth and lead to an increase in Apgar scores. Chumth
IUGR: 40-60%, Birth weight52500 g " mortality 10% , Survival rate in et al (2011) concluded that reflexology significantly decreases the
tertial centers 90%. stress levels of adolescent mothers after the birth. McNeill et al (2005)
Clinical cases and summary results: Till late 90’s:birth at term, poor argue that reflexology applied before the birth have a positive effect
intestine condition- oedema, thickened walls, difficult one-step on pain management in labor. Li et al (2011) found that during the
surgery, more often bowel ischaemia NEC, often perforations, septic postpartum period, reflexology improves the quality of sleep.
shock due to bowels complications or long parenteral nutrition via Conclusion: Reflexology can help women during pregnancy, childbirth
cenral lines.Changes in diagnostics at the end of 20 century. Bowel and postpartum period without any side effects.There are a limited
loop dilation witth wall thickening.Other ultrasound data: abnormal number of studies on reflexology. More randomized controlled
umbilical artery flow- doppler ultrasound, stomach dilation, blood studies have to be conducted to generate more evidence.
flow in mesenteric blood vessels, many bowel loops dilation. Clinically
more important the changes dynamic. Recommended proceeding: Keywords: Antenatal, intranasal, postpartum, reflexology
ultrasound scan every 2 weeks from 26 weeks GA, elective c-section
34-36 weeks depending on ultrasound and changes dynamics,
steroids few days before planned c-section, fetal growth estimation
CTG monitoring, delivery at level III neonatal care hospital (with
surgery), infant assessment after birth and when stable transfer to the
operating theatre, operation within delivery room, surgical/neonatal 386
care during hospitalization.
Conclusion: What is the reason for better infant condition after birth The effect of violence upon
and long term outcome? Optimal time for c-section regarding the
bowels condition, Delivery at level 3 center - every transport and
women’s attitudes toward family
surgery delay worsening infants condition due to: i.v fluids and
bowels and coat oedema, mesentery pulling pain reaction, rarely two-
planning
step operation, faster enteral feeding, parenteral feeding and central
line time shortening, less nosocomial infections, hospitalization S. Şen, N. Bolsoy, Y. Çiçek, Ç. Gök2, and H. N. Şimşek
shortening. 1
Celal Bayar University Faculty of Health Sciences, Manisa, Turkey
and 2Uşak Family Health Center, Uşak, Turkey
Keywords: Gastroschisis, ultrasound diagnosis, in utero transport,
immediate surgery, level 3 centre
Introduction: Violence is an important public health problem that
could be encountered in every area of human life and gradually
increases in the world. World Health Organization (WHO) defines
violence as, ‘‘a condition where a physical power or power is applied
to another person as a deliberation, threat or reality and causes or
may cause injury, death and psychological damage in the person who
is subjected to violence’’. The most common type of violence is the
domestic violence which is applied by men to women and children.
This study was conducted for the purpose of determining the effect
196 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

of violence against women upon women’s attitudes toward family Clinical cases and summary results: 51.4% of the students are in the 18-
planning. 20 age group and their mean age is 20.67 ± 1.73, 36.2% of them are
Materials and methods: This is a cross-sectional and descriptive study. first grade students, 78.1% lived in the city for the most of their lives,
While the target population of the study consisted of 64.382 women 93.3% do not work, income of %63.3 of the students is equal to their
aged 15-49 in the city center of Manisa, the sample was calculated as expenditures. Students’ opinions on male midwives: 59.0% believe
382 women in the smallest sample number Epi Info 6 program with that gender is important in this profession and 55.7% believe that it is
50% unknown prevalence and 5% margin of error. 342 women aged a job for women. 49.0% of the students believe that both men and
15-49 that had applied to the aforementioned FHCs and accepted to women can be midwives. Half of the students believe that male
participate in the study were included in the study. The study data midwives would change the profession and improve it. But when
were collected by using three forms consisting of ‘‘Data Collection asked to choose a midwife for themselves, 79.5% prefer to see
Form for Women’s Introductory Information’’, ‘‘Scale for Domestic women helping them as the midwife.
Violence against Women (SDVW)’’ and ‘‘Family Planning Attitude Conclusion: Half of the students believe that men can become
Scale’’, which were prepared according to literature. midwives and improve the profession but prefer women midwives to
Clinical cases and summary results: It was determined that 41.2% of take care of them if they were pregnant.
women were in the age group of 21-30 and 29.5% were primary *This study was presented at the 1rd International & 5th National
school graduates. 31.9% of women had given birth twice, 27.5% used Students of Midwifery Congress.
no family planning method, 72.5% used a family planning method
and 29.8% used condom as a family planning method. It was also Keywords: Midwifery, occupation, women, men
determined that they obtained a score average of 89.00 ± 9.77 from
the Scale for Domestic Violence against Women and 119.15 ± 2.25
from the Family Planning Attitude Scale. As a result of correlation
analysis that was conducted between the score averages of Scale for 388
Domestic Violence against Women and the score averages of Family
Planning Attitude Scale, a negatively and moderately significant The effect of postpartum
relationship was deternined (r=-0.345, p 50.001). It could be
suggested that as the possibility for women to be exposed to functional condition of mothers
violence increases, their attitudes toward family planning are affected
negatively.
upon their life quality
Conclusion: As a result of this study, it was determined that violence
against women had a negative effect upon women’s attitudes toward Y. Cicek1 and A. Saruhan2
family planning and their condition of using reproduction health 1
services. Faculty of Health Sciences, Celal Bayar University, Manisa, Turkey
and 2Obstetrics and Gynecology Nursing Department, Faculty of
*This study was presented at the First Congres of Aegean Midwifery
and Labor. Nursing, Ege University

Keywords: Violence against women, family planning, attitude Introduction: Postpartum functional condition is defined as ‘‘a
mother’s preparedness for taking the responsibility of her baby,
herself, housework, social and professional activities’’. Today, the
objective of postpartum care is to cope with possible postpartum
387 problems, develop the power of self-care and increase mother’s
independence and life quality. This descriptive study was conducted
Perspectives of midwifery for examining the effect of postpartum functional condition of
mothers upon their life quality.
students on men becoming Materials and methods: The study sample consisted of 357 mothers
that were registered to 11 Family Health Centers in the City Center of
midwives Manisa, had had vaginal birth or c-section and were selected via
Stratified Random Sampling Method. The study data were collected
S. Sen, N. Bolsoy, Y. Cicek, M. Topac, and B. Oguz between July 2013- December 2013 via ‘‘Mothers’ Introductory Form’’
aimed at determining the socio-demographic and other variables of
Celal Bayar University, Department of Midwifery, Manisa mothers, ‘‘Postpartum Functional Condition Inventory (PFCI)’’ and
‘‘Postpartum Life Quality Scale (PLQS)’’.
Introduction: Midwifery is one of the oldest professions in the world, Clinical cases and summary results: Examining the distribution of
starting with the history of humanity, with women help each other mothers according to their socio-demographic features, it was
in childbirth for many years. It is based on a master-apprentice determined that 40.9% of them were in the age group of 25-30,
relationship. Long-term changes to midwifery are similar in most 40.3% were literate and primary school graduates, 51.8% had been
countries, but not in sync. It is known that in some countries there married for one-five years, the average duration of marriage was
are male midwives. But in Turkey, midwifery is still a woman’s job. 5.59 ± 4.89 years, 77.6% were unemployed and 37.5% of working
This study was conducted in order to determine the perspective on mothers were civil servants. Factors affecting the postpartum life
the idea of man becoming a midwife. quality of mothers were determined as educational level, economic
Materials and methods: The study was a cross-sectional descriptive condition, duration of marriage, number of children, difficulties with
study. The population of the study was the Celal Bayar University housework in daily life and infant care. According to the multivariate
School of Health Midwifery Department students (N ¼ 257). In the regression analysis, self-care activities, mother’s educational level,
study sample selection was not made, all students who agreed to difficulties with housework in daily life and infant care, which are
participate in the study and those who could be reached constituted among the subscales of postpartum functional condition, affect the
the sample of the study (n ¼ 210). Data of the survey is collected postpartum life quality. 21.0% of postpartum life quality scores could
using the ‘‘Information Form’’ created by the researchers. The form is be explained with three independent variables here.
designed to determine the sociodemographic characteristics of the Conclusion: As a result of the study, it was determined that as
students and their perspectives on the idea of a male midwife. Data domestic activities and infant care responsibilities of mothers
was collected in the classrooms of the students who agreed to increased in the postpartum period, their life quality decreased
participate in the study. The participation rate is 81.7%. and as social and self-care activities increased, their life quality
increased.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 197
*This study was presented at the 1rd National Gynaecological Continued
Diseases and Maternal and nfant Health Congress
Nifedipine Atosiban
Keywords: Postpartum period, functional condition, life quality Total n=27 n=9
n=36 (75%) (25%) p
APH of unknown origin 12 (33.3) 5 (18.5) 7 (77.8)
Gestational age at delivery 30.2 (4.0) 31.4 (4.1) 27.6 (2.1) 0.066
(w.d)
Gestational age at delivery 12 (33.3) 6 (22.2) 6 (66.6) 0.034
394 534w
Antepartum hemorrhage and use Latency from admission to
delivery (d)
5.8 (5) 5.7 (3.7) 6.2 (7.8) 0.873

of tocolytics in hospital clinic of Days of hospitalisation (d)

Delivery during hospitalisation
6.7 (6.9) 5.7 (4.6)
18 (50) 12 (44.4)
9.8 (11.1) 0.149
6 (66.6) 0.282
Barcelona Corticosteroids for fetal 31 (86.1) 23 (85.1) 8 (88.8) 0.781
lung maturation
Caesarean section 15 (41.6) 10 (37) 5 (55.5) 0.975
C. De Guirior, M. Vargas, L. Salazar, S. Escura, and Abruptio placentae 3 (8.3) 3 (11.1) 0 0.180
M. Palacio Need for transfusion 6 (16.6) 4 (14.8) 2 (22.2) 0.606
Number of packed red cells 0.8 (1.9) 0.7 (1.9) 1.0 (2.0) 0.686
Hospital Clinic, Barcelona, Spain transfused
50 Apgar  7 3 (8.3) 1 (3.7) 2 (22.2) 0.180
Introduction: To describe the use of different tocolytics and maternal UA pH  7.10 3 (8.3) 2 (7.4) 1 (11.1) 0.952
and perinatal outcomes in women admitted because of antepartum Neonatal death 3 (8.3) 2 (7.4) 1 (11.1) 0.975
hemorrhage.
Numbers are expressed as n(%) or mean (SD) when appropriate.
Materials and methods: Descriptive study in a tertiary center between
april 2014 and september 2015 including women admitted because
of antepartum hemorrhage (APH) between 23.0 and536.0 weeks. The
clinical management of these women included tocolysis, corticoster-
oids, and eventually blood transfusion and planned delivery. Maternal
and perinatal outcomes were compared based on whether Atosiban
395
or Nifedipine was used for tocolysis. Nifedipine capsules or oral Experience in external cephalic
solution were considered. A descriptive study was carried out on
qualitative and quantitative variables to characterize the study version at Hospital Universitario
population. X2 tests or two-sided Fisher test and Student’s t-test or
Mann-Whitney U-test, were used when appropriate. Quiron Dexeus
Clinical cases and summary results: 36 admissions from 32 women
were evaluated. Nifedipine was more frequently used than Atosiban. N. Li, E. Meler, A. Rodrı́guez Melcon, E. Murillo,
Gestational age at admission and at delivery was earlier in the
Atosiban group although latency to delivery was similar in both
N. Rodrı́guez, and B. Serra
groups. Nifedipine was more frequently used for APH due to placenta Department of Obstetrics, Gynecology and Reproductive medicine
previa while Atosiban was preferably used for APH of unknown origin. Salud de la mujer Dexeus. Hospital Universitario Quiron Dexeus,
No differences in days of hospitalisation, number of transfusions, Barcelona, Spain
postpartum hysterectomy, abruptio placentae, corticosteroids, mode
of delivery and neonatal outcomes were observed. Nifedipine oral
solution was administered to two patients getting similar results to Introduction: Breech presentation occurs in 3-5% of all term deliveries.
Nifedipine capsules. Three neonatal deaths were due to extremely It represents around 20% of elective caesarean sections. Vaginal
preterm, parenchymatous hemorrhage and sepsis. breech deliveries can associate adverse perinatal outcomes.
Conclusion: In this series there was no evidence to suggest that there Caesarean section is the main choice but it is not exempted from
is a significant difference in maternal or perinatal outcomes between maternal morbidity. External cephalic version (ECV) is an alternative,
the use of Nifedipine (whether capsules or oral solution) or Atosiban reducing the rate of caesarean section and therefore, complications in
in the management of antepartum hemorrhage. future pregnancies. ECV is not carried out routinely in all hospitals,
but success rate is around 65%. It is usually performed at early term
and patients are delivered home afterwards. We present our results
Keywords: Atosiban, Nifedipine, antepartum, hemorrhage, tocoly-
from June 2012 to March 2016. We have to point out that our centre
tics, maternal, perinatal
offers private health care: insurances do not pay for the ECV and that’s
the reason why we induce patients into labour after the ECV.
Materials and methods: In this period, we evaluated 77 singleton
pregnancies with breech presentation in the last control. The mean
Nifedipine Atosiban gestational age at the moment of evaluation was 36.3 weeks [range
Total n=27 n=9 33.4—39.2]. At that moment, 82% (63 patients) kept in breech
n=36 (75%) (25%) p presentation whereas 18% (14 patients) had changed to cephalic
presentation spontaneously. Among the patients who kept breech
Nulliparity 15(41.7) 10 (37) 5 (55.6) 0.364
Multiple pregnancy 7 (19.4) 4 (14.8) 3 (33.3) 0.224 presentation, 63.5% were nulliparous (n=40) and 36.5% were multi-
Previous caesarean section 3 (8.3) 2 (7.4) 1 (11.1) 0.738 parous (n=23). We offered the ECV to 58 patients, of which 22
Gestational age at admission 30.1 (3.5) 31.0 (3.6) 27.5 (3.2) 0.026 accepted, 35 rejected and 1 presented a premature membrane
(w.d) rupture before taking a decision. The other 6 patients were discarded
Diagnosis at admission 0.040 because of oligohydramnios or fetus small for gestational age with
Placenta previa 18 (50) 15 (59.3) 3 (22.2) nuchal cord. Among the 22 patients that accepted, two presented
Placenta hematoma 6 (16.7) 6 (22.2) 0 premature rupture of membranes before the procedure.
Clinical cases and summary results: The mean gestational age at the
(continued ) moment of the ECV was 38.6 weeks (range 37-39.4). The technique
198 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

was successful in 70% of the cases (n=14), of which 50% were method. However, the cesarean section rate among adolescents was
primiparous (n=7) and 50% were multiparous (n=7). Vaginal delivery low. Among the indications for cesarean delivery were obstetric-
was possible in 10 out of 14 cases (71.4%). VCE was not possible in related issues such as malpresentation, fetal distress, premature
30% (n=6): 4 of them required an emergency cesarean section rupture of membranes, preterm births, eclampsia, etc.
because of fetal distress and 2 of them because of the failure of the Conclusion: The analysis of the reviewed articles revealed that while
technique. After the cephalic presentation was obtained, 21.4% of the rates of perinatal, postnatal, obstetric and neonatal complications
patients were discharged home (n=3) and 78.6% of them were were higher in adolescent pregnant women, the rates of utilization of
induced into labour (n=11). Vaginal delivery was achieved in 100% of antenatal care and family planning services were low. Adolescent
patients from the first group and 63.6% from the second group (n=7), pregnancies are an important issue in the world and Turkey. Training
as three patients required an emergency cesarean section due to fetal related to reproductive health should be provided for the young.
distress during the induction of labor and one because of arrest of Effective antenatal care and family planning services can improve
dilation. ECV has allowed us to reduce the rate of elective cesarean maternal and fetal outcomes.
section in 0.11% during this period.
Conclusion: During these 3 years, the success rate of the procedure Keywords: Adolescent pregnancy in Turkey, teenage pregnancy,
has been 70%, similar or even a bit higher compared to the mean rate adolescent pregnancy
in Spain, although the mean gestational age at the moment of the
procedure was 38.6 weeks. According to our results, late term ECV
seems feasible and we could avoid an intervention in spontaneous
cephalic version before 38 weeks.

Keywords: External cephalic version, breech presentation 406 (CLINICAL CASE)

Coexistence of congenital
diaphragmatic hernia, distal
397
esophageal atresia, tracheoeso-
Adolescent pregnancy in turkey: phageal fistula and trisomy 18
a systematic review C. Çıralı1, ÖMA. Özdemir1, H. Ergin1, and C.N. Semerci2
1
Paediatric Dept., Pamukkale University, Denizli, Turkey and
H. Ozturk1 and M. Balcık Colak2 2
Genetics Dept., Pamukkale University, Denizli, Turkey
1
Midwifery Department, Ege University Faculty of Health Science,
Izmir Turkey and 2Ege University Institue Of Health Science, _Izmir, Introduction: The coexistence of congenital diaphragmatic hernia
Turley (CDH) and esophageal atresia (EA) with distal tracheoesophageal
fistula (TEF) is extremely rare and has a higher mortality rate. Here, we
present a female newborn with CDH, EA, TEF, trisomy 18.
Introduction: Adolescent fertility is an extremely important issue, both
Clinical cases and summary results: The patient, first child of non-
for health reasons and for social reasons. Adolescent mothers are
consanguineous parents, was born at 36 weeks of gestation by
more likely to be exposed to adverse pregnancy outcomes or
cesarean section due to fetal distress. The pregnancy was compli-
mortality than are adult mothers. In addition, having children at an
cated by polyhydramnios and triple screening test was abnormal. The
early age causes adolescents to discontinue their education and
fetal ultrasonography and echocardiography performed at 28th week
prevents them from accessing job opportunities. The mean fertility
of gestation revealed cerebellar vermis agenesis, polycystic kidney,
rate among adolescents aged 15-19 in the world is 43 %. This rate is
and Fallot’s tetralogy. Her mother refused amniocentesis. Physical
115% in Africa, 26% in the UK, and 63% in the United States of
examination showed microcephaly, triangle face, prominent occiput,
America. According to TDHS-2013 results, almost 5 percent of
low set and malformed auricles, widely spaced nipples, the absence
adolescent women have begun childbearing. AIM: The research
of breathing sounds on the left side of the chest, a grade 1-2/6
questions in this study are as follows: What are the pregnancy and
pansystolic murmur in the mesocardiac region, scaphoid abdomen,
childbirth consequences of adolescent pregnancy?
absence of distal interphalangeal joint on second and fifth finger,
Materials and methods: The EBSCOhost, Science Direct databases and
partial syndactyly of second, third, and forth tongues, and short
Google Scholar were retrospectively scanned between March 30 and
hallux. Chest X-ray showed the feeding tube curl up in the upper
April 30, 2013 by using the Ege University Library online database. All
esophageal pouch, loops of intestine on left side of the thorax, and air
articles published both in Turkish and in English in Turkey between
in stomach and bowel. She was diagnosed left CDH, EA with TEF.
2000 and 2013 were reviewed. During the literature review, the
Echocardiography revealed ventricular septal defect, patent ductus
phrase ‘‘adolescent pregnancy’’ was used to search for articles in
arteriosus, secundum atrial septal defect, left arcus aorta, and
English and the Turkish phrase ‘‘genç gebelik’’ meaning ‘‘teenage
pulmonary hypertension. Urinary sonography showed increased
pregnancy" for articles in Turkish,and 6227 articles were accessed. Of
renal parenchymal echogenicity with loss of corticomedullary
these articles, 21 were directly related to the topic of the review.
differentiation. Chromosomal analysis revealed trisomy 18. She
Therefore, a table presenting research methods, objectives, findings,
became progressively unstable and died at 24th hour.
conclusions, and the recommendations of these 21 articles was
Conclusion: The patients with coexistence of CDH, EA, TEF should be
prepared, and then the articles were analyzed by the years they were
investigated in terms of chromosomal abnormalities.
published.
Clinical cases and summary results: Evaluation of the results of the 21
articles included in the study demonstrated that the frequency of Keywords: Congenital diaphragmatic hernia, esophageal atresia,
prenatal care was low whereas intrauterine growth restriction (IUGR), tracheoesophageal fistula, Trisomy 18
low birth weight (LBW) and birth complication rates were significantly
high. In addition, of the adolescents, 2.94%-7% experienced
premature rupture of membranes, 24.3%-52.94% gave preterm
birth, 55.6% gave birth to low birth weight infants, 28.4%-82% did
not receive antenatal care, and 57.2% did not use any contraceptive
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 199
mainly the cardiovascular, skeletal and ocular systems. Pregnancy in
412 women with Marfan’s syndrome puts two prin issues: the risk of
Paraplegia in pregnancy: two transmission to the fetus and the cardiovascular risk for the mother.
The risk of aortic dissection is increased in pregnancy so it is
clinical cases with different injury important to assess cardiac funtion and structure. Furthermore
marfan sydrome is associated with premature delivery, premature
levels and mode of delivery rupture of membranes and increased mortality.
Clinical cases and summary results: In this report we describe a 22-
C. Soares, M. Marinho, J. Santos Castro, C. Lourenço, year-old woman with Marfan syndrome referred to obstetric
evaluation at 30 weeks of gestation. This woman was diagnosed
M. Carrilho, and C. Godinho with Marfan syndrome in 2014 after her first pregnancy. The patient
Gynaecology and Obstetrics Dept., Centro Hospitalar de Vila Nova de did not have a recent cardiac evaluation because of missed
Gaia/ Espinho appointments and exams. She reported a family history of Marfan’s
syndrome, her mother and her first child are affected. At the obstetric
appointment it was scheduled a cardiologist evaluation. The
Introduction: A significant proportion of spinal cord injury (SCI) occurs
ecocardiogram revealed good cardiac function but with severe
in women of reproductive age. Pregnancy in this setting involves
mitral regurgitation, left auricular dilatation and slight dilatation of
special concerns. Complications of SCI include anaemia, urinary tract
the aortic root. It was recommended elective cesarean to prevent
infections and thermoregulation impairment. Autonomic dysreflexia
excessive maternal efforts. At 34 weeks she was admitted at obstetric
(ADR) is a potentially life-threatening syndrome that affects up to 85%
emergency department at labour. Together with the cardiologist we
of the patients with lesions above T6 level. The manifestations of ADR
decide to perform vaginal delivery. The labour went without
(malignant hypertension, syncope, arrhythmia) are due to exagger-
complications. Post-partum course was unevent-full. The baby
ated sympathetic activity in response to stimuli below the level of the
genetic test to identify marfan’s family mutation was positive.
lesion (e.g. distension of the cervix). Uteroplacental vasoconstriction
Conclusion: This case report reinforces the importance of multi-
may develop, leading to fetal hypoxaemia. The ability to perceive
disciplinary approach in the care of pregnant women with Marfan’s
labor pain may be decreased in these patients. Vaginal delivery with
syndrome. Health care providers should be familiar with the need for
close monitoring is generally indicated.
high-risk obstetric surveillance. Preconception counseling is essential
Clinical cases and summary results: The authors present two cases of
due to the risk of fetal transmission and maternal cardiovascular risk.
pregnancy in paraplegic women: 36-year-old women, G2P1 with SCI
The risk stratification of the pregnant women with hearth disease,
at T4-T5. The patient had an uneventful pregnancy except for
timing, place and mode of delivery are important to achieve good
multiple urinary tract infections. She was hospitalized at 37 weeks and
outcomes.
an elective caesarean-section was performed by request at 39 + 6
weeks, under spinal anesthesia at L3-L4. A healthy male was born
weighing 3315g, Apgar score of 9-10 (10 and 50 ). A 28-year-old
woman, G3P2 (two vaginal deliveries before SCI) had a road traffic OTHER - 419
collision 4 years before, which resulted in SCI at T7-T9. The patient
presented hiperreflexia with broad involuntary spastic movements of Anxiety experienced by fathers
abdomen and inferior limbs in response to skin and vaginal
stimulation. There were no complications during pregnancy. She during labor at a state hospital
was hospitalized at 38 weeks and had a spontaneous labor at 39
weeks. Spinal analgesia at L3-L4 was performed. Eutocic delivery of a
and affecting factors
male newborn, weighing 4080 g, Apgar score of 9-10 (10 and 50 ).
Conclusion: Pregnancy in SCI patients requires a multidisciplinary H. Demirci, H. N. Simsek, R. Salan, and G. Gencer
team that must be aware of the main complications, according to the
level of the injury. Most of those pregnant females have concerns Midwifery Department, School of Health, Celal Bayar University,
about their ability to perceive labor pain. In this setting, liberal Manisa, Turkey
hospitalization can be considered near term. A vaginal delivery should
generally be preferred. However, both patients were afraid of not Introduction: Whereas anxiety is considered as fears whose origins are
being able to cooperate. Mode of delivery should be discussed during not determined, it is feeling influent on social relationships, activities
the pregnancy. and daily lives of individuals and mostly results in perturbation on
individuals. The birth process includes numbers of unknown issues for
Keywords: Delivery, paraplegia, pregnancy fathers as much as mothers. In this process, it is important to
investigate into feelings of prospective fathers who are usually
neglected within the scope of holistic approach. Therefore, the
present research was conducted to determine the anxiety levels and
factors influent on anxiety levels of fathers whose spouses
hospitalized for coming birth operation.
415 Materials and methods: Universe of the present descriptive and cross-
sectional study is consisted of spouses of pregnant women
Marfan sydrome and pregnancy, hospitalized in a state hospital in the period between January 1st
and February 28th, 2015. No any selection method was adopted, 161
a need for special surveillance fathers whose spouses were administered into the hospital in the
aforesaid period, who agreed to participate in the study were
F. Vilela, A. Edral, R. Martins, and A. Pacheco included in the sampling group. The research data was collected
through a 35-item survey form applied face-to-face and prepared
Obstetric Dept, Faro Hospital, Faro, Portugal based on the available literature plus the Anxiety Status Scale upon
the relevant permission was issued by the hospital administration.
Introduction: Marfan’s syndrome is a genetic connective tissue Collected data was analyzed through the SPSS package software by
disorder caused by mutation in the gene encoding fibrillin 1. using mean, percentage, chi-square, Kruskal-Wallis and Mann-Whitney
Fibrillin is an extracellular matrix protein that provides support to U test.
rigid tissues and also enable skin and vessels to stretch. It is an Clinical cases and summary results: It was observed that 49.1% of
autosomal dominant heritable disease. This systemic disease affects respondent fathers were in 28-35 age group, 34.8% were graduated
200 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

from a primary school, 88.8% has medium income level, and 80.1% Clinical cases and summary results: Among 100 patients meeting the
have an elementary family. 68.9% of women gave birth before and inclusion criteria of the study, 68 (68.0%) presented with pruritus, 27
57.7% of these births were cesarean. It was observed that 47.8% of (27.0%) with incidental detection of elevated transaminases and 5
fathers have received partial information about status of their wives (5.0%) with other complaints. A total of 57 (57.0%) patients were
and babies, and the information resource was usually ‘‘phone diagnosed to be ICP. There was a statistically significant difference
conservation with their wives’’. Median total score of fathers based between groups in terms of the symptom/sign leading to ICP
on the Fathers’ Anxiety Status Scale was determined as 43, anxiety diagnosis (p=0.004). 46 (67.6%) among 68 were diagnosed to be ICP
level of 80.7% of fathers was at medium level. Finally it was in group P. This was reduced to 37.0% (10 in 27) for group T and
determined that the differences between median total scale scores 20.0% (1 in 5) for group O. When ICP cases, group P, group T and
and father’s age, education level, income level, family type, marriage group O were analyzed within themselves depending on the season
length, accompanying wives during physician examinations, debrief- of patient admission, winter followed by spring were the leading
ing about status of wife and baby, being disposed to be next to their times of the year when the ICP cases and symptoms/signs implicative
wives during birth operation, having birth experience before were of a hepatic problem accumulate. However, this difference did not
statistically significant (p 50.05). reach statistical significance in all of the groups (Table 1).
Conclusion: Fathers experienced medium level anxiety status. When Conclusion: The results were consistent with the fact that pruritus is
factors related with anxiety were taken into consideration, it could be the most important clue leading to ICP diagnosis in majority of cases.
suggested that following conditions are required to be fulfilled, Our data strengthened the suspicion of seasonal effects not only on
fathers to accompany their wives during antenatal examinations, ICP cases, but also on presenting symptoms and signs implicative of a
establishment of pregnancy training centers for couples and to hepatic problem. The reason why the difference did not reach
encourage them to attend these trainings, informing fathers during statistical significance may be explained by the relatively limited scale
each stage of labor, and allowing fathers to participate in labor if they of our study and our institution being a tertiary referral center. Further
are disposed to support their wives. studies are mandatory.

Keywords: Anxiety, father, labor Keywords: Intrahepatic cholestasis of pregnancy, environment,

seasonal variations

444
Environmental effect on intrahe-
patic cholestasis of pregnancy:
seasonal variations in diagnosis
and presenting symptoms/signs
D. C. Katlan1, B. Konuralp Atakul2, T. Yüce1, A. Koç1, and
F. Söylemez1
448
1
Ankara University Faculty of Medicine, Department of Obstetrics
and Gynecology, Ankara, Turkey and 2Kızıltepe State Hospital,
Influence of short umbilical cord
Mardin, Turkey to neonatal neutrophilia
Introduction: Intrahepatic cholestasis of pregnancy (ICP) is the most
S. Janchevska and S. Ivanovska
common pregnancy specific liver disease classically presenting in the
third trimester with pruritus, abnormal liver function tests and raised PHO University Clinics of Gynecology and Obstetrics, Skopje, Republic
serum bile acid (sBA) levels, the latter being the most sensitive and of Macedonia
specific marker for diagnosis. Although the etiology is complex and
appears to be related to hormonal alterations in genetically
Introduction: An umbilical cord is considered short, if it is less than
susceptible women, several environmental factors are also reported
35 cm. The long umbilical cord can transform to relatively short
to play a role. Low selenium and vitamin D levels have been accused
umbilical cord with wrapping around the fetus. Case mothers and
of more frequent diagnosis of ICP in some countries during winter.
infants are more likely to experience labor and delivery complications,
Therefore, we aimed to re-check this environmental effect and
such as signs of fetal distress, when the fetus has not been receiving
demonstrate seasonal variations in symptoms and signs which
enough oxygen. A next link in the chain will be neonatal shift
may be warning clues for the diagnosis of ICP or other hepatic
neutrophilia.
disturbances.
Materials and methods: We analyzed the results of the triangle of short
Materials and methods: Patients who were admitted to Ankara
umbilical cord, fetal distress and neonatal neutrophils number. The
University Department of Obstetrics and Gynecology between May
cohort contents 386 newborns with short umbilical cord, of late
2010 and September 2015 were retrospectively evaluated. Among
preterm and full term pregnancies with fetal distress, collected during
those, women presenting with symptoms and signs implicative of a
two years in the University Clinics of Gynecology and Obstetrics.
hepatic problem with documented sBA levels were selected. They
We followed neutrophils dynamic in neonate’s peripheral venous
were grouped into three according to presenting symptoms/signs:
blood for three times: after birth, in the end of first and second
pruritus in the absence of a rash (group P), incidental detection of
postnatal day.
elevated transaminases (group T), and intractable abdominal dis-
Clinical cases and summary results: The first group of 120/386 (31%)
comfort together with nausea and vomiting unattributable to other
neonates delivered spontaneously vagynaly or 42/386 (10.8%) by
causes (group O). The ones with sBA levels 410.0 mmol/L were
vacuum extraction and a second group neonates 224/386 (58%)
diagnosed to be ICP. These three groups and ICP patients were
delivered by Cesarean Section. Two thirds of newborn babies were
compared within themselves depending on the season of patient
with high Apgar score in the first and fifth minutes, but others were
admission.
livid asphyctic. The early neonatal neutrophilia among the
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 201
investigated newborn babies was 38% (148/386), in the range from 1425] were higher than at the recovery stage (587 [334, 789]) (W=48,
74% to 87%. The results of next investigations showed a decreasing of p=0.053).
the neutrophils number to normal value, without of each one Conclusion: The measurement of blood presepsin level may be used
therapeutic treatment, excluding 24/386 (6.2%) septic newborns. for the evaluation of severity of gut wall damage. The changes of
There is not significant differences of neutrophilia between the blood presepsin level reveal the dynamics of pathological processes.
groups.
Conclusion: Short umbilical cord trigerred brief placental insufficient Keywords: NEC, presepsin
for more time, what results in fetal distress such an uncommon
complication of labor. It typically occurs when the oxygen delivery to
fetus decrease. Newborn’s answer high number than normal of
neutrophils in peripheral blood. Neutrophilia may result from a shift 462
of cells from the marginal to the circulating pool. This post stress
neutrophilia appears quickly and disappears to some hours after an Neonatal death in a tertiary care
influence of provocation.
center in Brazil
Keywords: Short umbilical cord, fetal distress, neonatal neutrophilia
P. P. Guizilini1, D. Willig1, M. Dexheimer1,
O. H. M. Feuerschuette2, S. K. Silveira3, and
A. Trapani Jr.4
454 1
Unisul, Tubarão, Brazil, 2Unisul, Tubarão, Brazil and Hospital
Universitário/UFSC, Florianópolis, Brazil, 3Hospital Universitário/
Blood presepsin level in neonates UFSC, Florianópolis, Brazil, and 4Hospital Universitário/UFSC,
with necrotizing enterocolitis Florianópolis, Brazil

E. M. Kozlova, G. L. Shunkina, N. M. Chumak, and Introduction: One of the most sensitive ways to measure the quality of
health care as well as socioeconomic status of a nation is infant
P. P. Bolshakov mortality rate, especially neonatal mortality. The objective of this
Nizhniy Novgorod Pediatric Hospital No1, Nizhniy Novgorod, Russian study was to establish a profile of the newborns that evolved to death
Federation in a NICU in south of Brazil.
Materials and methods: It was performed an observational study that
included all hospitalized infants born at Hospital Nossa Senhora da
Introduction: Necrotizing enterocolitis (NEC) is one of the most serious Conceição that died in the NICU from January 2010 to March 2015.
diseases of neonates because of severe complications (e.g. gut Clinical cases and summary results: 12 201 babies were born during
perforations and peritonitis). Early diagnostics of NEC is very the period of the study. 836 newborns were admitted to the NICU and
important factor for fatal outcomesprophylaxis. In fact we have no 128 (15.3%) died during hospitalization. 62.5% of the newborns that
specific features of the NEC beginning and very few diagnostic criteria died were born by cesarean section, 53.9% were female, 81.3% were
for differential diagnostics of the NEC stages. sCD14-ST(presepsin) is preterm, 48.4% weighed51.000g and 16.4% 2.500g, and 43.7% had
the protein with molecular weight about 13 kDa. Its blood level apgar score 7 at 5 minutes. The average number of days of life of
depends of phagocitosis activity and may be used as a marker of these infants was 5.60 ± 6.22 days. 30.5% of the death ocurred in the
bacterial infection. Some authors suppose blood presepsinlevel 1st day of life and 46% between the 2nd and 7th day of life. The main
increasing in neonates with NEC. The aim of our investigation was clinical problems of the newborns associated to death were transient
to estimate level of blood presepsin in neonates with gastrointestinal tachypnea of the newborn (60.2%), sepsis (44.5%), jaundice (35.2%),
tract pathology. respiratory distress syndrome (33.6%), hypoglycemia (31.3%), birth
Materials and methods: 18 neonates were examined. All patients were defects (16.4%), intrauterine hypoxia (15.6%), pneumonia (11.7%),
admitted to the hospital at the first week of life. All of them had two pulmonary hemorrhage (10.2%), and pneumothorax (7.8%). 90.6% of
or more clinical or X-ray signs of gastrointestinal tract disorders but the newborns required mechanical ventilation, 57.8% received
different diagnoses after examination. Gestational age was 34 [30,37] surfactant, 39.1% blood transfusion, and 37.5% parenteral nutrition.
weeks, birth weight - 2010 [1700, 2738] grams, average age at the Conclusion: The in-hospital neonatal mortality rate was 0.09%0.
moment of gastrointestinal disturbance - 8 [4,16] days and NTISS - 28 Prematurity and low birth weigh were the leading problems related
[24,33]. (All data is presented as mediana and interquartile [25,75] to neonatal death. The prevention of prematurity is a important goal
interval). The examination included dynamic evaluation of clinical to improve neonatal survival.
signs, blood counter, biochemical analyses, X-ray, US investigation.
We estimated level of blood presepsin by method of chemilumines-
cention (analyzer Pathfast) in the first hours after gastrointestinal tract Keywords: Neonatal death, prematurity, mortality
disorders revealing.
Clinical cases and summary results: The blood presepsin level of
800 pg/ml was chosen as a cut-off. 8 patients (one with partial
intestinal atresia, one with NEC I and six neonates with NEC II-III)
revealed presepsin level more than 800 pg/ml, 10 neonates (one with
Hirshprung disease, one with low intestinal impassability, one with
NEC II-III and seven neonates with NEC I) were included to the group
with blood presepsin level less than 800 pg/ml. So there were
significant difference in the number of patients with NEC I or NEC II-III
in both groups (2=5.368, p=0.021). Blood presepsin level in neonates
with NEC II-III was higher (1213 [1144, 1688] pg/ml) than in patients
with NEC I (671 [532, 747] pg/ml) (z=5.357, p=0.020). ROC-analyses
demonstrated following data: sensitivity - 86%, specificity - 88%, AUC
- 0.87. Dynamics of blood presepsin was estimated in 11 patients with
NEC. The data at the beginning of pathological processes (762 [531,
202 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

The aim: To estimate the concentration of sexual hormones in women

463 of reproductive age with cirrhotic portal hypertension, in dependence
Evaluation of medical counseling of functional liver reserve Child Pugh.
We selected 60 women of reproductive age with cirrhotic portal
in contraceptive methods to hypertension, caused by chronic virus hepatitis. The functional liver
reserve was determined, according to the child pugh A/B/C -25/20/15.
puerperal women We tested the plasmatic levels of oestrogen, progesterone, LH
and FSH.
Clinical cases and summary results: In the first group in 25 cases
F. Z. Mattos1, D. Willig1, M. Dexheimer1, (41,6%), where the functional reserve of liver child pugh a, was good,
O. H. M. Feuerschuette2, S. K. Silveira3, and A. Trapani Jr4 the medium level of e2 in all the phases of menstrual cycle was at
1 upper admissible range (130,7±30,5PG/ML). In the second and the
Unisul, Tubarão, Brazil, 2Unisul, Tubarão, Brazil and Hospital
third group with poor functional reserve child B,C in 24 cases (58,3%)
Universitário, Florianópolis, Brazil, 3Hospital Universitário, the level of oestrogen have been increased in all the phases of
Florianópolis, Brazil, and 4Hospital Universitário, Florianópolis, Brazil menstrual cycle (366,6±46,3PG/ML). This fact can be explicated by
and Unisul, Palhoça, Brazil functional insufficiency of the liver and perturbances of protein
synthesis in liver, which cause severe pathogenetic infringements in
Introduction: Family planning is an important issue to avoid unwanted oestrogenic metabolism. The plasmatic medium concentration of
pregnancies and unsafe abortions. The aim of this study was to assess progesterone in the first group was 34,5±3,6 NMOL/L and in group
the knowledge of puerpera women about contraceptive methods, with poor liver reserve it was a breakdown of progesterone contents
counseling received about family planning during pregnancy and till 16,7±3,4NMOL/L (P0,05).
puerperium, and contraceptive methods used. Conclusion: The increased value levels of estrogen and poor
Materials and methods: A cross-sectional observational study that concentration of progesterone in women with cirrhotic portal
included 587 women who gave birth at Hospital Nossa Senhora da hypertension, explain the absence of menstruation and anovulatory
Conceição, Tubarão, Brazil, from March to June 2015, was performed. cycles in patients with poor liver reserve, which are the main factors
The informations about contraceptive methods were obtained of infertility in these patients.
through the application of a questionnaire prepared by the
Keywords: Infertility, sexual hormones, portal hypertension
researchers.
Clinical cases and summary results: The median age of the
respondents was 27.3 ± 6.8 years. Most of the patients were married,
had high school education, and a low income. The pregnancy was 476 (CASE REPORT)
planned in 52% of the cases. 62.7% were using a contraceptive
method before pregnancy. 64.1% became pregnant by stopping the The umbilical cord pathology -
method, and 30% by improper use. The methods more frequently
used were oral contraceptive (80.7%) and male condom (9.1%). The two true knots and thrombosis of
major difficulty in proper use was forgetfulness. Among those who
did not use contraceptive method, 37% believed that they would not the umbilical cord - case report
became pregnant, and 21.5% were unaware of the methods. Doctors
were the main source of counseling about family planning. 71.9% S. Srzentic, V. Djokvucic, and Z. Srzentic
found the received informations adequate. Only 3.15% of the women
were advised during prenatal care and 17.7% on puerperium. 64.4% JZU Opsta bonica Bar - Department of Gynecology and Obstetrics at
of the puerpera women did not want another infant. 99.3% wanted to PHI General Hospital Bar, Bar, Montenegro
use a contraceptive method after delivery. Oral contraceptives and
female sterilization were the methods of choice (44.2% and 17%). Introduction: All states of the umbilical cord pathology can be divided
Conclusion: Puerpera women knew and used various contraceptive into two groups. The first includes organic conditions - insertions
methods. However non-use or misuse still led to unplanned abnormalities, vasa previa, blood vessel of umbilical cord pathology,
pregnancies. There is a need to modify strategies to improve the umbilical hernia and tumors. The second group includes functional
efficiency of counseling on family planning. abnormalities - the state of the umbilical cord caused by malfunction
or the influence of certain external forces - true and false knot,
Keywords: Puerpera women, contraceptive methods strangulati of the cord around the neck, umbilical cord descent,
umbilical cord prolapse and umbilical cord edema. In our paper, a
case of patient with a successful brought out pregnancy with two
true knots and its thrombosis.
Clinical cases and summary results: The patient 28 years old, quartipara
has been hospitalized due to pain in the bottom of the stomach and
467 notable edema on her feet. At the department, the patient lab, clinical
and ultrasound processed, and concluded that it is a vital pregnancy
The level of sexual hormones in of 39th week. Biometrics and morphology of fetus neat. CTG reactive.
On the third day of hospitalization, the patient complains that she
women of reproductive age with does not feel the movements of the fetus. CTG silentan, and opted for
cirrhotic portal hypertension an emergency cesarean section. A (female) child was born live, 3700gr
| 54cm | 34cm, AS 5 | 7, reanimated. The amniotic fluid green.
Umbilical thrombosis with two true knots. The baby was immediately
A. Lupascu sent to the Department of Neonatology Podgorica. Operative and
postoperative tones were in order. PH finding - placenta measure
The Institute of Mother and Child Care, Chishinau, Moldova 18x14x3cm with cord length 75cm paracentral insertion. In placenta
there are many dark brown areas. Ramifications of the placenta was
Introduction: Chronic liver diseases are commonly associated, in introduced, areas of bleeding in several places with the elements of
dependence of severity and duration of disease, with menstrual cycle necrosis. In the vein of the umbilical cord in several places
disorders such as amenorrhea and anovulation. In most of cases the thrombosis. Complete blockage of blood vessels thrombus. In two
possibility of pregnancy is poor but sometimes these women become true knots, there is also thrombosis of blood vessel.
pregnant.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 203
Conclusion: The presented case of umbilical venous thrombosis and
two true knots was successful thanks to rapid caesarean section and 498
child was born alive. Intrauterine diagnosis of umbilical venous
thrombosis is difficult. The umbilical venous thrombosis rarely occurs
When do we have to obtain
and it is unpredictable, fatal in most cases. Maternal and fetal
pathology is missing in many cases. It occurs suddenly, and it is a
rebound bilirubin levels?
tragic loss. The diagnosis is often set out after birth, based on
histopathology of umbilical cord. Ozdemir H., Bilgen H., Mutlu A., Unkar Z.A., Memisoglu
A., and Ozek E.
Keywords: Umbilical cord, true knot, umbilical venous thrombosis
Marmara University School of Medicine, Department of Pediatrics
Division of Neonatology, Istanbul, Turkey
480 (CASE REPORT)
Presenter: Hulya Bilgen
The functional damage of the Introduction: The aim of this prospective study was to evaluate the
newborn adrenal glands as a clinical utility and timing of inpatient rebound serum total bilirubin
(STB) levels.
result of birth trauma - Case Materials and methods: Infants with a gestational age older than 35
weeks of gestation and for whom phototherapy was started
report according to the American Academy of Pediatrics Practice
Parameters guidelines, were eligible for the study. Data including
V. Djokvucic, S. Srzentic, and Z. Srzentić the demographic features of the babies, onset of jaundice and the
etiological factors were recorded. The bilirubin work-up included
JZU Opsta bolnica Bar - Department of Gynecology and Obstetrics at blood groups of the mother and baby, STB, direct bilirubin level,
PHI General Hospital Bar, Bar, Montenegro direct Coombs test, reticulocyte count, peripheral blood smear,
albumin and glucose-6-phosphate dehydrogenase levels. Rebound
Introduction: Due to its extreme size and hyperemia, adrenal gland in STB levels were obtained between 8-12.hours and 24.hours after the
a newborn is extremely fragile and prone to haemorrhage. The clinical termination of phototherapy. All babies were followed up for
picture is nonspecific and varies from asymptomatic image to the hyperbilirubinemia during their first month of life.
development of acute, subacute or chronic adrenal insufficiency. Clinical cases and summary results: Data was available for 108 infants
Along with good anamnesis and a careful clinical exam, the gold (82% term and 18% late preterm infants). The median (min-max) age
standard for the diagnosis and monitoring represents abdominal and mean (±SD) STB at onset of phototherapy were 96(3-192) hours
ultrasound exam. and 17.6±5.5 mg/dl, respectively. The median(min-max) duration of
Clinical cases and summary results: A newborn from secundipara, phototherapy was 24(8-72) hours for the whole group. Of the 108
desired, controlled pregnancy, during which the mother had neonates who received phototherapy, 17(16%) had blood incompat-
hypertension (taking methyldopa). Birth at term, 40 week, PM ibility and six (29%) of them required exchange transfusion while
4600 gr, PD 60 cm, APGAR 8/10. On the fourth day of the birth, an seventeen (16%) were late preterm and sixteen (15%) babies had
increase in serum of bilirubin is noticed and the newborn is sent to excessive weight loss. No risk factor was found in 54% of the cases.
the Neonatology. The newborn is placed in the incubator, the i.v. The rebound rate necessitating phototherapy was 9.3%. All babies
hydration, antimicrobial therapy and phototherapy are engaged. who rebounded had a risk factor. Most of the babies (80%)
Ultrasound of abdomen performed, showing an elliptical, clearly rebounded between 8-12 hours, except two babies who rebounded
limited change in the region of the left adrenal gland corresponding at 24 hours. The rebound group had a significantly longer duration of
to hemorrhage. In the first days of hospitalization, the newborn is of phototherapy [median (min-max); 36(18-72) vs 24(8-72)] hours;
good general condition, stable, takes and tolerates meals. Bilirubin in p:0.001) and increased number of patients (40%vs12%;p:0.019) with
the fall, so phototherapy switched off. In the fifth day of hospitaliza- hemolysis.
tion, the general condition of the newborn deteriorates; febrile Conclusion: Although AAP guidelines states that ‘‘discharge need not
38,8?C, skin intense yellow, no tolerance of meals through the probe. be delayed for rebound bilirubin levels’’,in countries where the
Lab findings: elevated indirect bilirubin, PCT, low value of sodium. The incidence of hyperbilirubinemia is high and the adherence to follow-
i.v. rehydration with electrolyte correction and phototherapy are up after discharge is low,rebound STB has to be obtained inpatient.
engaged. In further course, the situation improves, the newborn takes Our results support that it is essential to check post-phototherapy
and tolerates meals, lab analysis within the reference values. Control bilirubin levels in babies with risk factors and found that early
ultrasound: limited change in the region of the left adrenal inpatient rebound bilirubin levels could detect 80% of the babies who
corresponding hemorrhage. needed a second course of phototherapy.
Conclusion: Visible birth trauma with perinatal asphyxia data, early Keywords: Newborn, hyperbilirubinemia, rebound bilirubin
hyperbilirubinemia should rise suspicion of possible adrenal glands
hemorrhage. Clinical manifestation is nonspecific, U/S of the abdo-
men required. In case of adrenal glands hemorrhage confirmation,
monitoring & testing for possible development of transitory/chronic
insufficiency is necessary. Unrecognized insufficiency may deteriorate
& develop acute insufficiency, one most urgent condition in pediatrics
when child’s life is endangered.
Keywords: Adrenal glands, haemorrhage, insufficiency
204 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

507 (CASE REPORT)

Pemphigus vulgaris during
pregnancy
R. Sulukhia1, N. Pirstkhalava2, L. Melia3, and K. Tsanava4
1
Department of Obstetrics and Gynaecology, Academician O.
Gudushauri National Medical Centre, Tbilisi, Georgia, 2Department of
Obstetrics and Gynaecology, Academician O. Gudushauri National
Medical Centre, Tbilisi, Georgia, 3Department of Obstetrics and
Gynaecology, Academician O. Gudushauri National Medical Centre,
Tbilisi, Georgia, and 4Department of Internal Medicine, Academician
O. Gudushauri National Medical Centre, Tbilisi, Georgia

Presenter: N. Pirtskhalava
Introduction: Pemphigus Vulgaris (PV) is an uncommon immune -
mediated bullous dermatosis, which is very rare during pregnancy. Its
management during pregnancy is a challenge and sometimes very
difficult. The disease may be associated with adverse fetal outcomes
such as intrauterine death, which is confirmed due to umbilical cord
prolapse, placental dysfunction or not diagnosed, prematuity and
fetal death. The neonate can develop transient skin lesions. We 509
present a case of patient who conceived during the active phase of
PV required high doses of corticosteroids and cesarean section was Fetal ductus arteriosus constric-
performed due to stop extended uterinal bleeding and finish
spontaneous abortion.
tion and maternal consumption
Clinical cases and summary results: 33 Year old woman G3P2 was
referred to internal medicine department for suspected PV. On
of polyphenol-rich foods in late
admission, there was flare of her disease during pregnancy. She was pregnancy: a 6 year experience in
admitted at 17- week gestation with history of developing persistent
gingival erosions, a shift from mucosal - dominant, erosions were a portuguese tertiary-care
present on the mucous membranes of the mouth and the vermillion
bordesr of the lips, causing considerable pain and bleeding. Blisters hospital
were developed over the abdomen,gradually extended all over the
body. Clinical and histologic features were the basis for diagnosing M. Marinho, C. Soares, M. Melo, A. Carriço, and F. Valente
PV. She was treated with high doses of sytemic corticosteoids, she
conceived while still on treatment without any difficulty. When she Obstetrics Department; Centro Hospitalar Vila Nova de Gaia/Espinho;
referred to our clinic, the body surface was covered with diffuse Porto, Portugal
infiltrated erythema, with blisters with frail roof. The treatment was
continued with oral therapy - Prednisone 75 mg, Cephepim, B Group Presenter: Marcia Marinho
Vitamins, Fluconasol, Amitriptilin. She needed one transfusion of
Venofer. Two week after hospital treatment, she developed early Introduction: The ductus arteriosus (DA) plays an essential role in fetal
pregnancy bleeding, pain in the region of hypogastrium.Gynecologist circulation. It is a small vessel connecting the pulmonary artery and
suspected spontaneous, unaccomplished abortion with extended the proximal descending aorta that allows 80-85% of the blood from
bleeding, the endocervix was not ready for delivery .It was performed the right ventricle (RV) to bypass fetal pulmonary circulation. Ductal
cesarean section, post cesarean section supravaginal amputation. patency depends on circulating prostaglandins (PG) especially during
Significantly, the scar after cesarean section had healed completely third trimester and also endothelial nitric oxide and low O2 blood
and was free from any skin lesions. During the hospitalization, oral tension. Polyphenols are present in a large part of our daily food (dark
therapy with methylprednisolone was continued. chocolate, fruits and vegetables, etc) or beverage ingestion (green,
Conclusion: It is seen in our case that during active phase of PV, it is black or other teas). They’re able to inhibit PG synthesis, interfere with
possible to conceive. Our case indicates that PV in pregnancy requires DA dynamics and condition a constrictive effect. Intrauterine DA
care by a gynecologist, dermatologyst and internal medicine doctor. constriction (DAC) may lead to RV hypertrophy, pulmonary hyperten-
We believe that the cesarean section performed in the same cases sion, heart failure or even perinatal death.
could be a standard procedure, conceivably preventing induction of Materials and methods: This is a retrospective study of all cases of DAC
pemphigus lesions such as blisters or erosions in genital region related with maternal polyphenol-rich substances consumption, that
during parturition. Finally, our case shows that prednisolone is first occurred between January 2010 and January 2016 presenting to a
choice treatment for PV. tertiary care hospital. A search of our hospital’s electronic medical
record system was used to identify all the cases.
Keywords: Pemphigus vulgaris, SIRS, Pregnancy Clinical cases and summary results: We present four clinical cases: two
with pre-natal and two with post-natal diagnosis.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 205
In two cases, the diagnosis of DAC was made during a fetal states, it is important to exclude cerebral venous thrombosis,
echocardiography in the 3rd trimester and related to a maternal thrombophilia, hemorrhage and also arteriovenous malformations.
ingestion of Ice Tea (4 1L/day). After it’s suspension there was a Eclampsia presents as tonic-clonic seizures, besides headache,
reversion of DAC in one of the cases but not in the other. The 3rd case hypertension, proteinuria,etc. It seemed unlikely in our case.
was a dichorionic twin pregnancy monitored and uneventfully until Inaugural epilepsy in the postpartum period is uncommon and a
35 weeks of gestation, when a caesarean was performed after a exclusion diagnosis that must be considered.
preterm membrane rupture. A few hours after birth, one of the
newborns presented respiratory distress signs and hypoxemia with no Keywords: Convulsions, postpartum
response to O2 supplementation. An echocardiogram was performed
and DAC in utero was hypothesized and related to maternal
consumption of black tea, dark chocolate and orange juice. In the
last case, the diagnosis was also made after birth and DAC was related 514
to maternal Ice Tea consumption in late pregnancy.
Conclusion: Polyphenols are abundant micronutrients in our diet.
Mode of delivery and perinatal
Besides an anti-oxidant action, their anti-inflammatory effect (similar
to NSAIDs- nonsteroidal anti-inflammatory drugs) inhibits the
results on donor oocyte
synthesis of PG. Excessive consumption during third trimester may pregnancies
interfere with DA hemodynamics leading to its constriction or
premature closure. Since polyphenols consumption can be a
reversible cause of DAC, dietary habits during pregnancy need to L. Álvaro, C. Villalaı́n, R. Bermejo, O. Villar, I. Herráiz,
be paid attention. E. Gómez-Montes, and I Mejı́a
Keywords: Polyphenols; ductus arteriosus constriction Obstetrics and Gynecology Dept; Hospital Universitario 12 de
octubre; Madrid, Spain

Presenter: I. Mejı́a
510 (CASE REPORT)
Introduction: Pregnancies conceived through oocyte donation are on
Seizures in early postpartum the rise, most of them characterized by advanced maternal age,
period: a diagnostic challenge primiparity and multiple gestation. They have been linked to
complications of abnormal placentation, hypertensive disorders,
increased rate of induction of labor (IOL) and cesarean delivery.
M. Marinho, C. Soares, I. Ferraz, C. Ferreira, and Most research has focused on the first two and little on mode of
M. Barbosa delivery and perinatal results which have been justified by maternal
characteristics
Obstetrics Department; Centro Hospitalar Vila Nova de Gaia/Espinho; Materials and methods: The study group included 136 women who
Porto, Portugal conceived through IVF-DO within 2011-2015 and were followed up at
our center. Medical files were reviewed to make a description of the
Presenter: Marcia Marinho basal characteristics, mode of delivery: vaginal delivery (VD),
instrumental delivery (ID) and cesarean section (CS), looking for
Introduction: There are several causes of seizures in the post-partum perinatal complications including Apgar57 at 5 min, arterial pH57.1,
period. Evaluation and management should be performed in a neonatal intensive care unit (NICU) admission and perinatal mortality.
stepwise fashion and may require a multidisciplinary approach with We searched for differences in obstetric outcomes between singleton
other specialties such as neurology. and multiple pregnancies and between under and over 35 years old
Differential diagnosis includes eclampsia, epilepsy, cerebrovascular of maternal age.
accidents (ex. cerebral venous thrombosis), infectious encephalitis, Clinical cases and summary results: We studied 136 pregnancies; 94
brain tumors, liver/renal failure, metabolic derangement, thrombo- singletons and 42 multiples (41 twins and one triplet). Maternal age
philia, posterior reversible encephalopathy syndrome (PRES), throm- distribution was bimodal with two peaks at 30 and 40 years. Mean
botic thrombocytopenic purpura (TTP), etc. body mass index (kg/m2) was 24.2(SD3.6).
There may also be considerable overlap in the presentation of these In singleton pregnancies, 30.5% of women start labor spontaneously,
conditions, making diagnosis and treatment difficult. The distinction 55.0% undergo IOL (main cause having reached 41weeks of gestation)
of etiology is critical, because therapy must be directed at the and 14.5% have a planned CS (main causes preeclampsia and breech
underlying disorder in order to achieve seizure control. presentation). In multiple pregnancies 27.2% of women start labor
Materials and methods clinical cases & summary results: G2P0 spontaneously, 12.2% undergo IOL and 60.6% have a planned CS
previously healthy woman with an uneventful pregnancy followed (main cause fetal malpresentation). In singleton pregnancies,
at our institution because of maternal age (38 years old). She received prevalence (%) of VD, ID and CS on women who started labor
a lumbar epidural during labor and delivered a healthy baby boy via spontaneously or underwent IOL was 31.9, 18.8 and 49.3 respectively.
cesarean section after nonreassuring fetal status. At the 3rd day after On multiples it was of 23.1, 7.7 and 69.2. No significant statistical
delivery she started paroxysmal episodes of involuntary contraction differences were found when stratified by maternal age (under and
of the last three fingers and left hand, lasting seconds with over 35 years old). Main causes (%) for CS on singletons (excluding
spontaneous cessation and then a stronger seizure with loss of direct CS) were failure of induction of labor (26.2) labor arrest (14.3)
consciousness. There was no altered state of consciousness, and non reassuring fetal status (14.1%). In general, rate of VD, ID and
hypertension, headache, nausea, visual disturbances or fever. She CS were of 26.2%, 16% and 57.8% in singletons and 9.1, 3.0 and 87.9%
had 3 more episodes after the inaugural one. Magnesium sulphate on multiples.
was started until eclampsia was safely excluded. Laboratory tests with Mean gestational age at delivery (weeks) was 38.9 (SD7.5) in
no thrombocytopenia, liver or renal impairment. singletons and 35.7 (SD3.6) in multiples. Mean neonatal weight was
Lumbar puncture, head CT scan, EEC and ECG did not reveal any 2795 (SD784) grams. There were 3 cases of Apgar 57 at 5 minutes
abnormality as well as cerebral MRI and magnetic resonance (2.2%), 13 (9.6%) infants who required NICU admission, two postnatal
angiography. After being studied these partial/focal seizures were deaths, (one on a singleton, one on a twin pregnancy), and one
interpreted as inaugural epilepsy. stillbirth.
Conclusion: Seizures in the postpartum period poses a clinical Conclusion: IVF-DO pregnancies have a higher rate of IOL (42.3%) and
challenge. Since pregnancy and postpartum are pro-thrombotic CS (66.1%) than spontaneously conceived pregnancies. Main causes
206 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

of CS on women who attempted VD were failure of IOL and labor 519

arrest. These differences remain statistically significant when stratified
by maternal age and number of fetuses. Further research is Pulmonary hypertension during
recommended in order to find other factors that might be playing
a role on mode of delivery so we can improve these outcomes. pregnancy: perinatal and mater-
nal outcomes in our hospital
516 A. Vázques Sarandeses, D. Montáñez Quero, C. Martı́nez
Transported neonates in tunisia: Gómez, P. Barbero Casado, I. Camaño Gutiérrez, O. Villar
Ruiz, P. Vallejo Pérez, and A. Garcı́a Burguillo.
condition at arrival and outcome
Department of Obstetrics and Gynaecology. Hospital Universitario 12
1 1 2 de Octubre. Universidad Complutense de Madrid. Madrid, SPAIN
F.Z. Chioukh , K. Ben Ameur , K. Ben Helel , H.
Mejaouel2, S. Blibech3, H. Kébaier3, M. Doagi3, I. Ksibi4, Presenter: Alicia
S. Kacem4, N. Mahdhaoui5, H. Ayech5, H. Seboui5, H. Ben
Hammouda6, H. Soua6, R. Régaieg7, Bouraoui A.7, Introduction: Pulmonary hypertension is a syndrome defined by
elevated mean pulmonary arterial pressure. It is a rare disorder with
A. Gargouri7, and K. Monastiri1 multiple etiologies, one of them is primary PH (without previous
1
Department of Intensive care and Neonatal Medicine of Monastir, cardiac damage)and secondary HP (in wich the clinical situation is a
result of a heart injury. This condition is mainly characterized by flow
Tunisia, 2Department of Neonatology of Kairouan,Tunisia,
3 restriction through the pulmonary circulation, entailing an increase
Department of neonatology of Military hospital of Tunis, Tunisia,
4 resistance in the pulmonary vessels. Pregnancy in this patients poses
Department of Neonatology LaRabta of Tunis, Tunisa, 5Department a high risk with elevated maternal an fetal mortality rates (30%-50%).
of Neonatology of Sousse, Tunisia, 6Department of Neonatology of Current guidelines advise against pregnancy, and still consider PH as
Mahdia, Tunisia, and 7Department of Neonatology of Sfax,Tunisia a contraindication. However, an intensive multidisciplinary team
approach and the development of new drugs has improved the
Presenter: K. Ben Ameur survival of these patients.
Materials and methods: We designed a descriptive, retrospective and
Introduction: To describe the transport of sick neonates to a tertiary no controlled study. We include all patients followed in our hospital
care hospital and evaluate their condition at arrival and outcome. between September 2011 and April 2015, with an evolutive
Materials and methods: A multicenter, prospective cohort study was pregnancy who decided to go on, despite full awareness of the
performed from 1st april to 31 July 2015.During this period, a total of risks and serious complications.
4122 neonates were admitted to 7 NICUs in Tunisia. Demographic Clinical cases and summary results: A total of 7 women were included.
parameters, transport details and clinical features at arrival were 71% (5/7) were affected by primary pulmonary hypertension.
recorded. All neonates were followed up till discharge or death. Treatment before pregnancy was Sidenafil in 57,9% of the patients
Clinical cases and summary results: A total of 239 consecutive and Calcium channel blockers were used in the rest of them. Each
neonates were enrolled in the study representing 5.7% of all patient same treatment and no modifications were made during the
admitted infants. Sex-ratio was 1.46. Preterm infants represented pregnancy. 86% of them had a good NYHA (II).
24% of transported babies. Maternal risk factors were present in 26% Antenatal corticoids for fetal maturation were administrated in 4/7
of neonates admitted. Seventeen percent of neonates had severe (57%). Mean gestational age at delivery was 34 + 6 weeks (from 31 + 5
respiratory distress and 10% had hemodynamic troubles. Referred to 37 + 5). An elective cesarean was performed in all cases, 5 with
hospital was not informed in 24% of cases. Regarding the transport regional and 2 cases using general anesthesia.
mode, 113(47.5%) were transported in ambulance accompanied by a All women delivered healthy babies with a great Apgar score.
nurse and the majority of the transportations had been done without Neonatal mean weigh was 2410 g (from 1490 to 3360 g). Prematurity
monitoring blood oxygen(75%).Transport incubator was available in complications occurred in 5 of the newborns. One of them is affected
28% of cases. Documentation during transfert was present in 14% of by a supraventricular tachyarrhythmia of hard management. No
cases. Five babies expired on arrival and rate mortality was 13.8%. complications took place during the obstetric follow-up or post-
Conclusion: Transporting neonates in developing countries is a partum. There were no maternal or neonatal deaths.
challenge. Organized transport services in Tunisia are not available. Conclusion: Although Pulmonary Hypertension has a high risk of
No health provider is available to accompany the baby and mortality, current treatment allow to achieve a successful pregnancy
communication systems are inefficient. So, in cases of at-risk if this situation is managed by a skilled multidisciplinary team ideally
pregnancy, it is safer to transport the mother prior to delivery than at a centre with experience in these disorders so this pathology could
to transfer the sick baby after birth. be no more an absolute contraindication for pregnancy.
Keywords: Ambulance, Birth weight, Neonatal transport, mortality
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 207

521
Attempted operative vaginal
delivery: evaluation of maternal
and neonatal outcomes
A. Vázquez-Sarandeses, V. Bebia Conesa, P. Barbero
Casado, I. Mejı́a Jiménez, and L. Forcén Acebal.
Department of Obstetrics and Gynaecology. Hospital Universitario 12
de Octubre. Universidad Complutense de Madrid. Madrid, SPAIN

Presenter: A. Vázquez Sarandeses

Introduction: The purpose of this study is to assess the short-term
maternal and fetal morbidity associated with operative vaginal
delivery (OVD). In this study we intend to evaluate whether there is
an association of OVD to the development of adverse maternal and
neonatal outcomes.
Materials and methods: Retrospective study of 309 women carrying
singleton fetuses who underwent attemped lowpelvic OVD. The
mean gestational age was 39 +4 weeks (from 33 + 4 to 42 + 5 weeks).
This group is composed of 254 nulliparous (82.2%) and 55 multi-
parous (17.8%) women. Severe maternal morbidity was defined as
postpartum hemorrhage, fever, blood transfusion, thromboembolic
events, third or fourth degree perineal laceration and the develop-
ment of urinary or fecal incontinence. Severe neonatal morbidity was
considered as Apgar score below 7, metabolic acidosis (umbilical
artery pH57,10), shoulder dystocia, respiratory distress requiring the
use of positive pressure ventilation or intubation and neonatal
intensisve care unit admission. For data analysis STATA IC14 was used.
Clinical cases and summary results: During 2015, 4200 deliveries
occurred. There were 309 lowpelvic OVD (7,4%): 144 Spatula (46.6%),
133 Forceps (43.0%) and 32 Vacuum (10.4%) attemped. Most
common indication for OVD was prolonged second stage of labor
n=170(55.0%) followed by Suspicion of inmediate fetal compromise
n=74(24.0%). There were no maternal or perinatal deaths. Severe
maternal morbidity rate was 17.6% (n =53): 86.8% in nulliparous, and
13.2% in multiparous women. Main adversal outcome was severe
perineal laceration n=22 (30.1%), followed by blood transfusion n=16
(22.9%). Mean birth weight was 3307.8 (from 1490 to 4870g). Severe
neonatal morbidity rate was 17.5% (n =54) and respiratory distress
was the main cause 37.0% followed by metabolic acidosis 22.2%.
Shoulder dystocia occurred in 5 cases, all of them presented brachial
plexus neurophaty with good subsequent recovery
Conclusion: In those fetuses who manifests signs of compromise and
when shortening the second stage of labor might result in a maternal
benefit, operative vaginal delivery, performed by a trained profes-
sional is a good alternative. It has proven to be safe for both, the
mother and the newborn. Finally, we are not able to conclude that a
type of OVD is safer than another one.
541
Advanced maternal age and the
risk of stillbirth at term
V. Petrov1, N. Bursacovschi1, and C. Eţco2
1
Institute Mother and Child, Chisinau, Moldova and 2State Medical
and Pharmaceutical University ‘Nicolae Testemitanu’

Presenter: Petrov Victor

Introduction: Delayed child-bearing, which has increased greatly in
recent decades, is associated with an increased risk of adverse
pregnancy outcome [Laopaiboon M et al. 2014, Jo-Ann Johnson et al.,
2012]. Thus, advanced maternal age (35 years) has been reported as
a risk factor strongly associated with stillbirth in many developing
countries [Aminu M. et al., 2014]. Fretts and colleagues have shown
208 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

that maternal age over 35 years is associated with increased risk of (OR=13,75; 95% CI 5.14 - 36.79, p50.0001) and fetal hypoxia (OR=3,28;
fetal death. These findings were confirmed in multiple studies, and 95% CI 1.63 - 6.61, p=0.0009) was observed in this group of patients,
association persists even after adjustment date for potential while rate of fetal growth retardation had no significant difference
covariates such as genetic problems, innate defects, medical with the control group. Among women with recurrent miscarriages in
problems and maternal weight [R.M. Silver, 2007]. anamnesis higher rate of intraamnial infection (OR=18.64; 95% CI
Materials and methods: A retrospective case-control study was 4.3055 - 80.7236, p=0.0001) and olygohydramnios (OR=12.00; 95% CI
handled. The sample size was limited by the total number of 1.53 - 94.28, p=0.02) were discovered. Rate of polyhydramnios was
stillbirths at term (0 Apgar score at the first and fifth minute of life) the same in both groups.
registered in the Institute of Mother and Child (IMC) of Republic of No differences in rate of early and late miscarriages, preterm labor,
Moldova during 2013-2014. The control group consisted of live births gestational diabetes mellitus, gestational pyelonephritis were dis-
in the same obstetric units. As mature were considered newborns covered between study group and control group. Rate of fetal
since 37 obstetric week. The study group (L1) included 39 cases of macrosomia has no significant differences in both groups.
intrauterine fetal demise at term, the control group (L0) - 69 live Conclusion: Thus, women with recurrent miscarriges in anamnesis
births. In order to obtain the necessary information it has been have more complications during pregnancy and require better
examined the stationary patient chart (Form 000-1/e). Data collection preconception.
was carried out by means of a specially developed questionnaire.
Clinical cases and summary results: The stillbirth rate in the IMC was Keywords: Pregnancy complications, fetal hypoxia, gestosis, mis-
equal to 12%0 and 9,0%0 in the 2013 and 2014, respectively, carriages, placental insufficiency, intraamnial infection
compared with 7.1 and 6,2 at the national level. A considerable
difference is explained by the fact that the IMC is a medical institution
of III level, where, according to predetermined criteria, are focused
556
pregnant women with the presence of risk factors, as well as those,
whose pregnancy has complicated by intrauterine fetal death. In 2013 The relation of expectant
in the framework of IMC stillbirth explained 54.5% of all perinatal
losses (72/132), in 2014 - 51, 3% (61/119). Stillbirth rate at term was mothers’ health-related practices
stable during 2013-2014 years (3,3 and 3,2%, respectively).
The present study revealed that the average age of women who gave during pregnancy and fatigue in
birth to an intrauterine mature demised fetus is higher than in the
control group (29.26 vs. 26,75 years). At the same time, the share of
mother and prenatal attachment
women with the age 35 years is higher in the group of stillborn’s
(25,64% vs.2.9%). Odds Ratio (OR) for this risk factor was equal to 11.6 N. Cinar1, S. Yalnizoglu Caka2, S. Topal3, H. Uslu Yuvaci4,
(CI 2,38-56,05). and U. Erkorkmaz5
Conclusion: Advanced maternal age is a significant risk factor
1
associated with stillbirth at the gestational term of 37 weeks and Paediatric Nursing Dept., Faculty Of Health Science, University of
over. The risk of intrauterine death of mature fetus is, at least, double Sakarya, Sakarya, Turkey, 2Paediatric Nursing Dept., Faculty Of
times higher in the older pregnant women. Deeper research should Health Science, University of Sakarya, Sakarya, Turkey, 3Paediatric
be carried out in order to prove the influence of maternal age on the Nursing Dept., Faculty Of Health Science, University of Sakarya,
course of ante- and intrapartum period in association with the Sakarya, Turkey, 4Obstetrics and Gynecology Dept., Faculty Of
coexisting factors and medical conditions.
Medicine, University of Sakarya, Sakarya, Turkey, and 5Biostatistics
Keywords: Stillbirth, maternal age Dept., Faculty of Medicine, University of Sakarya, Sakarya, Turkey

Presenter: Sinem Yalnizoglu Caka

545 Introduction: Pregnancy is a complex process that brings along many
changes in physiological, psychological and social aspects. While
Pregnancy complications in expectant mother experiences the initial excitement, she can also
patients with recurrent miscar- encounter undesired problems during pregnancy. Fatigue is one of
the most important problems experienced. Although fatigue is
riages in anamnesis observed at each stage of pregnancy, health behaviors can be an
important factor in the decrease/increase of fatigue felt. Prenatal
attachment is used in defining the emotional, cognitive and
O. Lebedeva, Y. Dyumina, T. Rugal, O. Yakovleva, and behavioral attachment established between the baby and the
S. Pakhomov woman during pregnancy. The purpose of this study is to examine
the relation of expectant mothers’ health-related practices during
Belgorod State National Research University, Belgorod, Russia pregnancy and fatigue in mother and prenatal attachment.
Materials and methods: The descriptive correlational study was carried
Presenter: Olga Lebedeva out at a State Hospital in Sakarya. The study sample consisted of
pregnant women (at least 20-week gestation) who applied to
Introduction: Rate of recurrent miscarriages at late pregnancy is about prenatal care services and agreed to participate in the study. This
1% (H. Carp, 2012). There are very small data about pregnancy study was approved by the Ethical Board in Sakarya University. The
complications in women having recurrent miscarriages in anamnesis, data were collected through a Personal Information Form, Brief
in spite that some conditions, which led to miscarriages, still can exist. Fatigue Inventory (BFI) and The Prenatal Attachment Inventory (PAI).
Materials and methods: Pregnancy complications according to out- The Cronbach’s alpha coefficient in this study for PAI was 0.97. The
patient case histories were estimated in 100 pregnant women with Cronbach’s alpha coefficient in this study for BFI was 0.93. The data
recurrent miscarriages in anamnesis (2 or more miscarriages) and in collected were analyzed by percentage distribution, means square,
89 pregnant women without miscarriages in anamnesis (control Spearman’s correlation, Mann-Whitney U-test and Kruskal-Wallis test.
group). Groups were randomized by age. A p-value 50.05 was considered significant.
Clinical cases and summary results: It was showed, that in patients with Clinical cases and summary results: 43.1% of the expectant mothers
miscarriages had significantly higher rate of emesis gravidarum (n=91) participating in the study were in the 24-29 age range. 59.7%
(OR=15,53; 95% CI 2,01-120,26, p=0.009) and gestosis (OR=4,20; 95% (n=126) of the participants had a middle income level, 35.5% (n=75) of
CI 1.5044-11.7259, p=0.006). Also higher rate of placental insufficiency them were secondary school graduates, and 92.4% (n=195) of them
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 209
went for regular controls. While the PAI average of the expectant catheter for an average 12.25 days (1-71) and mechanical ventilation
mothers going for regular control was 55.18±15.79, who did not go for (MV) for 4,8 days (0-71).
regular control was 43.56±16.23, and the difference between them was During admission, 24 (50%) had sepsis, 7 (14,6%) microbiologically
found to be statistically significant (p=0.004). While the PAI average of confirmed. 7 (15,6%) had digestive and 6 (12,8%) neurological dis-
the expectant mothers who smoked during pregnancy was orders. Cardiac surgery was performed (postoperative care in pediatric
45.29±14.18, who did not smoke during pregnancy was 54.85±16.05, intensive care unit) in 29 (60,4%) and 6 (12,8%) died before surgery.
and the difference between them was found to be statistically There were fewer deaths among those born in our hospital against
significant (p=0.032). While the BFI average of the expectant mothers transferred patients (0 vs 6, not statistically significant (NS) (p=0,07))
with planned pregnancy was 28.93±12.07, the BFI average of the with fewer VAD need (p=0.015), shorter MV (p=0.027) and fewer
expectant mothers with unplanned pregnancy was 38.69±12.88, and infections (p=0.035).
the difference between them was found to be statistically significant Children with prenatal diagnosis required less VAD (p=0.04), with
(p50.001). While the BFI average of the expectant mothers with longer treatment with prostaglandins (p=0.012) and had less (NS,
sufficient sleep duration was 31.26±12.56, the BFI average of the p=0.07) neurological disorders.
expectant mothers with insufficient sleep duration was 41.19±14.09, Conclusion: Children with DDC have significant morbimortality, with
and a statistically significant negative relationship was found between long stays at hospital and with venous catheter and MV during long
fatigue and sleep duration (r= -0.331, p50.001). The PAI averages of the periods, favouring the appearance of complications (death,
participants were 54.30±16.09, and the BFI averages were 32.77±13.26, infections. . .).
and a negative, weak but statistically significant relationship was found There may be side effects of prolonged treatment with prostaglan-
between BFI and PAI (r=-0.184,p=0.007). dins, although new prospective studies are still needed.
Conclusion: It was observed that the expectant mothers’ health- Prenatal diagnosis and birth in a tertiary hospital with a neonatal unit
related practices during pregnancy positively affected the fatigue and is associated with lower morbidity and mortality.
prenatal attachment. It was determined that the prenatal attachment
was negatively affected as the fatigue increased in pregnant women. Keywords: Ductus dependent cardiopathies, prostaglandins
The fact that expectant mothers develop positive health behaviors
during pregnancy will decrease the fatigue felt and positively affect
the prenatal attachment.
Keywords: Pregnancy, Prenatal Attachment, Fatigue

558
Ductus dependent cardiopathies.
aproach and evolution in a neo-
natal unit
R. Roldán López1, B. Rodriguez Azor1, S. Ariza Aranda1,
D. López Martı́n1, V.M. Schmitz2, E. Salguero Garcı́a1, and
T. Sánchez Tamayo1
1
Neonatology Unit, Hospital Regional Universitario de Málaga.
Málaga, Spain and 2Ginecology and Obstetric Dept. Hospital
Regional Universitario de Málaga. Málaga, Spain

Presenter: R. Roldán López

Introduction: Congenital heart defects (CHD) are the most frequently
admitted to neonatal critical care units (NICU) congenital malforma-
tion. They require a quick diagnosis and treatment, specially ductus
dependent heart defect (DDC). Our objective is to describe the
characteristics, management and complications until discharge from
the Neonatology Unit of the children with DDC in our NICU. Our
secondary aim is to evaluate possible evolution predictors. The 561
frequency of side effects described previously in the literature as
associated with the use of prostaglandins was also registered. Drug use knowledge and prac-
Materials and methods: A transversal study was performed, by clinical
story revision of the children with DDC hospitalized in our NICU in the tices of expectant mothers during
last five years (2011-2015).
Clinical cases and summary results: We studied 48 patients (43,8%
pregnancy period
female), 18 with prenatal diagnosis (37,5%). 41 (85,4%) born at term and
7 (14,6%) preterm (32-36 weeks). 17 (35,4%) were born in our hospital S. Yalnizoglu Caka1, S. Peksen2, M. Goktas3, F. Alagoz4,
and 31 (64,4%) came transferred from other hospitals. 25 where N. Cinar5, and S. Altinkaynak6
asymptomatic and 23 symptomatic (cyanosis or low cardiac output).
1
The most frequent DDC were great arteries transposition (16; 34,8%) Paediatric Nursing Dept., Faculty of Health Science, University of
and aortic flow changes (13; 28,2%). 8 (16,8%) associated non-cardiac Sakarya, Sakarya, Turkey, 2Obstetrics and Gynecology Dept.,
major malformations. Rashkind technique was performed in 3. Perinatology Early Pregnancy Unit, Responsible Nurse, Hospital of
All patients received prostaglandins, for an average 10.6 days (1-71). Zekai Tahir Burak Women’s, Ankara, Turkey, 3Director of Patient Care
Vasoactive drugs (VAD) were needed in 23 (47%) (more often
Services, Hospital of Zekai Tahir Burak Women’s, Ankara, Turkey,
dobutamine (17) and dopamine (11)). They needed central venous 4
Obstetrics and Gynecology Dept., Perinatal Intensive Care Unit,
210 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Nurse, Zekai Tahir Burak Women’s Hospital, Ankara, Turkey, among pregnant women due to insufficient knowledge on diagnostic
5
Paediatric Nursing Dept., Faculty of Health Science, University of possibilities of, potential risks and benefits for further process of
Sakarya, Sakarya, Turkey, and 6Paediatric Dept., Faculty of Health treatment. The objective of this study was to assess knowledge of the
Science, University of Sakarya, Sakarya, Turkey, possibilities, benefits and risks associated with prenatal diagnostic
among pregnant women.
Materials and methods: A prospective evaluation of questionnaires
Presenter: Sinem Yalnizoglu Caka filled by 100 pregnant women. The patient women were hospitalized
Introduction: Drug use during pregnancy, the used drug has a special between December 1st 2015 and January 31st 2016 at the
importance because it may have potential risks that could threaten Department of Obstetrics and Perinatology of Jagiellonian
the life of the mother and fetus. To compare the benefits of drugs and University Medical College in Cracow. The research was based on
its potential harms to mother is a basic principle in pregnancy. the questionnaire that included 21 questions about women’s
Medicines and some substances used in pregnancy may create knowledge on prenatal tests.
teratogenic effects in embryonic period, also can lead to morpholo- Clinical cases and summary results: In this research mean age was 26.6
gical and functional problems at later stages. Therefore, mothers years; min:19 max:39. Among 100 women: 93% (93) performed the
should not use drugs without doctor recommendation during ultrasound between 11 and 13 + 6 weeks of pregnancy. Only 37% (37)
pregnancy. The study was conducted to determine the knowledge female had simultaneously double test. All participants had made an
and practices regarding drug use of pregnant women in this process. ultrasound between 18 and 22 week of gestation. 43 women
Materials and methods: The descriptive study was carried out at a conducted it at private gynaecologists, 57 women were in the
State Hospital in Ankara. The study sample consisted of pregnant public healthcare units. Among first group gynaecologist recom-
women aged 18 years or above (n=266) who applied to prenatal care mended to perform double test more often (30 - 69.77%) compared
services and agreed to participate.This study started after receiving to the second group (7 - 12.28%) (p 50.05). Detailed information on
approval from related local authorities.The data were collected prenatal tests women obtained from: the Internet (99%), their own
through a Personal Information Form which were prepared by the gynaecologist (85%), in fashion & lifestyle magazines (78%), friends
researchers themselves.Personal Information Form included items on (56%). 19% (19) women considered frequent ultrasound as potentially
age, educational status, economical status, drug use etc.The harmful to the fetus.
participating women were informed of the purpose of the study Due to medical indications 65% (65) participants would perform
and the methods to be used and signed an informed consent invasive diagnostic. The majority - 85 patients (85%) considers it
statement.The obtained data were evaluated using percentage and reasonable to carry out information campaigns about the possibilities
average.All statistical analyses were performed using commercial of prenatal diagnosis.
software (IBM, SPSS statistics V. 22). Conclusion: This study demonstrated insufficient knowledge on
Clinical cases and summary results: 31.2% of respondents (n = 83) in possibilities and risks of prenatal diagnostics. More information
the 25-29 age range and mean gestational age was 27.26±10.59 about prenatal diagnostic is obtained from private gynaecologists.
weeks. 75.2% of respondents (n = 197) was nuclear family, 66.9% (n = Performing information campaigns on prenatal tests is necessary.
176) with middle-income, 76.8% (n = 202) housewife, 41.9% (n = 111) Keywords: Prenatal testing, patient, knowledge
primary/secondary school graduate. 60.6% of pregnant (n= 152)
experienced various health problems during pregnancy and 18.9% of
them (n= 44) has been treated by medication. 43.1% of respondents
(n = 113) do not have information about drugs can be used in 568
pregnancy and 15.1% of respondents (n= 38) stated that used drugs
before learning to pregnancy. 12.4% of respondents (n= 32) stated
Improving the quality of medical
that did not use the drug for fear it would harm the baby although
the doctor recommended. For the question of ‘‘when you have any
care for mothers and newborns in
health problem during pregnancy, first what you do?’’ 89.8% (n= 237) kyrgyzstan by funding health
of women answer was ‘‘I take drug with the doctor’s advice’’. 91.3% of
women (n= 239) stated that drugs use will affect the baby during care based on the results
pregnancy, 57.3% of them (n= 149) will not use drug in pregnancy
period for fear it would harm the baby despite the doctor’s
recommendation, 50.2% (n = 132) of respondents stated that the
S. Abduvalieva1, A. Askerov2, and C. Rakhmanov3
drug should not be used at all if possible during pregnancy. 1
Department of Obstetrics and Ginecology, Kyrgyz Government
Conclusion: Inform women about the use of drugs in pregnancy will Medical Academy,Bishkek, Kyrgyzstan, 2Department of pathology
reduce their concerns about the issue and will prevent incorrect
and prematurity babies, The National Centre of Maternity and
applications.
Childhood, Bishkek, Kyrgyzstan, and 3Department of pathology and
Keywords: Pregnancy, drug use, health problems prematur

Presenter: Sagynbu Abduvalieva

562
Introduction: Kyrgyzstan has achieved the MDGs in 2015, reducing
An analysis of patient’s knowl- child mortality by 2/3 from 71 to 23% since 1990. Maternal mortality
edge on prenatal testing in the last 10 years is not close to the target criterion of 15.7 per
100,000 children born. The trend in maternal mortality in the country
is volatile; its lowest value observed in 2011 (43.8 per 100,000 children
P. Ossowski, M. Nowak, A. Gadamer, J. Spaczynska, born in 2013 to 39.2 per 100,000, and the highest in 2009. 75.3).
M. Radon-Pokracka, and H. Huras The Ministry of Health of Kyrgyzstan follows the strategy ‘‘Den
Sooluk’’ aimed at addressing key disadvantages in the current system
Obstetrics and Perinatology Department, Jagiellonian University of health care, with emphasis on maternal and child health. Project
Hospital, Cracow, Poland ‘‘HFBR’’ (health financing based on the results) has been proposed for
the maintenance of health programs for maternal and child care in
Presenter: Magdalena Nowak health care organizations of the district and hospital level.
Materials and methods: I component -Testing two alternative
Introduction: Prenatal tests are one of the basic diagnostic methods approaches to improve the quality of maternal and newborn health
during pregnancy. Nevertheless, they arouse many controversies care at the level of district hospitals;
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 211
II component - financing, training and technical assistance to were examined for antibodies to cardiolipin, annexin V, b2-
providers of medical services; glycoprotein I, prothrombin and lupus anticoagulant circulation.
Assessment tools include: Clinical cases and summary results: Total 42,1% patients of I group had
 scorecard consisting of 7 sections APA circulation. Among them - antibodies to cardiolipin - 8,9%, to b2-
 Infants, children up to 5 years GPI - 31,4%, annexin V - 24%, to prothrombin - 13,5%. LA circulation -
 Management, security, hygiene 19,6%. In II group APS was diagnosed in 19%. In women with
 Human resources, training successful outcome of IVF in 12.4% we observed subsequent
 Patient Satisfaction reproductive fetus wastage. No stillbirth or antenatal fetal death.
 Quality Assurance Miscarriage occurred as stagnant pregnancy before 12 weeks of
 Surgery pregnancy. All women with pregnancy after IVF received the therapy
 Obstetrics (LMWH, antioxidants, folic acid, aspirin, vitamins group B) were
All components used structured (quantitative) questionnaires or delivered at term with alive healthy newborns.
checklists for data collection, all field workers, doctors have been Conclusion: Women with APA circulation demonstrate significantly
previously trained evaluation methods. high IVF failures (42,1%) and worser reproductive outcome compares
Clinical cases and summary results: Results: with the women undergoing IVF protocols but without APA. We
 The pilot hospitals located in rural areas and small towns, held consider the presence of antiphospholipid antibodies as temporary
stimulating payment by results of activity and intensive monitoring contraindication for the IVF programme.
of the quality of care for mothers and newborns.
 Increased capacity of the Government (the Ministry of Health, Keywords: Antiphospholipid antibodies, pregnancy loss, IVF
Mandatory Health Insurance Fund) and the provider of health
services in the award of contracts by the results of the activities,
also in monitoring and evaluation.
As a result of the ‘‘HFBR’’ (health financing based on the results) 588
project integration have been identified:
 Process changes in the hospital
Planned home birth- attitude of
 Defining vital medicines needs, purchase of medicines, medical
products. destination, changing medication storage conditions
polish women
 Improve hygiene conditions for patients and staff.
 Components library, Internet connection P. Ossowski, M. Nowak, J. Spaczynska, A. Gadamer, M.
 Education management and staff Radon-Pokracka, and H. Huras
Indicators of the project impact were:
 Improving the material resources Obstetrics and Perinatology Department, Jagiellonian University
 Improving medical supplies Hospital, Cracow, Poland
 Strengthening the capacity to manage governance
 Capacity building professionals Presenter: Malgorzata Radon-Pokracka
 Availability of patient satisfaction
The highest growth was recorded in the group of hospitals with Introduction: Home birth is an increasingly popular form of labour in
incentive pay based on the results of activity and intensive certain countries of Western Europe and the United States. In Poland,
monitoring of the quality of care for mothers and newborns. according to the latest data in 2014, only 111 children were born on
Conclusion: In this way, the integration of the intensive monitoring of the road of planned home birth. The aim of this study was to analyze
the quality of medical care for mothers and babies at the district pregnant women knowledge and attitude to this form of labour.
hospitals of Kyrgyzstan with all the quality components of medical Materials and methods: Prospective analysis was performed using data
services, with a challenging payment by the results of the health care obtained on the basis of a specially prepared questionnaire. The
organization, improve the material and technical base, medical questions related to the women knowledge of the possibility of
supplies, enhances the potential of managers and health profes- planned home birth and the risks associated with this form of giving
sionals of the hospitals and most importantly - improves patient birth. The study involved 100 patients hospitalized in the Department
satisfaction of care. of Obstetrics and Perinatology, Jagiellonian University in Cracow in
the period from 1 January 2016 to 29 February 2016.
Clinical cases and summary results: 83% of respondents answered that
they were aware of the possibility of home birth but were not
586 interested in, 17% didn’t know about this option. All women as a
reason for not choosing to undergo a planned home birth indicated
IVF outcome in patients with concerns about the ability to provide adequate supervision over the
safety of the woman and the fetus. To the question ‘‘Do you consider
antiphospholipid antibodies planned home birth as a safe form for the mother and the fetus?’’ 27%
respondents answered ‘‘definitely not’’; 67% ‘‘probably not’’ and only
J. Khizroeva, N. Makatsariya, and V. Bitsadze 7% ‘‘rather yes’’. Main advantages of the home birth that women
included were: greater sense of intimacy during childbirth (88%),
I.M. Sechenov First Moscow State Medical University, Department of possibility of support from family (76%) and establish a family
obstetrics and gynecology, Moscow, Russia tradition (18%). More than 50% of survey participants answered that
hospital conditions are sufficient to maintain the family atmosphere
Presenter: J. Khizroeva of the childbirth. All respondents considered lack of connection
between a possible better mental and emotional child development
Introduction: it has been suggested an association between APA and the home birth.
circulation and IVF failure. We evaluated the IVF outcome among Conclusion: Planned home birth is not a widespread problem in
APA-positive patients and determined the relationship between the obstetrics in Poland yet. Among Polish pregnant women there is a
presence of antiphospholipid antibodies and IVF success. high awareness of the danger to the mother and the fetus in case of
Materials and methods: since 2008 to 2016 we observed 367 women birth outside the hospital - both with or without proper doctor or
undergoing IVF. I group composed 228 women with IVF failure (1 to 9 midwife supervision. The conditions of perinatal care in the hospital
failures) and II group consist of 139 women with IVF success. Control are considered by patients to be sufficient to provide the necessary
group consist of 60 healthy pregnant women. Serum from all patients comfort and intimacy of childbirth.
Keywords: Home birth, labour
212 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

598 Presenter: P. Araujo Salinas

RH0(D) immunoglobulin in Introduction: The JAM3 protein belongs to the group of transmem-
brane proteins with tight junction function (tight binding). Those are
pregnancy with immune necessary to maintain the integrity of the endothelium in the brain
circulatory system. A female patient was diagnosed with a mutation
thrombocytopenia (case report) of the JAM3 gene (Junctional Adhesion Molecule 3). She belonged to
a consanguineous family, her two brothers had died presenting
similar clinical features (one of them in utero, the other one in the
V. Kazliakova, U. Savochkina, M. Artsiusheuskaya,
early neonatal period).
V. Zmachinski, S. Michalevich, L. Neden, and N. Andreeva Clinical cases and summary results: Newborn, 37 3/6 weeks, result of a
Belarusian Medical Academy of Post-Graduate Education, Minsk, fourth gestation that was well controlled and uneventful. Gestation
ended by emergency caesarea due to pathological fetal record (held
Belarus
fetal tachycardia, slowdowns and low variability), born in apnea with
bradycardia and in need of dvanced resuscitation maneuvers.
Presenter: V. Kazliakova Extubated within minutes, when she started spontaneous breathing.
Introduction: It is well known that the main goal of maternal therapy Apgar 1/5/6/9. The phisical examination revealed bilateral leukocoria,
of Immune Thrombocytopenia (ITP) during pregnancy is to minimize pale skin and superficial tachypnea. At 24 hours she started showing
the risk of hemorrhage and to restore a normal platelet count. Usually signs of irritability, plenty protruding fontanella, myoclonus and
the initial treatment is prednisone 0,5 to 2,0 mg/kg/day. But is not reduced suction. Transfontanelar ultrasound showed diffuse cerebral
clear how steroids improve platelets counts and decrease bleedings ischemic and hemorrhagic parenchymal alterations with ventricular
in patients with ITP that are beginning from glucocorticoids dilatation. Ophthalmologic study reported bilateral nuclear cataract.
(prednisone). Hypertension, osteoporosis, glucose intolerance, psy- On the 9th day of life, brain MRI shows massive hypoxic-ischemic
chosis, moon faces, increased risk of premature rupture of the changes, severe periventricular cystic transformation in all the four
membranes are adverse effects of glucocorticoids during the ventricles and hydrocephalus. Given the results of clinical and
pregnancy. We presented a case of ITP in pregnancy with the imaging techniques, limitation of the therapeutical effort applied.
usage of Rh0 (D) immunoglobulin. Given the suspected gene mutation, genetic study was performed on
Clinical cases and summary results: A 29-year-old woman, with history JAM3 and confirmed that the patient carried out homozygous
of menorrhagia, gravida 2, para 2 was monitored with laboratory mutation c.2T4 G in the 11q25 locus of the JAM3 gene; parents have
control from 9 weeks of gestation because of Immune the same mutation in heterozygous form. On the 17th day, in order to
Thrombocytopenia (ITP) (platelet 88,000 cells/ml). Medrol (methyl- confirm the classic triad, cerebral CT scan was performed showing
prednisolone) was taken by the patient from 15th weeks of gestation brain subependymal calcifications in band distribution. The case
(platelet 45,000 cells/mL). The lowest level of platelet was revealed at resulted in death at 43 days of life.
the 25th weeks of gestation (19,000 cells/mL) with maximum dosage Conclusion: JAM3 proteins are necessary to maintain endothelial
of Medrol of 52 mg/day. The patient was admitted to our clinic integrity of cerebral circulatory system. We should suspect the
because of vaginal bleeding at the 28th weeks of gestation (platelet mutation of the gene that regulates the synthesis of JAM3 protein
count 63,000cells/ml). Fetal ultrasound examination revealed polihy- when the triad of congenital cataracts, cerebral hemorrhage and
droamnios without any signs of retroplacental hematoma. The cerebral calcifications is present in a consanguineous family . The
treatment included intravenous Tranexamic acid 10mg/kg, antibiotic presence of the triad also forces us to look for other family members
(ceftriaxone 2,0 gr/day+metronidazole 1,5 g/day). After the bleeding with similar symptoms given the inheritance pattern.
has stopped, Rhesonativ (Rh0 (D) immunoglobulin) 1250 ME was
used. Second injection of Rhesonativ was at the 34th weeks gestation.
After Rh0(D) immunoglobulin injection the level of platelet was not
less than 100,000 cells/ml till the date of delivery. A female infant was
606
born by cesarean section at the 37th weeks with a weight of 2760 g, A case of fetal facial multilocular
and length 47 cm.
Conclusion: Rh0(D) immunoglobulin can be used in the Immune cystic tumor
Thrombocytopenia during pregnancy. However it is not clear now
what kind of dose of Rh0(D) immunoglobulin is necessary for patients
to obtain the optimal clinical effect.
K. Biringer, M. Hrtankova, K. Ladiverova, E. Kudela,
M. Nachajova, and J. Danko
Keywords: Immune Thrombocytopenia (ITP), Medrol, Rh0 (D)
immunoglobulin Dpt. of Gynecology and Obstetrics, Jessenius Faculty of Medicine in
Martin, Comenius University in Bratislava, Slovakia

Presenter: K. Biringer
600
Introduction: Fetal head cystic tumors are relatively frequent finding
JAM3 gene mutation in a new- indicating possible genetic abnormality (e.g. cystic hygroma).
born with congenital cataracts, However, facial location is rare, bringing some diagnostic difficulties
and needing individual approach in the management. We present a
brain calcifications and cerebral case of fetal facial multilocular cystic tumor.
Clinical cases and summary results: A 24-years-old secundigravida was
hemorrhage referred to our perinatal center in the 19 + 1 gestational week (g.w.)
with the finding of fetal facial subcutaneous anechogenic cystic lesion
of 27x12mm on 2D ultrasound. Its untypical location in the right
P. Araujo Salinas, D. Vazquez Sanchez, A. Roca Bajona, cheek extending retro-orbitally and retro-zygomatically leaded to the
J. Quilis Esquerra, R. Martorell Albareda, and E. Cañadell differential diagnosis of parotic cyst, brachial cleft cyst and
Yetano meningocele. 3D/4D ultrasound and in-utero fetal MRI were
performed. They confirmed previous finding with normal passage of
Paediatric Dept., Hospital de Terrassa, Barcelona, Spain amniotic fluid. No other anomalies were identified, and amniocenth-
esis excluded chromosomal abnormality. Three weeks later, we found
a clear progression in tumor size (40x20 mm) leading to the deviation
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 213
of zygomatic arch and facial dysmorphism. Pregnancy with uncertain Clinical cases and summary results: 66 NICU from all continents, which
prognosis was interrupted according to patient’s request by intra- correspond to a population of more than 215,000 births a year and
amniotic prostaglandins in the 23rd g.w. An autopsy confirmed fetal more than 9,500 very low birth weight premature infants at birth. The
facial multilocular lesion as fetal cavernous lymphangioma. majority of hospitals surveyed used the caffeine citrate like
Conclusion: Fetal facial lymphangiomas are rare in the fetal age. They methylxanthine drug of choice. A 30% of NICU do not have protocol,
are more frequent in children as the consequence of infection and Spain wasone of the countries where less protocolized is its use. The
injury. Differential diagnosis also includes cysts of thyroglossal duct, 83% of the centers used prophylactically in preterm infants 528
dermoids, cervical bronchogenic cyst, and ranulas. Progressive weeks of gestation and a 60% in51g, being these lower rates in Spain
growth can lead to airway obstruction requiring emergency surgical with respect to rest (see attached table 1). 90% of the NICU
intervention. However, such finding has uncertain prognosis, and administered 20 mg/kg of caffeine citrate like loading dose, but there
their management must be individualized including EXIT procedure is a disparity in the maintenance dose, observing that in the 50% of
and emergency tracheostomy. NICU already use doses between 8-10 mg/kg/day. Most of the centers
don’t control levels of caffeine. 49% of the units use the caffeine for
Keywords: Fetus; cavernous lymphangioma; ultrasound other purposes, mainly in the pulmonary broncodisplasia (27%) and
as a neuroprotective agent (15%), among others.
Conclusion: Despite being one of the most used drugs in our NICU,
there is no protocol for use in many of our units. There is a disparity in
their indications, as well as in the dose to manage. The current trend
is to use higher doses without entailing a risk for the premature but
quite the opposite.
Therefore, all the NICU should have a protocol for the use of the
caffeine and get to know the real impact on morbidity and mortality
in preterm to obtain the maximum possible benefit.
Keywords: Caffeine citrate, Apnea of prematurity, Neuroprotection

610
Postpartum fever: study of cases
in a tertiary hospital
I. Mejı́a Jiménez, R. Garcı́a Guerra, R. Bermejo Martı́nez,
A. Váquez Sarandeses, E. Batllori Badia, and A. Garcı́a
Burguillo
609 Gynaecology and Obstetrics department, Hospital 12 de Octubre,
Madrid, España
Caffeine beyond the apnea.
Observational study of its use and Presenter: I. Mejı́a Jiménez

indications in the neonatal units Introduction: Postpartum fever is defined as an oral temperature of
38.00C or more after delivery, excluding the first 24 hours. It is a sign
worldwide that can be associated with a wide range of pathological entities, such
as endometritis, surgical wound infection or ovarian vein thrombosis.
It is described as a relatively common obstetric complication, with a
L. Castells Vilella1, J.F. Muñiz Llama1, N. Pumares Parrilla1, frequency of approximately 5-7% of births, and is more common after
and E. Guirado Sayago1. a cesarean delivery compared with vaginal birth. The aim of this work
is to describe the number, main characteristics and diagnosis of
Neonatal Intensive Care Unit, Paediatric Department, Hospital woman admitted in a Tertiary Hospital that consulted in Emergency
Universitario General de Catalunya, Sant Cugat del Vallés, Barcelona, Service for presenting postpartum fever.
Spain Materials and methods: A retrospective descriptive study was
performed in a Tertiary Hospital in Madrid (Spain), between 1
Presenter: Laura Castells Vilella January of 2015 and 31 December of 2015. All the patients that were
admitted in Hospital presenting postpartum fever, regardless of
Introduction: Since more than 30 years ago, the caffeine is considered diagnosis, were included in this study.
as the pharmacological treatment of choice in the apnea of Clinical cases and summary results: 56 patients (1.31% of all deliveries)
prematurity, being one of the drugs that are more secure, more were admitted in Hospital for presenting postpartum fever in 2015.
effective and more cost/benefit from those used in our Neonatal The diagnosis were: 35 (62.5%) endometritis, 8 (14.3%) mastitis,
Intensive Care Units (NICU). 4 (7.1%) surgical wound infection, 2 (3.6%) ovarian vein thrombosis,
There are many studies on the use and benefits of the caffeine in 4 (7.1%) pielonefritis and 3 (5.4%) patients presented other causes.
preterm infants. Recently papers have been published on the Among endometritis group, we registered 24 (68.6%) normal
prophylactic use in very low birth weight premature infants as well deliveries, 2 (5.7%) instrumental deliveries, 8 (22.9%) cesarean
as new benefits beyond the apnea of prematurity. sections. The mean time of symptom’s onset after delivery was 8.5
Materials and methods: We wanted to know about the use of caffeine days. 7 (20%) patients required puerperal curettage. The mean time of
in the daily practice of the NICU of Spain and compare it with the intravenous antibiotic was 3.2 days.
practices in other countries. In the surgical wound infection group, the mean time of symptom’s
A survey was designed with 11 questions. It was proposed the onset after surgery was 15.5 days. All of the patients required wide
participation through NICU teams and scientific societies through spectrum antibiotics. The mean time of intravenous antibiotic was
social networks for professionals. 12.5 days. All the patients required surgical treatment.
214 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

In the ovarian vein thrombosis group, both patients had a normal

delivery. None of them received prophylactic anticoagulation
629
treatment during the first 7 days of postpartum. The mean time of
symptom’s onset was 4 days after delivery. The treatment for both
Primary hyperparathyroidism
patients was therapeutic doses of subcutaneous HBPM. during pregnancy and it’s effects
Conclusion: The incidence of postpartum fever in our Hospital is lower
than reported. The main cause of postpartum fever was endometritis, in newborn - A case report
followed by mastitis, surgical wound infection and pielonefritis. The
two cases of ovarian thrombosis group were reported after a normal C. Reis Gonçalves1, M. Israel Rocha2, P. Lança Gomes1,
delivery, just the opposite as described in the literature, with a higher
incidence after cesarean delivery. Is it important to define risk of
and M. Dias Corrêa Júnior2
potential postpartum complications in order to prevent them in 1
Maternidade Odete Valadares, Belo Horizonte, Brazil and 2Hospital
immediate puerperium. das Clı́nicas Universidade Federal de Minas Gerais, Belo Horizonte,
Keywords: Postpartum fever, endometritis, ovarian vein thrombosis Brazil

Presenter: C. Reis Gonçalves

617 Introduction: Primary hyperparathyroidism(PHP) is a rare life-threaten-

ing condition which is usually diagnosed between the fifth and sixth
Fetal oxytocin levels at term decade of life. Its prevalence in the general population is 0.15%. In
pregnant women, there are no more than 200 cases reported in the
O. Baev, O. Tysyachnyu, T. Ivanets, and V. Burlev English literature. The incidence of PHP in reproductive age women is
reported to be 8/100,000 population/year. The diagnosis can be
Research Center For Obstetrics, Gynecology and Perinatology, difficult to establish during pregnancy, given the nonspecific
Moscow, Russia symptoms related to hypercalcemia. Maternal complication rates
related to PHP during pregnancy can reach 67%, and fetal
Presenter: Oleg Baev complications are reported to occur in up to 80% cases. The most
serious fetal complications are neonatal tetany, still birth, and
Introduction: Postterm pregnancy is commonly defined as patients miscarriage.
beyond 42 completed weeks. Numerous studies have associated Clinical cases and summary results: Patient C.C.S., 43 years old, on her
postterm pregnancies with increased rates of perinatal and maternal second pregnancy, was being followed on high risk prenatal care due
complications. But this complications of pregnancy increases not as a to one episode of bilateral deep venous thrombosis. She was
discrete risk beyond some threshold, but instead continuously with diagnosed with diabetes and systemic hypertension. Besides that, was
increasing gestational age from 39 to  41 completed weeks also identified total serum calcium level above 11 mg/dL, elevated
(Caughey A. et al., 2004; Heimstad R. et al., 2006; Tita A. et al., 2012). parathormone level, and a solid nodular lesion located in one of her
Why pregnancy lasts beyond 40 week is still unclear. It is speculated parathyroid gland, thus, was also diagnosed with primary hyperpar-
that fetal oxytocin may play a part in the initiation of labour. But athyroidism. She remained stable and her baby was uneventfully
exactly how oxytocin secretion changes during these weeks is still delivered within 39 weeks GA. The newborn presented with seizures
unknown. before first 24 hours, which were identified, after being broadly
The purpose of this study was to evaluate the concentrations of investigated, as hypocalcemia-induced seizures. His mother’s
oxytocin in the fetus blood from 38 to 42 weeks of pregnancy. unchanged hypercalcemia induced by primary hyperparathyroidism
Materials and methods: Forty one women at term gestation were was surgically treated with parathyroidectomy 20 days after delivery.
included (26 who were delivered vaginally and 15 - by elective After operation she had a satisfactory recovery, with normal glucose
cesarean section). All women were divided to four groups (early term and blood pressure levels, nevertheless, remained hospitalised for
37 - 38 + 6/7, full term 39 - 40 + 6/7, late term 41 - 41 + 6/7 and clinical following in use of warfarin.
postterm 42 and 4), accordingly ACOG and SMFM recommendation Conclusion: Most of the evidence supports conservative treatment
on Term Pregnancy Definition (2013). Patients who received oxytocin during first and third gestational trimesters - which includes
before delivery were not included to this study. hydration, loop diuretics and low-calcium diet. Surgery is the
Eighty-two umbilical blood samples (41 arterial and 41 venous) were definitive treatment on the second trimester, and our patient had
obtained. Each sample was taken and collected in a chilled tube surgery on postpartum period and her newborn presented with a
containing EDTA and immediately centrifuged at 40C and stored at - complication associated to PHP. Further studies are needed in order
200C until assay. Oxytocin concentrations were measured by the to build better evidence concerning the safety of surgery, therefore
ELIZA method. providing new options for patients with late diagnosis.
The measured values are given as mean ± SD. To compare means, a
t-test was carried out. Keywords: Primary hyperparathyroidism, treatment, complications
Clinical cases and summary results: Newborn Apgar scores were
greater than 7 in all cases and pH values were within normal range.
The mean concentration of the oxytocin in the umbilical artery
increased from early term (52.94±21.62) to full term (80.28±36.27)
633
and than decreased to late term (55,25±30,90) pregnancy (p50.05). Modifiable risk factors for obste-
The mean concentration of the oxytocin in the umbilical vein
was lower, but revealed the same changes (22.38±6,97; 44.69±23.29; trical anal sphincter injuries
36.23±17.55).
Conclusion: There are significant changes of oxytocin concentration in (oasis)
fetus blood between different weeks of term pregnancy. These
changes do not have continuous trend simultaneously with increas- Y. Baumfeld, AY. Weintraub, S. Yaniv Salem, E. Spiegel,
ing gestational age, but decrease to late term pregnancy. We suppose
Z. Yohai, D. Elharr, and D. Yohai
that low oxytocin levels may took a part in prolongation of pregnancy
and was a risk factor of rising of perinatal complications after 40 + 6/7 Department of Obstetrics and Gynecology, Soroka University Medical
week of gestation. Center, Beer Sheva, Israel
Keywords: Term pregnancy, postterm, oxytocin
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 215
Presenter: Yael Baumfeld
635
Introduction: Obstetrical anal sphincter injuries (OASIS)are associated
with significant long-term morbidity in young healthy women. Many Kidney’s 3d-ultrasounds com-
studies have explored the risk factors for OASIS; however, these are
largely non-modifiable risk factors including nulliparity, fetal macro-
bined with renal biochemical
somia and instrumental delivery. Vaginal candidiasis has been found
associated with different pregnancy complications. Some modifiable
parameters in newborns and
risk factors such as the experience of the midwife and vaginal children: A multidisciplinary
candidal infection have not yet been widely explored. No studies, to
date, have investigated the association between OASIS and vaginal approach to dohad
candidial infection.
Materials and methods: A retrospective cohort study of all women
B. Cappuccini1, A. Barbati2, M.C. Aisa2, G. Clerici2,
with OASIS who gave birth between January 2011 and March 2016 at
the Soroka University Medical Center (SUMC) was undertaken. E. Torlone3, M.R. Zamarra2, I. Giardina2, and
Reported modifiable and unmodifiable risk factors were evaluated. G.C. Di Renzo4
Data was collected from the SUMC perinatal database and from the 1
neonatal hospitalization data. The study was approved by the SUMC Department of Neonatology, Hospital SM della Misericordia,
2
Institutional Review Board. Department of Surgical and Biochemical Sciences, Section of
Clinical cases and summary results: A total of 60 women suffered Obstetrics and Gynecology and Centre of Perinatal Medicine, 3MISEM,
OASIS during the study period. University of Perugia, Italy, and 4GeBisa Research Foundation
With regard to unmodifiable risk factors, the majority of subjects
(81.7%) were nulliparous. Prolonged second stage of delivery was
Presenter: Benito Cappuccini
found in 10% of patients. Vacuum extraction was the mode of delivery
in 27% and episiotomy was performed in 41%. Twenty percent of Introduction: Noncommunicable diseases has assumed great rele-
neonates were macrosomic, weighing over 4000 grams. vance. The leading metabolic risk factor is the hypertension (18% of
Modifiable risk factors reviled that a high rate of inexperienced global deaths) Kidney is central in the blood pressure control. Fetal
midwives (55 years’ experience) were involved in deliveries compli- exposure to intrauterine growth restriction (IUGR), prematurity (PR)
cated with OASIS (47%). Vaginal cultures were available for 52% of the and/or gestational diabetes (GDM) can have a negative impact on
women. Out of these, 42% had normal flora, 19% had group B nephrogenesis, resulting and these insults represent a mayor risk for
streptococcus and 39% had candida, the distribution is shown in renal function impairment, long term renal diseases/high blood
figure 1. pressure[1,2].
Perinatal outcomes reviled that eleven neonates suffered from Aim of the study: Realize an early multidisciplinary follow-up in
hypoxia, with a pH level measured under 7.1 and nine neonates newborns of high risk pregnancies, correlating results of biochemical
with a first minute Apgar score under 7. approach to the 3D ultrasounds studies of the kidney[3], in order to
Conclusion: OASIS has grave long term morbidity and with many better evaluate the crucial postnatal renal adaptation
known unmodifiable risk factors. Midwife experience may play a role Materials and methods: We estimated renal volume (RV) and renal
in the occurrence of OASIS.We found an increased rate of vaginal cortex volume (RCV)using 3D-ultrasounds (VOCAL II, GE Ultrasounds,
candida infection and believe there might be an association between USA),in more than 300 newborns of high risk pregnancies
the two. (IUGR,PR,GDM), vs healthy matched newborns (C), at 30-40 days of
corrected age. Data were correlated to biochemical parameters of
Keywords: Severe perineal tear; Risk factors; Long term morbidity
renal function/injury (i.e.urinary levels of Cystatin C and of the activity
of Cathepsin B and NAG).
Clinical cases and summary results: IUGR showed lower RV, RCV and
significant higher Cystatin C urinary levels (p50.001) vs Controls[4].
We found a strong correlation among Cathepsin B,RV, RCV as well as
an early microalbuminuria in postnatal kidney adaptation of PR and
IUGR vs C (p50.001)[5]. Unexpectedly, in the last two years, renal
volumes and the biochemical urinary parameters were often normal
in the GDM.Postnatal kidney’s adaptation, in IUGR and in PR is altered
compared to C. Most of the newborns of GDM seems to have a
normal renal function, while in an our previous study, GDM children
at 3 years of age showed a significant lower RCV and microalbumi-
nuria vs healthy ones [6]. Probably, these results in GDM are related to
early diagnosis and the appropriate management of gestational
diabetes, except when it is underestimated or complicated by obesity:
further studies are needed
Conclusion: Conclusions: Kidney’s 3D ultrasounds is an useful
technology that, if combined with biochemical parameters of renal
function/injury, could represent an improved multidisciplinary
approach of postnatal renal follow-up.
Keywords: KIdney, DOHAD

References
1. ‘‘The Cape Town Manifesto’’ DOHAD, 2015.
2. Simeoni U’’, Am J Perinatol, 2014.
3. Riccabona M, Eur J Radiol, 2014.
4. Barbati A,Cappuccini B, Neonatology, 2016.
5. Aisa MC,Cappuccini B, J. of Ped.Nephrol., in press.
6. Cappuccini B, J of DOHAD, 2013.
216 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

636 639
Analysis of perinatal outcomes Thrombohpilia evaluation in
after in vitro fertilization women with history of ischemic
Nachajova M.1, Kudela E.1, Biringer K.1, Visnovsky J.1, stroke and VTE
Zibolen M2, and Danko J.1
1
A. Makatsariya, S. Akinshina, V. Bitsadze, J. Khizroeva,
Department of Gynecology and Obstetrics, Jessenius faculty of and N. Stuleva
medicine, University Hospital in Martin and 2Department of
Neonatology, Jessenius faculty of medicine, University Hospital in I.M. Sechenov First Moscow State Medical University
Martin
Presenter: A.Maksatsariya
Presenter: M. Nachajova
Introduction: Despite intensive research, arterial and venous throm-
Introduction: In assisted reproductive techniques the number of boses still account for a significant maternal mortality and morbidity.
transfers of frozen and fresh embryos is increasing worldwide. The Our aim was to determine thrombophilia in patients with history of
known benefits of frozen embryo transfer include a minimum arterial and venous thromboembolism and to evaluate the efficiency
proportion of pharmacological and surgical treatment and a lower of antithrombotic prophylaxis.
risk of ovarian hyperstimulation syndrome. It also allows to store Materials and methods: Group I: 57 women with a history of VTE,
embryos almost indefinitely, until the time suitable for fertilization. group II: 59 women with a history of stroke and 60 healthy pregnant
Materials and methods: A retrospective comparative analysis of women were screened for genetic and acquired thrombohpilia
perinatal outcomes after frozen and fresh embryo transfers at the (homocysteine level and titer of antiphospholipid antibodies).
Department of Obstetrics and Gynaecology in Martin in the period Subgroup Ia (20 women with history of VTE) and subgroup IIa (22
from January 2011 to December 2015. Data were obtained from women with a history of stroke) received prophylaxis with LMWH in
medical records of patients. Rated parameters represented a patients preconception period, during pregnancy and at least 6 weeks
age, pregnancy, parity, birth length and weight of the newborn, postpartum. In 17 women with history of VTE (subgroup Ib) LMWH
gestational age, route of delivery and Apgar score. We evaluated the was started from II-III trimesters.
incidence of pre-eclampsia, gestational hypertension and diabetes, Clinical cases and summary results: in the group I genetic thrombo-
the incidence of premature rupture of membranes and intrauterine philia was detected in 94,1%, including fibrinolytic defects in 64,7%,
fetal distress. antiphospholipid antibodies circulation - in 49%, hyperhomocystei-
Clinical cases and summary results: The study included 98 women, 40 nemia - in 45%. In the group II in women with history of stroke
after frozen embryo transfer and 58 after fresh embryo transfer. thrombophilia was revealed in 88,2%,including fibrinolytic defects in
Average age of women who became pregnant after transfer of frozen 76,5%, antiphospholipid antibodies circulation - in 41,2%, hyperho-
embryos was 34 years (range 20-50 years), the mean number of mocysteinemia - in 19,6%. In subgroup Ia and IIa no one had severe
pregnancies was 1.73 (1-5) and 1.3 parities (1-3). In this group, 44 obstetric complications. All patients were delivered at term and all
children were born with an average weight of 3264 ± 212 (1350-4650) babies were alive. In subgroups Ib and IIb moderate to severe
g and a length of 51 ± 2 (40-56) cm at 40 ± 1 (31-42) weeks of obstetric complications were noted.
gestation. 70% of pregnancies were terminated by cesarean section, Conclusion: Thrombophilia might be th essential pathogenetic
27.5% by spontaneous delivery and 2.5% by forceps. The average age mechanism of thrombosis in women of childbirth age. LMWH was
of women after fresh embryo transfer was 34.3 (20-50) years, the effective for prevention of recurrent thromboembolism and obstetric
average number of pregnancies was 1.5 (1-5) and parities 1.17 (1-3). complications. Women with personal or familial history of throm-
66 were born in this group with an average weight of 3050.53 ± 201 boembolism or with history of obstetric complications should be
(875-4400) g and a length of 50.5 ± 2.5 (34-55) cm, at 39.5 ± 0.5 (27- screened for thrombophilia.
42) weeks of gestation. In 70.7% was performed cesarean section,
Keywords: Venous thromboembolism, stroke, pregnancy,
27.6% gave birth spontaneously and 1.7% by forceps. The most
thrombophilia
common indication for caesarean section in both groups was
intrauterine fetal distress (30%), followed by breech presentation
(12.86%), not progressing labor (11.43%), locked twins (11.43%) and
other (34.28%). The only statistically significant difference was 640
observed in the number of newborns admitted to the care of
intensive care unit (p50,05) in group after fresh embryo transfer. We IVF outcome in women with
have not seen significant difference in any other parameter of
compared groups. antiphospholipid antibodies
Conclusion: We conclude that the frozen embryo transfer does not
adversely affect perinatal results in comparison to the transfer of fresh J. Khizroeva, N. Stuleva, N. Makatsariya, and V. Bitsadze
embryos. Our study supports the importance of further, more
extensive analyzes dealing with perinatal outcomes of both methods I.M. Sechenov First Moscow State Medical University, Department of
of assisted reproduction. obstetrics and gynecology, Moscow, Russia
Keywords: In vitro fertilization, frozen embryo transfer, fresh embryo
transfer Presenter: J. Khizroeva
Introduction: It has been suggested an association between APA
circulation and IVF failure. The proposed mechanism of such failure
includes abnormal implantation, placentation, and early embryonic
vascular compromise. We evaluated the IVF outcome among APA-
positive patients and tried to determine the relationship between the
presence of antiphospholipid antibodies and IVF success.
Materials and methods: since 2008 to 2016 we observed 367 women
undergoing IVF. I group composed 228 women with IVF failure (1 to 9
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 217

failures) and II group consist of 139 women with IVF success. Control This noninvasive, easily applied technique, is based on traditional
group consist of 60 healthy pregnant women. Serum from all patients Chinese medicine; it uses fingers to stimulate acupoints, seeking to
were examined for antibodies to cardiolipin, annexin V, b2- restore the flow of vital energy (Chi). For the Western medicine, the
glycoprotein I, prothrombin and lupus anticoagulant circulation. effect of acupressure is based on the stimulation of neural strucutres
Clinical cases and summary results: total 42,1% patients of I group had and the release of endorphins. Our objective is to asses whether or
APA circulation. Among them - antibodies to cardiolipin - 8,9%, to b2- not acupressure is effective to help women cope with labor pain.
GPI - 31,4%, annexin V - 24%, to prothrombin - 13,5%. LA circulation - Materials and methods: A literature research and subsequent meta-
19,6%. In II group APS was diagnosed in 19%. In women with analysis were carried out, following PRISMA guidelines. The terms
successful outcome of IVF in 12.4% we observed subsequent ‘‘acupressure’’ and ‘‘labor pain’’ were introduced in PubMed, Scopus
reproductive fetus wastage. No stillbirth or antenatal fetal death. and Web of Science search engines. 76 articles were obtained, of
Miscarriage occurred as stagnant pregnancy before 12 weeks of which 16 were relevant to our goals, being randomized controlled
pregnancy. All women with pregnancy after IVF received the therapy trials with outcomes such as pain assessment, maternal anxiety, labor
(LMWH, antioxidants, folic acid, aspirin, vitamins group B) were duration, mode of delivery, medication use, and neonatal outcomes.
delivered at term with alive healthy newborns. There were articles comparing acupressure with placebo, a control
Conclusion: women with APA circulation demonstrate significantly group or labor assisted by a doula. Assessment of the methodological
high IVF failures (42,1%) and worser reproductive outcome compares quality was made through Jadad scale. Finally, 9 papers were
with the women undergoing IVF protocols but without APA. We included in the meta-analysis, where the results of the treatment
consider the presence of antiphospholipid antibodies as temporary effects were presented as mean difference and odds ratio, with 95%
contraindication for the IVF programme. confidence interval.
Clinical cases and summary results: Regarding pain relief, stimulation
Keywords: In vitro fertilisation, antiphospholipid antibodies, of the SP6 and LI4 acupoints has shown a significant reduction in
pregnancy labor pain scores using a visual analog scale (VAS) when compared
with placebo (tactile stimulation), and when compared with control
group. These effects can be seen immediately after the application of
the technique, and last up to two hours; acupressure applied with
646 complete dilation has also shown efficacy in reducing pain intensity.
Effects of acupressure in labor: A Regarding duration of labor, comparison of BL32 and SP6 acupoints
stimulation with the control group showed shorter duration of labor,
meta-analysis with statistical significance. SP6 and LI4 acupoints stimulation also
shortens labor duration, when compared with the placebo group.
Also fewer caesarean sections were performed in the acupressure
C. Bejar1 and M. Santiago2 group when compared to the tactile stimulation group and the
1 control group. No significant differences in the Apgar test results were
Plasencia Health Area, Plasencia, Spain and 2Labor ward, Virgen del
observed, proving the absence of negative consequences for the
Puerto Hospital, Plasencia, Spain newborn.
Conclusion: The results of this study, whith better outcomes for both
Presenter: C. Bejar pain relief and labor duration, and fewer caesarean sections
performed in the acupressure group, make us recommend the
Introduction: Relief of labor pain is one of the main challenges that
inclusion of acupressure among the methods of pain relief offered in
women and health professionals must face. Finding a balance
labor wards, as it has proved to be a safe, noninvasive, easily applied
between the necessary relief and the use of analgesic methods
technique that can help mothers cope with pain. On the other hand,
might be complex, because it could cause over-medicalization of
in order to improve scientific evidence, conducting more high-quality
childbirth and this in turn can have adverse consequences. Thus,
randomized studies, is also recommended.
women might prefer alternative methods for labor pain relief, such as
acupressure. Keywords: Childbirth, pain relief, acupressure, alternative therapies
218 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

655
Presenter: K. Ben Ameur
Hereditary thrombophilia - pre- Introduction: Background and aims: Assisted reproductive technolo-
natal manifestation and care on gies (ART) raises a great debate about increased perinatal risks,
especially preterm birth, low Birth weight (LBW) and Birth defects
different stages of pregnancy (BD). The risks of preterm birth and LBW has been attributed largely
to the higher rate of multiple gestations associated with such
N. Veropotvelyan and J. Pogulyay technology. We aim to compare the neonatal outcome of newborns
from ART versus natural conception.
Multyregional center of medical genetics and prenatal diagnostics’’ Materials and methods: Methods: Study design: A 19-year retro-
Kryvyi Rih, Ukraine spective, descriptive and comparative study regarding neonatal
outcome and BD in two groups of newborns.
Setting Subjects: The first group included all newborns from ART
Presenter: N. Veropotvelyayn
admitted in Resuscitation and Intensive Care Unit of Neonatology of
Introduction: One of the probable reproductive losses causes is Military Hospital of Tunis between 1997 and 2015 (ART group). The
considered to be hereditary thrombophilia. As the observation and second group included newborns from natural conception admitted
analysis of clinical cases show, the manifestation of this disease can at the same period and selected randomly (Controls group).
occur on different stages of pregnancy and have different manifesta- Main outcomes and measures: preterm birth, very preterm birth, LBW,
tions - from early reproductive losses to stillbirths. Our objective was very low birth weight (VLBW), and BD. For LBW and preterm birth, we
to examine the frequency of main factors of hereditary thrombophilia compared separately singletons and twins, from ART and natural
polymorphic variants in a group of early reproductive losses and conception.
chorionic\placental abruption, antenatal fetal deaths and stillbirths. Clinical cases and summary results: Results: We identified 425
Materials and methods: A study to determine the SNP’s in genes newborns In the ART group and 328 newborns in controls group.
associated with susceptibility to blood clots and abnormal folate The rate of multiple births was 71.53% in ART group. Among
metabolism (FGB G455A, FII G20210A, FV 1691A, PAI-1 5G/4G, MTHFR singleton infants, the use of ART was associated with an increased
C677T, MTR A2756G) in groups of women with early pregnancy losses rates of LBW and VLBW (51% and 18.7%) than in controls (21% and
episodes (n = 781) and women who had a history of one or more 2%), (p510-3, Odds Ratio of 3.92 and 11.3, respectively). Among twins,
episodes of placental/chorionic abruption, stillbirth or antenatal fetal ART was not associated with a further increase in the risk of LBW
death (n = 59) were conducted. (66.45% versus 66.47%, p=0.99); however, the risk of VLBW was
Clinical cases and summary results: Analysis of the survey results statistically significantly higher only in twins from ART (33.5% versus
showed that the genotype frequency FII G/A group of early 5.2%, p=10-3, Odds Ratio of 9.2, 95% confidence interval (CI), 4 to 21).
miscarriage is 4 times higher than population prevalence of The risk of preterm birth, was statistically significantly higher, both in
mutations G20210A FII (5.8% vs. 1.4%; p 50.05); frequency of singletons (30.3% and 17%, p=0.01, OR=2.12; 95%CI, 1.14 to 3.97), and
genotype G/A FV group of miscarriage is 2.2 times lower than this in twins (74.6% and 57%; p=0.0003; OR=2.22, 95%CI, 1.4 to 3.6) of ART
mutation prevalence; combination heterozygous genotype C/T 677 than in controls. Newborns conceived with ART had a risk of BD that
MTHFR + A/G 2756 MTR significantly to 2.98 times more common in was 3 times that in controls (11.05% versus 3.65%; p=0.0001, 95% CI,
the group of women with multiple episodes of early abortion (20.56% 1.6 to 6.6). BD were major in 72.34% (34 of 47) in ART group versus
vs. 6.9%; p 50.01); genotype FGB A/A 455 at 4.66 times significantly 66.7% (8 of 12) in controls, p=0.72. The difference concerned cardiac
more common in placental/chorionic abruption (77.78% versus and neurologic BD. Birth defects were associated with
21.7%; p50,01); associative links with the pregnancy losses and the IntraCytoplasmic Sperm Injection (ICSI) in 40.4%. The risk of BD was
polymorphic variant gene PAI-1 could not be found. 2.4 times with ICSI (17.05%) than with all others techniques
Conclusion: Thus, today there are two approaches to the management condensed (8.03%), (95% CI; 1.23 to 4.68). Among malformed ART
of the patients with hereditary thrombophilia factors: prevention of newborns, BD were lethal in 23.4% and associated with major
early reproductive losses and placental abruption in women with handicap in 29.2% (7/24).
history of this pathology; and maintenance of the current pregnancy Conclusion: This study highlighted the increased perinatal risks even,
with the presence of retrochorial hematoma choosing an optimal in singleton infants conceived with ART than those naturally
treatment strategy and balanced use of hemostatic agents and low- conceived. Multiple births may be, partially responsible of these
molecular -weight -heparins. risks. BD risk is also, significantly increased in newborns from ART. The
exact mechanisms underlying all these risks remain unclear. Further
Keywords: Hereditary thromobophilia, miscarriage, placental studies are required to prove the part of ART underlying parental
abruption factors, and sterility itself in these risks.
Keywords: Assisted reproductive technologies (ART); Infant,
Premature; Infant, Low Birth Weight; Infant, Very Low Birth
656 Weight;Birth defects
Preterm birth, low birth weight
and birth defects after assisted 670 (CLINICAL CASE)
reproductive technologies. A Prader willi sı́ndrome:not as
19-year comparative study uncommon as we think
N. Kasdallah1, H. Kbaier1, H. Ben Salem1, K. Ben Ameur2, E. Guirado Sayago, L. Castells Vilella, E. Gabau, M. Garcı́a
F. Chioukh2, K. Monastiri2, S. Blibech1, and M. Douagi Puig, F. Muñiz Llama, and N. Pumares Parrilla
1
Resuscitation and Intensive Care Unit of Neonatology, University Neonatal Unit Care, Hospital General de Catalunya, St. Cugat del
Military Hospital of Tunis, Tunisia, and 2Department of Medical and Valles, Barcelona, Spain
Intensive Care Unit of Neonatology, University Hospital of Fattouma
Bourguiba, Monastir, Tunisia. Presenter: Esther Guirado Sayago
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 219
Introduction
 Prader willi sı́ndrome (PWS) is a neurogenetic disorder which main
clinical features are muscular hypotonia, growth retardation, short 678
stature, hypogonadotropic hypogonadism, abnormal facies with
small hands. In the neonatal period, the usual symptoms are severe
Platelet indices in the mother-
neonatal hypotonia causing feeding problems. fetus system and thromboelasto-
 Despite all these features, the diagnoses in the neonatal period is
very rare, Prader-Willi syndromés incidence is thought to be 1/ graphyc assessment of the
12.000 - 1/15.000 newborns.
 This syndrome is caused by genetic mechanisms that mainly affect hemostatic system in newborns
the 15q11-q13 region, regulated by genomic imprinting.
Clinical cases and summary results: In the last 5 years we have with cephalohematoma
diagnosed 4 cases of PWS in newborns, 2 of them wewre extremely
premature newborn. The guide symptom in all cases was hypotonia; K. U. Leonava1, T.A. Serzhan2, M.V. Artsiusheuskaya1, and
in all patients ogival palate and feeding problems due to hypotonia G.A. Shishko1
were present and in 3 of them hypogenitalism was detected.
1
Complementary exams were practiced (analytics, ultrasound, cerebral Belarusian Medical Academy of Post-Graduate Education, Minsk,
magnetic resonance and ocular exam), with no significant findings Belarus and 2Clinical maternity hospital of Minsk region, Minsk,
except for dilatation of left occipital horn and left choroid plexus Belarus
hemorrhage in one of them, secondarily to prematurity.
The diagnosis was achieved by positive Methylation test in all cases;
Presenter: Katsiaryna Leonava
karyotype was realized in 3 of them, with normal result. 15q11q13
paternal delection, SNRPN delected region and maternal uniparental Introduction: The transition from the intra- to extrauterine life leads to
isodisomy were identified. changes in all systems of a newborn, including the hemostatic
Conclusion: The importance of early diagnosis allows early interven- system. Many coagulation variables constantly change in various
tion and follow-up by a multidisciplinary team, achieving a better diseases, such as hypoxia, intraventricular and subdural hemorrhage.
prognosis. Platelet indices such as mean platelet volume (MPV), platelet
It is important to identify the genetic mechanism, to study distribution width (PDW) and platelet large cell ratio (P-LCR) have
correlations phenotype-genotype for prognosis and genetic been investigated as prospective platelet activation markers.
counseling. Thromboelastography (TEG) is a whole blood coagulation test that
Although the estimated incidence of PWS described is 1/12.000- provides a global assessment of hemostasis from clot initiation and
15.000 births,in the last 5 years we have detected up to 4 cases in a development, to fibrinolysis.
total of 13.844 births, so may be it is an increasing pathology in which Objectives: To investigate platelet indices in the mother-fetus system
we should think more often. and the coagulation system of newborns with cephalohematoma
(CH) according TEG.
Materials and methods: 91 pregnant women and their infants,
gestation age 37-41 weeks, were prospectively enrolled into the
study. These patients did not have infectious diseases, and these
women were not receiving any anticoagulant therapy during
pregnancy. The patients were divided into two groups: 45 infants
with cephalohematoma with their mothers and 46 healthy newborns
with their mothers. Platelets count (PC), MPV, PDW, P-LCR were
obtained from each woman before delivery, and from each child on
the 1 day of life. Blood samples were collected by venous cannulation
at 3-4 days of life and TEG was performed. Clot reaction time (R), clot
kinetics time (K), maximum amplitude (MA), a-angle, time maximum
amplitude (TMA) and coagulation index (CI) were obtained from the
TEG tracing (native citrated).
Clinical cases and summary results: In women’s samples PC and MPV
did’t differ significantly between the two groups. PDW and P-LCR
were 15,6 (13,6-16,6) and 39,3 (33,0-42,8)% respectively in group of
women who have delivered children with CH and were higher
compared to the control group (12,7 (11,5-14,5) and 32,7 (26,7-39,1)%
respectively). In infant’s samples PC and PDW did not differ
significantly between the groups. MPV and P-LCR were 9,9 (9,5-
10,0) fl and 22,6 (19,5-25,3)% respectively in group of children with CH
and were lower compared to the healthy newborns (10,1 (9,6-10,5) fl
and 24,9 (20,8-27,5)% respectively).
TEG R, K and TMA were statistically shorter in the group of newborns
with CH compared to the healthy control group (tab. 1). The a-angle,
MA and CI were statistically higher in newborns with CH compared to
the control group. Bivariate analysis showed a significant correlation
between P-LCR in women’s samples and R on TEG of newborns with
CH (r= -0,524; p50,0500), but no correlation in the control group.
Conclusion: Hypercoagulation has been demonstrated in the group of
newborns with cephalohematoma that manifested reduction of clot
reaction time, clot kinetics, time maximum amplitude, as well as an
increase of the a-angle, maximum amplitude and a high coagulation
index.
The disturbance of platelet hemostasis of newborns and their
mothers might play an important role in the genesis of CH, which
220 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

is manifested by a decrease in MPV, P-LCR of newborns and an published questionnaires and critical review from obstetricians from
increase in PDW and P-LCR of their mothers. this hospital. The questionnaires comprised scales with five-point
response scale, from ‘‘the worst’’ to ‘‘the best’’, except the pain scales,
Keywords: Cephalohematoma, hemostasis, platelet indices, which goes from ‘‘no pain’’ to ‘‘much pain’’. There were also open-
thromboelastography ended style questions. It was given to most patients who came for
ECV during that period or who had rejected it to be done.
Clinical cases and summary results: Questionary was completed by a
total of 46 patients, of which 33 (72%) were reported by the
gynecologist, 10 (22%) by midwife, and 3 (6%) by their family doctor.
There were no differences in the assessment of information received
by the various professionals, with an average score of 3.9 (good
information). Only 15% changed his mind about the technique after
receiving the information, referring lack of prior information in all
cases. 59% of patients were afraid about the technique, by the
supposed fetal risks in 96% of cases. ECV were performed to 30 of the
46 patients (65%), in 93% of cases to avoid a CS. In 47% the technique
was effective, with no significant differences in the degree of
satisfaction (4.4 vs 4) or the level of pain (2.2 vs 2.65) when compared
with non-effective. All those patients would recommend the
technique to other people. From the 16 patients (35%) that VCE
were not performed, the main reasons were fear of fetal or maternal
risks (31%), non-recommendation of the technique by acquaintances
(31%), or the desire of not intervention (25%). Most of them (56%) felt
that both techniques (ECV and CS) have the same risks.
Conclusion: Many women are now limited to two options for delivery
of a fetus presenting by the breech: ECV or CS. Given that most
Newborns with Healthy
women have a preference for vaginal birth, and their knowledge of
Variable cephalohematoma newborns Z, p
ECV is often from less reliable sources, as we shown having more than
Clot reaction time 7,3 11,5 Z= 3,67, 60% of patients who rejected the technique for fear and unsub-
(R), min (6,2-10,5) (8,2-15,6) p50,001 stantiated arguments; care providers should give women who are
Clot kinetics time 2,2 3,8 Z= 3,97, considering breech management options, true and complete
(K), min (1,8-3,2) (2,7-5,1) p50,001 information on ECV within a shared decision-making enviroment.
Alpha angle 59,1 46,8 Z= -3,77,
(a), ¯ (50,3-64,1) (38,1-56,3) p50,001 Keywords: External cephalic versión, breech presentation
Maximum amplitude 63,3 59,4 Z= -3,88,
(MA), mm (61,5-65,2) (57,3-61,9) p50,001
Time maximum 27,8 36,4 Z= 3,40,
amplitude (TMA), (24,7-32,0) (28,1-41,2) p50,001 690
min
Coagulation index 2,2 0,85 Z= -4,48,
Clinical and evolutionary features
(CI) (1,4-2,7) (-0,1-1,4) p50,001 in neonatal convulsive syndrome
M. Boia1, D. Cioboata2, O. Bilav2, and A. Manea1
679 1
University of Medicine and Pharmacy, Timisoara, Romania and
Pregnant women’s knowledge 2
Emergency Clinical Hospital for Children Timisoara, Romania

external cephalic version Presenter: M.Boia

Introduction: The convulsive syndrome in the neonatal period
J.M. Puerta-Sanabria, S. Copado, A. Pinto-Ibáñez, and represents a challenge for the physician due to increased frequency
A. Puertas and to its severe evolutionary potential.
Objectives: The authors aim to analyze the causes, the land on which
Virgen de las Nieves University Hospital, Granada, Spain.
is grafted and the evolution and prognosis of seizures in the neonatal
period.
Presenter: JM Puerta-Sanabria Materials and methods: The study was conducted in the Emergency
Hospital for Children ‘‘Louis Turcanu’’ Timisoara - Neonatology on a
Introduction: The effectiveness of external cephalic versión (ECV) to
group of 317 newborns at term and premature infants, who
reduce non-cephalic presentation, and caesarean section (CS) has
presented seizures (109 newborns at term and 208 preterm babies).
been demonstrated in good quality trials. Despite these findings the
The study was conducted over a 6 year period. Criteria for inclusion in
incidence of breech presentation at term remains unchanged.
the study were: the presence of seizures and clinical signs, cranial
Possible explanation for this is that ECV is not being accepted by
ultrasound ± brain CT or brain MRI, complete biochemical examina-
women, or that they do not receive real and contrasted information
tions, EEG and neurological checkup.
by the different proffesionals. In our hospital region, anecdotal
Clinical cases and summary results: In the study group 80.5% had
information suggested that women were declining ECV. This
ultrasound changes, the most common being signs of hypoxic-
prompted us to investigate the need for evidence-based information
ischemic encephalopathy 31.3%, followed by periventricular or
for women making decisions about breech management. As a
intraventricular bleeding 25%, 5.16% brain malformations, cerebral
baseline measure we needed to know women’s knowledge and how
and systemic infections 2.03%.
information were given to those patients.
Metabolic cause seizures (hypoglycaemia ± hypocalcemia) 9.95%. In
Materials and methods: The study was performed at Virgen de las
about 10% of cases there were not present clinical and biological
Nieves University Hospital between May 2015 and May 2016. We
signs.
conducted a questionnaire whose item were based on previously
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 221
The study group with term infants showed more severe clinical forms:
14% generalized tonic-clonic seizures recurrent under treatment; 27%
tonic and clonic seizures. Just for a rate of 3% of the group the
recurrent convulsive syndrome has not responded to treatment.
Conclusion: The neonatal convulsive syndrome can be easily
etiological diagnosed using brain ultrasound.
The most severe forms of disease were present in the babies to term
without etiologic diagnosis.
Keywords: Newborns, seizures

691 (CLINICAL CASE)

Vulvar rhabdomyoma associated
a new case of a lumbar syndrome
M. Nicolás1, A. Sarrat1, P. Araujo1, E. Garcı́a2, G. Guillén3,
S. Hernández4, A. Navarro5, and V. Garcı́a Patos6
1
Neonatology Dept., Hospital of Terrassa, Barcelona, Spain,
2
Gynecology and Obstetrics Dept., Hospital of Terrassa, Spain,
3
Pediatric Surgery Dept., University Hospital Vall d’Hebron, Barcelona,
Spain, 4Neonatology Dept., University Hospital Vall d’Hebron,
Barcelona, Spain, 5Pathology Dept., University Hospital Vall
d’Hebron, Barcelona, Spain, and 6Dermatology Dept., University 694
Hospital Vall d’Hebron, Barcelona, Spain
Pregnancy outcome in HIV
Presenter: Marta Nicolás positive women in a tertiary care
Introduction: Neonatal interlabial masses are very infrequent. Their
diagnosis is usually clinical but sometimes histopathological studies
centre in India
are required. They represent a vast spectrum of heterogeneous
lesions. K. Khoiwal, V. Dadhwal, A. Sharma, D. Deka, P. Sarkar,
The most frequent include hymeneal cysts, paraurethral glands cysts, and P. Vanamail
urethral anomalies and tumours like botryoid rhabdomyosarcoma.
They can be associated with multiple malformation syndromes wich is All India institute of medical sciences, New delhi, India
important for management.
Clinical cases and summary results: Newborn, 39 + 4 gestational weeks. Presenter: Dr. Kavita Khoiwal
No incidents, except the finding on 20 weeks USS of genital interlabial
mass. Karyotype (46XX), negative arrays and adrenal hyperplasia Introduction: About 2.4 million (1.93 - 3.04 million) people are living
study in amniotic fluid. Eutocic delivery, weight 3550g. There is a with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among
polypoid mass in right minor labia and anorectal malformation women. 5.4% of infections are from mother to child transmission
vestibular fistula type. Colostomy, excision and biopsy of the mass are (MTCT), 25,000 infected children are born every year. Besides the risk
performed at 24 hours of life and malformation studies:abdominal of mother to child transmission of HIV, these women are at risk of
USS shows low anorectal malformation with fistula, right kidney higher adverse pregnancy outcome. The objectives of the study were
slightly rotated and abdominal MRI dysplasic coccyx, lipomatous to compare the obstetric and neonatal outcome in women who are
lesion in conus medularis and partial sacrum agenesia. HIV positive with low risk HIV negative women and effect of
She is discharged after 8 days. Histology report of the mass is a fetal antiretroviral drugs on preterm birth and IUGR.
intermedium type rhabdomyoma. Materials and methods: Retrospective case record analysis of 212 HIV
At 23 days it appears a segmentary hemangioma in perineum and positive women delivering from 2002 to 2015, in a tertiary health care
lumbosacral region orienting the case as a LUMBAR syndrome(lower centre which was compared with 238 HIV negative controls. Women
body infantile hemangioma, urogenital anomalies and ulceration, who underwent MTP and abortion were excluded. Obstetric outcome
myelopathy, bony deformities, anorectal malformations, arterial and analyzed were PIH,intrauterine growth restriction, preterm birth,
rectal anomalies). anemia, gestational diabetes and ICP. Neonatal outcome analysed
Conclusion: Neonatal tumours are very rare in newborns. Due to their were birth weight, apgar score, NICU admission and perinatal
scarcity there is little literature about them. We should consider them transmission. Out of 212 HIV positive women, 204 received
in our differential diagnosis in order to rule out rare malignant forms, antiretroviral therapy (ART) to prevent MTCT, 27 women received
specially the rhabdomyosarcoma. Excepcionally they can appear single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of
associated with polimalformative syndromes. zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women
received duovir and 80 women received triple drug therapy
depending upon the time period of presentation.
Clinical cases and summary results: Mean age of 212 HIV positive
women was 25.72 + 3.6 years, 101 women (47.6%) were primigravida.
HIV positive status was diagnosed during pregnancy in 200 women.
Among 212 HIV positive women, 20(9.4%) women had preterm
delivery,194 women(91.5%) delivered by cesarean section and18
women(8.5%) delivered vaginally.178 neonates received exclusive top
feeding and 34 received exclusive breast feeding. When compared to
HIV negative women, HIV positive women were more likely to deliver
222 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

preterm (OR 1.27), have anemia (OR 1.39) and IUGR(OR 2.07). hospitalization in both term and preterm infants. More studies are
Incidence of PIH, DM and ICP was not increased. Mean birth weight required to evaluate its effectiveness.
was significantly lower in HIV positive women (2593.60 + 499 gm)
than HIV negative women (2919 + 459 gm). Complete follow up is Keywords: Apgar, combined Apgar, modified combined Apgar
available for 148 neonates till date. Out of these 7 neonates found to
have HIV positive status. Risk of preterm birth(P value = 0.039) and
IUGR (P value = 0.739) was higher in HIV positive women who did not
704
receive any ART during pregnancy than women who received ART.
Conclusion: HIV positive pregnant women are at increased risk of Features of influence in folate-
adverse pregnancy outcome. Multidisciplinary team approach and
use of highly active antiretroviral therapy can optimize the maternal related genes polymorphisms on
and perinatal outcome.
neonatal period course and
female reproductive disorders
695
Comparison of the utility of Z. Rossokha1, V. Pokhylko2, V. Poltoropavlov2, and
N. Gorovenko3
modified combined apgar score 1
Reference-centre for molecular diagnostic of Public Health Ministry
with both combined and con- of Ukraine, Kijv, Ukraine, 2Paediatric Dept., Higher State Educational
Establishment of Ukraine ‘‘Ukrainian Medical Stomatological
ventional apgar scores in the Academy’’, Poltava, Ukraine, and 3Dept. of medical and laboratory
delivery room genetics, National Academy of Postgraduated Education named after
P.L. Shupic,Kijv, Ukraine

M. Cetinkaya1, G. Buyukkale1, B. Cebeci1, T. Akca2, Presenter: Z. Rossokha

A. Babayigit1, S.Y. Semerci, D. Kurnaz, and G. Vardar
Introduction: Introduction. Polymorphisms in folate-related genes
1
Neonatology Dept., Kanuni Sultan Süleyman Training and Research involved in homocysteine metabolism and nutrients delivery.
Hospital, Istanbul, Turkey and 2Pediatric Dept., Kanuni Sultan According to certain studies folate-related genes polymorphisms
Süleyman Training and Research Hospital, Istanbul, Turkey are affected in fetal development disorders and neonatal pathologies.
It has been shown that both maternal and fetal genotype influence
Presenter: M. Cetinkaya on disorders risk. Folate-related maternal genes polymorphisms
traditionally studied in case of reproductive disorders with incon-
Introduction: Apgar score has been used to define the status of the sistent results. Different results may be due to gene-gene and gene-
newborn just after the delivery. As it has been affected by the factor interactions. Nutrients consumption and vitamin requirement
gestational age and interventions performed, combined Apgar score interact with widely studied folate genes polymorphisms. The
has been developed by evaluation of the requirement of positive purpose of this study was to examine the contribution of folate
pressure ventilation, oxygen, intubation, chest compression and genes polymorphism in neonatal and reproductive disorders in
drugs. We expanded the combined Apgar scoring by inclusion of the context of folate metabolism changes.
cord blood gases analyses and oxygen saturation and called it as Materials and methods: Materials and methods. Case-control study
modified combined Apgar scoring system. The aim of this study was conducted in 56 term neonates with perinatal asphyxia (moderate
to evaluate the efficacy of modified combined Apgar scoring system severity), 24 term neonates with intraventricular hemorrhage (III-
and to compare it with both conventional and combined Apgar IVstages) and 75 clinically healthy term neonates (control group) from
scores. Poltava region. This study included also 550 women with reproduc-
Materials and methods: This prospective study was performed tive disorder (primary and secondary infertility, premature birth) from
between July 2015 and January 2016 and all live born infants were different Ukrainian regions. All patients had full clinical and laboratory
included. Infants with major chromosomal abnormalities and stillborn examinations. Study was approved by the Ethics Committee. The past
were excluded. The three Apgar scores of all infants were evaluated at history of patients, folic acid status (homocysteine in plasma, folic acid
minutes 1, 5 and 10 by the same physicians. The demographical data, level in serum and red blood cell), MTHFR (C677T, A1298C), MTRR
all Apgar scores and requirement of hospitalization were recorded. (A66G) folate-related genes polymorphism were analyzed. Statistical
Appropriate ststistical analyses were performed by using SPSS 20.0 approach was determined using binary logistic regression (SPSS 17.0).
statistics programme and p50.05 were called as significant. Clinical cases and summary results: Summary results. There was found
Clinical cases and summary results: A total of 800 infants (228 preterm no significant differences in frequencies of MTHFR (C677T, A1298C),
ad 572 term) were included. The mean gestational age and birth MTRR (A66G) folate-related genes polymorphism in the three
weight of infants were 37.5±2.9 w and 3008±737 g, respectively. The neonatal groups. But we defined significant differences in distribution
median conventional and combined Apgar scores of infants at of combined genotypes between neonates with perinatal asphyxia
minutes 1 and 5 were (9 -10) and (16-17), respectively. The median and neonatal control group. Neonates with perinatal asphyxia
modified combined Apgar scores at minutes 1 and 5 were 18 and 19. compared to control group had significantly increased frequencies
The modified combined Apgar scores at minutes 1 and 5 showed a of 1298AC or 1298CC genotypes combined 66AG or 66GG; 677CT or
positive correlation with both conventional and combined Apgar 677TT genotypes combined 66AG or 66GG; 1298AC, 677CT and 66AG
scores. A total of 231 infants were hospitalized and the best AUC or 66GG (51,78%; 50%; 28,57% different from 36%; 37,33%; 12%,
value for hospitalization of all infants were determined by the 1st respectively). Neonates with perinatal asphyxia had significantly
minte modified combined Apgar score. For preterm infants that reduced folic acid levels and significantly increased homocysteine
required hospitalization, the best AUC was established with the levels after delivery. Folate-related genes polymorphism in women
modified combined Apgar score at minute 5. with reproductive disorders had frequencies corresponding to
Conclusion: The modified combined Apgar sytem developed by population distribution. Defined changes in folate status of patients
inclusion of cord blood gas and oxygen saturation just after delivery correlated with MTHFR genotypes despite taking folic acid.
were found to be used as a effective scoring system in the delivery Conclusion: Conclusion. Combinations of folate-related genotypes in
room. It may be superior to determine the evaluation of neonates were associated with development risk of perinatal asphyxia
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 223
accompanied by impaired folate metabolism after birth. Folate status patients who underwent invasive fetal procedure or presented
in neonates with perinatal asphyxia may be the result of gene- normal amniotic fluid at the end of pregnancy.
nutrient interactions in complicated women. The optimal choice of
folic acid drug in these and other patients will improve the folate Keywords: Previable PPROM, outcome, viability, term
metabolism in neonates. Further research of gene-nutrient interaction
is needed in the mother-fetus system.
Keywords: Folate-related, gene, neonatal outcome

710
Obstetric outcomes and prenatal
predictor factors in previable
preterm premature rupture of
membranes
A. Abascal-Saiz, S. Marı́n-Camacho, L. Sotillo-Mallo,
M. de la Calle Fernández-Miranda, F. Magdaleno Dans,
M.M. González Arlanzón, and J.L. Bartha Rasero
Fetal Medicine Unit Department of Obstetrics and Gynecology, H. U.
La Paz, Madrid, Spain

Presenter: M. de la Calle Fernández-Miranda

Introduction: Previable preterm premature rupture of membranes
711 (CASE REPORT)
(PPROM) complicates 50.1% of pregnancies. The latency period until
delivery is 7 days in about 50% of cases, and 2-5 weeks (w) in 80%, Adnexectomy of remaining annex
resulting in late miscarriage and extrem preterm deliveries (24w, the
obstetric history is the most important. Iatrogenic PPROM usually at 11 weeks of pregnancy
courses with small defects away from cervix, therefore it used to
recovers the amnioic fluid, and it has better fetal outcome and
M. Boia, A. Correia, A. Santos, R. Neto, I. Ferreira, and
survival.
Our target is to analyze the obstetric outcomes in PPROM and relate S. Neto
factors that can predict survival, fetal viability and term reaching. Department of Obstetrics and Gynecology - Centro Hospitalar do
Materials and methods: Retrospective observational study, case series,
Baixo Vouga
of PPROM pregnancies524.0w diagnosed in H.U. La Paz from January
2011 to December 2015. Only singleton pregnancies were evaluated,
excluding twin pregnancies in order to avoid inherent bias. Presenter: M. Boia
Statistical analysis was performed with SPSS Statistics 20, executing Introduction: The incidence of non-obstetric surgical pathology
T-Student and Chi-square tests, setting significance at p 24.0w), and during pregnancy varies between 0.2-2.2%. The delay in the diagnosis
term reaching (4 37.0w). of these conditions is common due to the increased difficulty in the
Clinical cases and summary results: 136 PPROM were reported, differential diagnosis and use of complementary tests. The treatment
13.24%(16) of them were twin pregnancies and 86.76%(118) singleton decision is complex, taking into account the gestational age,
ones. Obstetric outcomes are shown below. anesthesic aspects and surgical approach routes. We present a
The average PPROM GA was 18.32± 2.7w; the average latency until clinical case referring to an intervention with removal of the
delivery was 60.78± 67.58 days. Overall survival was 48.5%(33/68). remaining annex at 11 weeks of pregnancy with a successful term
61.2%(41/67) of PPROM reached viability, and 45.0%(18/40) of these delivery.
get to term. Clinical cases and summary results: 35 years old, 2 pregnancies 1
The average PPROM GA was similar in patients who survived (p 0.60) delivery (pregnancy without complications, vaginal delivery at term,
or reached viability (p 0.71). PPROM was earlier in patients who came healthy newborn). History of left adnexectomy for a borderline
to term (17.28w vs. 19.91w; p 0.008). ovarian tumor. She resorted to the emergency department of our
In the group of patients who had made a previous invasive fetal hospital at 10 weeks of amenorrhea, due to pelvic pain with a week of
procedure (16/68) reached viability 87.5%(14/16, p 0.013), and evolution, with progressive worsening. A 10-week and 5-day
71.4(10/14, p 0.014) of these came to term. pregnancy and a 10 cm right ovarian cyst were diagnosed,
In patients with oligoamnios (46/67) fetal viability was 52.2%(24/46, p hospitalization was proposed. Cyst ecoguided puncture was per-
0.025), and only 21.7%(5/23, p 0.001) of these came to term. formed with suction of 440 cm3 of cyst fluid, leading to great relief of
The fetal survival rate was 87.5%(14/16, p 0.001) in patients who symptoms.
underwent invasive fetal procedure; however, they survived only Due to further worsening in D4, with acute abdomen, a decision to
35.6%(16/45, p 0.003) who had oligoamnios. perform laparotomy was made. Necrosis of the whole right annex due
Conclusion: The average PPROM GA seems not to be related to overall to cyst torsion was observed, and adnexectomy was performed. The
survival, neither viability; however, it does in getting term. cytological study of the fluid revealed no cellular elements. The
PPROM after invasive procedure seems to have a positive influence in surgical specimen revealed serous cystadenoma without malignancy.
reaching viability and term, probably because of amniotic fluid Hospital surveillance was maintained, she remained asymptomatic
recovery. Pregnancies with oligoamnios seem to have higher risk of and without sonographic or analytical changes, under vaginal
not reaching fetal viability or term. The survival is increased in those progesterone. Spontaneous labor at 40 weeks occured, with eutocic
224 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

delivery. Newborn with 3370 g and Apgar score 10-10 at 1rst and 5th body mass index (BMI), systolic and diastolic blood pressures, and
minutes. Uneventful puerperium. side and degree of hydronephrosis were documented. Urine (spot
Conclusion: The incidence of pelvic tumor in pregnancy varies and 24 hours) and blood samples were collected from all subjects.
between 0.5 to 2.2%, being the serous cystadenoma adnexal Blood urea nitrogen (BUN), creatinine, uric acid, serum cystatin-C,
tumors 21% of adnexal tumors in the first trimester. The annex uNGAL levels and complete urinary analysis were determined.
torsion is an emergency situation and, in cases of acute abdomen, a Additionally, creatinine clearance values were calculated in all
fundamental principle is to treat the woman as if she was not participants using the creatinine clearance formula.
pregnant. We managed to treat this surgical emergency and it was Clinical cases and summary results: Demographic data and laboratory
possible to proceed with the pregnancy, despite the absence of both results of controls and hydronephrosis cases were summarized in
ovaries. Table 1. In the study group, 21 of patients had severe, 7 had mild, and
16 had moderate hydronephrosis. There were no statistically
Keywords: Surgical pathology, pregnancy significant differences between groups in terms of age, BMI, gravidity,
mean systolic, diastolic blood pressures and the creatinine clearance
values; but significantly elevated uNGAL levels were detected in the
presence of asymptomatic maternal hydronephrosis compared to
controls (Table 1). The demographic characteristics were comparable
among all hydronephrosis groups without any significant differences.
An increasing trend in uNGAL levels was detected with increasing
degrees of hydronephrosis, (29.57±23.87 in mild; 41.61±35.72 in
moderate; 60.61±53.96 in severe hydronephrosis; p=0.163). Maternal
pelvic diameter was found as a significant independent factor
influencing uNGAL concentrations (b=0,289 95% CI: 0.522-3.061;
p=0.006).
Conclusion: Mean uNGAL levels in uncomplicated pregnancies were
reported as 30.5 and 47.8 ng/mL (33.2 ng/mL in our study). We
detected higher uNGAL levels in increasing degree maternal
hydronephrosis similar to higher levels with worsening obstructive
nephropathy in children. Increased tubular pressure might be one of
the underlying mechanisms for up-regulated uNGAL levels in our
study. In conclusion, significantly elevated uNGAL levels were
detected in the presence of asymptomatic maternal hydronephrosis.
713
Keywords: Maternal hydronephrosis, urinary Neutrophil gelatinase-
Does maternal hydronephrosis associated lipocalin

have an impact on urinary neu-

trophil gelatinase associated
lipocalin (UNGAL) levels?
E.G. Pabuccu1, G.S. Caglar1, M. Kiseli1, A.Y. Gursoy1,
T. Candar2, S. Tangal3, and I. Ergun4
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk
University, Ankara, Turkey, 2Department of Biochemistry, Faculty of
Medicine, Ufuk University, Ankara, Turkey, 3Department of Urology,
Faculty of Medicine, Ufuk University, Ankara, Turkey, and
4
Department of Nephrology, Faculty of Medicine, Ufuk University,
Ankara, Turkey

Presenter: Mine Kiseli

Introduction: Maternal hydronephrosis during pregnancy occurs
mainly due to compression of the ureter by the gravid uterus or
secondarily due to the dilatant effect of progesterone on the urinary
tract. Asymptomatic dilatation of the renal calyces in pregnancy is
generally considered physiological. Neutrophil gelatinase-associated
lipocalin (NGAL) is a small molecule of almost 25 kd that belongs to
the well-defined superfamily of proteins called lipocalins. Marked
elevation in NGAL levels indicates the renal injury. NGAL has been
postulated to regulate renal epithelial morphogenesis and suggested
to play a role in repairing damaged tubules by means of re-
epithelization in the ascending limb of Henle’s loop. The aim of the
study was to determine uNGAL levels in asymptomatic maternal
hydronephrosis.
Materials and methods: We recruited 44 uncomplicated pregnant
women with hydronephrosis and 46 pregnant women without
hydronephrosis as controls between the 24-36 weeks of gestation.
The diagnosis of hydronephrosis was graded according to the
maximal calyceal diameters: 5-10 mm mild, 10-15 mm moderate,
and 415 mm as severe hydronephrosis. Patient age, gestational age,
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 225

721
Relevant conditions of stillbirth at
term
N. Bursacovschi1, V. Petrov1, and C. Eţco2
1
Institute of Mother and Child, Chisinau, Moldova, Republic of and
2
State Medical and Pharmaceutical University’’Nicolae Testemitanu’’

Presenter: N. Bursacovschi
Introduction: Stillbirth cases are the most important adverse outcomes
of pregnancy, however poorly understood and recognized [Jay E
Lawn et al., 2011]. Intrauterine death of mature fetus justifies up to
50% cases of stillbirth [Stratulat P. et al., 2014]. Many times these
deaths are due causes which may be prevented [A. Choudhary, 2014,
H. L. Kidanto, 2014]. Reduction of stillbirth at term requires mostly 732 (CASE REPORT)
inexpensive interventions [Stratulat P. et al., 2014]. To do this, it is
crucial to understand the causes and factors associated with stillbirth
Impact of electrical shock in
[Aminu M. et al., 2014]. Classification helps to identify the probable
etiology of fetal deaths and series of events that eventually led to
pregnancy
fetal death, as well as to formulate prevention policies and protocols
[A. Choudhary, 2014]. I. Ferraz1, J. Silva2, and A. Nogueira3
Materials and methods: A retrospective case-control study was
handled. The sample size was limited by the total number of Obstetrics and gynecology department, Centro Hospitalar Vila Nova
stillbirths at term (0 Apgar score at the first and fifth minute of life) de Gaia, Portugal, Porto
registered in the Institute of Mother and Child (IMC) of Republic of
Moldova during 2013-2014. The control group consisted of live births Presenter: I. Ferraz
in the same obstetric units. As mature were considered newborns
Introduction: Electrical shocks during pregnancy are very rare. The
since 37 obstetric week. The study group (L1) included 39 cases of
spectrum ranges from transient unpleasant sensation with no effect
intrauterine fetal demise at term, the control group (L0) - 69 live
on the fetus to sudden maternal and fetal death. The severity of
births. In order to obtain the necessary information it has been
maternal injury is not predictive of fetal outcome. The pathophysiol-
examined the stationary patient chart (Form 000-1/e). Data collection
ogy of electric shock during pregnancy depends on the characteristics
was carried out by means of a specially developed questionnaire.
of the current and the pathway of electrical current through the
Clinical cases and summary results: The main disease that led to death
mother’s body. Most of the injuries come from low voltage and
in utero of mature fetus in IMC according to the ICD-10 was mostly
alternating current in standard household electrical installations.
intrauterine fetal hypoxia, present in 61.5% of cases and congenital
Vertical flow of the current may pass through the uterus and be more
abnormalities in 18%, intrauterine infection -20,5%. According to the
dangerous to the fetus. Adverse fetal outcomes include: spontaneous
ReCoDe classification, that seeks to identify the condition(s) which
abortion, placental abruption, cardiac arrhythmias, intrauterine fetal
existed at the time of death in-utero, approximately half of the cases
death, asphyxia, intrauterine fetal growth restriction.
of intrauterine death are related to fetus pathology (Fig. 1). The last is
Clinical cases and summary results: G4P2, 39-years-old gravida,
represented by intrauterine growth retention (17,9%) and congenital
presented to our emergency department at 32 + 6 weeks after an
abnormality (15%), as well as intrauterine infection (23%), confirmed
injury from electrical shock with low voltage at home. She was
by the histological examination. It should be mentioned that the
conscious and asymptomatic with no external injuries. Nevertheless,
majority of the IGR cases were not detected during ante/intrapartum
she was hospitalized for maternal and fetal monitoring. Blood tests
period. Umbilical cord pathology was present in 23% of the cases and
(renal function, basic serum electrolytes and coagulation tests) and
placenta related conditions (infarcts or inflammatory damage) -7, 7%.
ECG were performed, with no abnormality. A prolonged (4 hours)
Intrapartum fetal deaths were all due to acute intrauterine asphyxia
cardiotocography (CTG) was done with a normal tracing. Blood panel
(n=5). Maternal pathology was presented by hypertensive disorder.
tests, ECG and CTG were repeated on the very next day with normal
Conclusion: According to ICD-10 more than half of mature fetuses
results and the patient was discharged. They were performed one
died in utero due to acute or chronic intrauterine hypoxia. The
week later, with no abnormalities.
conditions that lead to the development of hypoxia vary and become
Pregnancy was monitored and uneventfully. She delivered a healthy
transparent after evaluation by the ReCoDe classification. In most
baby boy at 39 + 4 weeks.
cases, they were related to fetal and umbilical cord pathology, as well
Conclusion: The effects of electrical shock during pregnancy remain
as placental dysfunction, intrapartum asphyxia and hypertensive
unknown and the severity of maternal injury is not predictive of fetal
maternal disorder.
outcome. Women who suffered electric shock, even if it was minor,
Keywords: Stillbirth, relevant condition require a complete obstetric evaluation. There are no specific
guidelines for management during pregnancy and the majority of
authors recommend fetal monitoring after 20 weeks of gestation.
The effect of gestational age and other factors have not been
thoroughly studied yet.
226 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

736 737
Correlation between the declara- Maternal cardiac arrest
tion of drug abuse and psycho- A. Teixido1, I. Garcia-Ruiz1, S. Manrique2, A. Suy1, and
tropic drugs consumption and E. Carreras1
their detection in maternal hair 1
2
Obstetrics Dept., Vall D’Hebron Hospital, Barcelona, Spain and
Anesthesiology Dept., Vall D’Hebron Hospital, Barcelona, Spain
and neonatal meconium
Presenter: Itziar Garcia-Ruiz
L. Almeida, L. Cortés, J. Parra, M. Serra, M. Gibert,
Introduction: The objective of this analysis was to evaluate the
A. Mirón, and M.D. Gómez Roig frequency, potential etiologies, neonatal outcomes and survival rates
Obstetrics department, Hospital Sant Joan de Déu Barcelona, Spain of maternal cardiopulmonary arrest in a tertiary care centre.
Materials and methods: We performed a retrospective chart review of
maternal cardiac arrest in Vall D’Hebron Hospital, Barcelona,from 2005
Presenter: Laura Almeida to 2016.
Introduction: Major depression prevalence is 5-9%. Choosen treatment Clinical cases and summary results: Five cases were identified, for an
is selective serotonin reuptake inhibitors (SSRI). Recent studies have incidence of 1/6500 deliveries (0.15?). Four of the five women were
estimated the pregnant women consumption is 2-8%. There are obese (BMI 30) and three of them older than 35 years.
reasonable doubts about safe use in pregnancy. Up until now there The first patient collapsed being in-patient seven days after acute
are few studies that have been determined psychotropic drugs in myocardial infarction due to anterior coronary artery dissection.
maternal hair and meconium, so that no validated biomarker of Cesarean perimortem was performed. After delivery she was
chronic fetal exposure for these. successfully resuscitated. The second patient had placenta accrete
The aim of the study is: and underwent an elective c-section with uterine arteries emboliza-
 To know the prevalence of prenatal exposure to psychotropic drugs tion. She suffered massive pulmonary embolism and died. The third
because of maternal consumption by determination in alternative patient was abruptio placentae and suffered from amniotic fluid
biological matrices (maternal hair and meconium). embolism, resulting in encephalic death. The fourth patient suffered
 To find out the usefulness of the questionnaire to detect patient cardiac arrest due to the anesthetic induction during an emergency c-
consumption of antidepressant and anxiolitics compared to the section due to uterine rupture. The last patient suffered hemorrhagic
determination in alternative biological matrices. shock and fatal cardiac arrest during c-section for transverse lie. The
Materials and methods: DESIGN: This is a transversal observational necropsy revealed an Ehler-Danlos. All neonates survived without any
collaborative study. Five hundred mothers and their newborns will be morbidity
correlatively included after birth. Conclusion: Cardiac arrest in pregnancy is a rare event, but supposes
Instrumentalization: (1) Questionnaire about sociodemographic char- high maternal morbidity and mortality. Survival depends on the
acteristics and consumption and exposure to tobacco, alcohol, drugs underlying etiology of arrest. Clinicians must be trained in cardio-
of abuse, and anxiolytics and antidepressants during pregnancy. (2) pulmonary resuscitation. A community database, Catalan Obstetric
Biological samples: maternal hair, meconium. Surveillance System (CATOSS), for rare and severe maternal conditions
Measurements: Anxiolytics and antidepressants values in maternal is ongoing.
hair and meconium by gas chromatography coupled with mass Keywords: Maternal cardiac arrest
sprectrometry.
Clinical cases and summary results: There is an infradeclaration of
tobacco, alcohol and drug abuse; and psychotropic drugs consump-
tion in pregnancy when compare the questionnaire with alternative 743
biological matrices.
There is statistically significant differences in marijuana consumption, Newborn hearing screening on
antidepressant and anxyolitic consumption when compare maternal
hair detection with meconium detection, being meconium a better anoxic babies admitted on
matrix to measure maternal consumption than maternal hair.
There are not statistically significant differences found in those drugs
Brazilian follow - up service
different to marijuana when compare meconium with and maternal
hair detection. M. C. M. C. Muniz, J. M. deA. Bringel, C. S. Sousa,
Conclusion: Questionnaires do not reflect the real consumption of E. dosS. Catunda, A. I. Arruda, P. S. Magalhães, and
antidepressant, anxyolitics and drug consumption in pregnancy.
I. N. S. Santos
Meconium seems a better matrix than maternal hair to evaluate drug
abuse and psychotropic drug consumption in pregnancy, although Neonatal Unit, Paediatric Dept., Hospital Geral Dr. Waldemar
there are not statistically significant differences in the detection of Alcântara, Fortaleza, Brazil
some abuse substances. This lack of differences can be explained by
low number of pregnant women who are consumers of this type of
Presenter: Iumy Santos
drugs.
Introduction: According to WHO, in 2005, 278 million people have
Keywords: Meconium, maternal hair, pregnancy, depression, anxyo-
hearing loss from moderate to profound degree, and 80% of these live
litic, antidepressant, drug abuse
in developing countries . Half of disability on hearing can be prevented
and its effects minimized if the intervention starts early. Newborn
Hearing Screening (NHS) is nationally developed in Brazil between
patients with high and low risk for hearing loss through behavioral and
electrophysiological procedures for early detection.
Materials and methods: This is a cross-sectional study conducted from
January to December 2015. The test records held by the
Fonoaudiology Service at Hospital Geral Dr. Waldemar Alcântara, in
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 227
Fortaleza, Brazil, were analyzed and demographic and perinatal data of
751
screened patients were documented, in addition to results of their
tests. Uterine rupture in a 23 week
Clinical cases and summary results: On 2015, 341 newborns were
tested on hearing screening and of these, 66 had neonatal anoxia. gestational age pregnancy.
Among the anoxic babies, 38 (57.58%) were male and 28 (42.42%)
female; 64 (96.97%) were born by vaginal delivery and 2 (3.03%) by Management with preservation
cesarean delivery; and 45 (68.18%) had Apgar 6 in the fifth minute.
Hearing screening, 19 (28.79%) passed and 47 (71.21%) failed. 57
of pregnancy
(86.36%) have cochlear-palpebral reflex (CPR) present, 7 (10.61%)
absent and 2 (3.03%) doubtful. 52 (78.79%) achieved satisfactory I. Vlachodimitris1, C. Mavraganis1, A. Stylianaki2, and
results in the right ear (RE) and 54 (81.81%) in the left ear (LE); failed U. Circel1
14 (21.21%) and 12 (18.18%) in right and left ears respectively. Of
1
those who achieved satisfactory results in RE and LE, 84% to 94% had Department of Obstetrics and Gynecology, Johannes Wesling
accoustic emissions presenst in the frequency 2k, 3k, and 4k, and 71% Hospital, Minden, Germany and 2Department of Traumatology,
to 92% absent in 1k and 1.5k. All patients were referred to the Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
Audiology Service of reference for newborn monitoring with risk
indicator for hearing loss. Introduction: Uterine rupture is one of the most severe and
Conclusion: Most anoxic newborn obtained CPR present, and positives uncommon complications of pregnancy. In the majority of the
results on speech frequencies, which favors the stimulation and cases, the patients have a gynecological history of uterine interven-
communication of newborns. However, these results do not rule out tions, which provoke the formation of uterine scars affecting the
future hearing loss, requiring monitoring at least until school age, in integrity of the myometrial wall. The interruption of the myometrial
order to reduce learning difficulties among these children. structural integrity is the leading cause of the Intra gestational uterine
Keywords: Anoxic, Hearing Screening, Newborns perforation. The standard treatment of this complication is an
emergency hysterectomy after delivery in order to control the
massive intraabdominal bleeding.
Clinical cases and summary results: A 33 year old caucasian woman
750 (CASE REPORT) was brought to the delivery room during the 23rd week of her
pregnancy. Her vital signs were Arterial blood pressure of 50-
Progressive abdominal distension 16 mmHg and a cardiac frequency of 125 bpm.The physical
and severe blood dyscrasia examination showed diffuse abdominal tenderness without any
clinical signs indicating an acute abdomen or a vaginal bleeding.
The ultrasound performed showed the presence of a eutrophic fetus,
I. Sanmarful1, S. Pereira1, A. Vilan1,2, F. Flor-de-Lima1,2, with cardiac function in a breech position. The portion of amniac fluid
O. Brandão3, and H. Guimarães1,2 in the sac was deemed normal, the placenta was located in the
anterior wall without any signs of placental hematoma or placental
1
Neonatal Intensive Care Unit, Centro Hospitalar São João, Porto, dysfunction. Because of the hypovolemic shock we performed an
Portugal, 2Faculty of Medicine, University of Porto, Porto, Portugal, abdominal ultrasound which revealed a fair amount of free fluid in
and 3Department of Pathology, Centro Hospitalar São João, Porto, the abdominal cavity extending from the recto-uterine (Douglas)
Portugal pouch to the Morrison (hepatorenal) pouch. An emergency explora-
tory laparotomy was performed. Intraoperatively, an anterior uterine
wall rupture of 33 cm was revealed. An intraoperative obstetric
Introduction: Neuroblastoma is a tumor derived from the neural crest
ultrasound was performed showing a viable fetus. Given the viability
cells of adrenal gland medula or sympathetic ganglia and the most
of the fetus and the early age of the gestation, we took the decision
common malignant tumor in neonatal period. We report a case of
to maintain the pregnancy instead of performing immediate delivery.
newborn with abdominal distension and severe blood dyscrasia.
We performed Hemostasis by suturing the uterine lesion . In the next
Clinical cases and summary results: The mother was 29 year old with
weeks because of placenta previa totalis, a subsequent vaginal
normal obstetric ultrasounds, the last one at 34 week. It was a vaginal
bleeding led to an emergency cesarean section during the 29th
delivery at 38 weeks. The Apgar score at 1, 5 and 10 min was 7/8/8. At
pregnancy week. A classical cesarean section was performed for the
birth a progressive abdominal distension was detected, so he was
delivery of the fetus.
transferred to a level III NICU.
Conclusion: Despite the fact that Hysterectomy is considered to be the
He was admitted under mechanical ventilation with undetectable
golden standard for the treatment of intractable uterine bleeding,
blood pressure. Spontaneous bleeding in the local of venous
a pregrancy preservation should be kept in mind in cases of a vital
puncture and a marked abdominal distension were noted.
pregnancy by the time of the diagnosis.
Analytically, there was a severe metabolic acidosis, hemoglobin
Hysterectomy is sometimes the only choice for the successful control
10.7g/dL with 32x109/L platelets, APPT 158 sec; TP 4,1 sec; and
of an acute massive bleeding during pregnancy. We report this case
Fibrinogen 510 mg/dL. From five hours of life he presented a
because of the rarity of management of this obstetrical emergency.
refractory hypotension with severe blood dyscrasia. Death after
cardiac arrest was declared at 8 hours of live. Keywords: Uterine rupture, preservation of the pregnancy
Autopsy revealed an abdominal mass (11x10x9cm).The liver had
numerous metastasis. Normal hepatic parenchymal was scarce. The
adrenal glands where normal. The histological exam and the
immunohistochemical markers confirmed neuroblastoma.
Conclusion: Congenital neuroblastoma is rare. Autopsy alone or in
conjunction with ancilliary techniques play an important role in the
diagnosis of neuroblastoma.
Keywords: Neuroblastoma, Newborn
228 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

753 (CASE REPORT) 759

Intra-abdominal injury in birth Outcomes of high risk surgical
trauma neonatal cohort up to 18 months
I. Sanmarful1, F. Flor-de-Lima1,2, A. Vilan1,2, M. Fonte1,2,
at a UK tertiary perinatal referral
S. Pissarra1,2, and H. Guimarães1,2 surgical unit
1
Neonatal Intensive Care Unit, Centro Hospitalar São João, Porto,
Portugal and 2Faculty of Medicine, University of Porto, Porto, S-L. Chuang, H. Gbinigie, V. Shivamurthappa, and
Portugal E. Ogundipe
Department of Neonatology, Chelsea and Westminster Hospital,
Introduction: Birth injuries are those sustained during the birth London, United Kingdom
process, which includes labor and delivery. Liver is the most
frequently injured abdominal organ and trauma more often results
Introduction: Background: Preterm babies’ outcomes are better
in subcapsular hematoma than laceration of the liver.
monitored unlike for their neonatal surgical counterparts.
Clinical cases and summary results: A female newborn of 3975 g was
Aim: To determine the clinical and developmental outcome of high-
born at 36 weeks by vacuum delivery to a 28 years old, 1G 0P, healthy
risk surgical neonates at a tertiary referral perinatal centre over
mother. The birth was complicated with shoulder dystocia with very
6 years.
hard extraction and the Apgar Score at 1st and 5th min was 3 and 7.
Materials and methods: Clinical and demographic data was collated
She was mechanically ventilated during first hour of life. On 2nd day
retrospectively on eligible infants for the unit’s high-risk neurodeve-
of life, she developed seizures, acute renal failure, anemia and
lopmental program from 2008 to 2013 using clinical notes and
thrombocytopenia. An hepatomegaly was noted with increased levels
Standard Electronic Neonatal Database. Inclusion criteria: inborn 531
of alanine transaminase (4668UI) and aspartate transaminase (1748UI),
weeks gestation, hypoxic ischaemic encephalopathy (HIE) grades 2/3
without coagulopathy. Creatinine kinase was 13469U/L. A metabolic
and major surgical cases. Congenital diaphragmac hernia (CDH) and
disease was suspected and she was transfered to our NICU. An
tracheo-oesophageal fistula (TOF) are reported. Developmental
abdominal TC showed a distended liver with increased dimensions.
screening used standardised proforma and Bayley Infant
Dispersed by all liver segments there were extensive heterogeneous
Neurodevelopmental Screener (BINS) classifying as low, moderate
and hypodense areas without capture of contrast corresponding to
and high-risk for disability.
hepatic lacerations. Elevations of left diaphragmatic hemi-cupula was
Clinical cases and summary results: Of 221 infants; male (55%); 57
noted and phrenic paresis was confirmed. Hemi diaphragm plication
(37%) ex-utero. Eighty-five (38.6%) had TOF; 39 (17.7.8%) had CDH; 35
was performed. Metabolic disease was excluded.
(15.9%) had HIE. Median birthweight and gestation was 2449g and 33
Conclusion: Physicians should be aware for birth trauma involving
weeks respectively; 27.7% SGA. Commonest comorbidies were PDA
intra-abdominal organs because evolution can be fulminant and in
(26.6%; 47% preterm TOF), CLD (15.9%; 40% preterm-TOF vs 3% term-
newborns with undetected lesions.
TOF patients), IVH (10%; 40% surgical-preterm), Laser treated ROP
Keywords: Birth trauma (1.7%), and PVL (2%). Feeding was key discharge issue: 20%
nasogastric/gastrostomy/jejunostomy, 42% GORD and 43 (19.6%)
deaths post-discharge before 2 years; 34% had CDH. Surgical babies’
(n=37) BINS scores: at 3 months; 24% had moderate and 10% high
risk; 18 months; 29% moderate versus 13% high risk. By contrast,
medical preterms 531 weeks (n=56),10% moderate and 3% high risk
at 3 months and 12% moderate and 12% high risk at 18 months.
Conclusion: Post-discharge mortality and developmental morbidity to
18 months is higher in surgical infants compared to medical preterms
531 weeks.
Keywords: Outcomes, high risk, surgical neonates, preterm

769 (CASE REPORT)

Aplasia antebrachii et manus
congenita
S. Stefanovic1, and T. Gojkovic Radunovic1
Institute for Children’s and Youth Health Care of Vojvodine

Introduction: The appearance of the congenital major abnormality

varies, depending the time when problem occured during intrauter-
ine development. . There are few theories about its etiology
-intrauterine conditions as trauma, viral infections, placenta abnorm-
alities during embryo genesis but persistence of amniotic ribbon l can
be one of the major causes for partial unilateral partial muscle/bones
deformation or agenesia
Clinical cases and summary results: A few days ago we have
hospitalized a female newborn with rare congenital abnormality as
antebrachial and manus agenesia of right arm is Surprisingly it was
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 229
was detected at the birth! From discharge letter from Obstetric Clinic Introduction: Congenital pulmonary lymphangiectasia (CPL) is a rare
in Novi Sad we found out that it was mother’s second pregnancy, she condition caused by failure of the normal regression process of
claimed thatshe did not know that she was pregnant until pulmonary lymphatics. The prognosis has been reported to be very
spontaneous rupture of amnion membranes so she did not have poor.
even one check up during pregnanacy When amniotic membrans Clinical cases and summary results: We report a premature male
ruptured, she hurried to delivery room but it was too late so vaginal newborn presenting at birth with nonimmune hydrops, bilateral
delivery occurred at the entrance to delivery room. Neonatologist pleural effusion and severe respiratory distress syndrome. At birth he
after first assessment estimated GA at 40 weeks, BW 3000g BL48cmHC required immediate resuscitation, intubation and chest tube place-
34 cm/eutrophic for GA/AS 9/10.and described major abnormality of ment for drainage. He was not dysmorphic and karyotype was 46, XY.
right arm as antebrachial et manus agenesia is. After seeing the baby, After we started enteral nutrition on the 2nd day, effusion become
mother denied to take it home so we have already contacted social chylose, so we started with total parenteral nutrition and medium-
workers to find a family willing o take care of this otherwise healthy chain triglycerides (MCT) based formula afterwards. Despite that,
newborn baby. chest-drain losses were up to 200 ml/kg/day. One the 22nd day we
Conclusion: Although it is rare congenital abnormality it is important began treatment with octerotide, but without significant success. At
for gynecologist to try always to see both arms and legs as we had the age of 53 days diagnostic thorascopy and a lung biopsy was
cases of partial unilateral agenesia of leg as absence of foot, or only performed and at the same time pleurodesis with sterile talc. After
fingers but prenatal ultrasound was described as normal because that, we removed chest drains with no recurrance of the effusion.
gynecologist thought that if one leg is normally formed, the other leg Histopatologic findings confirmed congenital pulmonary lymphan-
is the same although he has not not seen it properly and nowadays giectasia. He was discharged to the regional center at 80 days of age,
he is under investigation for medical mistake that can cost him lost of still dependent on mechanical ventilation.
licence Conclusion: Adequate prenatal diagnosis and perinatal/neonatal
clinical care can reduce mortality rate and improve outcome of
Keywords: Congenital abnormality,newborn, aplasia antebrachii et newborns with CPL.
manus
Keywords: Pulmonary lymphangiectasia, congenital chylotorax, fetal
hydrops

068
A comparative study of hhhfnc
and ncpap in preventing re-intu-
bation in extreme preterm infants
born at less than 30 weeks
gestation
W Muhsen1 and R Roy2
1
Specialist Registrar, Neonatal Medicine Department, Rosie Hospital,
Cambridge University Hospitals, Cambridge, England and
2
Consultant Neonatologist, Neonatal Medicine Department, Norfolk
and Norwich University Hospital, Norwich, England

Introduction: Despite recent advances in respiratory support, the wide

use of antenatal steroids and surfactant replacement therapy,
NEONATAL LUNG - 067 (CASE REPORT) respiratory problems continue to represent the leading cause of
mortality in premature infants during the neonatal period. In the last
Congenital pulmonary lymphan- few years, HHHFNC has been widely adopted as a mode of non-
giectasia presenting as fetal invasive respiratory support for infants with respiratory difficulties.
However, data of the safety and efficacy of HHHFNC use in extremely
bilateral pleural effusion premature infants are scarce. This study will aid in bridging the
knowledge gap and sheds light on the efficacy and, more
importantly, the safety of HHHFNC as non-invasive respiratory
I. Ivanišević2, S. Rsovac2, S. Sindić1,2, B. Nestorović1,3, support for extremely premature infants.
S. Ilić1,4, J. Kalanj2, K. Milošević3, M. Petrović2, P. Salević2, Materials and methods: This is a retrospective comparative study
and S. Ðuričić1,5 conducted at Neonatal Intensive Care Unit (NICU), Norfolk and
Norwich University Hospital between 01/October/2010 and 31/
1
School of Medicine, University of Belgrade, Belgrade, Serbia, December/2014. Data were collected from the medical notes of the
2
Department of Pediatric and neonatal intensive care, University eligible patients. Participants’ total number was 26, 9 patients in
Children’s Hospital, Belgrade, Serbia, 3Department of Pediatric nCPAP group while HHHFNC group consisted of 17 patients. The
pulmology and alegrology, University Children’s Hospital, Belgrade, participants’ gestational age was ranging between 24 to 29 + 9 weeks
Serbia, 4Department of Cardio-surgery, University Children’s Hospital, who were supported by either nCPAP or HHHFNC after first
Belgrade, Serbia, and 5Department of Clinical Patology, Institute for extubation. Primary outcome defined as the need for re-intubation
within 72 hours post-extubation i.e. failure of non-invasive respiratory
mother and child, Belgrade, Serbia
support.
Clinical cases and summary results: Study showed no statistically
significant differences in either primary (nCPAP (9/2 [22%]), HHHFNC
230 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

(17/2 [12%], p ¼ 0.59) or secondary outcomes (Constant need for O2 year-old age at children born prematurely depending on a condition
in the first 4 weeks of life (p ¼ 0.62), Pneumothorax (p ¼ 1.0), nasal of PDA.
injury (p ¼ 0.35)). P value for spontaneous bowel perforation was not Materials and methods: The retrospective analysis of 146 preterm
computed as there was no affected patients. infants 24-32 weeks of gestation with BPD and follow-up during 3
Conclusion: The study demonstrate that HHHFNC is similarly safe and years was performed. The children was divided in group depending
efficacious in comparison to nCPAP as non-invasive respiratory on a condition of PDA: group 1 - 58 preterm infants at whom DPA it
support for extremely premature infants post-extubation. was closed independently in the early neonatal period, group 2 - 60
preterm infants with hemodynamically insignificant PDA which was
Keywords: Premature, HHHFNC, nCPAP not demanding closing by a surgical way, group 3 - 28 preterm
infants with hemodynamically significant PDA which was closed by a
surgical way at the age of 21.5 ± 1.6 day of life. Uitrasound criteria of
hemodynamically significant PDA (Tacy TA, 2009, Sehgal A, McNaMara
PJ, 2009, El Hajjar M, 2005): diameter of ductus arteriosus (DA) more
than 1.2-1.4 mm/kg body weight, left atrium-to-aortic root diameter
073 ratio of 1.4 in the parasternal long-axis view, presence of the is left-
right shunting of blood through DA, holodiastolic flow in the
Current bronchopulmonary descending aorta, resistance index in the a. cerebri anterior  0.8,
absence diastolic blood-groove in aa. renalis and/or mesenterica.
dysplasia at preterm children Clinical cases and summary results: At a treatment stage in perinatal
centre in group 2 was more children (23.3%, p 50.01) with heavy
with the patent ductus arteriosus degree BPD in comparison with group 1 (5.6%) and accordingly there
to age 3 year are less than children severe BPD (41.7%, 58.6%, p 50.05). In group 3
was more (53.6%) children with 3rd and more degree active
retinopathy of preterm infants in comparison with group 2 (35.0%,
T. Klimenko, O. Karapetyan, and A. Zakrevsky p 50.05) and a hearing disorder at (67.9%) of children that is
confirmed by the negative test of otoacoustic issues in comparison
Department of neonatology, Kharkiv Medical Academy Postgraduate with group 1 (46.8%, p 50.05). At the 1-year-old from 20 to 35% of
Education, Kharkiv, Ukraine children were healthy, about 50% had mild BPD, 15-20% mediate and
5-10% severe BPD. Authentic distinctions of weight BPD at the age of
Introduction: Although improvement in perinatal care over the past 1 year in comparison groups it is not revealed. At the age of 3th years
few decades has increased the survival of very low birth weight in 1 group there are more than children who have recovered (59.5%)
infants, these newborns continue to suffer from significant morbid- in comparison with group 2 (43.5%, p50.05) and with group 3 (25.0%,
ities such as bronchopulmonary dysplasia (BPD). The hemodynami- p 50.01), in group 2 it is revealed more children with severe BPD
cally significant patent ductus arteriosus (PDA) promotes formation it (11.5%) in comparison with group 1 (0%, p 50.05).
(Kaempf et al., 2013). There is insufficiently clear a role hemodyna- Conclusion: Presence of hemodynamically insignificant DPA promotes
mically insignificant (HI) PDA in formation and a current BPD. The aim severier current BPD at a nursing stage in the perinatal centre and at
of this study is to reveal features of current BPD in 1-year-old and 3- 3-years-old age children at whom ductus arteriosus was closed
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 231
independently in the early neonatal period or has been closed by a 95% CI: 1.2-2.1), elective CD (p50.001, OR=2.27, 95% CI: 1.7-3.04) and
surgical way. Do not revealed of authentic distinctions between serum TT4 514.4 mg/ld. (p50.001, OR=1.98, 95% CI: 1.49-2.64).
weight of current BPD from term of surgical closing DPA at average Conclusion: Male gender, elective CD and TT4 514.4 mg/ld. were
term of surgical closing of hemodynamically significant DPA 21.5 ± 1.6 significantly associated with increased risk for TTN. Our results might
days of life. raise questions regarding treatment of severe TTN by thyroid
hormones.
Keywords: Preterm infants, bronchopulmonary dysplasia, patent
ductus arteriosus
170 (CASE REPORT)
Congenital pneumonia
161
D. Iacob1, A. Fratila1, C. Cojocaru2, M. Dima1, N. Ionita2,
Hypothyroxinemia and increased I. Enatescu1, and C. Ilie1
risk for transient tachypnea of 1
University of Pharmacy and Medicine Timisoara, Romania and
newborn 2
County Emergency Hospital Timisoara, Romania

Introduction: Congenital pneumonia appears at birth or in the first

I. Makhoul1, I. Ulanovsky1,T. Smolkin1, S. Almashanu2, three days of life and is called so, because contamination was made
and T. Mashiach3 during the fetal period, before or during labor.
1 Clinical cases and summary results: We present the case of a male
Neonatology Department, Ruth Rappaport Children’s Hospital, newborn coming from GIII PII, 37/38 weeks of gestation, APGAR score
Haifa, Israel, 2National Newborn Screening Program, Public Health 9, good status at birth. After half an hour from birth, he shows
Services, Ministry of Health, Tel Hashomer, Israel, and 3Department of shortness of breath and grunting sounds while breathing, sharp
Epidemiology, Rambam Health Care Campus, Haifa, Israel pulling in of the chest below and between the ribs with each breath,
shallow breathing, rapid breathing (FR=80 resp/min), tachycardia
Introduction: Transient tachypnea of newborn (TTN) might require (FC=170b/min). The RDS is getting worse, and the newborn needs
mechanical ventilation. TTN is caused by retained fetal alveolar lung mechanical ventilation in IPPV mode for 24 h and SIMV mode for
fluid (FALF) which impairs gas exchange. Low umbilical blood FT3 and another 24 h. After 48 hours the newborn is extubated and continue
thyroxine deficiency after birth delay FALF clearance via reduction of the oxygen therapy for 72 hours. The chest x-ray shows opacity to
stimulation of both beta-adrenergic receptors and Na-K-ATPase the superior left lobe and to the median right lobe. Laboratory tests:
activity in epithelial lung cells. We hypothesized that low serum TT4 HLG(28.06) WBC=19.100/uL, RBC=5.270.000/uL, Hb=19.5g/dl,
level after birth is associated with greater risk for TTN. Ht=55.2%, Tr=172.000/uL, HLG(29.06) WBC=13.300/uL,
Materials and methods: This retrospective study was performed in the RBC=5.070.000/uL, Hb=18.6g/dl, Ht=54.9%, Tr=199.000/uL. The
nursery (1.1.2010-31.07.2015) at Ram bam Health Care Campus in blood culture, the vernix culture and the culture from the umbilical
Haifa. We included all 26549 term neonates except for two neonates catheter were negative. Mother cervical culture was positive, with
with hyperthyroidism. Blood for Neonatal Metabolic Screening was E.Coli. Under treatment, the evolution was favorable. He was released
collected at 40-48 hours of age and TT4 was routinely measured for all after 14 days.
term infants while TSH was measured for all premature infants. In case Conclusion: Newborn congenital pneumonia is a serious disease, that
of abnormal TT4, TSH was also measured and vice versa. could have unfavorably evolution and in most of the cases the germ
Clinical cases and summary results: Univariate analysis showed a involved can not be identify. The most newborn need mechanical
significantly greater risk for TTN with TT4514.4mg/ld., male gender, ventilation.
vacuum extraction delivery, Caesarean delivery (CD), maternal IDM,
and GDM. Nonetheless, emergency CD and epidural anesthesia were Keywords: Newborn, congenital pneumonia, mechanical ventilation
significantly associated with a lower TTN rate. Multivariate logistic
regression analysis showed significantly independent association
between higher risk for TTN and male gender (p50.001, OR=1.59,
232 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

189 NEONATAL LUNG - 204

Inhibition of RSV- and corticos- Pneumothorax in neonate
teroid-induced ctgf expression in K. Ben Ameur, O. Maatouk, H. Ben hamida, A. Ben Salem,
H441 lung epithelial cells by M. Bizid, FZ. Chioukh, and K. Monastiri
caffeine Department of Neonatal Intensive Care, *Department of radiology,
Teaching Hospital of Monastir, Faculty of Medicine of Monastir,
M. Fehrholz1, C. Krempl2, B. Ottensmeier1, Tunisia
S. Seidenspinner1, K. Glaser1, T. Kreuzahler2, C. P. Speer1,
Introduction: Pneumothorax is more frequent in the neonatal period
and S. Kunzmann1
than any other time in life. It occurs in 1-2% of full term newborn and
1 6% in premature infants. The aim of our study was to assess the
University Children’s Hospital, University of Wuerzburg, Wuerzburg,
Germany and 2Institute of Virology and Immunobiology, University of clinical presentation, therapeutic modalities and the early outcome of
Wuerzburg, Wuerzburg, Germany our patients with neonatal pneumothorax.
Materials and methods: We underwent a retrospective and descriptive
study in ICU and Neonatal Medicine of Monastir for a period of six
Introduction: Respiratory syncytial virus (RSV) is the leading cause of years (from 1 January 2010 to 31 December 2015).
severe lower respiratory tract infection during the first two years of Clinical cases and summary results: 67 newborns were included. The
life, especially in preterm neonates with bronchopulmonary dysplasia sex ratio was 2.7. The patients were in born in 73.1%. The average
(BPD). In addition, RSV acts as a trigger for elevated pulmonary gestational age was 35 WG [26- 42]. Patients were delivered by
morbidity (wheezing, bronchial asthma) in later infancy. Underlying caesarean section in 39 cases. The average age of newborn when
pathomechanisms are largely unknown so far. Methylxanthines such pneumothorax was diagnosed was 27 hours [1-240].The respiratory
as caffeine have been ascribed positive effects on airway inflamma- pathologies associated were: hyaline membrane disease in 31.3%,
tion as well as remodeling. The aim of the current in vitro study was infectious pneumonitis in 26.9%, transient tachypnea in 9% and
to define the impact of RSV on regulation of connective tissue growth inhaling meconium in 7.5%. Silverman average score was 3.11 [0-5].
factor (CTGF) in lung epithelial cells which plays a key role in airway When the pneumothorax was noted: the average of oxygen
remodeling. Furthermore, the impact of corticosteroids and caffeine saturation was 80.3% [40-100], pH rate was 7.26 [6.75 to 7.46].
on expression of CTGF was characterized. Diagnostic were confirmed by chest  ray in 100% of cases.
Materials and methods: The human airway epithelial cell line H441 was Pneumothorax was bilateral in 17.8% of cases right side in 56.7%
infected with recombinant RSV and subsequently treated with and left side in 25.4% of cases. Pneumothorax was partial in 15 cases,
different corticosteroids and caffeine. CTGF, TGF-b1-3 and TNF-a total in 52 cases. Pneumothorax was secondary to respiratory disease
mRNA expression were determined by quantitative real-time PCR. in 25 cases. Spontaneous pneumothorax was recorded in 15 cases.
Clinical cases and summary results: Infection with RSV significantly The initial treatment was exsufflation and assisted ventilation in 53.
induced CTGF mRNA levels in H441 cells (10.4 ± 1.8-fold, p50.0051), 7% of cases, controlled hyperoxia in 28.4%, exsufflation in 10.4% of
while no effect was observed on expression of TGF-b1-3. Surprisingly, cases and switching the ventilation mode in 7. 5% of cases. We had
the additional treatment with dexamethasone (DXM) led to further 5 cases of recurrence after an average of 5.4 days [1-11] and 4 cases
amplification of CTGF (2.5 ± 0.4-fold, p50.0004) indicating additive of immediate therapeutic failure. The main complications related
effects. Caffeine was able to significantly antagonize dexamethasone- to pneumothorax, were: 22 hemodynamic disorders, 15 nosocomial
and RSV-mediated induction of CTGF (p50.0001). The increased infection and 10 pulmonary arterial hypertension. The average
expression of TNF-a (53.9 ± 14.5-fold, p50.0001), which has been duration of stay in ICU was 7 days [1-32] and the hospital stay
described as potent inhibitor of CTGF expression, might provide a average was 10.8 days [1-44].
potential explanation for the observed caffeine-mediated inhibition. Conclusion: The neonatal pneumothorax is a frequent pathology
In accordance with DXM, also other corticosteroids like betametha- in neonatal ICU whose prognosis depends on its importance, its
sone, prednisolone, budesonide, and hydrocortisone were able to etiology and the initial therapeutic cares.
induce CTGF expression in lung epithelial cells. Again, caffeine was
able to antagonize these corticosteroid-mediated induction.
Conclusion: This in vitro study describes an upregulation of CTGF Keywords: Neonate, pneumothorax, respiratory distress
expression in H441 lung epithelial cells by infection with RSV and by
corticosteroids. In addition, caffeine was able to abrogate these
negative effects of corticosteroids and RSV. Should this effect of RSV
infection, steroid and caffeine on CTGF expression be also seen in
vivo, caffeine might help to restore normal lung physiology during
infection with RSV and may serve as an additional medication to 297
steroids. Respiratory distress in the new-
Keywords: RSV, caffein, CTGF, steroide born: review of cases admitted to
our hospital in 2014 and 2015
L. Zamorano Bonilla, A. Campos Martı́nez, A. Montoro
Sánchez, R. Pérez Iáñez, P. Cid Galache, and
J. Casas Gómez
Paediatric Dept. Motril,s Hospital, Granada, Spain

Introduction: Respiratory disease is one of the most frequent causes of

death in the neonatal period, affecting about 3% of newborns, and
up to 20% in 52.5 kg, due to both the anatomical development,
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 233
sometimes scarce in premature, and to changes in the lungs at the and broad-spectrum antibiotics and antifungals for refractory increase
time of birth. Thanks to the diagnostic and therapeutic advances, in inflammatory markers with however negative cultures.
mortality from this disease has decreased, but we are still very Echocardiography was normal. Patient was extubated/reintubated
interested on the issue. three times for recurrent desaturations, right upper lobe atelectasis
Materials and methods: We have conducted a review of cases and increase in the size of the infiltrates on CXR. She required PRBCs
admitted to present respiratory distress requiring hospitalization in transfusions for recurrent episodes of anemia. TORCH and RSV PCR
our neonatal unit level II-B, during the years 2014 and 2015, analyzing were negative. Dexamethasone was given for one week. Sputum
the following parameters: sex, gestational age (distinguishing culture then grew pseudomonas and enterobacter sensitive to the
between weeks gestational age 32-36 + 6 and 4¼ 37), infectious prescribed antibiotics. She developed fever after 2 weeks of
risk factor, type of delivery, Apgar score, elapsed until the time starts antibiotics. Bronchoscopy and consequent bronchoalveolar lavage
breathing difficulty, score Silverman, need for oxygen therapy, for acid-fast bacilli stain technically could not be done because of her
duration of oxygen therapy, performance or non performance of VLBW. CSF studies were negative. Chest CT scan showed no lung
chest radiography, channeling or venous access and antibiotic tissues with diffuse consolidation. HIV, CMV, EBV, Hepatitis B and C
therapy, part-time income, causing pathologies of distress, devices were all negative. On day 74 of life, the patient died because of severe
used (nasal prongs, nasal prongs high flow (HFNC), nasal CPAP or desaturation and bradycardia, unresponsive to CPR. Patient’s mother
mechanical ventilation) and mortality. Data were analyzed using SPSS and twin brother were both positive for TB.
19.0 statistical program. Conclusion: Congenital tuberculosis is a very rare condition and only
Clinical cases and summary results: 31 newborns were admitted by few cases have been reported in literature. Appropriate history taking
respiratory distress in the first 24 hours in 2014 and 2015.74.2% men. from the mother should be undertaken to increase the chance of
Premature between 32-36 + 6weeks gestation accounted for 45.2%, detecting congenital tuberculosis and any complaint during preg-
and 54.8% term. 42% of children had infectious risk factor. The nancy should be taken into consideration. This will improve the
delivery was eutocic in 51,6%, 35,5% by caesarean section. They outcome of the infected patients and help decrease the mortality
presented test Apgar47: 74.1%, 56: 25.9%. 90.3% of patients began especially in the endemic area because if left untreated, congenital TB
respiratory distress in the first hour of life. Silverman score was 7 is usually fatal.
in 13%.74.2% required oxygen therapy, spontaneus solution in the
rest. The average duration of the oxygen therapy was 24.9 hours. 58% Keywords: IVF, prematurity, RDS, tuberculosis
received antibiotic therapy. 61.3% of children underwent chest
radiography. The average admission time was 9 days (fashion 4
days). Among the factors causing distress,the most frequent was
transient taqchypnea (71.1%), followed by hyaline membrane disease 410
(12.9%). 87.1% of them used nasal prongs or HFNC, nCPAP 9.7%, and
intubation 3,2%. Only one patient was transferred to a level III NICU, Treatment of persistent pulmon-
he was the only one deceased.
Conclusion: Most of the patients admitted who presented respiratory ary hypertension of the newborn
distress in the first 24 hours of life were males (term). The main
cause of distress was the transient tachypnea of the newborn. Most
with INO - our experience
required oxygen therapy in the form of nasal prongs or HFNC, but
the distress was resolved in the majority of patients in the first P. Radulova1, L. Vakrilova1, B. Slancheva1, R. Marinov2,
25 hours of life. The average stay was extensive, probably because T. Pramatrova1, N. Yarukova1, St. Hitrova1, G. Petrova1,
patients with longer hospital stays have increased the average. Z. Emilova1, A. Popivanova1, and N. Jekova1
Mortality was very low.
1
Medical University of Sofia, Faculty of Medicine, University
Obstetrics and Gynecology Hospital ‘‘Maichin dom’’, Sofia, Bulgaria
and 2National Cardiology Hospital, Sofia, Bulgaria
364
Very low birth weight twins Introduction: Persistent pulmonary hypertension of the newborn
(PPHN) is a life threatening condition as a result of high pulmonary
product of repetitive ivf with vascular resistance and persistent right to left shunts across Foramen
ovale and Ductus arteriosus. The treatment of PPHN is complex and
unusual presentation of RDS often ineffective. Inhaled nitric oxide (iNO) as a selective pulmonary
vasodilator has been used since 1992 and since 1999 is the drug of
J. Boueri, J. Horkos, D. Hamod, and Y. Nassif choice for treatment of PPHN.
Materials and methods: INO for treatment of newborn infants is
Paediatric Department, Saint Georges University Medical Center, available in our hospital and for the first time in our country since 2015.
University of Balamand, Beirut, Lebanon We present the first six infants with PPHN treated with iNO, based on an
established protocol. The protocol enables the standardization of this
Introduction: Respiratory distress is a common neonatal presentation new for our country therapy. The effectiveness of the treatment is
and accounts for the most neonatal admissions. Perinatal tuberculosis based on the reduction of the OI (= MAP x FiO2 / PaO2).
(TB) is an extremely rare presentation of respiratory distress in Clinical cases and summary results: All patients had severe underlying
newborn and its diagnosis is challenging, as clinical signs are disease - asphyxia, congenital infection, pulmonary hemorrhage. In
nonspecific and maternal history, remains an important tool for the the first hours or days of life a critical deterioration with severe
suspicion of congenital TB. cyanosis and cardio-circulatory failure occurred. Cyanotic congenital
Materials and methods: Postmortem autopsy showed Mycobacterium heart disease was excluded by echocardiography, PPHN with supra
tuberculosis, morphologically compatible with military tuberculosis. systematic blood pressure in the pulmonary artery with right to left
Clinical cases and summary results: 27 weeker female was born by shunts through Ductus arteriosus and/or Foramen ovale was
repeat cesarean section for premature contraction and vaginal diagnosed. After starting the iNO therapy rapid effects in all babies
bleeding, with a very low birth weight, member of twins and product were established - the hemodynamic was stabilized, the OI under-
of repetitive IVF. The mother was known to have pelvic inflammatory went a fast reduction (fig. 1). All infants survived without side effects
disease treated as for C. trachomatis. Patient was asymptomatic until and with a good neurological outcome.
day 12 of life when she developed respiratory distress with bilateral Conclusion: The iNO for treatment of PPHN that was applied for the first
infiltrates on chest X-ray, managed by assisted mechanical ventilation, time in our country in the last year has demonstrated its efficiency and
234 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

safety. We recommend its use according the standardized guidelines 575

and after establishing the diagnosis PPHN by echocardiography.
Neonatal chylothorax in a level III
Keywords: PPHN, iNO
neonatal intensive care unit
J. Fonseca, and M. Gonçalves
Paediatric Department of Centro Hospitalar Vila Nova de Gaia/
Espinho, Vila Nova de Gaia, Portugal

Presenter: Jacinta Fonseca

Introduction: Neonatal chylothorax results from the accumulation of
chyle in the pleural space and may be either a congenital or an
acquired condition in most cases following intrathoracic surgery.
Diagnosis is confirmed when analysis of pleural fluid shows
triglyceride levels 4110 mg/dL and an absolute white cell count
41000 cells/mL with a lymphocyte fraction 480%.
Management, is independent of the etiology. It initially consists of
chyle drainage and dietary modifications (total parental nutrition or
enteral diet containing medium chain triglycerides). Octreotide may
be useful in refractory chylothorax not responding to conservative
management.The aim of this study is to determine the etiology,
clinical course and response to treatment of neonatal chylothorax in a
508 (CASE REPORT) tertiary neonatal intensive care unit.
Materials and methods: We performed a retrospective observational
Case study of a child with con- study of all newborns with the discharge diagnosis of chylothorax
between 2000 and 2015 in our neonatal intensive care unit.
genital diaphragmatic hernia, All data were obtained from the hospital computer database and
medical records.
fetal tracheal endoscopic catheter Demographic data and information regarding pregnancy and delivery
occlusion with balon-catheter were recorded. Pleural effusion characteristics were also collected:
congenital or acquired, laterality, clinical presentation, prenatal
diagnosis, gestational age at diagnosis, duration of the effusion and
R. Maslarska, M. Kalaydjieva, V. Konstantinova, S. Deneva biochemical, cytological and bacteriological analysis of the fluid. In
S. Kontilska, E. Igova, V. Alexandrova, A. Mindova, V. addition, data regarding treatment and neonatal morbidity and
Dukoska, P. Chaveeva, and V. Stratieva Ts. Georgiev mortality were collected. The impact of etiology on outcome and
response to treatment was investigated.
Neonatology Department, Tokuda Hospital Sofia, Bulgaria, Medical Clinical cases and summary results: Seven cases of chylothorax were
complex ‘‘Dr. Shterev’’, Sofia, Bulgaria, and Infant Surgery reported: 4 congenital and 3 traumatic following intrathoracic
Department, Pirogov‘‘ Hospital, Sofia, Bulgaria surgery.
Of the 4 cases of congenital chylothorax (CC), 3 were diagnosed
prenatally and started management during the antenatal period. One
Presenter: S. Deneva
case of CC was idiopathic and the others were associated with
Introduction: Congenital diaphragmatic hernia remains one of the hydrops fetalis (n=1), Noonan Syndrome (n=1) and Trisomy 21 (n=1).
leading causes of high mortality due to pulmonary hypoplasia and Traumatic chylothorax occurred after surgical repair of congenital
pulmonary hypertension. Over the past 20 years, efforts have been diaphragmatic hernia (n=2) and esophageal atresia (n=1). Pleural
directed to introduce intrauterine fetal surgery to improve perinatal effusion appeared between the 4th and 10th postoperative day.
lung maturation in severe cases of congenital diaphragmatic hernia. Treatment consisted of pleural taps when respiratory function was
Clinical cases and summary results: A case study of full-term boy born compromised, total parental nutrition (TPN), and respiratory support
in 37 g.week and three days with weight 3160 g., height - 49 cm from as required.
a second pregnancy with severe isolated congenital diaphragmatic Four cases who did not respond to TPN were successfully treated
hernia in 19 g. week and conducted intrauterine fetal endoscopic with continuous infusion of octreotide. The dose ranged between 4 to
tracheal occlusion with flexible balloon catheter in 28 g. week with 12 mg/kg/h and no side-effects were observed during octreotide
subsequent endoscopic removal of the balloon in 34 g.week. administration.
Performed resuscitation and intensive care after the delivery, neonatal Resolution time of chylothorax ranged between 15 and 86 days.
surgery at the 24 hour for recovery of the defect. After surgery and Two newborns died.
early neonatal period the child is with clinical evidence for GERD with Conclusion: Clinical outcome of chylothorax is generaly good but
esophagitis. Conducted treatment with prokinetik and positional etiology seems to be decisive in the evolution, with more prolonged
posture. course and associated morbility in congenital cases. Octreotide seems
Conclusion: The application of fetal endoscopic tracheal occlusion to be an important adjuvant treatment among the conservative
(FETO) is successfully conducted for the first time in Bulgaria in two strategies and appear to have a good safety profile in newborn. More
stages with the participation of a multidisciplinary team of specialists. studies are still necessary to investigate all aspects of octreotide
The outcome is a newborn without pulmonary hypoplasia, dis- treatment to determine the amount of its dose, initiation time and
charged for home care and raising three weeks after surgery. treatment duration.
Keywords: Neonatal, Chylothorax, Congenital, Octreotide
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 235
Clinical cases and summary results: Of 62 babies; 39 (61%) male, 33
587 (53.2%) antenatally diagnosed, 37 (60%) inborn with mean birth-
Bronchopulmonary dysphasia in weight 2950g (864-4000g). 50 (81%) had left sided CDH and 1
eventration; 6 (9.6%) were syndromic (Pierre Robin Sequence, Patau
extremely low birth weight Trisomy 13 syndrome, Trisomy 5p, unbalanced translocation 5/9).
Mortality was 83.3% in ‘syndromic’ versus 7 (12.5%) in ‘non-
infants syndromic’ babies. Median hospital stay was 12.5 days (2 - 246
days); 23 (41%) were discharged home but the majority needed
ongoing post-neonatal care.
R. Gueorguieva, D. Vlahova, V. Tomova, and Z. Malinova Conclusion: Survival with CDH has improved for ‘non-syndromic’
Neonatal Intensive Care Unit,University Paediatric Hospital, Sofia, babies but they have significant ongoing post-discharge morbidity.
Nearly all ’syndromic’ CDH babies died. Associated life-limiting
Bulgaria
syndromes should be actively sought, preferably antenatally, to
inform prenatal prognostic counselling within surgical referral
Presenter: R. Gueorguieva networks.
Introduction: Aim: To define the incidence and severity of broncho- Keywords: Prognosis, Congenital diaphragmatic hernia, associated
pulmonary dysphasia in the cohort of extremely low birth weight syndromes, antenatal counselling
infants, treated in the NICU, University Pediatric Hospital, Sofia for a
period of two years and to analyse some risk factors,possibly
contributing to the severity of the disease
Materials and methods: 52 premature infants with mean gestational 657
age 26,7 weeks and mean birth weight 817,69 +- 114,51 g. All infants
were treated with surfactant,mechanical ventilation and non invasive The effect of umbilical cord milk-
respiratory support. The diagnosis of bronchopulmonary dysplasia
was defined according to the criteria of Jobe and Bancalari based on ing and different umbilical cord
oxygen and/or respiratory support requirements after 28 postnatal
days. The following risk factors were analysed: absence of steroid
clamping techniques on early
prophylaxis,maternal-fetal infection and hemodynamically significant
persistent ductus arteriosus.
postnatal oxygenation of term
Clinical cases and summary results: 19% of the infants showed no infants: randomized control trial
evidence of chronic lung disease, 39% were with mild bronchopul-
monary dysplasia, 23% with moderate disease and 19% with severe
bronchopulmonary dysplasia. There was a significant correlation A. Memisoglu1, Kamil Sharifov2, Akan Yaman1, Sibel
between the severity of BPD and the presence of maternal-fetal Kalaca3, Hulya Selva Bilgen1, and Eren Ozek1
infection, hemodynamically significant persistent ductus arteriosus and 1
Department of paediatrics, division of neonatology, marmara
the absence of steroid prophylaxis. 11,54 of the patients died in the first
two years of age, all of them with severe bronchopulmonary dysplasia. university school of medicine, Istanbul, Turkey, 2Department of
Conclusion: 81% of the extremely low birth weight infants develop paediatrics, marmara university school of medicine, Istanbul, Turkey,
bronchopulmonary dysplasia, 19% were with severe form of the and 3Department of public health, marmara university school of
disease. Steroid prophylaxis, early screening for maternal-fetal medicine, Istanbul, Turkey
infection, persistent ductus arteriosus and proper treatment could
improve the respiratory outcome. Presenter: ASLI MEMISOGLU
Keywords: Bronchopulmonary dysplasia, low birth weight infants Introduction: Delayed cord clamping and umbilical cord milking have
shown to benefit neonates with leading to higher haemoglobin
concentrations, additional iron stores and less anaemia later in
infancy, higher red blood cell flow to vital organs and better
648 cardiopulmonary adaptation. This is the first study in which the
Outcomes at discharge of infants different umbilical cord clamping modalities have been compared on
the basis of early postnatal oxygenation and hemodynamic adapta-
born with congenital diaphrag- tion immediately after birth. The objective of this study was to
investigate the effect of umbilical cord milking, early or delayed
matic hernia over 8 years umbilical cord clamping on postnatal oxygen saturation in the first
minutes of life among term neonates and to compare with Dawson’s
reference curve.
E. Ogundipe1, A. Tang2, H. Gbinigie3, and S-L. Chuang1 Materials and methods: This was a prospective interventional trial.
1
Neonatal Unit, Imperial College London, Chelsea and Westminster According to randomization, neonates got either early cord
Hospital, London, UK, 2Undergraduate Department of Medicine, clamping(within 30 seconds) or late cord clamping(at 60 second) or
Imperial College London, UK, and 3Chelsea & Westminster Hospital, umbilical cord milking. All groups got similar routine care. If a
member of the research team was available to record preductal
London, UK
oxygen saturation(SpO2), heart rate(HR) and perfusion index(PI)
immediately after birth, infants of 437 weeks gestation who were
Presenter: Alice Tang spontaneously breathing and vigorous during postnatal stabilization
Introduction: Congenital diaphragmatic hernia (CDH) is a devastating were enrolled and their data were recorded with a data acquisition
congenital condition of the lung and factors affecting survival are system. SpO2, HR and PI were measured with a sensor applied to the
reviewed. right hand or wrist as soon as possible after birth; data were collected
Materials and methods: Clinical and demographic data were collated during 10 minutes.
retrospectively on all babies with a diagnosis of CDH admitted to our Clinical cases and summary results: The total 240 women were
neonatal unit, a designated perinatal unit for neonatal surgery from enrolled and randomized in three intervention groups. Finally, there
1st January 2006 to 31st December 2014 using clinical notes and were 63, 61 and 64 neonates who completed the study in the early
Standard Electronic National Database. cord clamping group (ECC), delayed cord clamping group (DCC) and
umbilical cord milking group (UCM), respectively. The baseline
236 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

characteristics of groups were comparable. The mean SpO2, HR and PI

values at 1, 3, 5 and 10 minutes were not statistically different
378
between the three groups (p40.05 for each comparison). Effects of pressure support plus
Conclusion: Milking the umbilical cord and late cord clamping are easy
interventions with the potential to prevent late anemia in term volume guarantee ventilation
babies. Our study demonstrated that different cord clamping
practices did not affect the SpO2, HR and PI values of neonates in versus synchronized intermittent
the first postnatal 10 minutes. Hence, we concluded that AAP’s
recommendations of SpO2 targets for delivery room resuscitation can
mandatory ventilation in
be used regardless of the umbilical cord clamping practices. extremely low birth weight
Keywords: Late cord clamping, neonate, cord milking, oxygen
saturation target, perfusion index
infants with respiratory distress
syndrome: a prospective,
768 (CASE REPORT)
randomized study
Congenital alveolar-capillary dys- X. Miracle, M. D. Salvia, J. Figueras, J. M. Rodrı́guez, and
plasia. An infrequent cause of X. Carbonell

irreversible pulmonary Newborn and Neonatal Care Department, Hospital Clı́nic de

Barcelona, Barcelona, Spain
hypertension
Introduction: Regardless the development of many new ventilation
modalities and its spread use, limited clinical data is available. Since
J.M. Osorio Cámara, R. Martı́n Masot, F.J. Pacheco the last Cochrane review in 2010 comparing volume targeted
Sánchez-Lafuente, and C. Roca Ruı́z ventilation (VTV) with pressure limited ventilation (PLV) modalities,
only 3 new articles have been published. SIMV is the most widely
Hospital materno infantil virgen de las nieves. Granada. España
used modality of PLV: We set the PIP and we obtain variable VT with
the risk of overdistending the lung. With PSV+VG only the VT is
Introduction: Interstitial lung diseases include a heterogeneous group chosen and the onset, rate, PIP and IT are dependent on the infant. In
of conditions that impair the development of alveoli and pulmonary this study, we aimed to compare safety and short-term outcomes of
vasculature, including the alveolar-capillary dysplasia (ACD). PSV+VG versus SIMV in the first 48h after surfactant admin. We
Congenital ACD is a rare condition whose etiology is unclear. It hypothesized that PSV+VG would detect and adapt ventilation better
involves persistent neonatal pulmonary hypertension (PNPHT) with to the faster changes in lung compliance and airway resistance given
right-left shunt and severe hipoxemia. Symptoms usually appear at this period.
within the first hours or days of life leading to a fatal and irreversible Materials and methods: Randomized controlled prospective study.
situation and, finally, death. 10% of cases are heritable in an Setting: Tertiary care neonatal unit. Patients: A total of 76 ELBW
autosomal dominant or recessive pattern. Most of them are ‘‘de infants between 25-32 weeks gestation and over 500g receiving
novo’’. Recently, alterations in the transcription of gene factor FOXF1 mechanical ventilation and surfactant because of RDS were studied.
has been identified in 40% of cases. A total of 35 babies were randomized to SIMV (1037+/277g, 28,0+/
Clinical cases and summary results: Newborn of 3210 grams of weight 1,69 weeks) and 41 babies to PSV+VG (1172+/392g, 28,7+/-2,37
and 40 weeks gestational age with Apgar 7-9, who required weeks), 30 minutes after administration of surfactant. We used
resuscitation at birth (type III). Prenatal diagnosis of left hydrone- Babylog 8000 Plus. Patients remained in the assigned modality until
phrosis. No infectious risk factors were described. After 24 hours of life extubation or changed to HFOV when conventional ventilation
generalized cyanosis and signs of respiratory distress appeared. failed. Study was based on the initial 48 h. We selected 64 variables
Respiratory distress rapidly increased with severe hypoxemia, and for each patient. PIP, MAP, VTe/Kg, MV/Kg, FiO2 and RRm were
mechanical ventilation was started in the second day of life. Chest x- recorded at one-minute intervals. Results were shown at 12 hours
ray was normal. No response was obtained with several pulmonary intervals.
specific vasodilator treatment. The patient showed hemodynamic Clinical cases and summary results:
instability with associated hypotension, needing vasoactive drugs.  There was homogeneity between the study (PSV+VG) and the
The physical examination revealed a nonspecific systolic murmur. control group (SIMV). No significant differences between the 18
Echocardiography showed structurally normal heart with pulmonary variables analysed were found.
hypertension. Right ventricle overload worsened progressively.  The modality PSV+VG was considered safe. There were no
Patient died on the sixth day of life. Postmortem lung biopsy significant differences between the 14 variables defining morbidity
showed images compatible with alveolar-capillary dysplasia. and mortality.
Conclusion: PNPHT may be due to a variety of diseases. It may also be  Infants on PSV+VG required significant lower MAP within the first
considered idiopathic, and if it shows poor response to conventional 12 hours after surfactant administration.
therapy ACD must be suspected. This condition is probably under-  We found significantly less hypocapnic episodes (530 mmHg) in
estimated. It is extremely important to make an early diagnosis by patients on PSV+VG.
performing open lung biopsy in order to avoid false expectations of  Patients on PSV+VG modality required fewer days on CPAP.
life and reduce unnecessary treatments. The genetic study probably Conclusion:
will not need to be performed routinely because alterations in FOXF1  PSV+VG has proved to be safe, with similar morbi-mortality rates
are usually ‘‘de novo’’. than SIMV. It doesn’t increase episodes of hyperventilation or
atelectasis.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 237

 Patients on PSV+VG required lower MAPs during the first Introduction: Hyperoxemia and hypoxemia may contribute to
12 hours, contributing to reduce mechanical ventilation lung injury. morbidity and mortality of preterm infants, e.g. by compromised
 PSV+VG reduced hypocapnic episodes and this could be neurodevelopmental outcome. Hypoxemia has been shown to
neurologically beneficial. influence cerebral oxygenation. Automated closed-loop control of
 Infants on PSV+VG showed a trend in reducing days on oxygen, the fraction of inspired oxygen (FiO2) helps to keep preterm infants
ventilation, days in NICU, and presented a significant reduction on receiving ventilation within predefined limits of arterial oxygen
days on CPAP. saturation (SpO2) during neonatal intensive care, but might already
be beneficial in the delivery room. We hypothesized that automated
FiO2 control in the delivery room could stabilize cerebral regional
Keywords: Mechanical ventilation, neonatal ventilation, pressure
tissue oxygenation (crSO2) in a preterm lamb model of preterm
support ventilation, volume guarantee ventilation, synchronized
respiratory distress.
intermittent mandatory ventilation, extremely low birth weight
Materials and methods: In a comparison trial of 22 preterm lambs
infants, premature infant, respiratory distress syndrome, prospec-
receiving automated or manual FiO2 control directly after operative
tive study
delivery, 12 animals received additional crSO2 measurement by near-
infrared spectroscopy (NIRS, InvosTM, Covidien). All animals received
standardized resuscitation including endotracheal intubation and
surfactant replacement therapy depending on FiO2, followed by
volume-guaranteed ventilation for 3 hours. SpO2 was measured by
pulse oximetry, and FiO2 was adjusted to keep SpO2 within a target
314 range defined by the Dawson curve in the first ten minutes and 90-
Arterial oxygen saturation (SpO2) 95% from the 11th minute of life (Figure 1).
Clinical cases and summary results: During resuscitation, we observed
and cerebral regional tissue a time delay between increase of crSO2 and increase of SpO2,
however the difference between automated and manual control was
oxygenation (crSO2) during not significant (figure 1). before and after surfactant therapy, we
observed stable SpO2 and stable crSO2 while FiO2 was automatically
automated control of inspired decreased. during subsequent ventilation, animals receiving auto-
mated fio2 control spent 94.4% [IQR 85.8-97.6%] of the time within
oxygen in a model of delivery the SpO2 target range, which was not significantly more than animals
room management in preterm in the manual group (84.4% [75.9-90.4%], p=0.082). in contrast, crSO2
showed a high variability from a ± 5% range above and below
lambs average crSO2 in both groups (time outside range 13.9% [9.1-37.3%]
versus 9.6% [1.7-34.0%], n.s.).
Conclusion: Our data suggests that stabilizing SpO2 by automated
M. Hütten1,2, T. Goos3,4, P. Andriessen1,5, D. Ophelders1, FiO2 control might only have minor effects on cerebral oxygenation
J. Dankelman4, T. Mohns5, I. Reiss3, and B. Kramer1 during postnatal adaptation. With automatically stabilized SpO2 and
1 declining FiO2 during surfactant administration, crSO2 is not affected
Department of Pediatrics, Faculty of Health, Medicine and Life by surfactant replacement therapy.
Sciences, School for Oncology and Developmental Biology,
Maastricht University Medical Centre, Maastricht, The Netherlands, Keywords: Delivery room, automated FiO2 control, cerebral regional
2
Department of Pediatrics, Neonatology, University Clinic, Medical tissue oxygenation
Faculty, RWTH, Aachen, Germany, 3Department of Pediatrics,
Division of Neonatology, Erasmus Medical Centre - Sophia Children’s
Hospital, Rotterdam, The Netherlands, 4Department of
Biomechanical Engineering, Delft University of Technology, Delft, The
Netherlands, and 5Department of Pediatrics, Máxima Medical Centre,
Veldhoven, The Netherlands
238 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

727

Accidental extubation, extuba-

tion failure and mechanical ven-
tilation in newborns admitted to
brazilian neonatal intensive care
unit
J. M. deA. Bringel1, M. C. S. Costa2, A. S. Araújo3,
C. H. O. Freitas4, C. C. G. Viana5, I. A. Hassmann6,
E. S. Catunda7, M. Coutinho8, and I. N. S. Santos9
Neonatal Unit, Paediatric Dept., Hospital Geral Dr. Waldemar
Alcântara, Fortaleza, Brazil.

Presenter: Iumy Santos

Introduction: Newborns survival has risen after use of pulmonary
surfactant and development of mechanical ventilation (MV) for
treating airway obstruction and respiratory failure. The maintenance
of patients with artificial airway is a safe practice nowadays, but not
without risks, as adverse effects resulting from failures associated with
mechanical ventilation may occur, including accidental extubation
(AE) and extubation failure (EF). Some european studies find AE values
in NICU ranging from 0.72 to 4.8 EA per 100 patient-days ventilated.
AE is a prevenible event that exposes the patient to the risks of a new
intubation (airway and oral cavity trauma), predisposes hypoxemia,
bradycardia and, in some cases, may cause death.
Materials and methods: To establish the association of AE and EF with
the MV time of newborns on NICU in Fortaleza, Brasil, a historical
cohort study of quantitative approach was made with 457 records.
The records of MV weaning protocol of the newborns admitted under
intubation to NICU in the period January 2012 to July 2014 were
445 collected in August 2015. The variables analyzed were duration of
Comparing the effectiveness of mechanical ventilation, monthly number of accidental extubation and
extubation failure. Data were stored and analyzed using the SPSS
two respiratory therapies - version 21.0 program. The numerical results were presented by mean
± standard deviation and percentage for categorical variables. Data
invasive/noninvasive for was performed to Pearson correlation, considered strong correlation
values above 0.7, moderate between 0.3 and 0.7 and weak between 0
premature under 30 weeks and 0.3.
gestational age Clinical cases and summary results: Between 457 patients, the average
time spent in the MV was 93.61 ± 23.33 days. The incidence of
extubation of newborns studied was 86.43% (395) of these 23.79%
Gabriela Olariu, Tunescu Mihaela, and Sebastian Olariu (94) had failed extubation and 14.43% (57) accidental extubation, with
accidental extubation rate average of 1.94 ± 1.88. There was
Municipal Emergency Hospital Timisoara / Maternity Odobescu, moderate and significant correlation between the duration of
Timisoara, Romania mechanical ventilation and cases of accidental extubation (R = 0.45
and p = 0.01) and duration of mechanical ventilation and extubation
Introduction: After 25 years since the introduction handling, admin- failure (R = 0.36 and p = 0.04)
istration of surfactant has become a routine although not currently Conclusion: In the sample studied was found association between
know the exact optimal ventilation therapy for premature babies. We mechanical ventilation with both accidental extubation events and
were seduced by evolving technology and invasive therapeutic extubation failure. Accidental extubation rate was within normal
practices without any evidence values described in the literature.
Materials and methods: The purpose of this study was to compare the
effectiveness of two methods: ( INSURE versus surfactant therapy and Keywords: Mechanical Ventilation, Extubation, Newborn
VM) for premature infants with VG 530 wk who received surfactant
for RDS. Cohort study included 268 newborns with VG under 30
weeks born between 2010 and 2015 in a III level center.
Clinical cases and summary results: 268 newborns with VG under 30
weeks born between 2010 -2015, which received surfactant, divided
into two grupe - INSURE versus mechanically ventilated. CPAP
ventilation should be the first embodiment for VLBW/ELBW -
immediately followed early surfactant therapy.
Conclusion: Minimally invasive therapy administration of surfactant
shows obvious benefits but further studies are needed to implement
an addequately management.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 239
1
NEUROSCIENCE (THE FETAL AND NEONATAL Department of Pediatrics, Maastricht University Medical Center, The
BRAIN) - 018 Netherlands, 2School of Mental Health and Neuroscience, Maastricht
University, The Netherlands, 3Department of Pathology, Antwerp
Estetrol attenuates neonatal University Hospital, Belgium, 4Department of Pathology, Maastricht
hypoxic-ischemic encephalopathy University Medical Center, The Netherlands, 5School of Women’s and
Infants’ Health, The University of Western Australia (M550), Australia,
- preclinical studies 6
Division of Neonatology/Pulmonary Biology, The Perinatal Institute,
Cincinnati Children’s Hospital Medical Center, United States, and
7
E. Tskitishvili1, M. Nisolle2, A. Noel1, and J. M. Foidart1 School of Oncology and Developmental Biology, Maastricht
University, The Netherlands
1
Laboratory of Developmental Biology and Tumor, University of
Liege, Liege, Belgium and 2Department of Obstetrics and Gynecology, Introduction: Intra-amniotic Candida albicans infection is associated
University of Liege, Liege, Belgium with preterm birth and high morbidity and mortality rates. Survivors
are prone to adverse neurodevelopmental outcomes. The mechan-
Introduction: Brain hypoxia and ischemia due to systemic hypoxemia isms leading to these adverse neonatal brain outcomes remain largely
and reduced cerebral blood flow (CBF) are the primary causes of unknown. To better understand the mechanisms underlying Candida
neonatal hypoxic-ischemic encephalopathy (HIE) accompanied by albicans-induced fetal brain injury, we studied immunological
gray and white matter injuries occurring in neonates. Perinatal HIE still responses and structural changes of the fetal brain in a well-
remains a challenge in perinatal medicine. About 20% of affected established translational ovine model of intra-amniotic Candida
newborns die in the postnatal period, and an additional 25% will albicans infection. In addition, we tested whether these potential
sustain childhood disabilities. So far no medical treatment provides adverse outcomes of the fetal brain were improved in utero by
important neuroprotection against HIE. Studies of new neuroprotec- antifungal treatment with Fluconazole.
tive agents in animal models of HIE may have importance for the Materials and methods: Pregnant ewes received an intra-amniotic
development of new compounds and treatment strategies for this injection of 107 colony forming units Candida albicans or saline
pathological condition. (controls) at 3 or 5 days before preterm delivery at 0.8 of gestation
Estetrol (E4) is a recently described estrogen with four hydroxyl- (term150d). Fetal intra-amniotic/intra-peritoneal injections of
groups that is synthesized exclusively during pregnancy by the Fluconazole or saline (controls) were administered 2 days after
human fetal liver. It has important antioxidative activity. Candida albicans exposure. Post mortem analyses for fungal burden,
Materials and methods: To study the neuroprotective and therapeutic peripheral immune activation, neuroinflammation and white matter/
effects of E4 in vivo neonatal HIE model of 7-day-old newborn rat neuronal injury were performed to determine the effects of intra-
pups was used. Rat pups body temperatures were examined along amniotic Candida albicans and Fluconazole treatment.
with their body and brain weights. Brains were studied at the level of Clinical cases and summary results: Intra-amniotic exposure to Candida
the hippocampus and cortex. Intact cell counting and expressions of albicans caused a severe systemic inflammatory response, illustrated
markers for neuronal cell viability (microtubule-associated protein-2 by a robust increase of plasma IL-6 concentrations. Cerebrospinal
(MAP-2)), neurogenesis (doublecortin (DCX)) and angiogenesis fluid cultures were positive for Candida albicans in the majority of the
(vascular-endothelial growth factor (VEGF)) were evaluated by histo- 3-day Candida albicans-exposed animals whereas no positive cultures
and immunohistochemistry. The serum levels of brain damage were present in the 5-day Candida albicans-exposed and Fluconazole
markers (S100B and glial fibrillary acidic protein (GFAP)) were treated animals. Although Candida albicans was not detected in the
measured by ELISA. brain parenchyma, a neuroinflammatory response in the hippocam-
Clinical cases and summary results: Our results demonstrate for the pus and white matter was seen which was characterized by increased
first time that E4 has a significant neuroprotective and therapeutic microglial and astrocyte activation. These neuroinflammatory
effects. It decreases the early gray matter loss and promotes neuro- changes were accompanied by structural white matter injury. Intra-
and angiogenesis in vivo. Estetrol treatment has no effects on body amniotic Fluconazole reduced fetal mortality, but did not attenuate
weight, brain weight or body temperature. neuroinflammation and white matter injury.
Conclusion: Taken together, E4 might become an important safe and Conclusion: Intra-amniotic Candida albicans exposure provoked acute
physiological substance to treat neonatal HIE. systemic and neuroinflammatory responses with concomitant white
matter injury. Fluconazole treatment prevented systemic inflamma-
tion without attenuating cerebral inflammation and injury.
Keywords: Estserol (E4), neonatal hypoxic-ischemic encephalopathy
(hie), neurorpotection, neurogenesis, angiogenesis
Keywords: Chorioamnionitis, Candida albicans, fluconazole, inflam-
mation, white matter injury, fetus, preterm

057
056 Blood hyperlactaemia as a pre-
Neuroinflammation and dictor of morbidity and mortality
structural injury of the fetal ovine in infants with hypoxic ischaemic
brain following intra-amniotic encephalopathy
candida albicans exposure
S. Radford1, D. Henderson1, D. Panjwani2, and
R. Gussenhoven1,2, D. R. M. G. Ophelders1,2, P. Satodia1,2
M. Lammens3, B. Küsters4, M. W. Kemp5, 1
Warwick Medical School, University of Warwick, Coventry, UK and
J. P. Newnham5,M. S. Payne5, S. G. Kallapur6, A. H. Jobe6, 2
NICU, University Hospitals Coventry and Warwickshire NHS Trust,
L. J. Zimmermann1,7, B. W. Kramer1,2,7, and Coventry, UK
T. G. A. M. Wolfs1,7
240 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Introduction: Hypoxic ischaemic encephalopathy (HIE) remains a

significant challenge with high levels of morbidity and mortality. 065
Accurate prognostication remains difficult. Hyperlactaemia may offer
a potential biomarker to predict short and long term mortality and
Miscellaneous examples of intra-
morbidity. The aim of this study is to assess the relationship of blood
hyperlactaemia with short and long term mortality and morbidity in
cranial hemorrhage in newborns
infants with neonatal encephalopathy due to hypoxic ischaemic
injury. V. Vusurovic, M. Raus, and T. Krstajic
Materials and methods: A total of 75 infants diagnosed with HIE were
Neonatology Department, University Childrens Hospital Belgrade,
retrospectively recruited in a tertiary level neonatal unit from
between 2010 and 2015. Medical records were reviewed to collect Belgrade, Serbia
labour, delivery and post-natal data including all blood lactate levels
from birth to 96 hours of age. Initial and peak lactate levels and the Introduction: According to our experience for the period 2011-2015,
time taken for lactate to normalise from birth (TLN) were analysed our 42 patients had various types of hemorrhage: subdural (39%),
with hyperlactaemia being defined as 45mmol/l. Infants were primary subarachnoid (33%), intraventricular (10%), intracerebellar
assessed for, and grouped according to their neurodevelopment (10%), various intraparenchymal (8%). Origins of intraventricular
outcome at follow up and their MRI results. These groups were then hemorrhage was in chorioid plexus (55%), tumor of choroid plexus
assessed in relation to each lactate value (initial, peak and TLN) using (9%), subependymal matrix (27%), intracerebral hemorrhage (9%).
the Kruskal-Wallis test. The Mann-Whitney U test was then used to Usual clinical symptoms were prolonged scream (60%), convulsions
clarify the differences found. A p-value50.05 was taken as statistically (57%), full fontanelle (43%), iritability (30%), hypertonia with
significant. opisthotonus (27%), lack of spontaneous movements (23%), pro-
Clinical cases and summary results: Out of 75 infants, 69 had longed tremor (23%), febrility (17%). Uncommon clinical symptoms
hyperlactaemia. 66 underwent therapeutic hypothermia. 36 (48%) can be opened eye or infrequent blinking (17%), hypotonia (10%),
had no neurological or developmental concerns, 11 (15%) had conjugate bulbus deviation (7%), spontaneous Moro reflex (7%),
abnormal neurological exam or developmental concerns (cerebral eyelid ptosis, facialis paresis (7%), anizsocoria (7%), decorticated
palsy, learning difficulties, speech delay or visual/hearing problems), position (7%). Predisposing factors for intracranial hemorrhage in
12 (16%) died before discharge and 16 (21%) had incomplete newborns (IHN) are pregnancy, delivery, gestational maturity, the
outcome data. Both initial (2 (3) ¼ 20.28, p50.001) and peak lactate occurrence of ‘‘hypoxic’’ event, trauma, the mode of resuscitation,
values (2 (3) ¼ 17.73, p50.001) were significantly elevated in babies neurologically impaired newborn, intracranial hypertension, discrete
who had abnormal neurodevelopment. 31% of infants’ lactate levels neurologic disorders.
failed to normalise until after 12 hours and TLN (2 (3) ¼ 8.569, Materials and methods: Localization of intracranial hemorrhage was
p50.05) was found to be significantly longer in the group with poor diagnosed by neuroradiology methods: ultrasonography, CT scan and
neurodevelopmental outcome (Table 1). Poor MRI outcome was nuclear magnetic resonance. The finding of bloody cerebrospinal fluid
found to correlate with higher initial (2 (5) ¼ 21.404, p50.001) and (CSF) must be differentiated from ‘‘traumatic’’ lumbar puncture. CFS
peak plasma lactate values (2 (5) ¼ 17.941, p50.003). However, the finding that indicate intracranial hemorrhage are xanthochromia, with
TLN (2 (5) ¼ 8.328, p ¼ 0.139) was not significantly different in elevated proteins level, hypoglycorrhachia and elevation of the
relation to MRI outcome (Table 2). number of red blood cells.
Conclusion: Initial hyperlactaemia (over 20mmol/L) and peak lactate Clinical cases and summary results: In our article, we present clinical
level (over 20mmol/L) predict poor neurodevelopmental outcome or and neuroimaging findings of 8 patients with miscellaneous types of
death and correlate with severe injury on MRI scan. Time taken for IHN: neonatal alloimmune thrombocytopenia (1), vitamin K deficiency
lactate to normalise correlated with poor neurodevelopmental (2), congenital protein C deficiency (1), congenital protein S deficiency
outcome. Hyperlactaemia and delayed lactate normalisation are (1), central neuros system tumor (1), venous-venous malformation, (1),
promising predictors of morbidity and mortality in infants with HIE. vein of Galen aneurysmal malformation (1).
Conclusion: It is possible to prevent neonatal alloimmune thrombo-
cythopenia during pregnancy and perinatal period. Vitamin K
deficienency can be prevented with prolonged oral vitanim K.

Keywords: Intracranial hemorrhage of newborn, miscellaneus

examples
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 241
L PLIC MD, L ALIC MD, L lingual gyrus MD, and R precuneus MD,
116
which accounted for 39% of the variance in BSID-III Motor Composite
score (R2=0.50, Adj. R2=0.46, LOOCV R2=0.39). Fine motor function
Prediction of cognitive and motor was predicted by L PLIC MD, R hippocampus MD, R supramarginal
gyrus FA, R PLIC MD, and R superior parietal gyrus MD, which
development in preterm infants accounted for 30% of the variance in BSID-III Fine Motor Subscore
(R2=0.40, Adj. R2=0.35, LOOCV R2=0.30).
using forward feature selection Gross motor function was predicted by L cuneus FA, L supramarginal
and linear regression on near- gyrus FA, R precuneus MD, R cingulum (cingular part) MD, and L
inferior temporal gyrus MD, which accounted for 30% of the variance
term regional white matter in BSID-III Gross Motor Subscore (R2=0.42, Adj. R2=0.38, LOOCV
R2=0.30).
microstructure assessed with dif- Results of an exhaustive search for the optimal set of three regional
DTI metrics that best predicted outcome of cognitive (L PLIC MD, L
fusion tensor imaging ALIC MD, L ACR MD) and motor (R supramarginal gyrus FA, L PLIC MD,
L ALIC MD) composite BSID-III, corroborated results obtained from
K. Schadl1,3, R. Vassar1,3, N. Barnea-Goraly1,3, forward feature selection linear regression with cross-validation.
Conclusion: Results of this exploratory analysis suggest that the
J. S. Tamaresis5, K. Cahill-Rowley1,2, S. R. Hintz4,
selected features of near-term brain WM microstructure explained
D. K. Stevenson4, and J. Rose1,2,3 considerable variance in both cognitive and motor BSID-III scores at
1
Department of Orthopaedic Surgery, Stanford University School of toddler age. Analysis in a larger population of preterm neonates can
determine if linear regression models that include regional WM DTI
Medicine, Stanford, CA2Motion Analysis Lab, Lucile Packard
metrics accurately identify high-risk neonates and inform therapeutic
Children’s Hospital, Stanford, CA3Neonatal Neuroimaging Research
interventions that can improve neurodevelopment and quality of life
Lab, Stanford University School of Medicine, Stanford, CA4Neonatal & for preterm children.
Developmental Medicine, Stanford University School of Medicine,
Stanford CAand 5Department of Biomedical Data Science, Stanford Acknowledgments: This research is supported by the Chiesi
University School of Medicine, Stanford CA Foundation (Parma, Italy), the NIH Clinical and Translational Science
Award UL1 RR025744 for the Stanford Center for Clinical and
Translational Education and Research (Spectrum) and for the
Introduction: Very-low-birth-weight preterm infants are at higher risk Stanford Center for Clinical Informatics and STRIDE (Stanford
for developing cerebral palsy and other neurodevelopmental impair- Translational Research Integrated Database Environment), the Lucile
ments. Early identification of preterm infants at risk for cognitive and Packard Foundation for Children’s Health, and the National Science
motor impairment is essential to guide early intervention at a time of Foundation Graduate Research Fellowship under Grant No. DGE-
optimal neuroplasticity, when treatment can be most effective. This 1147470.
study examined near-term brain white matter (WM) microstructure
assessed on diffusion tensor imaging (DTI) in relation to cognitive and
motor development at 18-22 months in very-low-birth-weight (VLBW) Keywords: Preterm infant, brain white matter, diffusion tensor
preterm children. This prospective, longitudinal study employed imaging, neurodevelopment
linear regression analysis with forward feature selection, constrained
to select no more than five features, and cross-validation to minimize
overfitting, to identify near-term regional WM microstructure metrics
that best predicted cognitive and motor development at 18-22
months. We hypothesized that a small number of optimal predictive
features would explain considerable variance in cognitive and motor 117
neurodevelopment as assessed by the Bayley Scales of Infant-Toddler
Development, 3rd edition (BSID-III) score at toddler age.
Classification of high-risk preterm
Materials and methods: 102 VLBW neonates born preterm
(BW1500g, gestational age (GA)32wks) admitted to the NICU at
infants using forward feature
Lucile Packard Children’s Hospital at Stanford were recruited to selection and logistic regression
participate in a study of MRI and DTI from 2010-2011, 66/102 infants
had DTI and 60 also had follow-up neurodevelopmental evaluation at on near-term regional white
18-22 months adjusted age. DTI metrics of fractional anisotropy (FA)
and mean diffusivity (MD) were used to assess the microstructure of matter microstructure assessed
developing right (R) and left (L) regional WM (DTI Studio and
Diffeomap, John Hopkins University). DTI scalars were adjusted for
with diffusion tensor imaging
postmenstrual age (PMA) at scan. Cognitive and motor development
at 18-22 months adjusted age were assessed with the BSID-III. An J. Rose1,2,3, K. Schadl1,3, R. Vassar1,3, N. Barnea-Goraly1,3,
automated forward feature selection of the available features was J. S. Tamaresis5, K. Cahill-Rowley1,2, S. R. Hintz4, and
performed to obtain the subset of five regional near-term DTI metrics D. K. Stevenson4
that best predicted the cognitive and motor development at toddler
1
age using linear regression with leave-one-out cross-validation Department of Orthopaedic Surgery, Stanford University School of
(LOOCV) and the highest adjusted R2 as the selection criteria. Medicine, Stanford, CA2Motion Analysis Lab, Lucile Packard
Distinct regression models for cognitive and motor development Children’s Hospital, Stanford, CA3Neonatal Neuroimaging Research
were independently fitted using this technique. Results were Lab, Stanford University School of Medicine, Stanford, CA4Neonatal &
obtained with Scikit-learn which is a machine learning toolbox for
Developmental Medicine, Stanford University School of Medicine,
Python.
Stanford CAand 5Department of Biomedical Data Science, Stanford
Clinical cases and summary results: Cognitive function was predicted
by L PLIC MD, L ALIC MD, L ACR MD, L superior occipital gyrus FA, and University School of Medicine, Stanford CA
R fusiform gyrus MD, which accounted for 28% of the variance in
BSID-III Cognitive Composite Score (R2=0.41, Adj. R2=0.36, LOOCV Introduction: Early identification of preterm infants at risk for cognitive
R2=0.28). Motor function was predicted by R supramarginal gyrus FA, and motor impairment is challenging, yet essential to guide early
242 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

intervention at a time of optimal neuroplasticity. Advances in participate in a study of MRI and DTI from 2010-2011, 66/102 infants
computational methods may offer an opportunity to identify more had DTI and 60 also had follow-up neurodevelopmental evaluation at
accurate prognostic factors compared to standard techniques. This 18-22 months adjusted age. DTI metrics of fractional anisotropy (FA)
study examined near-term brain white matter (WM) microstructure and mean diffusivity (MD) were used to assess the microstructure of
assessed on diffusion tensor imaging (DTI) in relation to cognitive and developing right (R) and left (L) regional WM (DTI Studio and
motor development at 18-22 months in very-low-birth-weight (VLBW) Diffeomap, JHU). DTI scalars were adjusted for postmenstrual age
preterm children. This prospective, longitudinal study used logistic (PMA) at scan. Cognitive and motor development at 18-22 months
regression analysis with automated feature selection based on adjusted age were assessed with the Bayley Scales of Infant-Toddler
exhaustive search constrained to three features, and cross-validation Development, 3rd edition (BSID-III). Children who scored below one
to minimize overfitting to identify near-term regional WM micro- standard deviation of the mean were considered to be high-risk for
structure metrics that best predicted cognitive and motor develop- cognitive and motor delay. An automated exhaustive search of the
ment at 18-22 months. We hypothesized that a small number of available features was performed to obtain the subset of three
optimal predictive features would identify preterm infants at highest regional near-term DTI metrics that best classified high-risk children
risk for cognitive and motor delay at toddler age. using logistic regression with leave-one-out cross-validation (LOOCV)
Materials and methods: 102 VLBW neonates born preterm and the largest Area Under the Receiver Operating Characteristic
(BW1500g, gestational age (GA)32wks) admitted to the NICU at Curve (ROC-AUC) as the selection criteria. Distinct classification
Lucile Packard Children’s Hospital at Stanford were recruited to models for cognitive and motor development were independently
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 243
fitted using this technique. The models cutpoints were optimized for group A (n=8), which included cases with isolated PVPC, and Group B
maximum sensitivity. Results were obtained with Scikit-learn: Machine (n=18), which included cases of PVPC with additional findings. Cases
Learning toolbox for Python (Pedregosa et al., JMLR 12, 2011). were further subdivided into connatal cysts and SEPC. Data collected
Clinical cases and summary results: High risk for cognitive delay at 18- included: prenatal history, MRI features, sonographic follow up, and
22 months (BSID-III Cognitive Composite Score585) was predicted by neurodevelopmental outcome.
the R cingulate gyrus MD, L caudate MD, and R middle temporal Clinical cases and summary results: All cases in group A (n=8) had a
gyrus MD, classified with AUC=0.998 (Sensitivity=1.00 [8/8], normal outcome. In group B (n=18) six pregnancies were terminated
Specificity=0.98 [50/51]). High risk for motor delay at 18-22 months, and two had an abnormal outcome. 80% of the cases in the connatal
(BSID-III Motor Composite Score585) was predicted by R superior cysts subgroup and 55% in the SEPC subgroup had a normal
occipital gyrus MD, L precuneus FA, and R hippocampal FA, classified outcome. No significant association was found between the
with AUC=0.912 (Sensitivity=1.00 [10/10], Specificity=0.82 [41/50]). morphological features on MRI and the neurodevelopmental
High risk for fine motor delay (BSID-III Fine Motor Subscore57) was outcome.
predicted by R angular gyrus MD, R tapetum MD, and R retrolenticular Conclusion: Neurodevelopmental outcome in isolated PVPC detected
capsule FA, classified with AUC=0.960 (Sensitivity=1.00 [7/7], prenatally appear to be normal. Additional findings on MRI, including
Specificity=0.94 [50/53]). High risk for gross motor delay (BSID-III mild to moderate dilated ventricles, asymmetrical ventricles, or T2
Gross Motor Subscore57) was predicted by L lingual gyrus FA, L hyperintense signal in the white matter without other findings or
inferior temporal gyrus MD, and R fornix MD, classified with major fetal abnormality, appear to be benign. Connatal cysts appear
AUC=0.830 (Sensitivity=1.00 [15/15], Specificity=0.51 [23/45]). to be benign.
Conclusion: Results of this exploratory analysis suggest that the
selected features of near-term brain WM microstructure demonstrate *Both authors contributed equally to this study.
high predictive value of both cognitive and motor outcomes.
Application in a larger population of preterm neonates can determine Keywords: Periventricular Pseudocysts, Connatal Cysts, Frontal Horn
if classification models that include regional WM DTI metrics Cysts, Subependymal Pseudocysts, Fetal Brain, Magnetic
accurately identify high-risk neonates to inform neuroprotective Resonance Imaging, Antenatal Evaluation, Neurodevelopmental
treatment and improve neurodevelopmental outcome and quality of Outcome
life for preterm children.
Acknowledgments: This research is supported by the Chiesi
Foundation (Parma, Italy), the NIH Clinical and Translational Science
Award UL1 RR025744 for the Stanford Center for Clinical and
Translational Education and Research (Spectrum) and for the 132
Stanford Center for Clinical Informatics and STRIDE (Stanford
Translational Research Integrated Database Environment), the Lucile Prediction of language develop-
Packard Foundation for Children’s Health, and the National Science
Foundation Graduate Research Fellowship under Grant No. DGE- ment in preterm infants using
1147470.
forward feature selection and
linear regression on near-term
131 regional white matter micro-
Prenatal evaluation, imaging fea- structure assessed with diffusion
tures, and neurodevelopmental tensor imaging
outcome of prenatally diagnosed
R. Vassar1,3, K. Schadl1,3, N. Barnea-Goraly1,3,
periventricular pseudocysts J. S. Tamaresis4, K. Cahill-Rowley1,2, and J. Rose1,2,3
S. Cooper1*, O. Bar-Yosef2*, M. Berkenstadt3,
1
Department of Orthopaedic Surgery, Stanford University School of
C. Hoffmann4, R. Achiron5, and E. Katorza5 Medicine, Stanford, CA2Motion Analysis Lab, Lucile Packard
Children’s Hospital, Stanford, CA3Neonatal Neuroimaging Research
1
Antenatal Diagnostic Unit, Department of Obstetrics and Lab, Stanford University School of Medicine, Stanford, CAand
Gynecology, 2Pediatric Neurology, 3The Danek Gertner Institute of 4
Department of Biomedical Data Science, Stanford University School
Human Genetics, 4Diagnostic Radiology, and 5Antenatal Diagnostic of Medicine, Stanford CA
Unit, Department of Obstetrics and Gynecology
Introduction: Very-low-birth-weight preterm infants have a higher rate
Introduction: Periventricular pseudocysts (PVPC) are cystic cavities that of language delay and developmental language disorders compared
lack the ependymal cell lining found in true cysts. They are found in to children born full-term. Early identification of preterm infants at risk
0.5-5% of healthy term neonates using transfontanellar ultrasound for language delay is essential to guide early intervention at a time of
(US) in the first days of life.They are usually located near the head of optimal neuroplasticity, when treatment can be most effective. This
the caudate nucleus, in the caudothalamic groove, or in the lateral study examined near-term brain white matter (WM) microstructure
aspect of the frontal horns of the lateral ventricle. PVPC are associated assessed on diffusion tensor imaging (DTI) in relation to expressive
with various pathological conditions including congenital infections, and receptive language development at 18-22 months in very-low-
metabolic disorders, and chromosomal aberration. Nevertheless, birth-weight (VLBW) preterm children. This prospective, longitudinal
PVPC have also been reported as an isolated finding. The growing study employed linear regression analysis with forward feature
use of prenatal imaging led to an increase in prenatal detection of selection, constrained to select no more than five features, and
PVPC. However, the significance of these finding is not well cross-validation to minimize overfitting, to identify near-term regional
established. The aim of the present study is to characterize PVPC WM microstructure metrics that best predicted language develop-
related factors and outcome. ment at 18-22 months. We hypothesized that a small number of
Materials and methods:A retrospective study of PVPC detected optimal predictive features would explain considerable variance in
prenatally on fetal MRI in 26 fetuses. The fetuses were divided into language neurodevelopment as assessed by the Bayley Scales of
244 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Infant-Toddler Development, 3rd edition (BSID-III) score at toddler Introduction: Therapeutic Hypothermia (TH) as a neuroprotective
age. strategy is established as standard of care in moderate/severe hypoxic
Materials and methods: 102 VLBW neonates born preterm - ischemic encephalopathy (HIE). It has been made available in
(BW1500g, gestational age (GA) 32wks) admitted to the NICU at Portugal since 2010. Herein we describe the experience, of a
Lucile Packard Children’s Hospital at Stanford were recruited to Portuguese referral center for TH in neonatal HIE, focusing on
participate in a study of MRI and DTI from 2010-2011, 66/102 infants possible prognostic factors to impaired outcome in children aged at
had DTI and 60 also had follow-up neurodevelopmental evaluation at least 18 months.
18-22 months adjusted age. DTI metrics of fractional anisotropy (FA) Materials and methods: Cohort prospective study (June 2010 till
and mean diffusivity (MD) were used to assess the microstructure of September 2015) of term or near term newborns (NB) with HIE with
developing right (R) and left (L) regional WM (DTI Studio and criteria for TH: Apgar score55 at 10 min or prolonged resuscitation or
Diffeomap, John Hopkins University). DTI scalars were adjusted for precocious (1st hour) ph16 mmol/L AND clinical moderate/severe
post-menstrual age (PMA) at scan. Expressive and receptive language encephalopathy (Sarnat II modified criteria). Patients underwent
development at 18-22 months adjusted age were assessed with the whole body cooling for 72 h with 33.5  C as target core temperature,
BSID-III. An automated forward feature selection of the available followed by slow re-warming. Data of medical charts were reviewed,
features was performed to obtain the subset of five regional near- concerning perinatal characteristics, evolution until discharge and
term DTI metrics that best predicted the expressive, receptive, and outcome after at least 18 months of age. Unfavorable outcome was
composite score for language development at toddler age using defined as death, cerebral palsy, mental and psychomotor develop-
linear regression with leave-one-out cross-validation (LOOCV) and the mental index 585 (BSID II) or sensory impairment
highest adjusted R2 as the selection criteria. Distinct regression Clinical cases and summary results: Ninety nine newborns with HIE
models for receptive, expressive, and composite language scores underwent TH, 9 of them with sudden unexpected collapse (SPUC),
were independently fitted using this technique. Results were happening at a median of 1.4h of life. Of these patients, 7 died. Out of
obtained with Scikit-learn which is a machine learning toolbox for the other 90, uneventful pregnancy was described in 59 NB (59.6%).
Python. Median gestational age and birth weight were, respectively, 39 weeks
Clinical cases and summary results: Language function was predicted and 3155 g. 58.6% of the patients were male and 73 (73.7%) were
by R precuneus MD, R insular cortex FA, R stria terminalis MD, L OUTBORN. Severe encephalopathy occurred in 48(48.5%) and death
cingulum (cingular part) MD, and L inferior temporal gyrus FA, which during hospitalization in 25 (25.3%). Sinus bradycardia and thrombo-
accounted for 27% of the variance in BSID-III Language Composite cytopenia were the most frequent adverse effects. On follow up, 46
Score (R2=0.40, Adj. R2=0.35, LOOCV R2=0.27). Expressive language children were accessed. Neurodevelopment evaluation was normal in
function was predicted by R precuneus MD, R insular cortex FA, L 33(71.7%). Unfavorable outcome was associated with severe ence-
lingual gyrus MD, L fusiform FA, and L superior temporal gyrus MD, phalopathy at admission (OR, 11.9, 95% CI, 3.3-4.2, p50.01), abnormal
which accounted for 30% of the variance in BSID-III Expressive aEEG at 48h (OR 23, 95% CI, 5-98.9, p50.01), impaired neurological
Language Subscore (R2=0.43, Adj. R2=0.39, LOOCV R2=0.30). Receptive evaluation at discharge (OR 15.7, 95% CI, 3.2-76.1, p50.001) and
language function was predicted by R precuneus MD, R middle abnormalities (BGT,WS) on cranial MRI (OR 45.5, 95% CI, 7.36-280,
occipital gyrus MD, L entorhinal cortex MD, R insular cortex FA, and R p50.001).
inferior fronto-occipital fasciculus FA, which accounted for 28% of the Conclusion: Our experience with HT supports the benefits in HIE.
variance in BSID-III Receptive Language Subscore (R2=0.42, Adj. Adverse effects of hypothermia were minimal. Abnormal aEEG at 48h
R2=0.38, LOOCV R2=0.28). and BGT/WS lesions in MRI were elements associated to impaired
Conclusion: Results of this exploratory analysis suggest that the outcome in survivors followed till after at least 18 months of age.
selected features of near-term brain WM microstructure explained
considerable variance in BSID-III language scores at toddler age. Keywords: Therapeutic hypothermia, newborns, neuroprotection
Analysis in a larger population of preterm neonates can determine if
linear regression models that include regional WM DTI metrics
accurately identify high-risk neonates and inform therapeutic inter-
ventions that can improve neurodevelopment and quality of life for 245
preterm children. This research is supported by the Chiesi Foundation
(Parma, Italy), the NIH Clinical and Translational Science Award UL1
Cognition properties of sensori-
RR025744 for the Stanford Center for Clinical and Translational
Education and Research (Spectrum) and for the Stanford Center for
neural hearing-loss children
Clinical Informatics and STRIDE (Stanford Translational Research without and with cochlear
Integrated Database Environment), the Lucile Packard Foundation
for Children’s Health, and the National Science Foundation Graduate implants or hearing aids: neona-
Research Fellowship under Grant No. DGE-1147470.
tal hearing screening
Keywords: Very-low-birth-weight, diffusion tensor imaging, white
matter microstructure, language development T. Devdariani, Z. Kevanishvili, Sh. Japaridze, and
N. Manjavidze
Perinatal Centre, Tbilisi, Georgia (Neonatology Departament),
138 National Centre Of Otorhinolaryngology Tbilisi, Georgia
Therapeutic hypothermia in Introduction: The cognition level has been measured in sensorineural
hipoxic-ischemic encephalopaty - hearing-loss children. The first test group included specimens without
any audio-habilitation means. The second and third groups covered
a Portuguese NICU experience children serviced with cochlear implants and hearing aids, respec-
tively. The fourth group represented normally - hearing children. All
these children were revealed of hearing disturbances and the
G. Cassiano Santos, E. Vieira, M. Rosal Gonçalves, L. Brito, immediate start of speech therapy practice, aiming to prevent thus
F. Pinto, I. Macedo, C. Matos, and T. Tomé speech, intellectual, emotional and developmental deficits in hard-of-
Maternidade Dr Alfredo da Costa, CHLC, Lisboa, PORTUGAL hearing children. In the recent years, the hearing screening
procedures in newborns as well as in small children have successfully
been implemented in Georgia too.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 245
Materials and methods: Three groups of hearing-loss children were factors: age of children, moment of exposure to stress, and kind of
selected for the research. In 25 examined children of the first group stress affecting mothers, to develop an overview of the effect of stress
no technical means, particularly, cochlear implant or hearing aids on children’s cognitive ability and its development over time.
were used for the hearing habilitation. In the second group the Clinical cases and summary results: The overall trend in children aged
implant was used on one ear of 10 children.13 examined children of 3-24 months is that exposure of the mother to non-specific-of-
the third group appeared to be the regular users of the hearing aids pregnancy stress has negative consequences on children’s cognitive
on one or both ears. Fourth -control group was presented by 62 development during the whole pregnancy, but especially during the
normally hearing children. In all children the cognitive function was second trimester, specific-of-pregnancy stress also seems to affect
determined by using Raven’s colored progressive matrix procedure. adversely, in particular during the third trimester. The undesirable
The comparison of Raven‘s indices in different species was performed consequences from stress can be seen as well in children aged 2 to 9
by Mann-Whitney‘s nonparametric test. years, particularly non-specific-of-pregnancy stress, and primarily if
Clinical cases and summary results: The mean cognition value in hard- exposure to stress occurs in the first and third trimesters of
of-hearing children without any audio-habilitation device amounted pregnancy. In children with 10 or more years only non-specific
to 42% while markedly, by 41%, and highly significantly lagged stress was studied, and it can be seen that exposure during the first
behind that in normally hearings., 83%. In children with similar ear- trimester of pregnancy maintains its negative effects on cognitive
dysfunction but made use of cochlear implants or hearing aids the development.
mean cognition signs equaled 62% and 73%, respectively. These Conclusion: Regardless of the moment of pregnancy in which it may
values by only 21% and 10% were less of that in controls, the decline happen, an excessive exposure to stress of the mother, and
moreover being significant with respect to implanted but not to consequently, the fetus (especially non-pregnancy-specific stress)
aided consumers. The variability of cognition indices in hearing-loss can lead to undesirable consequences at the cognitive level
children without any habilitation tools amounted to 50 %. It throughout the child’s life. We recommend the assessment of
substantially, by 39%, exceeded that in normally hearings, 11%. The prenatal stress during routine care provided to pregnant women,
variations appeared greater in implant and aid bearers also, 39% and this will allow us to take actions on those women with elevated stress
37%, respectively. With regard to controls the excess amounted thus to reduce it, in order to safeguard children’s cognitive ability.
to 28% and 26%, respectively, i.e. were smaller of that in hearing-loss
individuals without audio-habilitation appliances.
Keywords: Pregnancy, stress, fetal development, cognitive impair-
Conclusion: The conclusion has been reached that the cognition
ment, fetal programming
properties in hearing-loss children are markedly lagged behind that in
normally hearings while application of cochlear implants or hearing
aids provides a lucky chance of attaining rational cognition ranks, the
outcomes being although personally variable.The early estimation of
hearing and immediate start of rehabilitation has thus a crucial
291
significance. Fetal speech movement response
Keywords: Hard-of-hearing children, cochlear implants, hearing aids, comparing the intravaginal emis-
hearing screening, rehabilitation, abilitation
sion of a monody with a single
sustained pitch
260
A. Garcia-Faura, V. Moens, E. Valladares, A. Gracia, and
Influence of maternal stress M. Lopez-Teijon
during pregnancy on the cogni- Institut Marques, Barcelona
tive development of children
Introduction: Fetuses at 16-39 weeks of gestation respond to
1 2 3 3 intravaginally emitted music with repetitive speech movements,
C. Bejar , M. Santiago , L. Calvo , and M. Garcia that can be evaluated by transabdominal ultrasound.
1
Plasencia Health Area, Plasencia, Spain, 2Labor ward, Virgen del The aim of this study was to analyze by 3D/4D ultrasound, fetal
Puerto Hospital, Plasencia, Spain, and 3Labor ward, Tajo Hospital, speech movements in response to an acoustic stimulus emitted
vaginally, comparing an intravaginal flute monody (IVM) to an
Aranjuez, Spain
intravaginal flute sustained pitch (IVP).
Materials and methods: Sixty-two normal pregnancies between 16 and
Introduction: Since the emergence of fetal programming theory 38 weeks of gestation were randomized to 3D/4D ultrasound with:
(Barker, 1995), it became clear the necessity to consider all factors that IVM with a specially designed device emitting at 53.7 dB, and IVP
could disturb the intrauterine environment. One of these factors is emitting at 55.2 dB with the same device . Fetal speech movements,
maternal exposure to stress. There are studies showing consequences including mouthing (MT) and tongue expulsion (TE), were quantified
in the newborn from different types of stress, such as the death of a at baseline, during stimulation, and for 5 minutes after stimulation
relative, everyday hassles, natural or human disasters, etc. Initially, it was discontinued.
was thought that these consequences were only physical. However, Clinical cases and summary results: At baseline study, there were no
it’s being created a growing body of knowledge regarding the impact significant differences in MT (33% in IVM versus 50% in IVP) and TE
of stress during pregnancy on the fetus’s neurological development, (7% in IVM versus 0% in IVP). IVM elicited MT and TE in 87% and 47%
and consequently on child’s cognitive ability, behavior or emotions. of fetuses respectively, with significant differences when compared
We focus on the effect on cognitive development because it is a key with IVP both for MT (50%, p= 0.002) and TE (7%, p = 0.0003). After
index to assess the neurological development. stimulation, there were only significant differences between IVM and
Materials and methods: A systematic review of the literature was IVP for TE (31% for IVM versus 0% for IVP, p= 0.0006), and not fot MT
performed, after a comprehensive search in several medical databases (31% for IMV versus 56% for IVP).
(Scopus, Pubmed and Web of Science), quality of the studies was Conclusion: Fetuses over 16 weeks of gestation respond with a
assessed applying a modified version of the Scottish Intercollegiate significant increase in speech movements when we apply IVM, but not
Guidelines Network (SIGN) methodology checklist for cohort studies, when we use IVP, fetal response to IVP shows no differences in MT and
adapted by the authors. The results from the different studies TE during and after the stimulus, when compared to the baseline. Our
included were summarized and analyzed, depending on the following
246 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

findings suggest that a single susitained pitch is not able to activate

370
fetal neural pathways participating in the auditory-motor system, and
that melody and rhythm could be the responsible for that fetal Intrathecal vancomycin as treat-
response.
ment for ventriculitis in preterm
Keywords: Fetal hearing, fetal behaviour, intravaginal music,
ultrasound
infants 528 weeks gestation - a
study of cerebrospinal fluid (CSF)
pharmacokinetics
J. M. Parasuraman1, M. Albur2, and A. Heep1
1
Neonatal Intensive Care Unit, Southmead Hospital, Bristol, United
Kingdom, and 2Department of Microbiology, Southmead Hospital,
Bristol, United Kingdom

Introduction: Ventriculitis is a rare complication associated with

repeated cerebrospinal fluid (CSF) drainage, in preterm infants with
ventricular dilatation. Intrathecal vancomycin is used to treat
Staphyloccoci related ventriculitis, however data is limited on its
pharmacokinetics. We aimed to explore CSF vancomycin peak and
trough levels pattern using 3mg, 5mg and 10mg models of
intrathecal vancomycin, in babies528 weeks gestation.
Materials and methods: This was a single centre, retrospective clinical
299 case study. Data was collected on 7 babies, from 2009-2015.
Ventriculitis was defined as elevated CSF WCC or positive CSF culture,
Hypoxic ischemic on microbiology assessment, during daily CSF drainage. Following
single dose intrathecal vancomycin administration (15 episodes in 7
encephalopathy: as commom infants), relationships between dose and available CSF vancomycin
levels were analysed.
as we think Clinical cases and summary results: Mean gestational age of study
infants was 26 weeks (range 23 + 6 - 27 + 5 weeks) and mean birth
L. Zamorano Bonilla, A. Campos Martı́nez, A. Montoro weight was 821g (range 517-1130g). Ventriculitis, was diagnosed with
Sánchez, R. Pérez Iáñez, A. Rodriguez Leal, and P. Cid elevated CSF WCC in 1/7 infant or positive CSF culture in 6/7 infants,
at mean age of 64 days (range 26-164 days), and following daily CSF
Galache drainage using ventriculostomy catheter device, for a mean 21.1 days
Paediatrict Dept., Motril’s Hospital, Granada, Spain (range 4-43 days).
Conclusion: Our study demonstrates that adequate CSF vancomycin
peak and trough levels can be achieved at intrathecal vancomycin
Introduction: Perinatal hypoxic ischemic encephalopathy (HIE), is the doses of 3-10mg/dose. 24 hour monitoring of CSF vancomycin level is
main cause of dead, severe neurology morbidity and seizures in term recommended.
infants. It is responsible of the 20% of childhood cerebral palsy. The
objetive of our study is to describe prevalence of HIE in a Basical
Hospital and perinatal characteristics of the patients diagnosed with Keywords: CSF vancomycin, ventriculitis
HIE from Jan 2014 to Dec 2015.
Materials and methods: A restropective study was carried out. All
newborns with neonatal encephalopathy or intrapartum asphyxia
borned on weeks 36 th or after were identified. Different clinical
measurements were collected.
Clinical cases and summary results: In the last two years 10 patient
with hypoxic-ischaemic encephalopathy were found in our Hospital.
50% of them had risk factors such as placental abruption ,umbilical
cord prolapse and dystocia. All of them had abnormalities in the
cardiotocographic exam. 40% of the patients were transferred to a
third level hospital for therapeutic hypothermia. All of them had pH
57 in the test from umbilical cord blood. Furthermore, all of them
presented seizures in their first hours of life as well as intracranial
abnormalities in the brain imaging (ultrasound). In the follow up, only 382 (CASE REPORT)
one of them has presented clinical signs of cognitive impairment and
lack of psychomotor development as well as abnormal neurological Diagnosis of brain death in
examination.
Conclusion: HIE is an uncommon diagnosis. In our opinion, its low
neonatology
prevalence shows the necessity of a centred and regionalized
hypothermia program were this patients could be referred. A L. M. T. P. Oliveira, M. A. M. Cardoso, R. P. Toledo,
reference center could lead to ensure a high quality health care for N. S. O. Vargas, M. E. J. Ceccon, and W. B. Carvalho
this patients and it could help to optimised the resources availables.
Neonatal Intensive Care Unity of Child Institute, University of São
Paulo, São Paulo, Brazil
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 247
Introduction: Brain death is the total and irreversible absence of
cerebral functions, including the function of the brianstem. In 1997 390 (CASE REPORT)
the Federal Council of Medicine in Brazil presented the 1408
resolution, adopting the criteria for diagnoses of brain death all
Neonatal hydrocephalus - case
over the country, covering also the neonatal period.
Clinical cases and summary results: A.L.S.S., term newborn, female,
report
cesarean delivery, 2.055 kg, APGAR 8/9, healthy mother. Second day
of life the baby had hypoglycemia, respiratory distress, needing N. Ionita1, M. A. Dima1,2, A. E. Agoston-Vas1,
intubation and antibiotic therapy, having an evolution for seism and I. Enatescu1,2, D. Iacob1,2, and C. Ilie1,2
bregma uplift, receiving phenobarbital. The ultrasound transfontanela 1
showed important intraparenchymatous bleeding, confirmed with Emergency County Hospital ‘‘Pius Branzeu’’ - ‘‘Bega’’ Neonatology
the CT, that further more pointed out a hemoventricle with dissection Clinic, Timisoara, Romania and 2University of Medicine and
to the mildbrain. So baby was transported to a hospital of reference Pharmacy ‘‘Victor Babes’’ Timisoara, Romania
for her area, at that moment she was unconscious, unresponsive
middle fixed pupils, without brainstream reflexes or cough reflex, Introduction: Hydrocephalus is the enlargement of cerebral ventricles.
absence of hemorrhagic suffusions or hematomas in any of other The cerebral substance suffers a regresion process due to volume
parts of her body - this clinic exam maintained till the end. So the increase of cerebrospinal fluid (CSF). This is not due to cerebral
baby was evaluated by several especialities, like neurosurgery, atrophy or dysgenesis. The mecanism of hydrocephalus is in relation
neuroloclinic, endocrinology (because she had diabetes insipidus with production, resorbtion and circulation of CSF. Hydrocephalus is
too), hematology, ophthalmology, genetics, beyond neonatology. It caused by several factors: abnormal cerebral development, expanding
was decided to open the protocol for brain death after the seventh processes, pre-, peri- and postnatal bacterial or parasitic infections,
day of life, which is known by the Brazilian law (Federal Council of peri/intraventricular hemorrhage, CSF hyperproduction.
Medicine) since 1997, that defines the criteria for the diagnosis of Hydrocephalus used to be clasiffied into: communicating and
brain death, transplant and treatment, needing 2 clinical evaluations noncommunicating (most frequent). Newest clasiffications are based
and 1 complementary exams. In this age group, following the current on the age of the infant, ethiology and mecanis of hydrocephalus.
law, 2 clinical exams were made and 2 electroencephalograms with Clinical cases and summary results: We report the case of a premature
48 hours gap, with no cerebral electric signal, determining the death newborn, gestational age 31 weeks, birth weight 1350 g. History:
and turning off the support that the patient was receiving. premature membrane rupter for more than 9 days. At birth the infant
Conclusion: Brain death is considered synonymous of death. So in this needed minimal resuscitation maneuvres, Apgar score 6/1 min, 6/
situation, it’s occurrence and it’s meaning should be well informed to 5 min. He was admitted in the Neonatal Intensive Care Unit. General
the family and to the multidisciplinary team. From the moment that status evolved towards worsening 4 days after birth, he needed
this diagnosis is established on, any attempt in taking longer the noninvasive respiratory support, he presented seizures. Cerebral
health care for the patient is an unjustified therapy, without any ultrasound revealed peri- and intraventricular hemorrhage, bilateral
benefits for this patient or his/her family. fronto-parietal ischemia, bilateral progressive ventriculomegaly. The
diagnose was confirmed by computer tomography. A surgical
Keywords: Brain death, neonatology, Federal Council of Medicine intervention was performed in order to place an external ventricular
drainage system for 2 weeks, after that it was replaced with a
ventriculo-peritoneal drainage tube. The seizures persisted. He also
developed 2nd degree retinopathy.
Conclusion: Case particularity: the development of hydrocephalus at a
high gestational age, increased birth weight, infectious context,
favorable evolution after neurosurgical intervention, the follow-up
investigations reveal no major sequelle.For neonatologysts the
hydrocephalus secondary to infections, cerebral hemorrhages and
ischemia is the most common and it supposes a complex and urgent
establishment of the etiology and diagnose.

Keywords: Prematurity, infection, hydrocephalus

391
Cerebral near infrared spectro-
scopy in premature infants with
respiratory distress sindrome
N. Ionita1, A. E. Agoston-Vas1, M. A. Dima1,2,
I. Enatescu1,2, D. Iacob1,2, and C. Ilie1,2
1
Emergency County Hospital ‘‘Pius Branzeu’’ - ‘‘Bega’’ Neonatology
Clinic, Timisoara, Romania and 2The University of Medicine and
Pharmacy ‘‘Victor Babes’’, Timisoara, Romania

Introduction: Distress respiratory syndrome (RDS) caused by Surfactant

deficiency is due to immature lungs. Clinically we have respiratory
failure with onset in the first 4 hours of life, with a maximum severity
degree until 48 hours. The incidence and severity of RDS increase
248 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

inversely related to the decrease of the gestational age (GA). The clinical case of a premature newborn who was monitored using NIRS
INVOS (In Vivo Optical Spectroscopy) System provides noninvasive which helped us to detect and correct oxygenation issues such as
information, continuous and real time monitoring of the brain oxygen those associated with low cardiac output, shock, seizures, renal failure
saturation (regional oxygen saturation ¼ rSO2). or neurologic damages. Gestational age 30 weeks, birth weight
Materials and methods: We investigated premature born infants 1300 g. History: premature membrane rupture over 3 weeks, maternal
GA ¼ 24-31 weeks, who were admitted in the Neonatal Intensive Care infection with Escherichia Coli. Apgar score ¼ 6/10 , 4/5 0 .
Unit (NICU) in our hospital (‘‘Bega’’ Neonatology Clinic Timisoara) Materials and methods: Premature infant, gestational age 30 weeks,
between January 2013 - July 2014, they all had RDS due to Surfactant birth weight 1300 g. History: premature membrane rupture over 3
deficiency. The control lot included premature born infants GA ¼ 32 weeks, maternal infection with Escherichia Coli. Apgar score ¼ 6/1’, 4/
weeks with no severe pathology. Inclusion criteria for the study lot: 5’. He presented arterial ischemia at birth which affected his right arm
GA ¼ 24 - 31 weeks, perinatal risk factors, Surfactant administration, and he needed cardiac and respiratory resuscitation. We monitored
respiratory support, other pathologies. Exclusion criteria: GA 4 32 cerebral and somatic oxygenation using an INVOS device, we used
weeks, major congenital malformations, multiple birth, stillbirths. All neonatal sensors placed over the brain and abdomen area. At the
the infants were monitored according our NICU protocols. In addition same time we used sensors for preductal and postductal
we used INVOS for cerebral oxygen monitoring from the first 4 hours pulsoximetry.
of life and during 72 hours. Clinical cases and summary results: The infant presented arterial
Clinical cases and summary results: We studied: behaviour during ischemia at birth which affected his right arm, he needed cardiac and
conventional ventilation, Surfactant administration, apnea episodes, respiratory resuscitation. We monitored cerebral and somatic
cardiac arrhythmias, seizures, anemia, blood pressure fluctuations. We oxygenation using an INVOS device (at 48 hours after birth and
monitored: vital signs, blood gases, blood glucose, hemoglobin, during 72 hours). At the same time we monitored preductal and
hematocrit. Study lot included 2 categories: INSURE (intubation- postductal pulsoximetry. The INVOS device generates a vital sign
surfactant-extubation) + nCPAP group, mechanical ventilation + called regional oxygen saturation (rSO2), which is a venous-weighted
pathology (patent ductus arteriosus, cerebral hemorrhages, anemia, measure of the hemoglobin bound oxygen remaining after tissues
seizures) group. We had no negative effects of INSURE procedure on have taken what they need. The lower and upper alarm limits have
the brain oxygenation, orotraheal intubation maneuvers decreased been set at 50 and 90%. Nurses have been trained to mark all the
rSO2. Surfactant administration raised rSO2. There is an important interventions. Transfontanelar ultrasound has been made before,
relationship between severe RDS, low mean blood pressure and during and after monitoring to detect brain injuries. There have been
cerebral oxygenation. We had decreases of rSO2 with 20% below the detected several periods of hypo or hyperoxia which have not been
critical ranges and increases over the superior reference value of 80%. detected on time by pulsoximetry device or by laboratory investiga-
We could calculate the cerebral tissue extracted fraction of oxygen tions. Care team intervened by changing the ventilatory parameters,
(cFTOE). repositioning the baby or administering fluids.
Conclusion: A special category: premature infants with RDS and PDA. Conclusion: Decreases in the venous reserve of oxyhemoglobin
Ibuprofen administration determined rSO2 increase. NIRS is a indicate increased ischemic risk and compromised tissue perfusion.
noninvasive, real time method to monitor cerebral oxigen. rSO2 It is very important to intervene at the right time in order to prevent
reflects the balance between the cerebral oxygen supply and or lessen ischemic complications and injury. Newborns are sensitive
metabolism. Main goal: to use NIRS for cerebral oxygen settle in to minor changes in therapeutic management or manipulation this is
premature infants (first 72 hours of life) and to guide our therapeutic why it is very important to take advantage of all the noninvasive
interventions after the values of the rSO2 in order to reduce negative methods of monitoring and diagnose to improve their outcome and
effects of hypoxia and hyperoxia on the brain. NIRS gives us an important helping hand.

Keywords: Cerebral oxymetri, near infrared spectroscopy, brain, Keywords: Prematurity, cerebral, oximetry
prematurity

402
392
Perinatal stroke in term-born
Clinical cerebral and somatic neonates
oximetry versus pulsoximetry for
a better therapy management in M. Starcevic1, V. Duranovic V2, J. Lenicek Krleza3, and
E. Bilic4
neonatal care - case report 1
Department of Neonatology, University Hospital Center Zagreb,
1 1 1,2 Zagreb, Croatia, 2Department for Child Neurology, Children’s
N. Ionita , A. E. Agoston-Vas , M. A. Dima , Hospital Zagreb, Zagreb, Croatia, 3Department for Medical
I. Enatescu1,2, D. Iacob1,2, and C. Ilie1,2 Biochemistry and Hematology, Children’s Hospital Zagreb, Zagreb,
1
Emergency County Hospital ‘‘Pius Branzeu’’ - ‘‘Bega’’ Neonatology Croatia, and 4Department of Pediatric Hematology and Oncology,
Clinic, Timisoara, Romania and 2The University of Medicine and University Hospital Center Zagreb, Zagreb
Pharmacy ‘‘Victor Babes’’,Timisoara, Romania
Introduction: Stroke is more likely to occur in the perinatal period than
Introduction: oninvasive procedures are eligible. The INVOS System is any other time in childhood. The incidence has been estimated at 1 in
a noninvasive device which provides regional, oximetry by near 1600-5000 births. Arterial ischaemic stroke (AIS) accounts for 80% of
infrared spectroscopy (NIRS). Often provides earlier warning than all perinatal strokes and the rest are either haemorrhagic or due to
traditional measures such as pulsoximetry (SpO2). Our aim is to cerebro-venous sinus thrombosis (CVST). Diagnostic confirmation is
improve the clinical management of neonates in our care and so to typically based on neuroimaging findings. While a number of risk
take advantage of the newest technologies. We are presenting the factors have been proposed, extensive investigations many times
remain inconclusive.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 249
Materials and methods: Four term neonates with perinatal stroke born Clinical cases and summary results: Preterm infants had the following
in our maternity hospital during the four years period. Cranial measurements of coagulative hemastasis : PT 13.7(12.8-13.8), PTq
ultrasound (cUS) and magnetic resonance imaging (MRI) of the brain 80.7(75.9-84.3), INR 1.2(1.15-1.2 2), APTT 44.07(39.8-48.4), TT 24.42
were performed to all. Laboratory tests included blood count, platelet (22.28-26.56), Fbg 2.34 (2.15-2.53). Full term infants had : PT 12.06 (11.5-
count, coagulation tests, protein C and protein S (level and activity), 12.6), PTq 92.8 (85.2-100.3), INR 1.07(1.03-1.11), APTT 33.21(29.7-36.8),
antithrombin III, fibrinogen, anti-phospholipid antibodies and homo- TT 25.64 (22.76-28.52), Fbg 3.56 (1.99-6.13). The differences between
cistein (genetic-factor V Leiden and factor II 20210A, prothrombin, study groups of infants are determined according to the following
MTHFR). parameters of coagulative hemostasis: PT,PTq, INR, ARTT (P0.05).
Clinical cases and summary results: Two neonates had AIS due to the Conclusion: The obtained results prove the existance of differences in
infarction of the middle cerebral artery, confirmed by both coagulative hemostasis potential, blood-coagulation factor capacity
neuroimaging methods. One was a girl who had an apnoic event and concentration between study groups of full term and preterm
on the second day of life. Another was a boy with prenatally detected infants. These results should be taken into the concederation during
left sided ventriculomegaly, with mild abnormalities of muscle tone the diagnostication of different forms of perinatal affection of the
after birth. Two neonates had CVST. One manifested seizures on her central nervous system.
third day of life. cUS showed left sided echodensity while MRI
detected thrombosis of the sigmoid, transverse and superior sagittal Keywords: Neonatology, hypoxic-ischemic lesion, preterm infants,
sinus. Another patient presented with hypotonia and feeding hemostasis
difficulties on her second day of life. Left sided intracranial
haemorrhage with thalamic laesion were detected by cUS, while
thrombosis of the left sigmoid and transverse sinus was diagnosed by
MRI. No maternal or placental disorders were found at any case. All
infants were otherwise healthy. Sporadic laboratory abnormalities 503
were transient. Treatment was symptomatic. The incidence of stroke
in our population was approximatelly 1 in 4000 births. Non-pharmacological procedures
Conclusion: Neurologic disturbances, even subtle, in term-born
previously well-appearing newborn should be evaluated for perinatal to relieve pain during procedures
stroke. Althought brain ultrasound remain basic neuroimaging
method, MRI has to be done in all suspected cases. Individual
in nicu, a pilot study
approach in planning optimal timing for specific laboratory tests is
recommended, depending on possible risk factors and based on A. Hoxha (Qosja)1, E. Prifti2, A. Daja1, and E. Tushe1
clinical judgement. 1
Neonatology Department, University Hospital of Ob-Gyn ‘‘Koco
Gliozheni’’, Tirana, Albania, and 2High Risk Pregnancy Unit,
Keywords: Perinatal stroke, neonatal neurologic disturbances,
neuroimaging University Hospital of Ob-Gyn ‘‘Koco Gliozheni’’, Tirana, Albania

Presenter: Enkeleda Prifti

Introduction: Effective management of procedural pain in neonates is
required to minimize acute physiological and behavioral distress and
may also improve acute and long-term outcomes. Neonates in the
434 NICU often experience painful procedures during routine care, such as
Coagulative hemostasis of full needle insertions, suctioning, gavage-tube placement, tape removal
as well as stressful disruptions, including diaper changes, chest
term and and preterm infants physical therapy, physical examinations, nursing evaluations, and
exposure to environmental stimuli.
with hypoxic-ischemic lesions of Aim: To compare the efficacy and safety of three interventions for
relieving procedural pain associated with heel lances in term
the central nervous system neonates prior painful procedures on pain responses.
Materials and methods: In a randomized controlled trial, 40 neonates
E. Ivchenko1, A. Pijanzin1,2,3, A. Fedorov2, K. Khrulev3, were randomized to receive (a) sucrose (n = 13), (b)kangaroo position
(n = 4), (c) non-nutritive sucking (pacifiers, n = 13), and no
Z. Akinina1, and J. Miller1
intervention group (control) (n = 10) to evaluate the efficacy (pain
1
Altai Region Clinical Children’s Hospital, Barnaul, 2Altai State response) as assessed by physiological (heart rate (HR), respiratory
Medical University, Barnaul, and 3Altai State University, Barnaul rate, saturation of peripheral oxygen in the blood (SpO2), behavioural
pain indicators (cry duration, proportion time crying, facial actions).
Data were collected to determine efficacy and immediate and long-
Introduction: The researches of coagulative hemostasis of full term
term adverse events. Data on clinical outcomes and neurobiological
and preterm infants with hypoxic-ischemic lesions of the central
risk status were collected at 28 days or NICU discharge.
nervous system are very important for carrying out precise differential
Clinical cases and summary results: There were not statistical
diagnostics and choosing an adequate therapeutic approach.
differencies related to gestational age, birth weight and drilling time.
Materials and methods: We examined (n=27) full term and (n=43)
Significant differences in pain response existed among treatment and
preterm infants (at the age of 4-7 days after the birth). All infantsl had
control groups related to behavioural pain indicators (cry duration
hypoxic-ischemic lesion of the central nervous system. The para-
[p=0.002] and proportion time crying [p=0.017] but not for facial
meters of hemostasis were searched by means of the Automated
actions [p=0.09]). Significant differencies exist and for physiological
Blood Coagulation Analyzer CA 1500 (Sysmex Corporation, Japan).
response (heart rate (HR) [p=0.01], respiratory rate [p=0.01], saturation
The following parameters were being diagnosted: prothrombin time
of peripheral oxygen in the blood (SpO2) [p=0.006]. No group
(PT) - seconds , prothrombin time (PT) - seconds , prothrombin time -
differences existed for adverse events.
quick (PTq) - %, international normalized ratio (INR), activated partial
Conclusion: Consistent management of painful procedures with
thromboplastin time (APTT) - seconds, thrombin time (TT) - seconds ,
sucrose plus pacifier or kangaroo position was effective and safe for
levels of fibrinogen (Fbg) - g/L). The non-parametric Wilcoxon-Mann-
preterm neonates during their stay in the NICU. Further exploration of
Whitney tests were used. The results are presented as follows -
consistent pain management with sucrose on clinical, developmental,
confidence interval for the mean (lower bound, upper bound).
and neurobiological outcomes is required.
250 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Keywords: Pain, newborn, NICU, routine procedure, pharmacologic

and nonpharmacologic therapies
538 (CASE REPORT)
Early infantile epileptic
encephalopathy
526
The effect of perinatal asphyxia R. Gueorguieva
on cerebral palsy candidate gene Neonatal Intensive Care Unit, University Paediatric Hospital, Sofia,
Bulgaria
transcription
Introduction: Aim: To present a clinical case of early infantile epileptic
M. Barkhuizen1,2,3, K. Cox-Limpens1,2, D. van den Hove2,4, encephalopathy (Ohtahara syndrome) with initiation of clinical
B. Kramer1,2, L. Zimmermann1, J. Vles2,6, and symptoms in the early neonatal period
Clinical cases and summary results: Boy with gestational age 37 weeks,
A. Gavilanes1,2,5
born from first twin pregnancy after in vitro fertilization.There was no
1
Department of Paediatrics, Maastricht University Medical Centre evidence of perinatal asphyxia, only mild delay of cardiopulmonary
(MUMC), Maastricht, The Netherlands, 2Department of Translational adaptation. Neurological symptoms were noted on the first day of life:
Neuroscience, School for Mental Health and Neuroscience (MHeNs), absence of primitive reflexes, no sucking and swallowing, muscle
hypertonia, tonic seizures, respiratory pauses and apneas. The
Maastricht University, Maastricht, The Netherlands, 3DST/NWU
seizures were resistant to the treatment with phenobarbital and
Preclinical Drug Development Platform, North-West University, diazepam. Biochemical evaluation and metabolic screen showed no
Potchefstroom, South Africa, 4Department of Psychiatry, evidence of congenital error in metabolism, mitochondrial disease or
Psychosomatics and Psychotherapy, University of Würzburg, pyridoxine dependency. MRI studies showed normal structure of the
Würzburg, Germany, 5Institute of Biomedicine, Facultad de Ciencias brain, cerebellum and brain stem, non dilated subarachnoid and
Médicas, Universidad Católica de Santiago de Guayaquil, and intraventricular spaces. EEG - non-reactive burst suppression back-
6 ground activity. There was progressive impairment of consciousness,
Department of Child Neurology, Maastricht University Medical
Centre (MUMC), Maastricht, The Netherlands limited reactivity, reduced spontaneous movements,frequent sponta-
neous and provoked tonic spasms of the extremities and trunk,
lasting 2-10 seconds. The infant was treated with supportive therapy,
Presenter: M. Barkhuizen
including mechanical ventilation, non - invasive respiratory support,
Introduction: Cerebral palsy (CP) is a common, clinically heterogenous parenteral nutrition and anticonvulsant drug - vigabatrin. The
group of disorders affecting movement and posture. Whilst hypoxic condition of the infant deteriorated progressively and the patient
ischemic encephalopathy due to perinatal asphyxia (PA) is a major died at the age of six months. DNA analysis could not identify specific
contributor to cerebral palsy, only 13% of these infants later develop genetic mutation.
CP [1]. A recent whole-exome sequencing study suggested a similar Conclusion: Early infantile epileptic encephalopathy can be presented
percentage of CP cases had a potential genetic origin. KANK1, GAD1, immediately after birth as a idiopathic disease without structural brain
ZC4H2, NKX2-1, TUBA1A, SCN8A, KDM5C, AGAP1, JHDM1D, MAST1, disorders or metabolic abnormalities.
NAA35, RFX2, WIPI2, L1CAM, PAK3, CD99L2 and TENM1 were named
Keywords: Eally encephalopathy, neonatal epilepsy
as genetic candidates [1,2]. We investigated whether these genes are
also mediated the acute neurological damage seen after PA.
Materials and methods: We analysed the effect of severe PA during
birth [3] on the transcription the CP candidate genes [2] in a rat model 546
of global PA. The transcriptome of a brain hemisphere was measured
at 6 and 96 hours after birth with an Affymetrix Gene1.0ST chip (n = 5 Neonatal hypoxic-ischaemic
per group). Data was analysed with the Bioconductor limma package
[3]. P-values smaller than 0.05 were considered statistically significant. encephalopathy patterns demon-
Clinical cases and summary results: PA significantly increased the
transcription of CD99L2 at 6 and 96 hours after birth (1.15 fold, strated by magnetic resonance
p50.05) and WIPI2 at 6 hours (1.09 fold, p5 0.05), but not 96 hours
after birth. The expression of TUBA1A, SCN8A, AGAP1, MAST1, RFX2,
imaging
L1CAM, PAK3, KANK1, GAD1, ZC4H2 and NKX2-1 was not significantly
altered by PA. The remaining genes were not present in our array. C. Scheau1,2, M. Enyedi1,2, E. Tarta-Arsene1,2, A.E.
CD99L2 and WIPI2 are both immune system associated genes. Scheau2, R.I. Papacocea2, C.M. Ciornei2, A.I. Badarau2,
CD99L2 is involved in the extravascularization of leukocytes and WIPI2 L. Ples2, and R.M. Sima2
is involved in autophagosome formation. CD99L2 is also associated
with autism [4]. 1
The ‘‘Victor Babes’’ Center of Diagnosis and Treatment,
Conclusion: Genes with functions in the immune system may be Bucharestand 2The ‘‘Carol Davila’’ University of Medicine and
involved in the neurodevelopmental pathology seen after PA. Further Pharmacy, Bucharest
research is needed to determine whether these transcription changes
are sustained long-term.
Presenter: Romina-Marina SIMA
Keywords: Perinatal asphyxia, cerebral palsy, transcriptome
Introduction: Neonatal hypoxic ischemic encephalopathy (HIE) is a
syndrome that evolves during a period of days or weeks, and leads to
acute or subacute brain injury due to asphyxia. The diminishing of
References cerebral blood flow and reduced blood oxygenation lead to abnormal
anaerobic oxidation of glucose with the activation of inflammatory
1. MacLennan, A. H., et al. (2015). American journal of obstetrics and mediators leading to acidosis and apoptosis. The location and extent
gynecology, 213(6), 779–788. of the lesions may be identified by Magnetic Resonance Imaging
2. McMichael, G., et al. Molecular psychiatry 20.2 (2015): 176–182. (MRI) which is an efficient modality for assessing brain injury in
3. Cox-Limpens, K.E.M., et al. BMC neuroscience 15.1 (2014): 67. neonates and established their long time prognosis. The degree of
4. Ramos, P.S., et al. Molecular autism 3.1 (2012): 1.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 251
neonatal brain development is a factor of the extent of brain Clinical cases and summary results: We present the case of a 43 years
vulnerability to asphyxia, but other antepartum or intrapartum factors old women. She had a history of four normal pregnancies with normal
may influence the lesional patterns as described by MRI. deliveries and healthy children, and she has been diagnosed with
Materials and methods: Twenty-six neonates (15 male, 11 female) with Gilbert syndrome. She had an spontaneous singleton pregnancy. In
diagnosed HIE have been investigated by cerebral MRI in our center, week 13 + 5, we do the first trimester ultrasound, sowing a singelton
on a 1.5T machine between Jan 2013 and Dec 2015. The routine alive fetus, with a skull-rachis length 61.8 mm (normal for the
protocol of investigation included the following sequences: axial T2/ gestational age) and a nuchal translucency of 3.1 mm. It does’t have
PD SE, coronal 3DT1 FSPGR, DWI (EPI), paracoronal T1 IR, SWI. Several any morphological alterations. She do the combined screening, and
parameters were also noted, such as: gestation age, Apgar score, she presents a risk of neural tube defects 1/552.
intubation at birth, acid-base equilibria and other perinatal events. Genetics department notified for early scan in second trimester for an
The patients did not require sedation, and were examined with the elevated alpha fetoproptein (73.8 ng/ml). We make a new ultrasound
standard head coil. Eighteen patients were followed up to one year subjected in week 16 + 5 wherein we observed an alive fetus, suitable
and a clinical examination established overall condition. Writen at gestational age (PFE 151gr.) But in this ultrasound, we diagnosed
consent was obtained from the parents or legal guardian, depending an holoprosencephaly with agenesis of the corpus callosum, central
on the case, and medical ethics approval from the center’s board was cleft lip and cleft palate. The patient decided to undergo a legal
granted. abortion in week 17.
Clinical cases and summary results: The most common paterns of brain Conclusion: Alpha-fetoprotein in maternal serum has been the
injury in HIE were organised into these categories: focal spot-like primary screening test used to identify pregnancies at increased risk
white matter anomaly, vascular border lesions (watershed), basal of open neural tube defects at 15 to 18 weeks of gestation. A value
ganglia or brainstem, and generalised lesions. Gestation age is a main above 2.0 to 2.5 MoM is designated an abnormal result. If the
delineator of lesion location and extent, with full-term neonates elevation persists in a second analisis, the next step is to obtain a
showing lesions in the thalamus, posterior putamen, perirolandic specialized ultrasound examination to further assess whether a neural
cortex and watershed zones while preterm neonates developed tube defect, or other anomaly, is present.
lesions in the basal ganglia, thalamus, brainstem, cerebellum and the
periventricular white matter. Germinal matrix hemorrhage was
confirmed in two preterm neonates, with previos positive ultrasound.
Spot-like white matter lesions with no other concurring patterns were
593
found in five preterm and one full-term patients, and all showed a Neuromonitoring in neonatology
good outcome at one year follow-up. Single watershed lesions
showed a favorable outcome, and were found in two fullterm - differential diagnostics of par-
neonates. Four preterm and two fullterm neonates demonstrated a
diffuse involvement with poor prognostic. oxysmal events in premature
Conclusion: MRI is an invaluable tool in the confirmation of HIE with a
potential positive impact in managing the complications of hypoxic-
infants
ischemic brain injuries. Correct identification of the various imaging
patterns of HIE may show insight to the extent of the injuries as well D. Kostiukova, Ye. Shunko, T. Ivanova, T. Orlova, and
as a direct correlation to the long-term outcome. Although gestation L. Nikonova
age dictates predominantly affected areas, the correct morphological
assessment is the warranty of a complete and thorough diagnosis. National Children’s Specialized Hospital ‘‘OHMATDYT’’1, Shupyk
National Medical Academy of Postgraduate Education2, Kyiv,
Keywords: Neonatal hypoxic ischemic encephalopathy, MRI
Ukraine

Presenter: D. Kostiukova
570
Introduction: Paroxysmal events in premature infants often remain
Holoprosencephaly, diagnosis by unrecognized. Complete neuromonitoring provides differential diag-
nosis of paroxysmal conditions, timely treatment at the hospital,
alpha-fetoprotein following-up premature infants for implementation of a system of
early interdisciplinary intervention. To run a clinical and electro-
M. Urtasun, S. Garcı́a-Francés, A. Safont, M. Donazar, encephalographic diagnostics of paroxysmal epileptic and paroxys-
mal nonepileptic events (PNEs) in order to optimize treatment,
B. Pérez, N. Abián, B. Gastón, and C. Larrañaga neuromonitoring of premature infants risk groups of different
Servicio de obstetricia y ginecologı́a, Complejo Hospitalario de gestational ages.
Materials and methods: Prospective cohort clinical study included 78
Navarra, Pamplona, Navarra, España
infants of gestational age (GA) 24-36 wk. with paroxysmal events
aged 6 days to 3 months at the intensive care unit. Conducted clinical
Presenter: Maitane Urtasun and electroencephalographic differential analysis of paroxysmal
Introduction: Holoprosencephaly is a developmental defect of the epileptic events and PNEs using standard electroencephalography
embryonic forebrain that results from incomplete development and by the computer complex BRAINTEST, DX-systems. The duration of
separation of the midline central nervous system structures and has a the study ranged from 40 minutes to 6 hours according to the clinical
spectrum of presentations. It is commonly associated with midfacial features of paroxysmal states. Premature newborns were divided into
defects. The diagnosis is made by prenatal ultrasound. groups of GA: 24-27 wk, 28-31 wk, 32-33 wk., 34-36 wk. Conformity
The incidence is 1 per 10,000-15,000 birth Prognosis depends on the assessment of maturity bioelectrical activity of the brain was
degree of the malformation, severe cases are not compatible with life. performed according to the classification patterns of electrical activity
The clinical features are: some degree of intellectual disability or of the brain by Ellingson R. (A - to 30 wk, B -30-35 wk, C - 37 wk, D - 39
developmental delay, epilepsy, hydrocephalus, dystonia, movement wk)
disorder, autonomic dysfunction, and hypothalamic/pituitary dysfunc- Clinical cases and summary results: In the GA group of 24-27 wk. there
tion. The degree of patient care required generally differs based upon were 23% of children, the GA group of 28-31 wk.- 57% of children, the
the severity of the condition but multidisciplinary approach is the GA group of 32-33 wk. - 10%, the GA group GA of 34-36 wk. - 10%
best. Thanks to a timely conducted clinical and electroencephalographic
monitoring group GA of 24-27 wk. paroxysmal epileptic events were
252 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

detected to 55.5% of children, paroxysmal nonepileptic events - analyzed; 179 were hyperoxemia (PaO2 480 mm Hg). At an upper
44.4%; GA group of 28-31 wk. - paroxysmal epileptic events to 72.7%, alarm limit from 74% to 68%, tissue oximeter detected hyperoxemia
PNEe - 18.2%; GA group of 32-33 wk. - paroxysmal epileptic events to with sensitivity from 80% to 88% and specificity 23% and 12%
50%, PNEe - 50%; GA group of 34-36 wk. - paroxysmal epileptic events respectively.
to 66,6%, PNEe - to 33,3% . The clinical and electroencephalographic Conclusion: NIRS monitored crSO2 may also be useful for detection of
analysis of the risk of brain bioelectrical activity developmental delay hyperoxemia in neonates. At an upper limit of cerebral hyperox-
was revealed in GA groups of 24-27 wk., GA 28-31 wk., GA 32-33 wk. ygenation 68% NIRS can detected hyperoxemia with 88% sensitivity.
In GA groups of 24-27 wk. and GA groups of 28-31 wk. maximum
frequency abnormal patterns in the form of EEG seizures (over 50%), Keywords: Hyperoxia, neonates, oxygen, near infrared spectroscopy
transient epileptiform graphic elements of diffuse and focal
discharges were found. The GA group of 32-33 wk. had a high
frequency of EEG seizures (50%) and transient epileptiform graphic
623
elements according to EEG data. In the GA group of 24-27 wk. and 28-
31 wk. the highest percentage of hemorrhagic lesions (intraven- Neuroimaging and outcome of
tricular hemorrhage), periventricular leukomalacia and the combi-
nated brain lesions were revealed. In the GA group of 32-33 wk. the isolated fetal ventriculomegaly
highest incidence of hypoxic-ischemic encephalopathy was found.
Conclusion: The electroencephalography is necessary in electrophy-
P. Satodia1, I. Seso Blazic2, L. Farrall2, and S. Mukherjee2
siological methods of differential diagnostics of paroxysmal events in
1
premature infants.The clinical and electroencephalographic analysis NICU, and 2Obstetrics and Gynaecology, University Hospitals
demonstrated a link between low GA and high risk of developmental Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United
delay of bioelectrical brain activity, confirming the need to monitor Kingdom
ontogenetic markers of brain bioelectrical activity.
Keywords: Neonatal seizures, premature infants, paroxysmal none- Presenter: Prakash Satodia
pileptical events, electroencephalography
Introduction: Fetal ventriculomegaly is defined as ventricular atrial
width 10.0 mm across the atrium of the posterior or anterior horn
undertaken at any gestation by ultrasound imaging (1). It is
603 considered isolated if there are no associated fetal abnormalities.
Neurodevelopmental outcomes depend on severity of ventricular
The possibilities of nirs for the enlargement, underlying brain malformations and the presence of
other associated body malformations. Fetal magnetic resonance
detection of hyperoxemia in imaging (MRI) is being increasingly used to guide further manage-
neonates ment. Value of postnatal MRI in isolated mild ventriculomegaly
confirmed by fetal MRI is unclear. The study aim was to evaluate the
fetal and postnatal neuroimaging and short term outcome in a cohort
D. Sankavets and T. Gnedko of isolated fetal ventriculomegaly in our hospital.
Materials and methods: All women with fetal ventriculomegaly
National research and Practical Center ‘‘Mother and child’’, NICU detected on antenatal ultrasound scan from 19 weeks of gestation
department, Minsk, Belarus onwards (January 2008 to May 2015, 7 years & 5 months) were
identified from fetal medicine database. The ventriculomegaly was
Presenter: D. Sankavets categorized into the following groups: mild ventriculomegaly 10-
12 mm; moderate ventriculomegaly 12-15 mm; and severe ventricu-
Introduction: Everyday neonatologists face a difficult task in balancing lomegaly 4 15 mm (2). All cases were followed up with additional
the risks of too little oxygen with those associated with excessive antenatal ultrasound scans and/or MRI. Retrospective review of
oxygen use. Measurements of the arterial oxygen partial pressure medical charts and electronic medical records was carried out and
(PaO2) are considered the gold standard for assessing oxygenation. data were collected on labour and delivery details, postnatal
However, this technique requires invasive catheters. In clinical examinations, investigations and short term neurodevelopmental
practice pulse oximetry provides immediate and non-invasive data follow up.
about oxygenation and is now part of the standard of care for Clinical cases and summary results: Out of 51 cases, 16 had non-
neonates receiving supplemental oxygen. The main physiological isolated ventriculomegaly & were excluded. 35 cases had isolated
limitation of pulse oximetry is the inability to detect hyperoxemia in ventriculomegaly (21 mild, 5 moderate & 9 severe). 32 were live births
the higher SpO2 range due to the shape of the oxygen dissociation (M:F=18:14), 2 were MTOP & 1 was stillbirth.
curve. Another non-invasive technique as Near-Infrared Spectroscopy 18 had fetal MRI (7 mild, 3 moderate & 8 severe). In 7 cases (1 mild, 1
(NIRS) may also help to detect conditions associated with moderate & 5 severe) fetal MRI showed additional findings (absent
hyperoxemia. corpus callosum, dilated 3rd ventricle). In 11 cases fetal MRI did not
Materials and methods: We investigated the possibility of using NIRS show additional findings compared to ultrasound.
for detection of hyperoxemia in neonates. In addition to standard Postnatal follow up was available in 30 cases up to 1 year of age. Of
monitoring of vital functions, carried out the measurement of 21 mild ventriculomegaly cases, 14 resolved in utero & had normal
regional cerebral oxygenation (crSO2) by NIRS with the INVOS development. Of rest 7 cases, 1 was stillbirth, 2 remained mild, 2 had
5100C tissue oximeter. Every time an arterial blood sample was normal postnatal US/MRI, 1 had external hydrocephalus at 11 months
taken in conditions of normothermia, the crSO2 readings were & 1 had cerebral palsy at 6 months. Postnatal US and/or MRI was
recorded at the moment the arterial blood was drawn into the syringe abnormal in 12 (3 mild, 3 moderate & 6 severe) out of 23 cases (13
for analysis. Blood gas analysis was performed immediately after mild, 3 moderate and 7 severe). All babies with severe ventriculome-
sampling in Radiometer ABL 800 blood gas analyzer. Statistical galy had delayed development at up to 1 year of age.
analysis was performed using the MedCalc. Conclusion: Fetal MRI provides additional information mainly in cases
Clinical cases and summary results: Eighty-one neonates (69 term/12 of isolated severe ventriculomegaly. Mild isolated fetal ventriculome-
preterm) with a median GA of 37 (range 30-41) weeks and birth galy usually resolves and has normal short term postnatal outcome.
weight median of 3140 (range 1220-4770) grams were enrolled. All
measurements were carried out during the first week of life. All Keywords: Fetal MRI, Neurodevelopmental Outcome
neonates were mechanically ventilated, 24 of them needed high
frequency ventilation. In total 321 blood gases samples were
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 253
Introduction: Survival of preterm infants has been improved over the
742 last decades with implementation of sophisticated respiratory
Dandy-Walker complex: accord- support modalities and other therapeutic strategies. But perinatal
brain damage with adverse neurodevelopmental outcome still affects
ing to a clinical case a considerable number of these infants. Hypoxia, hyperoxia and
hemodynamic instability during the first days of life are important
etiological factors of brain damage. Most of modern monitoring
N. Abián Franco, B. Pérez Munárriz, S. Garcı́a Francés, techniques of cerebral condition do not provide continuous informa-
M. Urtasun Murillo, J. Barrenetxea Arrinda, B. Gastón tion on the perfusion and oxygenation of the brain. Near infrared
Moreno, A. Safont Gastón, and C. Larrañaga Azcárate spectroscopy (NIRS) oximetry enables non-invasive estimation of
regional tissue haemoglobin oxygen saturation.
Obstetric and Gynecology Dept., Complejo Hospitalario de Navarra, Aim: To investigate regional tissue oxygen saturation in preterm
Pamplona, Spain newborns with different grades of PIVH
Materials and methods: This study contains analysis of 56 preterm
Presenter: N. Abián Franco newborns with gestational age (GA) 25-36 wks (32 [28; 34]) as a part
of larger study comprising 99 babies of various GA in NICU at Moscow
Introduction: The importance of ultrasound scan and magnetic Municipal Hospital 24. For measuring the regional oxygen saturation
resonance imaging (MRI) for the prenatal diagnosis of central nervous we used Equanox Model 7600 device. Neonatal sensors were placed
system (CNS) abnormalities is described in this clinical case presented. over the forehead for cerebral regional saturation (cStO2) and over
This sort of medical problem affects multiple atmospheres such as the liver in the right upper quadrant of anterior abdominal wall for
economical, political and social, and also requires an adequate and somatic regional saturation (sStO2). To investigate the balance
individualized management. between oxygen delivery and oxygen consumption, we used the
Clinical cases and summary results: A 25 year-old woman from relative cerebral fractional tissue oxygen extraction (cFTOE) as a ratio:
Morocco, G3P0C2, with a healthy son and another son death from a (SaO2-cStO2)/SaO2. Statistical analysis was performed using Statistica
cerebral malformation, consults for the first time at 31st week 8, data are represented as Me [LQ; UQ].
gestation with no other previous examinations. An ultrasound is Clinical cases and summary results: All preterm newborns were divided
practiced, estimating fetal weight in a 50 percentile, anterior placenta into 2 groups depending on presence/absence of high grade peri-
and normal amniotic fluid. However, and taking into account the intraventricular hemorrhage (PIVH) (Tab.) In group I 15 newborns
difficulty of this technique due to maternal obesity, a this point a CNS (30,6%) didn’t need any respiratory support, 10 (20,4%) received
malformation in the posterior fossa is suspected. The ultrasound scan diffuse O2, 16 (32,7%) - continuous positive airway pressure (CPAP), 6
was repeated in 32nd week gestation, confirming the suspicion of a (12,2%) - assisted mechanical ventilation (IMV) and 2 (4,1%) - high
CNS malformation, consisting of cuatricameral hydrocefalus with a frequency oscillatory ventilation (HFOV). In group II all patients
19 mm left lateral ventricle and 17 mm wright one, 15 mm of cavum received respiratory support: CPAP - 2 neonates (28,6%), IMV - 3
and dilated anterior horns. The cortex measure was 6 mm and (42,9%) and HFOV - 2 (28,6%).
posterior fossa 25 mm, which is extended to the fourth ventricle and In patients with PIVH II-III cStO2 values were significantly lower than
observing a small cyst on it. Cerebellum defined as hypoplasic and in patients without PIVH (F (1,54) = 11,958, p=0,001).
detailing the absence of the vermix. All this elements considered, the At the same time the cFTOE values in group II were significantly
final diagnosis was indeed Dandy-Walker Complex. Afterwards, an higher than in group I (F (1,54) = 4,978, p=0,03). (Pic.)
amniocentesis was performed (results in process) and also a MRI in Evaluation of somatic oxygenation depending on PIVH grade showed
order to try to specify the fetal prognosis as precisely as possible. As a significant reduction in sStO2 values in high grade PIVH infants in
matter of fact, the MRI detected, furthermore, agenesis of the corpus comparison with PIVH 0-I group (F(1,48)=13,231, p=0,0007
callosumand and a diffused supra-infratentorial encephalic atrophy. Conclusion: Cerebral StO2 monitoring could be an important part of
Conclusion: The patient applied for the voluntary termination of the brain oriented protective strategy, preventing deleterious
pregnancy, which was accepted by the appropriate committee. imbalance between oxygen delivery and consumption.
Foeticide and subsequent iterative cesarean section were proceeded A decrease of cFTOE suggests a decrease of oxygen extraction of the
smoothly. Prenatal diagnosis of Dandy-Walker Complex is substan- brain because of less use of oxygen or a constant oxygen
tially based on ultrasound scan. The MRI contributes to the accuracy consumption of the brain with an increased oxygen delivery to the
of the vermix integrity definition, which actually represents the most brain. It might be because of the higher speed of cerebral blood flow
crucial parameter for fetal neurological prognosis. and imperfection of its autoregulation.
Keywords: Dandy-Walker Complex. Posterior fossa malformations. Keywords: NIRS, preterm neonates, PIVH, cerebral tissue saturation
Central Nervous System malformations. Ultrasound scan and mag-
netic resonance imaging for prognosis

745
Regional oximetry in preterm
neonates in NICU
O. Grebennikova1, V. Abalova2, A. Zavadenko1, M.G.
Degtyareva1, M. Medvedev1, M.V. Degtyareva1, and S.
Rogatkin1
1
Neonatology Dept., N.I. Pirogov Russian National Research Medical
University, Moscow, Russia, and 2NICU, Moscow Municipal Hospital
24, Perinatal Center, Moscow, Russia

Presenter: Olga Grebennikova

254 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

were classified in two groups depending of whether they had (1) a

761 patent ductus arteriosus (PDA) or (2) a non-significant (nPDA) or
Assessment of oxygen extraction closed ductus. Cerebral oxygen extraction fraction (OEF) was
calculated using the relation: OEF (%) = 100*(SaO2-ScO2)/SaO2.
in cerebral tissue in preterm Statistical analysis: Variable description by mean (+/- SD) or median
(range), relation description by linear correlation analysis and group
infants using neonatal NIRS comparison by t-test
Clinical cases and summary results: At total 10 preterm infants (4F/6M,
device 26-30 gestational weeks, birth weight 880-1790 g, postnatal age:
mean 12 days and range, 1-25 days). At the time of cerebral NIRS
S. Goudjil, M. Nourhashemi, E. Carpentier, E. Haraux, exploration, 5 infants in 10 had a completly closed ductus while the 5
E. Caron-Lesenechal, L. Barcat, F. Moreau, remaining infants had a PDA. In nPDA group ScO2 was 78.4% +/- 13
nPDA group vs 69.7% +/ 8.4 in PDA group. The OEFwas positively
M. Mahmoudzadeh, A. Leke, F. Wallois, and G. Kongolo related with the left atrial-to-Aorta root diameter ratio (coeff=18.1,
Pôle Couple Femme Enfant, NICU, GRAMFC Inserm U1105, University r=0.39, p=0.04) a classical criterion of ductal shunt severity. Two
Hospital of Amiens-Picardie, France infants had EEG anomalies in PDA group and 3 had a grade IV
intraventricular hemorrhage. In the group nPDA two patients had EEG
anomalies, in whom one developed leucomalacia lesions
Introduction: Monitoring oxygen metabolism in cerebral tissue is of
subsequently.
relevance for the understanding mechanisms of complications such
Conclusion: NIRS belongs to new generation techniques for non-
as intraventricular hemorrhage and leucomalacia. Optical techniques
invasive monitoring of cerebral metabolism of oxygen. Our study
with near infrared spectroscopy (NIRS) allows assessment of oxygen
found that NIRS is a safe and feasible technique for preterm infants.
consumption by non-invasive approach. In this study, we present
Cerebral oxygen extraction slightly greater in infants in PDA group
results of measurements performed in a 10 preterm infants series with
than those in nPDA group. Appropriate models based on physiologic
a neonatal NIRS device.
mechanisms are needed for a better interpretation of data from these
Materials and methods: The cerebral tissue oxygen saturation (ScO2)
new techniques. Larger populations are necessary before we to
was measured by NIRS optical device (INVOS 3500, Covidien) and
confirm definitively the findings of this study.
arterial oxygen saturation by pulse oxygen oxymetry. Other study
variables were: Gender, Apgar score, respiratory support data, arterial Keywords: NIRS, cerebral tissue saturation, neuro-hemodynamics,
blood gases, cranial ultrasound findings, functional echocardio- cerebral oxygen extraction
graphic data and arterial blood pressure. The infants of this study
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 255

579 580
Evolution of pregnancy in a Colposcopic-cytological parallels
patient with multiple sclerosis in pregnant women with different
according to a case intergenetic intervals
J. Barrenetxea, N. Abián, B. Perez, M. Donazar, A. Safont, L. Tumanova, O. Kolomiyets, G. Grebinichenko, and
M. Urtasun, and C. Larrañaga N. Badzyuk
Complejo Hospitalario de Navarra, Pamplona, Spain SI ‘‘Institute of Pediatrics, Obstetrics & Gynecology of National
Academy of Medical Sciences of Ukraine’’, Kyiv, Ukraine
Presenter: J. Barrenetxea
Presenter: O.Kolomiyets
Introduction: Multiple sclerosis (MS) is an immune mediated
demyelinating disease of the central nervous system characterized Introduction: More and more women want to realize their reproduc-
by relapses and remissions of neurologic deficits. MS is a disease that tive function after 30 years of age - for the first time or with prolonged
affects more women than men by a ratio of 2:1. Pregnancy seems to intergenetic interval (more than 10 years between deliveries). The
decrease de disease activity, while the postpartum period is importance of this problem is supported by statistic data: portion of
associated with an increase in MS activity. Overall, taking into a women with prolonged intergenetic interval in the total amount of
count de protective effect during pregnancy and the increased risk in pregnant women in Ukraine was 1.98% in 1987, 20 years later, in
the early postpartum, the net effect is that there is no increase in the 2007, it increased to 10.7% and in 2010 - to 12.2%. The optimal
risk of exacerbation. interval between births is considered to be around 3-5 years. It is well
Materials and methods: A 35 years old women (GOP0) with gestational known that pregnancy with the inherent physiological immunodefi-
desire was diagnosed of premature ovarian failure in 2006 (at the age ciency has an unfavourable - stimulating effect on the clinical course
of 26). Diagnosed of MS in 2009 with dysautonomic disorders of benign and premalignant diseases of the cervix, accelerating
(Neurogenic bladder treated by sacral neuromodulation with correct evolution of cancer.
control of the disease). No other neurological disturbances. Gestation Materials and methods: 162 pregnant women from 3 groups were
achieved by assisted reproductive technologies. examined: group 1 - 60 patients with prolonged intergenetic interval,
Clinical cases and summary results: In the 22nd gestational week the group 2 - 60 nulliparous women, older than 30 years; group 3 - 42
patient starts to show more dysautonomic disorders, this time she patients with the optimal intergenetic interval. Examination included
starts with defecatory disturbances (defecatory emergency). colposcopic and cytological methods. Colposcope Olympus OCS 500
Following consultation of de Neurologist, no corticosteroid treatment was used. For data description and analysis, we used classification of
is settled. There is no sensory disturbances nor motor disturbances. colposcopic terminology adopted in Rio de Janeiro in 2011.
In te 39 + 2 gestational the patient starts with regular contractions Specimens were collected by brush and placed in a vial with
every 4-5 minutes and with cervical modifications. The process of preservative fluid. Automated, semi liquid-based cytology was then
labor goes with no disturbances. The aplication of a vacuum is used as cytological method. The aim of the study was to determine
decided for the expulsive due to inadequate descent of the the relationship between the character and the degree of colposcopic
presentation once the complete dilatation is achieved and after and morphological pathology of the cervix in pregnant women from
2 hours of maternal struggles. Mild postpartum uterine atony that is different groups.
resolved with uterine massage and the administration of 1000 Clinical cases and summary results: During colposcopy normal findings
micrograms of intrarectal Misoprostol. Correct puerperium with no (multilayered squamous epithelium) were in 56.7% of women in
neurological disturbances and no more outbreaks of the MS. group 1, in 58.3% in group 2, and in 66.7% in group 3; benign cervical
Conclusion: Multiple sclerosis is a neurological pathology that can lesions (ectopy, gland openings, nabothian cysts, deciduosis) were
affect women of childbearing age. During pregnancy it seems to found in 23.3% of patients in group 1, in 26.7% in group 2 and in
decrease the disease activity, while the postpartum period is 28.6% in group 3. Premalignant diseases of the cervix during
associated with an increase in MS activity. Acute MS relapses during colposcopy were diagnosed in 18.3% of cases in group 1, in 15.0%
pregnancy can be treated with intravenous glucocorticoids, which are and 4.7% in groups 2 and 3 respectively. In one 44 year old patient
not teratogénic. In this case no treatment was needed, and the from group 1 (1.7%) an invasive cancer of the cervix was detected by
pregnancy outbreak had a favorable resolution as the pregnancy itself. colposcopy and confirmed by cytology. Normal cytological findings
were in 58.3% of women from group 1, in 60.0% from group 2, and in
Keywords: Multiple Sclerosis, Dysautonomia, pregnancy outbreak
71.4% from group 3. Benign cytological changes and ASCUS features
were in 21.7% of patient in group 1, 25.0% in group 2 and in 26.2% in
group 3. Premalignant diseases (LSIL + HSIL) were diagnosed in 18.3%
of patients in group 1, in 15.0% and 2.4% in groups 2 and 3
respectively.
Conclusion: The rate of premalignant diseases of the cervix was
significantly higher in women with prolonged intergenetic interval,
then with optimal: 18.3% vs. 4.7% by colposcopy (p50,05) and 19.9%
vs. 2.4% by fluid cytology (p50,01).The similar rate of premalignant
diseases, found in women with prolonged intergenetic interval and in
nulliparous women older than 30, could be probably explained by
reduction of papillomavirus self-elimination with age, and thus
increase of the risk of precancer and cancer.
Keywords: Pregnancy, prolonged intergenetic interval, cervical
diseases
256 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

581
582
Rupture of an hemi- uterus with a Deficiency of multiple acyl -coa
rudimentary horn on a 15 weeks dehydrogenase or glutaric acid-
pregnancy uria type II
I. Reis, M. Martins, C. Rodrigues, C. Araújo, S. Ferreira,
M. Torres1, L. Geronès1, J. Herrero1, M.C. Cèspedes1,
L. Sousa, and T. Teles
F. Camba1, JA. Arranz2, M. del Toro3, and F. Castillo1
Department of gynaecology and obstetrics, Centro Hospitalar de 1
Neonatology Intensive Care Unit, Hospital Maternoinfantil Vall
Entre o Douro e Vouga, Santa Maria da Feira, Portugal
d’Hebron, Barcelona, Spain, 2Metabolic Disease Dept., Hospital
Maternoinfantil Vall d’Hebron, Barcelona, Spain, and 3Pediatric
Presenter: I. Reis
Neurology Section, Hospital Maternoinfantil Vall d’Hebron, Barcelo
Introduction: Congenital anomalies of the uterus are mostly assymp-
tomatic and therefore its incidence is difficult to determine. Presenter: MIREYA TORRES MOLINER
An hemi-uterus is defined as the unilateral uterine development; the
contralateral part could be either incompletely formed or absent. Introduction: The deficiency of multiple acyl CoA dehydrogenase or
Clinical cases and summary results: A 30-year-old primipara, 15 weeks glutaric aciduria type II is a change in the oxidation of fatty acids and
pregnant, resorted to the Emergency department mentioning amino acids. The autosomal recessive inheritance is caused by
abdominal pain with about 2 hours of evolution. As relevant mutations in genes ETF- A, ETF-B, and ETF-DH, encoding the alpha
background, she had been diagnosed with an hemi-uterus of and beta subunits of the electron transfer flavoprotein (ETF), and ETF-
normal characteristics and a rudimentary horn on the right. coenzyme Q- oxidoreductase. It is a rare disease, presenting a
The first trimester ultrasound (about 2 weeks before) showed an clinically heterogeneous phenotype, ranging from causing serious
evolutionary pregnancy with a fetus of 13 weeks and 4 days located neonatal deaths during the first weeks of life, to a mild disease of
in the right uterine horn. She was informed about the risks of keeping childhood or adulthood with intermittent episodes of metabolic
this pregnancy, and it was proposed to terminate it, however, she decompensation.
declined that option. Clinical cases and summary results: We present two cases of severe
At admission to the Emergency department she denoted very intense neonatal form confirmed by genetic diagnosis. Both have metabolic
abdominal pain, with no history of trauma or blood loss. Ultrasound acidosis, hyperammonemia, hypoglycemia and hypotonia since the
showed a fetus with no cardiac activity. Haemoglobin level was 10 g/ first hours of life; one with multiple organ failure and irreversible brain
dl on the blood count. During the two hours following the damage from birth for whom the limitation of therapeutic efforts is
observation, a rapid deterioration of her general condition was decided jointly with the family after seven days of life. The second
observed, with hypotension and tachycardia, and the ultrasound case presents as a peculiarity, injuries consistent with glutaric aciduria
revealed intra-abdominal fluid content in large quantities. type I based on neuroimaging, is stable in the supportive care until
It was decided to perform an emergent laparotomy. The fetus and the ten weeks of life, presenting metabolic decompensation in the
amniotic sac were observed in the abdominal cavity, with a significant context of respiratory infection with respiratory and progressive
blood loss and rupture of the uterine hemi-cavity. The first gasimetry neurological impairment for which comfort measures are taken and
during surgery showed a level of haemoglobin of 4 g/dl. the patient dies.
A conservative approach was performed, with a metroplasty on the Conclusion: The glutaric aciduria type II is a rare life-threatening
right uterine horn, preserving the normal hemi-uterus. disease. The treatment is supported by a diet rich in carbohydrates,
Clinical evolution was satisfactory and she was discharged from the fats, proteins, and restrictive supplementation altered enzyme
hospital seven days after surgery. cofactors. The importance of the diagnostic confirmation in relation
Conclusion: Although pregnancy outcomes have been reported to be to genetic counseling should also be noted.
close to normal, some women do develop complications. This case
Keywords: The deficiency of multiple acyl CoA dehydrogenase or
highlights the significance of uterine malformations during preg-
glutaric aciduria type II
nancy and the importance of prompt and correct diagnosis to
minimize life threating events.
Keywords: Uterine rupture; rudimentary horn
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 257

672 (CLINICAL CASE)

MASSIVE Pulmonary embolism in
third trimester of pregnancy
M. Kiseli1, G.S. Caglar1, N. Ogan2, A.Y. Gursoy1, H. Yilmaz3,
S.D. Cengiz1, and R. Pabuccu1
1
Department of Obstetrics and Gynecology, Faculty of Medicine, Ufuk
University, Ankara, Turkey, 2Department of Chest Diseases, Faculty of
Medicine, Ufuk University, Ankara, Turkey, and 3Department of
Anesthesiology, Faculty of Medicine, Ufuk University, Ankara, Turkey

Presenter: Mine Kiseli

Introduction: Pregnancy is a hypercoagulable state with a high risk of
tromboembolic complications. Pulmonary embolism (PE) is a leading
cause of maternal mortality in developed countries, contributing to
the death of approximately 2 women per 100,000 live births each
year. Cardiovascular collapse associated with a massive PE may
require immediate aggressive intervention to save the mother and
fetus. Management of delivery deserves attention and should be
attended by an experienced multidisciplinary team. Here we present
management of a case of massive pulmonary embolism at 35 weeks
of pregnancy suffering from trombocytopenia.
Clinical cases and summary results: 31 year-old woman admitted with
left inguinal pain at 35 weeks of pregnancy. Ultrasonography revealed
live fetus with normal amniotic fluid. Due to left leg swelling and pain,
Doppler venous ultrasonography was planned. An acute thrombus in
left main femoral vein and subacute thrombus in the left deep
femoral vein was demonstrated. Therapeutic low molecular weight
heparin and leg elevation was initiated. Emerging shortness of breath
and decrease in oxygen saturation and hypoxia/hypocarbia in arterial
blood gas analyses suggested a PE. Echocardiography revealed right
ventricular dysfunction. Emergency cesarean section was planned and
2300 gr healthy newborn was delivered. Postoperatively, massive
thromboembolic lesions were demonstrated in the pulmonary
angiography with computerized tomography. During the early
postoperative period, the platelet number decreased up to 47000
k/mL and intravenous heparin could not be started until postoperative
24 h. Because of the refractoriness to the heparin infusion (no-increase
in aptt), warfarin treatment was started at the second day. On
postpartum 17th day, the patient was discharged with warfarin
therapy.
Conclusion: Treatment of massive PE in patients with hemodynamic
compromise especially during labour and delivery remains contro-
versial. In the case presented here severe thrombocytopenia hinders
thrombolytic therapy and laboratory refractoriness to heparin futher
limited the treatment options. Even if emergent cesarean section
complicates postoperative management in third tirmester massive PE,
none of the treatment options assure fetal and maternal well-being.
Keywords: Pulmonary embolism, heparin
258 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

748 PERINATAL NUTRITION - 009

Healthy live-born child with tris- High osmolality of fortifier
omy 22: when the amniotic cells human milk adding with vitamin
tell the truth? (ADEC)
W. Slimani1, A. Jelloul1, M. Kouira2, M. Said3, A. Saad1, V. Rigourd1,3,5, I. Dridi Brahimi2, S. Smii3, C. Gobeaux2,
and S. Mougou-Zerelli1 H. Razafimahefa4, F. Quetin5, H. Hovanishian5, Z. Assaf5,
1
Laboratory of Human cytogenetics, Molecular Genetics and Biology
A. Giuseppi5, A. Lapillonne5, M. Granier4, and R. Serreau3
of Reproduction, Farhat Hached University Teaching Hospital, 1
Lactarium Régional d’Ile de France, Hôpital Necker, Paris, France,
Sousse, Tunisia, 2Unit of Reproductive Medicine, Farhat Hached 2
Service de Diagnostic Biologique Automatisé., HUPC, site Cochin,
University Teaching Hospital, Sousse, Tunisia, and 3private radiolo- Paris, France, 3Réseau Médical, France, 4NICU, Hôpital Corbeil,
gist, Sousse, Tunisisa France, and 5NICIU, Hôpital Necker, Paris, France

Introduction: Trisomy 22 (T22) is a rare chromosomal disorder Background: Fortifying human milk with energy, protein, mineral,
characterized by the presence of an extra copy of the chromosome vitamins AEDC and iron is essential in order to improve the infant’s
22. This case is not compatible with life; in fact, it is associated with growth. In order to reach nutritional purposes, human milk has to
early spontaneous miscarriage or death after birth unlike mosaic reach 2 g/dL. In 2013, Lafeber states that when women’s milk is
trisomy 22. fortified up to 2 g/dL, it may increase it’s osmolality up to 500 mosm/
Materials and methods: Here we report on a case of mosaic trisomy 22 kg. He also said to be care fulfull when adding a drug or vitamins into
prenatally diagnosed on amniotic cells at 17 weeks of gestation. the milk.
Conventional and molecular cytogenetic analysis of the fetal and Aim: We studied for the first time the impact on a women’s fortified
parental cells were performed simultaneously. milk osmolality, when adding multivitamins (ADEC).
Clinical cases and summary results: Amniocentesis showed de Novo Materials and methods: The osmolality of 36pasteurized fortified
supernumerary chromosome marker (SMC) present in mosaic. R- human milk samples was measured with an advanced micro-
banding allowed classifying this SMC as a chromosome 22. FISH osmometer model (FiskeÕ Modèle 210 (FISKEÕ ASSOCIATES,
Analysis performed on amniotic cells confirmed this result. The Norwood, Massachusetts, USA). The method was the freezing point
proband’s karyotype is mos 47, XY, +mar .ish der 22 (WCP 22*3) [6]/46, measurement with a precision of 1 mosm/kg. Measures were made in
XY [13]. At 21 weeks of gestation, ultrasound showed no morpho- triplicates. The amount of milk required as a solvent to maintain
logical abnormality except mild bilateral pelvicalyceal dilatation. osmolality below 500mosm/kg was then determined.
Despite the presence of an extra copy of chromosome 22 in 31, 5% of Results: The 2mL fortified human’s milk reached up to 750mosl/kg
cells, the fetus showed none of the T22 features or congenital when the 0.3ml of multivitamins ADEC was added. The osmolality
malformations.: Interestingly, postnatal Karyotype on lymphocytes decreased proportionately with the solution dilution. It is only with
was normal. 20 mL of milk that the osmolality comes down to its initial rate
Conclusion: Nevertheless, a karyotype on fibroblasts is necessary to 430mosm/kg. Stronger the milk’s fortification is, the bigger impact it
confirm the prenatal mosaicism found in the amniotic fluid. Indeed, has on the milk osmolality.
certain chromosomal abnormalities cannot be seen on the blood cells Conclusion: New nutritional recommendations for premature infants
but may be present in other tissues such as skin. Several studies are needed. In the meantime, when the fortified milk intake is under
emphasize the importance of fibroblasts exploration for better 20 mL, it is preferable to extend parenteral intakes with fat-soluble
diagnosis of mosaic trisomy 22. Our case confirm that amniotic fluid vitamins. Also, we should use enriched women’s milk as fortifier and
cells alone are not sufficient to predict mosaic trisomy 22 outcome. be cautious with fortification ‘‘à la carte’’ or when adding drugs and
electrolyte solutions.
Keywords: Mosaic trismoy 22, Amniocentesis, ultrasound, FISH
Keywords: Human milk osmolality, human milk fortifier, vitamin D,
preterm, nutrition

S.Mougou-Zerell
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 259
Conclusion: A multiprofessional team was able to support and
encourage exclusive breastfeeeding in almost all the patients, a
fundamental starting point to keep breastfeeding for at least 6 weeks.

Keywords: Breastfeeding, Perinatal Nutrition

110
Impact of probiotic treatment on
breast milk jaundice
N Köksal, O Bağcı, H Ozkan, _I varal, and P Dogan
Figure 1. Osmolality (mosm/kg H2O) of human milk with or without Uludag University Faculty of Medicine, Department of Pediatrics,
different process of fortification unfortified milk (HM), HM with a 4%
Division of Neonatology, Bursa, Türkiye
human milk fortified (HMF) containing whole protein, dextrin and
mineral (suppletine, milupafrench) and 0.5% of a exclusively whole
protein fortified (HMF 1) and anotherone with 4% HMF and 0.5% of a Introduction: Breast milk jaundice (BMJ) is the most common cause of
exclusively whole protein fortified (HFM2). Different volume (2, 6, 12 prolonged jaundice and develops in 2-15% of all newborns. Many
and 20) of each HM was added with vitamin D (0.3ml). theories concerning its pathogenesis have been formed, however
mechanisms leading to BMJ have not been yet fully understood.
There are no treatment options for BMJ, thus it continues to be a
concerning situation for both families and pediatricians. Recent
studies have suggested that breast milk microbial content and
050 infantile intestinal flora may play a role in development of BMJ. Aim of
this study is to investigate the relationship between BMJ and
Breastfeeding support on the microorganisms in breast milk and infantile gut, and the impact of
tendencies of breastfeeding rates probiotic treatment on jaundice.
Materials and methods: This study includes term and near-term babies
in the hospital Estadual da Mâe - who applied to Uludağ University Neonatology outpatient clinic with
prolonged jaundice and diagnosed as breast milk jaundice, and is
Baixada Fluminense - Rio de designed randomized and prospectively. With 77 babies with breast
milk jaundice and 35 healty babies as control group, a total of 112
Janeiro - RJ, Brazil in 2015 babies are enrolled in the study. Probiotic treatment was applied to
37 of jaundice patients for a week. Quantitative DNA measurement of
Lactobacillus rhamnosus, Lactobacillus gasseri, Lactobacillus plantorum,
A. Cunha, F. Aguiar, F. Melino, S. Teixeira, M. Batista, V.
Bifidobacterium longum, Bifidobacterium bifidum and Bifidobacterium
Tavares, V. Lira, and A. Muniz adolescentis species was performed in breast milk and fecal samples
Hospital Maternidade Terezinha De Jesus, Hospital Estadual Da Mãe of all patients at application and once more in fecal samples of
patients with jaundice a week later. Breast milk and fecal microbial
- Mesquita - RJ - Brazil
content, impact of probiotic treatmet on breast milk and fecal
microbial content, bilirubin levels, rate of decline in bilirubin levels,
Introduction: Breast feeding is fundamental for the babýs health. weight gain and fecal microbial content was compared among
Today, it is advised to discharge patients on a regime of exclusive groups.
breast feeding. The Hospital Estadual da Mãe has this policy with all Clinical cases and summary results: Patients with breast milk jaundice
the women, including the vaginal births and the cesarean section, had significiantly lower amounts of L. rhamnosus, L. gasseri, L.
6688 in 2015, with a 24% of cesarean rate. plantorum, B. longum and B. bifidum in breast milk as well as
Materials and methods: A special team, called ‘‘Breast Feeding Support significantly lower amounts of L. gasseri, L. plantorum and B. bifidum in
and Incentive Commission - Mesquista Regional Complex - Maternity fecal samples compared to control group (p=0.05). Additionally, time
and Womeńs Clinics’’, including obstetrician, nurses, physiotherapist, for resolution of jaundice was significantly shorter in probiotic
nutritionist, pediatrician, phonologist and psychologist was consti- treatment group (p50.05). Weight gain was also significantly higher in
tuted to support the patients that have delivered in the Hospital probiotic group.
Estadual da Mãe, Mesquista, Rio de Janeiro, RJ, Brazil. The place is a Conclusion: There is growing evidence that breast milk microbial
very large one, with 3 500 000 inhabitants and 11 counties. The content and infantile intestinal flora may play a role in development
maternity is reference for low risk pregnancy and has 70 beds for of jaundice. Reduced amounts of breast milk and fecal probiotic
mothers and 8 intermediate neonatal care. The exclusive breast bacteries in patients with jaundice, and reducing effect of probiotics
feeding rate is assessed at different moments with different on bilirubin levels and duration suggest that probiotic replacement
populations: at the discharge, at the return 6 weeks later (from the may be a treatment option for babies with breast milk jaundice.
group of our inner patients and outer ones, with and without prenatal Further investigation is required for determination of ideal content,
care). There is some exclusion criteria such as fetal death, abortions treatment duraiton and dose of probiotics in breast milk jaundice.
and HIV positive patients.
Clinical cases and summary results: In the group of hospital discharge,
Keywords: Breast milk jaundice, probiotic
the exclusive breast feeding rate was 98.93%, although only 78.97%
had joined the discharge group, when they receive the final
instructions. In this same group when they came back 6 weeks
after birth, the rate was 88.16% if they were cared in our hospital
during the prenatal period.
111 Abstracts - Poster
260 J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Impact of breast milk microbial levels with oxytocin, prolactin, and noradrenalin levels in order to
examine the effect of reflexology, which is performed on hypophysis
content and infantile intestinal and reproductive organs and lumbosacral area in the early
postpartum period, on the lactation hormones.
flora on development of breast Materials and methods: This study was conducted at Celal Bayar
milk jaundice University Health High School and Hafsa Sultan Hospital Ward of
Obstetrics and Gynecology. A questionnaire form comprising the
information about the sociodemographic, pregnancy and delivery
O Bağcı,N Köksal, H Ozkan, I Varal, and P Dogan backgrounds and State and Trait Anxiety Scale were applied to the
control group comprising 30 people and the reflexology applied
Uludağ University, Faculty of Medicine, Department of Pediatrics, group comprising 60 people (hypophysis and reproductive organs in
Division of Neonatology, Bursa, Türkiye the 1st group and lumbosacral in the 2nd group) and prolactin,
oxytocin and noradrenalin levels in the collected blood of these
Introduction: Breast milk jaundice (BMJ) is the most common cause of groups were measured using Elisa method.
prolonged jaundice and develops in 2-15% of all newborns. Many Clinical cases and summary results: There was not any statistically
theories concerning its pathogenesis have been formed, however significant difference between the experimental groups 1 and 2 and
mechanisms leading to BMJ have not been yet fully understood. the control group in terms of sociodemographic, fertility features,
There are no treatment options for BMJ, thus it continues to be a body mass index and visual analog scale (p 50.05). In group 1 and 2
concerning situation for both families and pediatricians. Recent had a statistically significant increase in their oxytocin and prolactin
studies have suggested that breast milk microbial content and levels when compared to the control group. Noradrenalin levels
infantile intestinal flora may play a role in development of BMJ. Aim of statistically decreased in the group 1, but increased in the group 2
this study is to investigate the relationship between BMJ and when compared to the control group. While there was not any
microorganisms in breast milk and infantile gut. difference between the experimental group 1 and 2 and the control
Materials and methods: This study includes term and near-term babies group in terms of state anxiety scale score average, there was a
who applied to Uludağ University Neonatology outpatient clinic with statistical difference in the continuous anxiety scale score average
prolonged jaundice and diagnosed as breast milk jaundice, and is (p50.05).
designed randomized and prospectively. With 77 babies with Conclusion: Since regularly made reflexology will increase the
breast milk jaundice and 35 healty babies as control group, a total hormones affecting lactation, there will be no need for nutritional
of 112 babies are enrolled in the study. Quantitative DNA measure- supplements for the development of the infant, breast milk alone will
ment of Lactobacillus rhamnosus, Lactobacillus gasseri, Lactobacillus be sufficient. Thus, healthier individuals will grow.
plantorum, Bifidobacterium longum, Bifidobacterium bifidum and
Bifidobacterium adolescentis species was performed with real time- Keywords: Postpartum Period, Reflexology, Oxytocin, Prolactin,
PCR in breast milk and fecal samples of all cases. Relationship Noradrenalin
between breast milk-fecal microbial content and bilirubin levels was
investigated among groups.
Clinical cases and summary results: Patients with breast milk jaundice
had significiantly lower amounts of L. rhamnosus, L. gasseri, L. 206
plantorum, B. longum and B. bifidum in breast milk as well as
significantly lower amounts of L. gasseri, L. plantorum and B. bifidum Effect of fortification on the
in fecal samples compared to control group (p50.05).
Conclusion: There is growing evidence that breast milk microbial osmolality of artificial milk
content and infantile intestinal flora may play a role in development
of jaundice. Reduced amounts of breast milk and fecal probiotic K. Ben Ameur K1,2 MA. Kotti, T. Khemis1, MA. Lassoued2,
bacteries in patients with jaundice suggest that probiotic replace- H. Ben Hamida1, N. Laadib1, S. Sfar Gandoura2,
ment may be a treatment option for babies with breast milk jaundice.
F.Z. Chioukh1, and K. Monastiri1
Keywords: Breast milk, jaundice 1
Department of Neonatal Intensive Care, Teaching Hospital of
Monastir., Faculty of Medicine of Monastir,Tunisia and 2Laboratory of
Pharmaceutics of the University of Pharmacy of Monastir, Tunisie
202
Introduction: To evaluate osmolarity of different infant milk formula
The effect of reflexology to before and after the supplementation of Dextrin maltose, Dextrose
solution and EOPROTINEÕ , at different concentrations.
lactation hormones in early Materials and methods: We underwent an experimental study within
the department of intensive care and Neonatal Medicine Teaching
period of postpartum hospital of Monastir. Therefore, Osmolarity was calculated on
different artificial milks formula fortified separately by EOPROTINEÕ ,
F. Kosova1, Ö. Çetin2, A. Göker3, S. _Ildan Çalim2, and 10% Dextrose solutions and maltodextrin at different concentrations
Z. Demirtaş2 (1% to 6%). Osmolarity analysis were done in the Laboratory of
Pharmaceutics of the University of Pharmacy of Monastir
1 Clinical cases and summary results: The study of the osmolarity was
Departmant of Biochemistry, School of Health, Celal Bayar
University, Manisa, Turkey, 2Midwifery, School of Health, Celal Bayar performed on 384 samples. Powder capacity of measuring spoon
University, Manisa, Turkey, and 3Department of obstetrics and showed an excessive percentage which varied between 1.15 and
gynecology, Faculty of Medicine, Celal Bayar University, 45030 34.1%. The different infant milk formula had different osmolarities
according to the nature and concentration of the supplement. Some
Manisa, Turkey
brands of milk exceeded 400 mOsmol/l at addition of EOPROTINEÕ or
maltose dextrin and all of them had exceeded this threshold value at
Introduction: Breastfeeding is the most appropriate method for the the addition of Dextrose solution and for some types of infant milk
healthy growth and development of the infants. Lactation is the formula even at low concentrations.
process of making breast milk. In this process, hormones are thought
to be effective. We aimed to look at the state and continuous anxiety
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 261
Conclusion: Taking in account of osmolarity schedule during the
artificial milk supplementation is essential to prevent digestive 311
disorders for newborns.
Breastfeeding and maternal edu-
Keywords: Newborn, enteral feeding, infant formula, fortified milk, cational level: presentation of the
osmolarity
current trend in the neonatal
intensive care unit (NICU) of
255
Archibishop Makarios III Hospital.
Importance of breastfeeding
interms of public health E. Papamichael1, E. Polycarpou1, M. Talias2, and
C. Karaoli1
1
Z. B. Yurtsal Neonatal Intensive Care Unit, Archibishop Makarios III Hospital,
Nicosia, Cyprus and 2Department of Health Management, Open
Midwifery Dept., Faculty of Health Science, Cumhuriyet University,
Univercity of Cyprus, Nicosia, Cyprus
Sivas, Turkey
Introduction: The objective of the study was the recording of the
Introduction: Supporting the process of breastfeeding is emphasized breastfeeding rates in infants hospitalized in the Neonatal Intensive
to be a necessary public health priority by the policies determined by Care Unit (NICU) during the period March 2013-March 2014 and the
the 2012 American Academy of Pediatrics (AAP). In addition, medical capture of the trend in relation to the educational level of their
studies support health benefits of breastmilk and community mothers. Our NICU hosts all hospitalized preterm neonates
programs. With the development of the social consciousness, nationwide.
breastfeeding is no longer perceived as just a form of nutrition for Materials and methods: The study lasted for the period March 2013-
newborn. However, breastfeeding continuesto be a public health March 2014 and involved 531 infants. The data collection was done
issue that needs to be solved.To identify significant threats to public by filling out standardized questionnaires which were completed by
health and to plan goals to reduce those threats, Healty People the researcher in collaboration with parents. The educational level of
Initiative was organized at the national level for health promotion and mothers was recorded as follows: elementary-school graduate
for prevention of dieseases. mothers(M1), high school graduates (M2) ,College-University gradu-
Materials and methods: Healthy People 2020 Breastfeeding Goals be ates (M3). The educational level of the mother was associated with
with the 2010 goals with regard to the improvement of public health. the administration exclusively of breast milk, mixed feeding and
The American Public Health Association (APHA) on the basis of exclusively formula milk for premature neonates.
scientific evidences agree that human milk is the best food for all Clinical cases and summary results: Data from 531/640 hospitalized
infants. In this context, some obstacles for breastfeeding are reported neonates 83% were collected. 312 male (54.60%) and 259 female
to be. The continuation of breastfeeding is seen as of important neonates (45.40%) were included. The educational level of mothers
preventive health measure. It is accepted that not breastfeeding has was: M1 n: 67 (10,5%), M2 n: 210 32,8%, M3 281 43,9%. The analysis
health risks including chronic diseases for both them other and the showed:
infant. However, promotion of the use of Formula instead of (I) Breastmilk 120/531, M1 9/67, M2 41/201, M3 70/263
breastmilk in the media threatens breastfeeding. The media also (II) Formula milk for premature neonates 148/531, M1 28/67, M2
states that breastfeeding is not supported in a continuous and a 62/201, M3 56/263
ccurate way. (III) Mixed nutrition 263/531, M1 28 / 67, M2 98/201, M3 137/
Clinical cases and summary results: APHA recommends health care 263
professionals, researchers and politicians all over the world that Mothers in M1 group give their babies exclusively breast milk in
breastfeeding should be considered as one of the issues of public extremely low degree. Mothers M2 give exclusively breast milk more
health. Investments with regard to support breastfeeding women will than the mothers M1 but less than M3. M3 mothers have the highest
improve their quality of life and lead to the reduction of acute and rates of exclusive breast milk delivery (p=0,001) while clearly there is a
chronic diseases in children. In making investments in the field of larger percentage of the choice of a mixed diet versus exclusive
public health, in the short term there might be a scarcity of economic administration of formula than in the other groups of mothers.
resources but in the long term it is certain that there will be potential Conclusion: The prevailing trend in our NICU is an increase in the
financial gains of these investments. exclusive administration of breastmilk in neonates born to mothers
Conclusion: Routine and preventive visits made at an early time by with a higher educational level.
doctors working in primary care are noted to increase breastfeeding.
Home visits made by midwives and nurses are also stated to increase
breastfeeding initiation rates. In this context, it is possible to say that Keywords: Breast milk, mother, education
breastfeeding has an an indispensable importance in terms of public
health and should be among public health priorities that must be
accomplished.

Keywords: Breastfeeding, public health

262 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

324 Introduction: The aim of this study was to interprete postnatal growth
rate of preterm infants, in dependancy of gestational age, condition at
Effect of feeding protocol on the birth, initiation of enteral feeding, respiratory support, duration of
parenteral nutrition and types of enteral feeding (mother milk with
gastroschisis neonatal outcome fortification or preterm formula).
Materials and methods: Postnatal growth was analyzed in 100 preterm
V. Champion1, A. Zurita2, S. Friszer3, D. Mitanchez4, and infants hospitalized in NICU: GW7 days (168 hours) and were free of
major congenital anomalies. Standard statistical methods were used.
S. Irtan5 Clinical cases and summary results: Average time of achiving full
1
Service de Néonatologie, APHP, Hôpital Armand Trousseau, enteral feeding in infants 528GW was 25,0 days (21,0-29,5), in infants
Paris2Service de Chirurgie Pédiatrique, APHP, Hôpital Armand 29-32 weeks 12,0 days (9,0-21), and in infants 33-36 GW 11,0 days (8,0-
14). At time of discharge 26,7% infants with GA 528 weeks had body
Trousseau, Paris3Service de Médecine Fœtale, APHP, Hôpital Armand
weight 55p. Birth weight of infants with APGAR score 55 was
Trousseau, Sorbonne Universités, UPMC Univ Paris 06, Paris4Service
statistically lower at 14. day (p 50,05) and 28. postnatal day (p 50,05).
de Néonatologie, APHP, Hôpital Armand Trousseau, Sorbonne In infants with initiation of enteral feeding within first 3 days, body
Universités, UPMC Univ Paris 06, Parisand 5Service de Chirurgie weight was statistically higher at 14. day, 28. day and at discharge
Pédiatrique, APHP, Hôpital Armand Trousseau, Sorbonne Universités, comparing with infants with initiation of enteral feeding after 3 days.
UPMC Univ Paris 06, Paris, France In infants with less tolerance of enteral feeding, including NEC, body
weight at 14. day was signifiucantly lower (p 50,05) at 28. day (p
Introduction: Various factors predicting neonatal outcome of gastro- 50,05) and at discharge (p 50,01). Duration of respiratory support is
schisis are reported in the literature. Sonographic predictors (bowel shown to be associated with postanatal growth rate at 14. day (p
thickness and dilatation) and surgery procedures are the main factors 50,05) and 28. day after birth (p 50,01), without significant diferrence
discussed because they may reflect bowel damages. There is a contro- at time of discharge. Infants fed with mother milk with fortification
versy regarding which factors most accurately predict neonatal had higher body weight at time of discharge (p 50,01) comparing
outcomes and feeding strategy was rarely investigated. We aim to with those fed with infant formula.
assess the benefit of a feeding protocol specifically designed for Conclusion: Postnatal growth rate of preterm infants depends not
gastroschisis, irrespective of ultrasound risk factors and surgical only of conditions affecting growth but also nutritional management
procedures. practice. Achiving optimal postnatal growth rate is very important,
Materials and methods: Data from patients with gastroschisis born since it improve long term outcome of preterm infants.
between January 2008 and December 2015 in a single institution were
prospectively collected. Prenatal sonographic data collected were
bowel or gastric dilatation, bowel wall thickness, peristaltism and
oligoamnios. Feeding protocol consisted in minimal enteral feeding 529
(1 ml of breast milk administered as hourly bolus) for at least five days
initiated five days after bowel reintegration. Feeding amount was
The relationship between vitamin
increased 12 to 24 ml/kg per day according to feed tolerance until full d levels and the nausea and
feeding. This was coupled with the stimulation of transit by enema. The
main outcome was the duration of parenteral nutrition (PN). vomiting of pregnancy
Clinical cases and summary results: Forty-four patients were included
with median gestational age of 35.9 weeks (31.3-37.3) and median
birth weight of 2462 g (1285-3200). 20.5% had growth restriction and
M.D. Kelesoglu, M.A. Ozek, and M. Bayram
25% had at least one ultrasound predictor of adverse outcome. None Gazi University, Department of Obstetrics and Gynecology
infant died. Perivisceritis was present in 38.6% of patients. 79.5% had
primary closure, 20.5% had a silo. Four infants had a stoma. First
Presenter: M.A. Ozek
stools were at median age 5 days (2-17). Total PN lasted 28.5 days (18-
94 days). Length of hospitalization was 43.5 days (27-108 days). In Introduction: Nausea and vomiting of pregnancy; and hyperemesis
univariate analysis, factors associated with PN duration of more than gravidarum (HG), is seen commonly and typically in the first trimester
one month were birth weight52500g (p=0.01), perivisceritis (p=0.05) of the pregnancy. The physical and psychological burden of these
and surgery (p=0.01). In multivariate analysis, only birth weight was symptoms can be so high. It constitutes much of the first trimester
significantly associated with PN duration of more than one month (OR hospital admissions. There is evidence for a link between vitamin D
4.4 (1.1-18.4), p=0.03). availability and the prevalence of immune mediated diseases,
Conclusion: Neither antenatal factors linked to adverse outcome nor especially inflammatory bowel disease (IBD). It has been shown
surgical procedures influence PN duration in neonates when using that, in VDR knock-out mice, pathogenic T cells contributed to the
this specific nutrition protocol. Only birth weight seemed to be development of gastrointestinal inflammation. In this study, we
associated with longer PN duration. A large prospective study is aimed to reveal the relationship between low vitamin D levels and
needed to confirm the benefit of this feeding protocol. severe cases of nausea and vomitting of pregnancy and hyperemesis
gravidarum.
Keywords: Gastroschisis, outcomes, enteral feeding, parenteral Materials and methods: Two hundred patients whom admitted with
nutrition complaints of newly onset nausea and vomiting in pregnancy,
between 1st of June and 30th of November 2015 were enrolled. The
history of vomiting was evaluated with the ‘Pregnancy Unique
329 Quantification of Emesis Scoring System (PUQE) and participants were
divided into two groups, mild and moderate/severe disease. Factors
Postnatal growth rate in preterm that has been proven to alter vitamin D levels, such as skin type and
infants hospitalized in NICU dressing habits, has also been questioned whether they have a
significant relationship with PUQE scores. Maternal serum vitamin D
levels are obtained. Cases were classified according to their serum
S. Heljic, S. Terzic, and H. Maksic vitamin D levels; normal (430 ng/mL), deficient (10-30 ng/mL) and
severe deficient (510 ng/mL).
NICU, Paediatric Clinic, University Clinical Center Sarajevo, Bosnia Clinical cases and summary results: Mean age of the participants was
and Herzegovina 28,5 (18-42). 47,5% (n: 95) had veiling habits. 37% (n: 74) had darker
skin. According to PUQE; 147 patients (73,5%) had moderate/high
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 263

scores. Only 4% of the cases had normal serum vitamin D levels dressing habits and the darker-skin types, also had a significant
whereas 68% was vitamin D deficient, 28% had severe vitamin D relationship with higher PUQE scores. We are in the opinion that,
deficiency. Among moderate/high PUQE score group, median serum much earlier prophylactic vitamin D supplementation in the high risk
vitamin D level was significantly lower. It was observed that; cases group, could prevent or alleviate nausea and vomiting of pregnancy
with veiling habits and darker skin had significantly higher PUQE and HG.
scores. The median PUQE scores of the women with veiling habits
was 9 (5-13) compared with 7 (3-10) in cases without veiling habits. Keywords: Vitamin D, deficiency, pregnancy, nausea, vomiting,
The fair-skinned group had median PUQE score of 7 (4-9) since it was hyperemesis gravidarum
9 (6-12) for the darker-skinned population.
Conclusion: The lower vitamin D levels and the higher PUQE scores
did show a statistically significant relationship. The risk factors related
with vitamin D deficiency in previous studies, such as covered-
264 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

544
Presenter: Simona Feyereislová
Monounsaturated fatty acids in Introduction: Breastfeeding is known to reduce infant morbidity and
early pregnancy and preterm improve well-being. Nevertheless, breastfeeding rates remain low
despite public health efforts. Our study aims to investigate the effect
birth of controlled limited formula usage during birth hospitalisation on
breastfeeding, using the primary hypothesis that early limited formula
E. Ogundipe1, Y. Wang2, M.R. Johnson3, and feeds in infants with early weight loss will not adversely affect the rate
of exclusive or any breastfeeding as measured at discharge, 3 and 6
M.A. Crawford3 months of the infants’ age.
1
Neonatal Unit, Imperial College, Chelsea & Westminster Hospital, Materials and methods: We randomly assigned 104 newborns, 24 to
48 hours old, with 5% loss of birth weight to controlled limited
London, UK, 2Department of Medicine, Imperial College London,
formula (CLF) intervention (10 ml formula by syringe after each
Chelsea & Westminster Hospital Campus, London, UK, and
3 breastfeeding, discontinued at onset of lactation) or control group
Academic Department of Obstetrics, Imperial College London, (standard approach - exclusive breastfeeding unless supplemental
Chelsea & W feeds were indicated, SA). Only healthy, singleton, appropriate for
gestational age (AGA) term neonates, born after uncomplicated
Presenter: Enitan OGUNDIPE pregnancy and delivery, who had no severe congenital defects were
enrolled. All participating mothers were educated by a specialised
Introduction: With respect to preterm labour, many trials on
nurse regarding breastfeeding and planned to breastfeed over long
supplementation of fatty acids have focused on docosahexaenoic
term. Groups were compared for demographic data and breastfeed-
acid (DHA), an omega-3 fatty acid (!-3 FA), with supplementation
ing rates at discharge, 3 months and 6 months of age (p-values
during pregnancy linked to increased gestation and birth weight.
adjusted for multiple testing).
Recent meta-analysis refuted the above. However, does not dispute
Clinical cases and summary results: Fifty newborns were analysed in
the demand for long chain super-unsaturated FAs for brain growth.
CLF and 50 in SA group. There were no differences in demographic
Most fetal neurogenesis occurs early with neurons in place to migrate
data or clinical characteristics between the groups. We found no
to form the cortex by the time of first antenatal visit.
evidence of difference between treatment groups in the rates of
Materials and methods: 300 pregnant women in high risk pregnancies
exclusive as well as any breastfeeding at discharge (p-value 0.2 and
were randomised blindly to receive ’fish oil’ supplement or placebo
40.99 respectively), 3 months (p-value 0.12 and 0.10) and 6 months
from early in pregnancy.
(p-value 0.45 and 0.34 respectively) of infants’ age. The rates of
Erythrocyte total lipids were extracted by the Folch method at 3 time
exclusive breastfeeding at discharge, 3 and 6 months of age were not
points, recruitment, delivery and cord blood. Fatty acids composition
affected by the mode of delivery (vaginal versus cesarean section) or
were analysed by capillary gas chromatography. The fatty acid
presence/absence of skin to skin contact in delivery room. The
profiles were correlated to the pregnancy and infant outcomes.
percentage weight loss during hospitalisation was significantly higher
Clinical cases and summary results: Oleic acid and mono-unsaturated
in the SA group (7.3% in CLF group, 8.4% in SA group, p = 0.002).
fatty acids (MUFA) levels at recruitment predicted preterm birth at 34
Conclusion: The study shows that controlled limited formula use does
and 30 weeks and low birthweight. AA and DHA sum correlated with:
not have an adverse effect on rates of breastfeeding in the short and
birthweight (r=0.286, p5 0.000); birthweight below 3,200g (r= 0.467
long term. Larger studies are needed to confirm a possible potential
p50.000) and gestational age (r=0.383, p50.000). Lipid profile
in controlled limited formula use to support establishing breastfeed-
changes from recruitment to delivery and cord blood showed
ing and to help to improve the rates of breastfeeding overall.
significant bio-magnification of saturated fatty acids (SFA) (16.0 and
18.0) from mother to fetus and converse with MUFAs Keywords: Breastfeeding, controlled limited formula feeding,
Conclusion: We report novel and unexpected findings that signifi- newborn
cantly impact our knowledge of nutrition at conception and early
pregnancy,
The impact on birthweight, gestational age and fatty acid biology
understanding are shown. Oleic acid and MUFA at recruitment
predicts adverse pregnancy outcome. Biomagnification of SFA
correlated to pregnancy outcomes. The sum of PUFAs; AA and DHA
were predictive of pregnancy outcomes. Hence ’tissue is the issue’
and FA profiles appear more important in prediction.
Keywords: Preterm birth, monounsaturated fatty acids, pregnancy
outcomes, fish oil

PERINATAL NUTRITION - 557

Limited amount of formula may
facilitate breastfeeding - a ran-
domized controlled trial
S. Feyereislová2, Z. Straňák1,2, M. Černá2, J. Kollárová2,
and J. Feyereisl3
1
Third Faculty of Medicine, Charles University, Prague, Czech
Republic, 2Department of Neonatology, Institute for the Care of
Mother and Child, Prague, Czech Republic, and 3Department of
Obstetrics and Gynecology, Institute for the Care of Mother and Child
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 265

621
Can mothers beyond one year of
lactation be donors of human
milk for premature infants
E. Sinkiewicz-Darol1, U. Bernatowicz-Łojko1,2,4,
A. Wesołowska3,4, K. Kaczmarek1, M. Puta5, D. Martysiak-
Z_ urowska5, and K. Karzel6
1
Human Milk Bank, Ludwik Rydygier’s Provincial Polyclinical Hospital
in Torun, Torun, Poland, 2Department of the Newborn and NICU
Ludwik Rydygier’s Provincial Polyclinical Hospital in Torun,
Department of the Newborn and NICU, Torun, Poland, 3Department
of Biochemistry, Medical University of Warsaw, Warsaw, Poland,
4
Human Milk Bank Foundation, Warsaw, Poland, 5Chemical Faculty,
Department of Food Chemistry Technology and Biotechnology,
Gdansk University of Technology, Gdansk, Poland, and 6Warsaw
594 University, Faculty of Psychology, Warsaw, Poland
Body composition and hormonal Presenter: Urszula Bernatowicz-Łojko
status at term equivalent age in Introduction: The percentage of preterm infants - beneficiaries of the
preterm infants of small and Human Milk Bank of Ludwik Rydygier’s Provincial Polyclinical Hospital
in Torun is 75% on average. The donors are usually women in the first
appropriate weight for gesta- year after delivery on time, or mothers of premature infants. In the
Kuyavian- Pomeranian Voivodeship the percentage of women
tional age breastfeeding till 16-24 months after delivery is 5%. We decided to
find out if their milk is also valuable for preemies.
I. Belyaeva, and M. Okuneva Materials and methods: We have analysed the macronutrients and
energy contents in 132 samples of expressed milk from 21 preemies’
mothers, 96 samples from 12 term infants’ mothers in the first 2-6
Scientific Centre of Children’s Health, Moscow, Russia weeks of lactation, and 144 samples from 30 mothers beyond one
year of lactation. We compared the results concerning fat, total
Presenter: I. Belyaeva nitrogen, carbohydrates and energy contents, using a human milk
analyser (MIRIS).
Introduction: SGA preterm infants are likely to suffer from the high risk
Clinical cases and summary results: Our results showed that
of body composition abnormalities in case of not optimal nutrition
concentration of fat in milk samples from compared groups was
that may cause in the high risk for hypertonia, heart diseases and
significantly different. Amount of fat in milk samples from mothers
interconnected mortality, type 2 diabetes mellitus and obesity at
over one year of lactation was higher than in milk samples from
adult age. The study aim was to estimate body composition and
preterm infants’ mothers (5.36 vs. 3.98 g/dL) or term mothers’ (5.36 vs.
growth hormones of preterm infants of small- (SGA) and appropriate
3.98 g/dL). Total nitrogen concentration significantly varied among
gestational age (AGA) at term equivalent age (38-42 weeks PCA).
compared groups. Total nitrogen content in term infants’ mothers’
Materials and methods: In the prospective study there was included: a)
milk was significantly lower than in preterm infants’ mothers’ milk
140 newborn preterm AGA (birth weight from 10th and 90th
(1.22 vs. 1.72 g.dL) and from mothers over one year of lactation (1.22
percentile of the standardized growth scale) infants; b) 28 SGA
vs. 1.71 g/dL). In case of energy contents we also observed significant
(birth weight 5 10th percentile) infants. Growth hormones (insulin,
differences among compared groups. The energy contents in milk
insulin-like growth factor-1 (IGF-1), somatotrophic hormone, C-
samples from mothers over one year of lactation was significantly
peptide, cortisol) and body composition of preterm infants were
higher than in both other groups - preterm infants’ mothers (82.41 vs.
estimated by air plethysmography at term equivalent age.
70.13 kcal) and term infants’ mothers (82.41 vs. 61.59 kcal).
Clinical cases and summary results: SGA preterm infants had less
Carbohydrates content showed no significant differences between
length and body weight and Z-score in comparison with AGA preterm
all analyzed groups.
infants (p50,01) in term equivalent age. Significant differences
Conclusion: The results allow to conclude, that women beyond one
between head circumference in SGA and AGA infants at the term
year of lactation shouldn’t be rejected as donors because the
gestational age were not found. Estimated of body composition
macronutrient value of their milk is appropriate to the needs of
components showed equivalently high fat mass concentration (Fat
premature infants. In addition, our results highlight the value of
mass, kg, %) in both groups of preterm infants. Higher concentration
breastfeeding for as long as World Health Organization recommend.
of insulin, IGF-1, C-peptide and cortisol in the blood sample was
It is desirable to conduct further research to evaluate bioactive
noted in SGA preterm infants (p50,001). Moreover, SGA preterm
content in milk obtained from such a subgroup of donors.
infants had less concentration of somatotropin hormone having
counterinsular and anabolic action in the blood sample comparing to Keywords: Donor’s milk, premature, human milk, nutrition
AGA preterm infants (p50,001).
Conclusion: In the neonatal period, plastic processes happening
against early beginning of ‘‘aggressive’’ nutrition in both SGA and
AGA preterm infants is characterized by the clear trend to
strengthening adiponeogenesis.
Keywords: Preterm infants, nutrition, body composition, SGA
266 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

705 PREECLAMPSIA - 026

Exploring the link between Preeclampsia and amyloidosis
maternal dietary protein intake type A
and the metabolomic profile of
T. Esteves1, C. Ferreira2, and F. Sousa2
second trimester amniotic fluid 1
Hospital do Espı́rito Santo de Évora, E.P.E. and 2Centro Hospitalar
Lisboa Central - Hospital D. Estefânia
M. Fotiou1, C. Fotakis2, F. Tsakoumaki1, C. Kyrkou1,
E. Athanasiadou3, T. Tsiaka2, A.-C. Chatziioannou4, Introduction: Preeclampsia is defined as the onset of arterial
A. Dimitropoulou1, G. Menexes5, G. Theodoridis4, hypertension associated with proteinuria, after 20 weeks of gestation.
B.C. Tarlatzis3, C.G. Biliaderis1, A.P. Athanasiadis3, However, this association can also correspond to a pre-existing renal
P. Zoumpoulakis2, and A.-M. Micha disease that, if not diagnosed and treated, can progress and worsen.
After birth, proteinuria may persist in 30% of cases, in which case it
1
Department of Food Science & Technology, School of Agriculture, may be an important indicator of underlying renal disease (e.g.
Faculty of Agriculture, Forestry & Natural Environment, Aristotle membranoproliferative glomerulonephritis, IgA nephropathy, or
University of Thessaloniki, Greece, 2Institute of Biology, Medicinal amyloidosis). Amyloidosis is a rare and progressive disease in which
Chemistry & Biotechnology, National Hellenic Research Foundation, normally soluble proteins are abnormally processed, becoming
Athens, Greece, 31st Department of Obstetrics & Gynecology, School insoluble and accumulating in several organs (kidney, liver, heart).
of Medicine, Aristotle University of Thessaloniki, Greece, 4Laboratory There are different types, associated with the accumulation of
different proteins. The most common is type A amyloidosis,
of Analytical Chemistry, School of Chemistry, Faculty of Sciences,
associated with chronic inflammatory or infectious diseases. Renal
Aristotle University of Thessaloniki, Greece, and 5Department of Field
function is affected in more than 90% of cases. Amyloid A is an acute
Crops & Ecology, School of Agriculture, Faculty of Agriculture, phase protein, present in the placenta; studies reveal that its levels
Forestry & Natural Environment, Aristotle University of Thessaloniki, are increased in preeclampsia, hypothesizing its role in its
Greece pathogenesis.
Clinical cases and summary results: Pregnant woman of 28 years old,
Presenter: A.P. Athanasiadis with a high risk pregnancy due to bicornate uterus. The pregnancy
was uneventful until 30 weeks of gestation, when hypertension was
Introduction: The aim of the present study was to examine the link diagnosed; it complicated at 34 weeks, with mild preeclampsia.
between maternal habitual dietary protein intake and second Because of the diagnosis of fetal growth restriction, labor was
trimester amniotic fluid (AF) metabolomic profile. induced at 36 weeks, with fetal distress motivating a cesarean
Materials and methods: Sixty-five women, undergoing second delivery. Three years later, the woman was diagnosed with chronic
trimester amniocentesis for prenatal diagnosis, participated in the arterial hypertension, secondary to renal failure, with proteinuria in
study. Dietary assessment was carried out using a semi-quantitative the nephrotic range. The renal biopsy showed type A amyloidosis.
food frequency questionnaire. Hierarchical cluster analysis was used Nowadays, after five years, the disease has evolved into chronic
to identify homogenous groups of women on the basis of habitual kidney disease (stage 5), requiring peritoneal dialysis. The results of
protein intake. A holistic NMR metabolomics approach was applied the genetic study for familial Mediterranean fever are pending.
using the CPMG pulse sequence to suppress protein signals. NMR Conclusion: When preeclampsia is diagnosed, one must be alert to
spectra were phase and baseline corrected, reduced into spectral other possible diagnoses, and reassess postpartum.
buckets of 0.0001 ppm and aligned using the MestReNova software.
Multivariate data analysis was performed with the SIMCA-P 14.0
Keywords: Amyloidosis, preeclampsia
software. S-line plots pinpointed the important metabolites for
sample classification. External data set, permutation testing, and
ROC curves validated the OPLS-DA models.
Clinical cases and summary results: A 2-group interpretable and
168 (CASE REPORT)
statistically significant clustering of participants was identified and
characterized on the basis of protein intake (% of energy intake) from Severe preeclampsia: according
different food groups. A total of 29 women were in cluster 1 (C1) and
36 in cluster 2 (C2). C1 was characterized by a significantly higher to a clinical case
energy contribution from sweets and confectionery proteins, while C2
had a higher energy contribution from meat/meat products, whole
C. Larrañaga Azcárate, N. Abián Franco, B. Pérez
milk, and yellow cheeses proteins. The implementation of
Chemometrics on the AF NMR spectral data allowed the identification Munárriz, S. Garcı́a Francés, M. Urtasun Murillo,
of metabolites associated with different protein intake. Specifically, J. Barrenetxea Arrinda, B. Gastón Moreno, and
NMR data indicated that AF specimens of women in C2 were A. Safont Gastón
characterized by increased creatine, histidine, and branched-chain
amino acids concentrations. Complejo Hospitalario de Navarra, Pamplona, Spain
Conclusion: The data presented in this study suggest that maternal
habitual dietary protein intake may be reflected in the AF Introduction: Preeclampsia represents a multi-system disorder char-
metabolomic profile. acterized by the new onset of hypertension and proteinuria or end-
This research has been co-financed by the European Union (European organ dysfunction or both in the last half of pregnancy. Although
Social Fund - ESF) and Greek national funds through the Operational most affected pregnancies deliver at term or near term with good
Program ‘‘Education and Lifelong Learning’’ of the National Strategic maternal and fetal outcomes, these pregnancies are at increased risk
Reference Framework (NSRF) - Research Funding Program: Thales. for maternal and/or fetal serious morbidity and mortality. This disease
Investing in knowledge society through the European Social Fund. is estimated to occur in 4.6 percent of pregnancies worldwide, and
late onset disease after 34 weeks is more prevalent than early onset
Keywords: Amniotic fluid, maternal habitual dietary protein intake,
before 34 weeks. We describe a representative clinical case of this
metabolomics
pathology.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 267
Clinical cases and summary results: A 41 year-old asymptomatic
woman, in her second pregnancy at 32 + 5 weeks gestation, is 178
admitted after an incidental finding of intrauterine growth restriction,
1240 grams as fetal weight estimation. she had a history of
Biochemical parameters of the
preeclampsia in her first pregnancy four years ago, with induction
of labor at 31 + 3 weeks and cesarian delivery due to risk of loss of
first trimester of pregnancy in the
fetal wellbeing. During hospitalization, fetal pulmonary maturation early and late preeclampsia
with betamethasone was performed. fetal ultrasound monitoring
revealed disturbances in doppler velocimetry with an umbilical artery
pulsatility index higher than 95th centile, cerebroplacental doppler M. Bogavac1, A. Jakovljevic2, Z. Grujic1, Dj. Ilic1,
ratio less than 5th centile, preserving normal ductus venosus. A. Nikolic3, and M. Milosevic-Tosic3
Meanwhile, the patient manifested mild headache and epigastric 1
Clinical Centre of Vojvodina, Department of obstetrics and
pain, with blood pressure (bp) maintained around 145/95. on the
suspicion of severe preeclampsia disease with maternal general gynecology, University of Novi Sad, Medical faculty, Novi Sad, Serbia.,
2
health worsening, it was decided to finish pregnancy, and using Clinical Centre of Vojvodina, Centre for Laboratory Medicine,
cervical ripening ballon at 33 + 2 weeks. peripartum intravenous University of Novi Sad, Medical faculty Novi Sad, Serbia, and 3Clinical
magnesium sulphate was also administered for fetal and maternal Centre of Vojvodina, Emergency Center, Urgent Laboratory at
neuroprotection. Unstable fetal presentation during labor was Department of Obstetrics and Gynecology, University of Novi Sad
verified, and delivery was performed by cesarean section owing to Medical Faculty, Novi Sad, Serbia
breech presentation. birth weight 1280 grams.the patient was Introduction: Preeclampsia is a specific disease related to pregnancy
discharged with thromboprophylaxis and one antihypertensive with unclear etiopathogenesis. Since it occurs independently from the
drug, attaining in 8 days normal bp range. presence of fetus in the uterus and can occur in the abdominal and of
Conclusion: Severe preeclampsia implies a serious threat to the lives of pregnancy, it is assumed that the pathophysiological root of this
both mother and fetus. The aims of management should be: disorder lies in the abnormalities in the development and maturation
confirmation of diagnosis, control of BP, prevention of convulsions of placenta.
and a decision regarding timely delivery balancing neonatal devel-
opment with maternal risk. Keywords: Aim of study: was to determine whether there is a
difference in biochemical parameters in serum of the first trimester of
Keywords: Preeclampsia, intrauterine growth restriction, cerebropla- pregnancy (between 11 and 14 weeks of gestation) in pregnant
cental doppler ratio women who developed early preeclampsia during the current
pregnancy (before 34 weeks of gestation) compared to the late pre-
eclampsia (34 weeks of gestation) .
Materials and methods: The study included 42 pregnant women
173 whose current pregnancy was diagnosed with preeclampsia and who
agreed to participate in the survey. The subjects were divided into
Umbilical arter copeptin level is two groups: The first group was composed of pregnant women
(n ¼ 17) who were diagnosed with early preeclampsia and another
related to severity of group (n ¼ 25) who were diagnosed with late preeclampsia. To all
pregnant women between 11 and 14 weeks of gestation were
preeclampsia determined specific hsCRP (immunoturbidimetric method), uric acid
(enzymatic color test), PAPP-A (modification Resolved Immuno
G. A. Bülbül1, O. Ozdemir1, B. S. Isenlik1, N. Erkal 1, methods), CBC (by flow cytometry), fibrinogen (coagulation method
B. Ozdemir2, and S. Kumru3 of Clauss-in) and lipid status (standard enzymatic method).
Clinical cases and summary results: Pregnant women in first group had
1
Dept of Obstet and Gynecology, Health Ministry Antalya Education significantly higher values of -hsCRP (p50.05), uric acid (p50.001) and
and Research Hospital, 2Dept of Anesthesiologyand 3Dept of Obstet triglyceride values (p 50.05), while other women in other group had
and Gynecology, Division of Perinatology, Akdeniz University Medical statistically significantly higher values of PAPP-A (p 50.05). Among
School other observed parameters there were not noticed statistically
significant differences between the observed groups.
Conclusion: The results of this study could indicate a certain degree of
Introduction: Since copetin seems a indicator of inflamation, we aimed differences in the pathophysiological mechanisms of early and late
to measure and compare copeptin levels of maternal venous blood preeclampsia, respectively higher values of hsCRP and uric acid can
(MVB), umbilical artery (UA) and umbilical vein (UV) copeptin levels in point that in the early pre-eclampsia there is a greater degree of
healthy pregnants and in pregnancies with mild and severe endothelial activation of mother and a higher level of oxidative stress,
preeclampsia. while lower values of PAPP-A in early preeclampsia indicate greater
Materials and methods: Seventy two pregnant women in the third damage of placental mechanisms of growth and development .
trimester of pregnancy were included into the study. They were
divided into three groups: 22 coplicated with mild preeclampsia, 28
coplicated with severe preeclampsia and 22 healthy pregnancies. Keywords: Preeclampsia, biochemical parameters, first trimester of
MVB samples were drawn just before birth. The fetal blood samples pregnancy
were obtained from the UA and UV just after the birth.
Clinical cases and summary results: Copeptin levels in MVB and UV
were not significantly different between three groups . But copeptin
level in UA was significantly higher in severe preeclampsia group
compared with control group.
Conclusion: Maternal copeptin levels seem not related to preeclamp-
sia and its severity. However, UA copeptin level seems related to
severity of preeclampsia.

Keywords: Copeptin, preeclampsia

268 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

244 Ziekenhuis Oost-Limburg, Genk, Belgium, and 3Department of

Physiology, Hasselt University, Hasselt, Belgium
Preditors of cardiovascular events
in pregnant women Introduction: Gestational hypertensive disorders (GHD) are major
contributors to maternal mortality worldwide. In Ziekenhuis Oost-
Limburg (Genk, Belgium), an interventional study started in January
A. Correia1, R. Ferreira2, S. Vidal3, A. Cadete4, C. Rainho5, 2015 to evaluate the relevance of a remote monitoring (RM) program
F. Leitão1, and J. Mesquita Bastos2 for women at risk for developing GHD. RM is a relatively new
1
approach that broadly can be defined as the application of
Obstetrics and Gynaecology Dept., Centro Hospitalar do Baixo telecommunication technologies in interchanging medical data,
Vouga, Aveiro, Portugal, 2Cardiology Dept, Centro Hospitalar do information and service between healthcare providers and patients.
Baixo Vouga, Aveiro, Portugal, 3USF Moliceiro, Aveiro, Portugal, Materials and methods: A retrospective study was conducted in 44
4
USF Águeda + Saúde, Aveiro, Portugal, and 5USF Flor do Sal, Aveiro, pregnant women who developed GHD and had a RM prenatal follow
Portugal up. They sent twice daily blood pressure measurements and once
daily weight measurements to our Clinical Call Center. Those patients
were compared with 98 patients with confirmed GHD in routine care
Introduction: Hypertension remains a major cause of morbidity and (RC). The inclusion period started at the first of January 2015 and
maternal and fetal mortality. However there is still no universally ended 31 December 2015. All the interchanged data were analyzed in
validated risk score to identify the increased risk of maternofetal detail. Primary endpoints were: number of prenatal consultations and
event during pregnancy, maternal death or major hypertensive- Maternal Intensive Care (MIC) admissions. Secondary endpoints were:
related complications. maternal and neonatal outcomes. SPSS was used for statistical
Materials and methods: Prospective and observational study which analysis.
included 139 pregnant women designed from the Obstetrics Clinical cases and summary results: Between the two groups, there is
appointment to the HT appointment, having done the ambulatory no difference in maternal demographics, gestational age at the first
blood pressure monitoring (ABPM), between January 2007 and June prenatal visit, the total number of prenatal visits, CTG’s and echo’s
2015. A sub group was submitted a Echocardiographie. The follow-up during pregnancy, or amount of days admitted to the MIC. In RM
in pregnancy occured until the child-birth (262 ± 28 days). Events versus RC, the total number of MIC admissions (29% versus 74%,
was defined: mother, fetal or neonatal dead, pre-eclampsia, eclamp- p50.01) and the number of birthing admissions to the MIC (18%
sia, gestational diabetes, prematurity and fetal growth restriction. versus 64%, p50.01) were lower. Maternal and neonatal outcomes
Clinical cases and summary results: The study included 139 pregnant were not different for gestational age at delivery, birthweight,
women with the age of 32 ± 6 years, 58% with cronic HT, 42% with birthweight percentile, length, Apgar at 1 minute or at 5 minutes
gestacional HT. In the follow-up, were detected 71 events. In relation and pH arterial or venous. In RM versus RC, the number of
to ABPM, Systolic Blood Pressure dipping pattern (SBP): 87 were spontaneous deliveries is higher (47% versus 27%, p= 0.01) and
Dipper (D) and 51 non-Dipper (ND). Comparing D versus ND, the D the number of admissions to the NIC was lower (11.3% versus 29.2%,
pattern had statisticaly significant less events (X2, p 50,017). In a p= 0.02).
Kaplan-Meier analysis of curves survivor free of events, the ND patter Conclusion: RM is useful to detect GHD in pregnant women at home.
was associated with worst curves of survivor free of events (log rank A lower number of admissions to the MIC and NIC departments is
6.22, p 50,01). When we analysed the echocardiographic data, Eco shown of RM patients. These results invite to further explore clinical-
showed that non dipper patients compared to dipper had an average and cost-effectiveness of RM in prenatal care for women at risk
ratio E / a lower, ratio E / E’ higher, greater mass and a greater degree for GHD.
of hypertrophy. The long term follow-up detected four cases of
maternal death and major hypertensive-related complications. Keywords: Gestational hypertensive dissorders, preeclampsia,
Conclusion: The non dipper profile seems to be an important remote monitoring
predictor of maternofetal and cardiovascular events. The authors
consider that ABPM is a essencial tool for pregnant with HT, because
this is the only method available for the analysys of sistolic blood
pressure dipping, which seems to be predictive of risk in pregnancy
and also is a associated a much more organ lesions.
274
Keywords: Hypertension in pregnancy, maternofetal event, ambula-
tory blood pressure monitoring Diagnostic value of ceruloplasmin
and antioxidative enzymes in pre-
eclampsia
A. Nikolic1, V. Cabarkapa2, M. Bogavac3, Z. Grujic3, and
252 M. Milošević-Tošić3
Remote prenatal follow-up of 1
Medical faculty, Department of Pharmacy, Unuversity of Novi Sad,
patients at risk for gestational Clinical Centre of Vojvodina, Department of Obstetrics and
Gynaecology, Novi Sad, Serbia, 2Medical faculty, Unuversity of Novi
hypertensive dissorders: maternal Sad, Clinical Centre of Vojvodina, Department of Laboratory
Medicine, Novi Sad, Serbia, and 3Medical faculty, Unuversity of Novi
& neonatal outcomes Sad, Clinical Centre of Vojvodina, Department of Obstetrics and
Gynaecology, Novi Sad, Serbia
D. Lanssens1,2, A. Van Moerbeke1, A. van den Hoogen1,
N. Geusens1,2, L. Grieten1,2, and W. Gyselaers1,2,3 Introduction: Oxidative stress and the generation of reactive oxygen
1 species (ROS) have been implicated in a pathophysiological processes
Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt
in variety of diseases including pre-eclampsia.The objective of our
University, Hasselt, Belgium, 2Department of Gynaecology,
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 269
study was to evaluate diagnostic value of ceruloplasmin together It is adapted from the well-tested SCOPE database to meet the
with other enzymatic and non-enzymatic antioxidants (Cu, following criteria:
Zn-Superoxide dismutase (SOD-1), glutathione peroxidase GSH-Px) (1) On-line data input using WiFi, G3 or G4 connections from PCs or
and uric acid) and to evaluate the level of oxidative stress in patients tablets.
with pre-eclampsia and compare it with normal pregnancy. (2) Highest standards of security and confidentiality
Materials and methods: In this prospective study, antioxidative (3) Standard data format for future use in large merged datasets
markers were investigated in two groups of pregnant women: (4) Generic flexible structure to encompass cohort and case control
patients with preeclampsia (n=32) and the healthy pregnant women studies.
(n=60). The following anti-oxidative markers were evaluated: serum (5) Modular structure to allow expansion for specific research interests
ceruloplasmin levels, uric acid, SOD-1 and GSH-Px.Serum ceruloplas- (6) Inventory system for sample storage and retrieval
min levels were measured by automated immunoturbidimetric assay (7) Appropriate for use in low, middle or high income countries.
using Beckman Coulter kits (Galway, Ireland). SOD-1 and GSH-Px (8) Low cost
activity were measured with RanSOD commercial colorimetric tests (9) Adaptable to study other pregnancy conditions or for use in clinical
(RanSOD, Randox, Ireland).Serum uric acid levels were measured by trials.
standardized enzymatic PAP-method with uricase and peroxidase, Clinical cases and summary results: The database has been built by
using commercial Beckman Coulter kits (Galway, Ireland). MedSciNet (www.medscinet.com) who also provide secure and
Clinical cases and summary results: Serum levels of ceruloplasmin, uric confidential data storage. The development has been funded by
acid and SOD-1 were significantly higher in the PE group compared to the Bill and Melinda Gates Foundation through the Global Pregnancy
the control group (471.2 ± 87.2 vs404.4 ± 74.5mg/L, 315.4 ± 79.3 Collaboration:
versus 219.1 ± 51.4 mmol/L, 29.9 ± 21.8 versus 20.5 ± 14.7 IU/ml Translation for use in different languages is available at a modest cost.
respectively, p 50,05). Serum levels of GSH-Px were not significantly The database is available to low and middle income researchers
higher in the PE group compared to the control group (1000.6 ± centres and new investigators at minimal or reduced cost. Users in
520.9 vs.813.5 ± 214.8 IU/L). ROC analysis showed the that serum high income countries will be charged $1200/year .
ceruloplasmin (plot area 0,886) and serum uric acid (plot area 0,855), The data are returned to the owners at the end of the research and
have the best diagnostic accuracy for PE and are more accurate when remains their own property under their exclusive control.
compared to antioxidative enzymes SOD-1 (plot area 0,679) and A service is also available at modest cost to convert existing
esspecialy more accurate than GSH-Px (plot area 0,504). databases to this format.
Conclusion: Serum ceruloplasmin level may have significant role as the Modules are under development for use in studies of other adverse
markers of oxidative stress in pre-eclampsia especially when used in pregnancy outcomes,
combination with uric acid levels. Conclusion: The CoLab database is ready to use now. There is no
requirement to become involved in collaborative studies but it is
Keywords: Ceruloplasmin, antioxidative enzymes, preeclampsia hoped that users will discover the advantages and power of the
facility to do so. Sharing will be greatly simplified and enhanced by
the use of a common database format worldwide.
Enquiries to - Ms. Lee Rager, Project Manager, [email protected]
gee.edu Phone +1 412-641-1427

277 Keywords: Preeclampsia, collaborative studies, global database

The global pregnancy collabora-

tion database: a powerful tool for
cooperative international pree- 330
clampsia research Postpartum dexamethasone for
1 2 3
C. Redman : J Roberts , L. Myatt , and on behalf of the women with hellp (hemolysis,
Global Pregnancy Collaboration. elevated liver enzymes, and low)
1
Nuffield Department of Obstetrics and Gynaecology, John Radcliffe
Hospital, Oxford, UK, 2Magee-Womens Research Institute, S. Kumru1, B. S. Isenlik2, O. Ozdemir2, M. Caglar3, A. Alci2,
Epidemiology and Clinical and Translational Research, Pittsburgh, and N. Serin2
USA, and 3Dept of Ob-Gyn, Oregon Health and Science University,
1
Portland, USA Obstetrics and Gynecology, Division of Perinatology Akdeniz
University, Medical School, Antalya, Türkiye, 2Obstetrics and
Introduction: Preeclampsia is a syndrome, now recognized to be the Gynecology Health Ministry Antalya Education and Research
end stage of multiple patho-etiological processes. Further under- Hospital,Antalya, Türkiye, and 3Obstetrics and Gynecology Duzce
standing is difficult to develop because very large datasets are University Medical School, Düzce, Türkiye
needed for analytical power. To be realistic, they can only be achieved
by individual patient data meta-analyses. But inconsistencies between Introduction: HELLP ((hemolysis, elevated liver enzymes, and low
the content and format of different data collections are major platelets) syndrome is thought a severe form of preeclampsia. The
impediments. They can be prospectively minimised by the use of a effectiveness of postpartum dexamethasone treatment has not been
single database format which meets the needs of most researchers clearly demonstrated yet. So this study was undertaken to determine
but preserves data compatibility between different studies. Here we the efectiveness of postpartum dexamethasone treatment in patients
describe such a database which is available to all researchers with (HELLP) syndrome.
interested in using their data in big collaborative preeclampsia Materials and methods: This prospective, open randomized controlled
studies. study was conducted in which 69 women with HELLP syndrome.
Materials and methods: The database captures data formatted Women were randomly assigned two groups as treatment or no
to comply with the minimal and optimal preeclampsia standard treatment groups following delivery. The effects of dexamethasone
datasets specified by Myatt et al (Hypertension 2014,63:1293-301).
270 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

treatment on laboratory and clinical parameters, maternal morbidity

and duration of hospital stay were evaluated.
398
Clinical cases and summary results: There were 30 women in Congenital thrombotic
dexamethasone treatment group while 39 women in no treatment
group. Demographic characteristics, clinical and laboratory para- thrombocytopenic purpura
meters were similar in two groups at the beginning of the study.
There were also no difference in duration of hospitalization and the during pregnancy
need for the use of blood products between groups. There were no
significant differences between groups for using blood products and K. Luterek1, A. Majewska2, A. Ostas3, B. Pietrzak1, and
antihypertensive drugs and the pattern of of platelet count recovery,
aspartate aminotransferase, lactate dehydrogenase, hemoglobin, or
M. Wielgos1
diuresis. 1
1st Department of Obstetric and Gynecology,Medical University of
Conclusion: Our findings do not support the use of dexamethasone in Warsaw, Warsaw, Poland, 2Students’ Scientific Association at the 1st
the postpartum period for recovery of patients with HELLP syndrome.
Department of Obstetrics and Gynecology, Medical University of
Warsaw, Warsaw, Poland, and 3Department of Anesthesiology,
Keywords: HELLP syndrome,dexamethasone, randomized controlled
Institute of Hematology and Transfusion Medicine, Warsaw, Poland
trial
Introduction: Moschcowitz syndrome, also known as thrombotic
trombocytopenic purpura (TTP) is a disorder of the blood-coagulation
359 system, in which extensive microscopic clots form in the small vessels
throughout the body. Most cases arise from the autoantibodies
Diagnostic value of ceruloplasmin inhibition of ADAMTS13, a metalloprotease responsible for splitting
large multimers of von Willebrand factor. It is a rare condition,
and antioxidative enzymes in pre- affecting women 2-3 times more often than men. Pregnancy is
regarded as a predisposing factor for inducing or recurrence of the
eclampsia disease. TTP is a severe, life-threatening disease that needs urgent
diagnosis. Preterm delivery and intrauterine fetal demise are frequent
A. Nikolic, V. Cabarkapa, M. Bogavac, Z. Grujic, and complications of TTP.
M. Milosevic-Tosic Clinical cases and summary results: A 34-year-old woman was
admitted to Hematology Institute at 21st week of third gestation
Departmentof Pharmacy, Clinical Center of Vojvodina, Department due to thrombocytopenia and rapidly worsened at 23rd week of
of Obstetrics and Gynaecology, Novi Sad Serbia gestation. Neurological symptoms, consciousness disorders and
memory loss occured. It was followed by the increase of blood
Introduction: Oxidative stress and the generation of reactive oxygen pressure, anuria and respiratory failure. Decreasing concentration of
species (ROS) have been implicated in a pathophysiological processes platelets (49000), increased LDH 954 and creatinine 269 umol/l was
in variety of diseases including pre-eclampsia. The objective of our found. US revealed placental abruption with intrauterine fetal demise.
study was to evaluate diagnostic value of ceruloplasmin together Differential diagnosis included HELLP syndrome and TTP - ADAMTS13
with other enzymatic and non-enzymatic antioxidants (Cu, Zn- concentration was evaluated. Due to a life threatening condition
Superoxide dismutase (SOD-1), glutathione peroxidase GSH-Px) and cesarean section and plasmapheresis was performed. Normal platelet
uric acid) and to evaluate the level of oxidative stress in patients with count was achieved after 8 plasma exchanges. On the 9th day she
pre-eclampsia and compare it with normal pregnancy. developed cardiac and respiratory failure, requiring mechanical
Materials and methods: In this prospective study, antioxidative ventilation and catecholamine administration. Differential diagnosis
markers were investigated in two groups of pregnant women: included TRALI and fluid overload. Plasmapheresis was implemented
patients with preeclampsia (n=32) and the healthy pregnant women again and her condition improved on the 19th day.
(n=60). The following anti-oxidative markers were evaluated: serum Conclusion: TTP was diagnosed basing on clinical presentation and
ceruloplasmin levels, uric acid, SOD-1 and GSH-Px. Serum ceruloplas- laboratory results. It is a rare disease that can be induced by or
min levels were measured by automated immunoturbidimetric assay reoccur during pregnancy. Differential diagnosis of TTP should
using Beckman Coulter kits (Galway, Ireland). SOD-1 and GSH-Px include HELLP, preeclampsia and DIC. Decisions regarding treatment
activity were measured with RanSOD commercial colorimetric tests should be based on the concentration of ADAMTS13. Undiagnosed
(RanSOD, Randox, Ireland). Serum uric acid levels were measured by TTP may pose a major risk for gestation and the pregnant patient.
standardized enzymatic PAP-method with uricase and peroxidase, Plasmapheresis is the treatment of choice, in contrast to contra-
using commercial Beckman Coulter kits (Galway, Ireland). indicated transfusion of platelets
Clinical cases and summary results: Serum levels of ceruloplasmin, uric
acid and SOD-1 were significantly higher in the PE group compared to Keywords: Thrombotic trombocytopenic purpura (TTP), pregnancy
the control group (471.2 ± 87.2 versus 404.4 ± 74.5mg/L, 315.4
± 79.3 versus 219.1 ± 51.4 mmol/L, 29.9 ± 21.8 versus 20.5 ± 14.7 IU/
ml respectively, p 50,05). Serum levels of GSH-Px were not
significantly higher in the PE group compared to the control group
(1000.6 ± 520.9 versus 813.5 ± 214.8 IU/L). ROC analysis showed the
that serum ceruloplasmin (plot area 0,886) and serum uric acid (plot
area 0,855), have the best diagnostic accuracy for PE and are more
accurate when compared to antioxidative enzymes SOD-1 (plot area
0.679) and esspecialy more accurate than GSH-Px (plot area 0.504).
Conclusion: Serum ceruloplasmin level may have significant role as the
markers of oxidative stress in pre-eclampsia especially when used in
combination with uric acid levels.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 271

414
Introduction: The aryl hydrocarbon receptor (AhR), a ligand-depen-
Continuous positive airway dent transcription factor, mediates a variety of biological processes
pressure in the management of including xenobiotic metabolism, dioxin toxicity and vascular devel-
opment. AhR has been extensively studied as a receptor for
preeclampsia with low cardiac environmental toxicants such as 2,3,7,8-tetrachlorodibenzo-p-dioxin,
which is present cigarette smoke. AhR has been known to be present
output: a pilot study in placenta, especially in syncytiotrophoblasts, and also seen in
endothelium of large blood vessels in villi and endothelium of
umbilical cord arteries and veins, implying the important role of AhR
A. S. Staelens1,2, S. Vonck1,2 , D. Lanssens1, and in maintaining trophoblast development. The aim of this study was to
W. Gyselaers1,2 evaluate the effect of smoking on the expression of sFlt-1 in pregnant
1 mice and investigate the involvement of AhR in this process.
Dept. Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk,
Materials and methods: Pregnant CD-1 mice were exposed to cigarette
Belgium and 2Dept. Medicine and Life sciences, Hasselt University,
smoke (1 or 2 cigarettes/day, 5 days/week) (smoke group) or sham
Hasselt, Belgium exposed (control group) throughout the pregnancy. To evaluate the
role of AhR, pregnant mice were treated with AhR agonist only (AhR-
Introduction: Continuous positive airway pressure (CPAP) is consid- agonist group) or antagonist only (AhR-antagonist group) and with
ered a safe treatment in pregnant women with sleep disordered antagonist prior to cigarette smoke exposure (AhR-antagonist+smoke
breathing, which cardiovascular effects are known to be similar to group) throughout the pregnancy. From the 5 treatment groups
gestational induced hypertensive diseases. As CPAP results in an (control, smoke, AhR-agonist, AhR-antagonist and AhR-antagonist+s-
increasing cardiac output (CO), it might be suggested as a treatment moke group), serum and placental levels of sFlt-1 were measured
for maternal low-CO related gestational diseases such as intra-uterine with ELISA and western blots analysis, respectively.
growth retardation and preeclampsia. The aim of this pilot study was Clinical cases and summary results: Compared to control group, smoke
to evaluate the effect of autoCPAP on maternal CO in pregnancies group had significantly lower serum sFlt-1 level. Smoke exposure
complicated with IUGR and/or gestational hypertensive diseases. significantly decreased protein expression of sFlt-1 in placentas from
Materials and methods: Patients admitted for hypertensive disorders smoke exposure group compared to those from control. The serum
and/or intra-uterine growth retardation were considered for inclusion. sFlt-1 level was lower in AhR-agonist group compared with control
Cardiovascular parameters were obtained using impedance cardio- and AhR-antagonist group. However, there was no difference in
graphy (ICG). Only patients with a CO 57.5L/min were asked to serum sFlt-1 level between AhR-antagonist group and AhR-anatago-
participate in the study (see figure). After a 2-hours habituation nist+smoke group.
process at daytime (day 0), patients were asked to use the CPAP- Conclusion: Smoking throughout pregnancy was associated with a
device every night till discharge or termination of pregnancy. ICG lower production of sFlt-1, and this protective effect of smoke is most
measurements were performed at day 0, day 1 and from then every likely to be contributed to the activation of AhR system. Further
other day during the CPAP treatment. studies are needed to evaluate the possibility that extraneous and
Clinical cases and summary results: 43 patients were eligible for endogenous AhR ligands without toxicity could be potentially used as
inclusion. In 17/43 (39.5%) patients, valid data were obtained (see a prophylactic or therapeutic tool for preeclampsia.
figure). The maximal participation time was 7 days (n=1).
Cardiovascular parameters are presented in table 1 (data presented Keywords: Preeclampsia, cigarette
as median and interquartile ranges): CO showed a small but
significant increase (Z=2.22, p=0.026) and diastolic blood pressure
and mean arterial pressure decreased (Z=2.39, p=0.017 and
Z=2.38, p=0.017) after the first night of therapy. No differences 429
were found for heart rate, systolic blood pressure and stroke volume.
Overall, there was no difference of any parameter at day 3 and 5 Serum zonulin is decreased in
(p40.097). These observations were seen both in women with and
without hypertension. preeclampsia
Conclusion: Although there is a temporary small increase of CO in
pregnant women with hypertension or IUGR, performing CPAP as a G. Mutluoglu1, T. _Ileri2, A. Boluk1, O. Cakir Madenci1, and
maintenance therapy seems difficult once gestational complications
A. Orcun1
have occurred. CPAP may be a safe and non-invasive method to
increase maternal CO, but needs further investigation. 1
Biochemistry Dept., Dr. Lutfi Kirdar Kartal Education and Research
Keywords: Cardicac output, maternal hemodynamics, CPAP Hospital, Istanbul, Turkey and 2Obstetrics and Gynaecology Dept., Dr.
Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey

Introduction: The aim of the study is to examine zonulin levels, which

420 is an intestinal epithelial permeability marker, in preeclampsia, to
Cigarette smoke and the produc- investigate its associations with the cellular immune response
marker soluble interleukin-2 receptor (sIL-2R) and exogenous antigen
tion of SFLT-1 in pregnant mice load marker lipopolysaccharide binding protein (LBP) and to evaluate
the implications of these findings in the etiopathogenesis of
and the possible role of AHR in preeclampsia.
Materials and methods: We designed a cross-sectional case-control
protective effect of cigarette study and enrolled 22 women diagnosed with preeclampsia and 22
healthy pregnant controls. Plasma zonulin levels were determined by
smoke ELISA. Serum sIL-2R and LBP levels were assessed by chemilumines-
cent immunometric method.
G. J. Cho, K. H. Ahn, S. Hong, M. J. Oh, and H. J. Kim Clinical cases and summary results: Women with preeclampsia had
lower levels of plasma zonulin and serum LBP than normotensive
Department of Obstetrics and Gynecology, Korea University Guro healthy controls (p 50.05). The difference in serum sIL-2R levels
Hospital, Korea University College of Medicine, Seoul, Korea between women with preeclampsia and healthy controls was not
272 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

significant (p: 0.751). There was a negative correlation between preeclampsia than in women without preeclampsia (4.9% versus
plasma zonulin and serum urea (r: -0.319, p: 0.035) and a positive 2.7%, respectively, p 50.001). Through the pre-pregnancy to
correlation between serum sIL-2R and ALT (r: 0.335, p: 0.026) or AST (r: postpartum period, women with preeclampsia had a greater increase
0.319, p: 0.035). in gestational weight retention, body mass index, waist circumfer-
Conclusion: We found that zonulin and LBP, but not sIL-2R, levels were ence, systolic blood pressure, and triglycerides, and a greater
significantly lower in women with preeclampsia as compared with decrease in high-density lipoprotein cholesterol, than women without
healthy pregnant controls. Reduced intestinal permeability in preeclampsia. Preeclampsia was associated with an increased risk of
preeclampsia might be, in part, associated with a lower fat mass, development of metabolic syndrome in the postpartum period in
malnutrition or impaired immune system functions. Further studies women without pre-pregnancy metabolic syndrome (odds ratio [OR]:
are needed to elucidate the exact pathogenetic role of intestinal 1.28, 95% confidence interval [CI]: 1.05-1.56). However, preeclampsia
permeability in preeclampsia. was not associated with the development of metabolic syndrome in
the postpartum period in women with pre-pregnancy metabolic
Keywords: Preeclampsia, intestinal permeability, zonulin, lipopoly- syndrome or 2 components of metabolic syndrome.
saccharide binding protein, IL-2 receptor Conclusion: In this study, preeclampsia itself led to the development
of metabolic syndrome in the postpartum period in women without
pre-pregnancy metabolic syndrome. However, the effects were
attenuated by predisposing risk factors in the pre-pregnancy period.
460
Keywords: Preeclampsia, metabolic syndrome, risk factor
Is preeclampsia itself a risk factor
for the development of metabolic
syndrome in the postpartum 572
period? Is there a role for echocardiogra-
phy in the management of
G.J. Cho1, J.H. Park2, S.A. Shin2, M.J. Oh1, H.J. Kim1, and
H.S. Seo3
hypertensive disorders in preg-
1
Department of Obstetrics and Gynecology, Korea University College
nancy? Results from a systematic
of Medicine, Seoul, Korea, 2Big Data Steering Department, National review
Health Insurance Service, Seoul, Korea, and 3Cardiovascular Center,
Division of Cardiology, Department of Internal Medicine, Korea
University Guro Hospital, Korea University College of Medicine, Seoul,
J. Castleman1,3, R. Ganapathy2, F. Taki1, G. Lip3,
Korea
R. Steeds3, and D. Kotecha3
1
Sandwell and West Birmingham Hospitals NHS Trust, Birmingham,
Introduction: The aim of this study was to determine the association United Kingdom, 2Epsom and St Helier University Hospitals NHS
between preeclampsia and the development of metabolic syndrome Trust, Surrey, United Kingdom, and 3University of Birmingham
after delivery, based on pre-pregnancy status. Institute of Cardiovascular Sciences, Birmingham, United Kingdom
Materials and methods: We enrolled Korean women who had their first
delivery between January 1, 2011 and December 31, 2012 and had
undergone a national health screening examination (NHSE) through Presenter: J. Castleman
the National Health Insurance Corporation 1-2 years before their first Introduction: Echocardiography is commonly used to direct the
delivery and again had an NHSE within 2 years after their first delivery. management of hypertensive disorders in medical patients, but its
Clinical cases and summary results: Among 49 065 participants, application in pregnancy is unclear. Our objective was to define the
preeclampsia developed in 3391 participants (6.9%). The postpartum use of echocardiography in pregnancies complicated by gestational
prevalence of metabolic syndrome was higher in women with hypertension (GH) and preeclampsia (PET).
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 273
Materials and methods: We performed a systematic review of articles pregnancy affected by GH/PET was the only significant predictor of
using an electronic search of bibliographic databases from inception increased Mon1 count (B±SE -0.46±21.8, p50.001).
to March 2015, prospectively registered with PROSPERO Conclusion: Mon1 are increased at the beginning of the second
(CRD42015015700). Studies of pregnant women with GH or PET trimester of pregnancy in women with a previous hypertensive
evaluated by echocardiography, regardless of study design, were pregnancy. Mon3 are increased in pregnancy irrespective of a history
eligible. of hypertension. Possible (patho)physiological and clinical effects of
Clinical cases and summary results: The search strategy identified 36 the changes in monocytes subsets in pregnancy will need to be
studies, including 745 women with GH and 815 women with PET. The established in the future.
populations were heterogeneous with respect to clinical character-
istics, parity and risk of bias. Increased vascular resistance and left- Keywords: Monocytes, hypertension, preeclampsia, pregnancy
ventricular (LV) mass were the most consistent findings in GH and
PET. Differentiating features from normal pregnancy were LV wall
thickness 1.0cm, exaggerated reduction in E/A (the ratio of the early
to late ventricular filling velocities) and lateral e’ (early diastolic mitral
annular velocity) 514cm/s. There was disagreement between studies
with regard to cardiac output due to the timing of echocardiography,
although reduced stroke volume was an indicator of adverse
prognosis. Diastolic dysfunction and left ventricular remodelling are
most marked in severe and early-onset PET, but are also markers of
PET before clinical manifestation, and are associated with adverse
outcomes.
Conclusion: Echocardiography is a valuable tool to stratify risk and can
guide management and counselling in the preclinical and clinical
phases of GH and PET. Changes in cardiac function and morphology
are recognisable at an asymptomatic early stage and correlate with 591
disease severity and adverse outcomes.
Pulmonary acute edema as an
Keywords: Pregnancy, hypertension, preeclampsia, echocardiogra-
phy, review outcome of puerperal
preeclampsia
573 V. Bebia-Conesa, M.I. Mejı́a-Jiménez, A. Vázquez-
Increased CD14++CD16-CCR2+ Sarandeses, D. Garcı́a-Alcázar, and E. Batllori-Badia
(MON1) monocytes in pregnant Obstetrics & Gynecology Department, Hospital Universitario 12 de
Octubre, Madrid, Spain
women with previous
hypertension Presenter: Bebia-Conesa, V
Introduction: The development of preeclampsia is not a unique
J. Castleman1,3, R. Ganapathy2, D. Kotecha3, G. Lip3, and feature of an ongoing pregnancy, whilst onset of preeclampsia within
puerperium may be a challenge for the clinician, regarding diagnosis
E. Shantsila3 and management, as the overall frequency of this complication is low.
1
Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Generally, most patients affected by preeclampsia experiment a
United Kingdom, 2Epsom and St Helier University Hospitals NHS significant improvement of their clinical features after delivery.
Besides, in patients who suffered severe preeclampsia, the return to
Trust, Surrey, United Kingdom, and 3University of Birmingham
pregestational BP figures may last up to 3 to 6 months. This group of
Institute of Cardiovascular Sciences, Birmingham, United Kingdom patients can suffer from the same complications seen in patients with
ongoing pregnancy and severe preeclampsia.
Presenter: J. Castleman We would like to present a clinical case of a pulmonary acute edema
Introduction: Individual monocyte subsets play distinct roles in the diagnosed and managed after induction of labour because of severe
pathogenesis of cardiovascular disease, but their implications in preeclampsia.
hypertension in pregnancy are unclear. Our objective was to examine Clinical cases and summary results: A gravida 2, para 1, 40-y-o
the difference in monocyte subsets between pregnant women with pregnant with no significant obstetrical history was admitted to our
or without previous gestational hypertension (GH) or preeclampsia labour ward at 36 + 3 GW because of high BP (192/99 mmHg),
(PET) and non-pregnant controls. headache, and elevated transaminases. With a diagnosis of severe
Materials and methods: CD14++CD16-CCR2+ (Mon1), preeclampsia, we started induction of labour, as well as infusion of
CD14++CD16+CCR2+ (Mon2) and CD14+CD16++CCR2- (Mon3) hidralazine and MgSO4 iv. The second stage of labour was assited
monocyte subsets were analysed by flow cytometry in 17 pregnant with Thierry’s spatulae, obtaining a healthy newborn.
women with previous hypertension in pregnancy, 42 pregnant During the 3rd day of puerperium, the patient experimented high BP
women without previous gestational hypertension and 27 healthy, and moderate effort dyspnea. SaO2 was 94%, while the pulmonary
non-pregnant controls. All women had blood pressure 5140/ auscultation and chest X-ray showed signs suggestive of pulmonary
90mmHg at the time of the study. acute edema.
Clinical cases and summary results: The groups were well-matched for The patient was admitted to ICU, where the echocardiography
age, body mass index and ethnicity (p40.05 for all). The pregnant findings were compatible with mild congestive cardiac insufficiency. It
women were studied at 13±1 weeks gestation. Total monocyte and was necessary to increase the antihypertensive medication up to 4
Mon1 counts were higher in women with a history of GH or PET different types, proceeding to decrease as the BP levels normalized.
compared to other groups (p50.001 for both) (Table). Mon3 were The patient was dismissed 13 days after delivery, asymptomatic and
higher in both groups of pregnant women compared to non- with normal BP levels and normal transaminases.
pregnant controls (p=0.002). Blood pressure and parity were Conclusion: Although the overall frequency of puerperal complica-
significantly higher in the group with previous GH/PET. A previous tions of preeclampsia is low, it can evolve into life-threatening
274 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

conditions that require an intense and proactive management. parameters may allow the usage of this noninvasive tool for
Among the clinical features showed by our patient, given the high evaluation of hemodynamic changes in different pathologies. The
risk of thrombosis of puerperium and preeclampsia, we also most important aspect is represented by identification of early
considered pulmonary embolism as differencial diagnosis, which hemodynamic subclinical changes in preeclampsia.
was ruled out by normal angio-CT. As clinician, it is important to be
wide aware of this kind of situations in abnormal puerperium. Keywords: Impedance cardiography, systemic vascular resistance

627 637
Sysyemic vascular resitance evo- Are we able to influence pulsati-
lution during normal pregnancy lity index values of uterine
demonstrated by impedance arteries in patients at risk of
cardiography preeclampsia?
R.M. Sima1,2, A.I. Badarau1, D. Gherman1, C.M. Ciornei1, P. Zabul1, and K. Preis2
R.I. Papacocea1, C. Scheau1, A.D. Stanescu2, and L. Ples1,2 1
Department of Obstetrics & Gynecology, the Sw. Wojciech Specialist
1 Hospital, Independent Public Complex of Integrated Health Care
The ‘‘Carol Davila’’ University of Medicine and Pharmacy, Bucharest
Units in Gdansk, 50 Al. Jana Pawł a II St., Gdansk 80-462, Poland.
and 2Bucur’’ Maternity, ‘‘St. John’’ Hospital, Bucharest, Romania
[email protected] 2Department of Obstetrics & Gynecology
Presenter: K.Preis
Presenter: Romina-Marina SIMA
Introduction: Uterine artery pulsatility index (Ut -PI) diminishes with
Introduction: Normal pregnancy is characterized by increased gestational age, its values are reduced with growing maternal age
circulating blood volume, changes in maternal heart rate (HR), and rise in the 3rd trimester. In the population of patients monitored
stroke volume (SV), cardiac output (CO) and systemic vascular for PE, we were able to confirm positive influence on uterine artery
resistance (SVR). The maternal heart is enlarged due to an increase pulsatility index (reduction) in patients with abnormal Ut-PI after 26
in venous filling. Hemodynamic alterations related to pregnancy are weeks of gestation (over 1.2), accompanied by vitamin D3 deficiency
different in women who have normal pregnancy compared to those of less than 30 ng/ml and other concomitant risk factors predisposing
who develop pregnancy complications. Impedance cardiography to preeclampsia.The aim of this paper was to examine potentially
(ICG) is a diagnostic method based on measurement of the electrical beneficial effect of vitamin D3 on uterine arterial flow and to establish
properties of the biological tissues applied to the thorax region. Many effective therapeutic dosage of said vitamin in patients predisposed
authors concluded that ICG may be the most appropriate and to preeclampsia.
accurate technique to measure normal hemodynamic changes during Clinical cases and summary results: 3 clinical cases
pregnancy and postpartum. Case 1
Materials and methods: The routine protocol of investigation included 1st pregnancy, week 24, elevated arterial blood pressure 145/95
the following steps: we obtained a detailed medical history of the In routine examination of uterine artery blood flow, pulsatility index
patient, we measured patient’s weigh, height, blood pressure, we was observed to be elevated in excess of reference values (Tab-1.) . In
obtained a usual blood sample, we realized obstetric ultrasound and view of these abnormalities and with consent of the patient, oral
we performed hemodynamic investigation using impedance cardio- supplementation of vitamin D3 was commenced at the dose of 2000
graphy. The patients did not require sedation or any other type of units. After 2 weeks of follow-up, uterine flow values clinically
anesthesia for cardiovascular monitoring. We evaluated pregnant improved and serum levels of vitamin D3 increased. In subsequent 2
patients in each trimester of pregnancy. The patient were included weeks of observation, despite continued vitamin D3 supplementation
into the study in the first trimester of pregnancy and there was a at the dose of 2000 units, its serum levels were found to drop and
follow up during pregnancy and postpartum. In parallel we obtained pulsatility index values were fluctuating. With this in mind,
the same parameters to a nonpregnant healthy women group. This supplementation dose was raised to 4000 units a day.
study is concerned on systemic vascular resistance changes during After another week of supplementing vitamin D3 at the level of 4000
pregnancy. units per day, we were able to obtain therapeutic serum levels of D3
Clinical cases and summary results: This study enrolled 161 persons. and to improve uterine pulsatility index values.
Among this 141 were pregnant women from the first to the last Case 2. . .
trimester of pregnancy and postpartum. The control group was Conclusion: Taking into account clinical observations reported by the
formed from 20 nonpregnant women. For study group mean age was authors, it seems vitamin D3 deserves further investigation as a likely
28.37 years (standard deviation 5.6 and CI: 17.39; 39.35). The majority contributor to the maintenance of normal arterial blood pressure, and
patients had vaginal delivery (62.4%). Mean birth weight of the fetus as a possible factor normalizing pulsatility index values in uterine
was 3230 g and mean gestational age at the birth time was 38.4 arteries of patients. The described correlation between the dose of
weeks. Regarding addictive behavior we observed that 63.5% patients vitamin D3, change in pulsatility index and BP suggests the need for
were nonsmokers. We observed that systemic vascular resistance was future population-based research.
about 1593.09 dyne.cm.sec-5 and it decreased in the second trimester
of pregnancy to a mean value of 910.89 dyne.cm.sec-5 (Z= -7.174, Keywords: Preeclampsia, vitamin D3, uterine pulsatility index
p50.0001). The mean value of this hemodynamic parameter increased
in the third trimester of pregnancy reaching a value of 1098.72 (Z=
-5.154, p50.0001). In postpartum it had a lower value compared with
the first trimester (Z= -7.217, p50.0001) and third trimester of
pregnancy (Z= -5.776, p50.0001).
Conclusion: Impedance cardiography is an important method that can
illustrate the hemodynamic profile of pregnancy, with its ability to
identify the correct trend of systemic vascular resistance during
pregnancy. Correct identification of the normal cardiovascular
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 275

723 (CASE REPORT)

Mirror syndrome associated with
eclampsia PRETERM BIRTH/THE PRETERM INFANT - 037

S. Fernández, S. Montes, M. Navarro, L. Amor, F. Moreno,

Circadian dynamics of heart rate
and J. Adanez and qtc interval in very low-birth-
Obstetrics Department, Asturias Central University Hospital, Oviedo, weight and extremely low-birth-
Spain
weight newborns according to
Presenter: M. Navarro 24-h Ecg monitoring
Introduction: Mirror Syndrome or Ballantyne Syndrome is described as
a triple edema, because it associates maternal, fetal and placental N. Korableva1 and A. Korablev2
edema. This rare syndrome has been related with different causes of
1
fetal hydrops. The pathogenesis is not clear. Some studies have Komi branch of the Kirov State Medical Academy, Syktyvkar, Russia
considered this disease as a form of severe preclampsia; however, and 2General Children’s Hospital, Syktyvkar, Russia
others suggest that they aren’t the same disease because mirror
syndrome has hemodilution instead of hemoconcentration. In Introduction: Analyses of chronotropic characteristics of heart rate and
addition, some publications evidence an alteration in the balance the dynamics of QTc interval in extremely low-birth-weight and very
between angiogenic and antiangiogenic factors in the mirror low-birth-weight newborns at the post-conceptual age of 37-42
syndrome similar to the inbalance observed in preeclampsia.The weeks.
diagnosis is usually difficult and it can cause serious consequences for Materials and Methods: Analyses of chronotropic characteristics of
mother and fetus. heart rate and the dynamics of QTc interval in very ELBW and VLBW
Clinical cases and summary results: We report the case of a 17-year-old newborns at the post-conceptual age of 37-42 weeks.
woman at 30 + 1 weeks of gestation who presents regular contrac- Clinical cases and summary results: The heart rate dynamics in the
tions, preterm premature rupture of membranes and vaginal investigated groups is presented in the Table 1. Significantly higher
bleeding. Fetal hydrops secondary to a severe myocardiopaty with maximum heart rate during sleep was observed in the group of very
fatal prognosis has been previously diagnosed. Vaginal delivery low birth weight infants (Dunnett’s test). This is probably due to the
required Simpson’s forceps indicated for second stage arrest. The fact that there were more infants with significant bradyarrhythmia
result was a 2.465 gr stillbirth female with generalized edema. The episodes while sleeping in the ELBW group. Circadian index in
placental study reveled a 726 gr placenta with thickened areas. In the newborns of investigated groups did not show the significant
second day after delivery, the woman presented peripheral edema, difference and amounted (median (3-97percentile) to 113% (105-
severe hypertension, headache, blurred vision, progressive visual 117) in VLBW newborns, and to 111% (102-119) in ELBW newborns.
neglect, cortical blindness, hemodilution and proteinuria. A posterior No significant differences between groups on being investigated
reversible encephalopathy syndrome is suspected, but on the fourth values were obtained (Table 2). However, there is a tendency to
day, the patient presents a new onset, generalized tonic-clonic increasing of values of QTc interval in VLBW infants at the post-
seizure, and requires intensive unit care admisssion. Analytical, conceptual age of 37-42 weeks, that is, this group of newborns shows
diuresis and clinical resolution is complete on the eighth day dysadaption opportunities of the electrical function of the myocar-
Conclusion: The onset of generalized maternal edema and hyperten- dium (lengthening of repolarization) that can predispose to the
sion in pregnancy or postpartum with fetal hydrops should be occurrence of lifethreating heart rhythm disorders. The time factor is
considered as a severe sign of preeclampsia. likely to be taken into consideration during the maturation of the
Preeclampsia in a mirror syndrome setting, usually behaves as an cardio respiratory system of premature infants, as ELBW infants live
atypical preeclampsia. Early diagnosis and treatment of mirror more prolonged time period reaching 37-42 weeks of their post-
syndrome improves maternal and fetal outcomes. Eclampsia preven- conceptual age.
tion with magnesium sulfate should de used until clinical and diuresis Conclusion: The significant difference of the circadian dynamics index
resolution. of heart rhythm both in ELBW and VLBW newborns at the post-
Keywords: Eclampsia, mirror syndrome, hydrops fetalis conceptual age of 37-42 weeks has not been found. Premature
newborns with ELBW are subject to clinical examination at the age of
37-42 weeks that requires the compulsory 24-h ECG monitoring with
the parallel recording reopneumogram (in case of impossibility of
fragmented ECG).

Keywords: Extremely low-birth-weight, very low-birth-weight new-

borns, QTc, heart rate
276 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

062

Effect of maternal age on preterm

delivery rate in singleton
Table 1 Circadian dynamics of heart rate in VLBW and ELBW
pregnancies
newborns in the post-conceptual period of 37-42 weeks.
S. Hitrova1, T. Dakov1, V. Dimitrova1, and T. Todorov2
VLBW newborns ELBW newborns 1
State University Hospital ‘‘Maichin Dom’’, Department of Obsterics
(n=20) (n=27)
*P ¼ 0.023 (Med (%3-97)) (Med (%3-97)) and Gynecology, Medical University - Sofia, Bulgaria, and 2Nilson
Bulgaria LTD
Average heart rate in waking 168 (151-178) 163 (147-181)
Heart rate min in waking 119 (84-143) 125 (101-153)
Introduction: The demographic shift towards later childbearing is a
Heart rate max in waking 210 (196-236) 210 (185-231)
major clinical and public health problem since according to some
Average heart rate in sleeping 149 (133-163) 149 (129-165)
Heart rate min in sleeping 124 (60-144) 120 (104-148) data in literature advanced maternal age (AMA) 35 years is
Heart rate max in sleeping 198* (175-228) 190 (166-210) associated with more frequent complications and worsened preg-
24 h average heart rate 157 (141-167) 153 (139-171) nancy outcome. Provision of adequate medical care and counseling in
these cases depends on appropriate evaluation of the particular risks.
The aim of the study was to evaluate the impact of AMA  35 years
on preterm delivery (PD) rate - overall, iatrogenic/induced and early,
051 in singleton pregnancies.
Materials and methods: 4078 women from the State University
Trajectories in parenting stress Hospital ‘‘Maichin Dom’’ in Sofia with singleton pregnancy and known
pregnancy outcome were enrolled in the study between 01/2010 and
for mothers of very preterm 12/2012. They were divided in 3 age groups (AG) - AG-1 - 34 years,
AG-2 - between 35-39 years and AG-3 - 40 years at the time of
infants to 2 years delivery. The following parameters were compared between the AG:
overall PD (oPD) rate before 37 completed weeks of gestation (w.g.),
P. H. Gray1,2, DM Edwards1, and K Gibbons2 iatrogenic/induced pretem delivery (iPD) rate and early PD (ePD) rate
before 32 w.g. Information about pregnancy outcome was retrieved
1
Growth and Development Unit, Mater Mothers’ Hospital, from the electronic hospital records. Data were processed with SPSS
South Brisbane, Queensland, Australia, and 2Mater Research 13.0 statistical package. Descriptive and comparative analysis was
Institute-University of Queensland, South Brisbane, Queensland, performed. The statistical hypotheses about different tested effects
Australia are assessed based on the appropriate statistical algorithms (Chi-
square Fisher exact test, Kolmogorov-Smirnov test, Shapiro-Wilk test,
Introduction: Parenting stress has been reported to be somewhat Student t-test, Mann-Whitney U test, Rearson and Spearman
higher in mothers of preterm infants, though others have not found correlations, ROC chart analysis). P values 2.0 considered clinically
any difference. The aim of the study was to examine levels of significant. Thus, with p50.05 and adjOR 4 2.0 the differences were
parenting stress in mothers of preterm and term infants when the considered both statistically and clinically significant.
children were 2 years old and to determine the trajectory of stress Results: Maternal age 40 years was associated with statistically
over 3 time periods. The association of maternal and neonatal factors significant increase of overall PD rate - from 11.7% (265/2256) in AG-1
and developmental outcomes with parenting stress was also to 13.4% (202/1511) in AG-2 and to 17.4% (54/311) in AG-3 (p=0.1387,
examined. p=0.0049 and p=0.0.0649 for AG 1-2, AG 1-3 and AG 2-3 respectively).
Materials and methods: Participants were families who took part in a However, the differences between the groups were not clinically
longitudinal study of parenting stress with outcomes at 4 and 12 significant (adjOR 0.86, CI 0.71-1.04 and 0.63, CI 0.46-0.87 for AG1-2
months previously established. At 2 years, 79 preterm mothers (96 and for AG 1-3 respectively). As for iPD rate, it was 35.8% (95/265) in
babies) who delivered at 531 weeks gestation and 64 term mothers AG-1, 45.5% (92/202) in AG-2 and 55.6% (30/54) - in AG-3, the
(77 babies) participated. The mothers completed the Parenting Stress differences being statistically significant (p=0.0341, p=0.0069 and
Index-Short Form (PSI-SF), the Depression Anxiety Stress Scale (DASS) p=0.1907 respectively when comparing AG 1-2, AG 1-3 and AG 2-3).
and the Child Behaviour Checklist (CBCL). The infants had medical and There was also a clinically significant difference in iPD rate when
developmental (Bayley-3) assessments. comparing AG-1 and AG-3 (adjOR 2.23, CI 1.24-4.04). AMA 35 years
Clinical cases and summary results: The mean total PSI-SF at 2 years was found to be associated with some increase in ePD rate532 w.g.
was significantly higher for the preterm group (74.0 ± 21.7) compared It was 23.8% (63/265) in AG-1, 28.2% (57/202) in AG_2 and 35.2%
to the term group (64.7 ± 16.1) of mothers (p=0.002). There was a (19/54) in AG-3. However, the differences were not statistically
significant increase in the mean total PSI over time. For mothers at 2 significant (p=0.2762, p=0.0803 and p=0.3195 for AG1-2, AG 1-3 and
years, there was an association with high levels of parenting stress AG2-3 respectively).
and abnormal scores on the DASS and high total T-scores on the Conclusions: Maternal age 40 years was associated with statisti-
CBCL. There was no association between parenting stress and cally, but not clinically significant increase in overall PD rate.
maternal demographic or neonatal factors or Bayley-3 results. Iatrogenic PD rate was statistically significantly increased after the
Conclusion: Parenting stress in mothers of very preterm infants age of 35 and was both statistically and clinically significantly
continues to be high at 2 years having increased over time. Maternal increased after the age of 40 compared to the age 34. Early PD
mental health and infant behavioural issues contribute to the stress. rate was increased with AMA but the differences were not
significantly different.
Keywords: Preterm, parenting stress, trajectories
Keywords: Preterm delivery, maternal age
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 277

090 105
A 5-year retrospective study on The risk of retinopathy of pre-
the outcome of antenatal dexa- maturity (ROP) and compairing
methasone administration on series igf1 levels and clinical
premature infants score system
A. Oncog, and C. Castañeda Y. Coşkun1, C. Dalkan2, O. Yabaş3, O. Demirel4, E. Bayar5,
S. Sakarya5, T. Müftüoğlu6, D. Ersanlı7, and I. Akman1,2
Pediatric Department, Gov. Celestino Gallares Memorial Hospital,
1
Tagbilaran City, Bohol, Philippines Bahceşehir University Medical Faculty, Medical Park Goztepe
Hospital, Pediatrics Dept., Istanbul Turkey2Near East University,
Introduction: In low/middle-income countries where preterm birth is Nicosia, North Cyprus. Pediatics Dept., Division of Neonatology,
more common, yet adequate neonatal care is often unavailable, Nicosia Cyprus3Bahceşehir University Medical Faculty, Medical Park
antenatal steroid administration has been identified as an essential Goztepe Hospital, Ophtalmotology Dept., Istanbul Turkey,
and feasible intervention that could be of enormous public health 4
Bahceşehir University Medical Faculty, Medical Park Goztepe
benefit. Sadly, studies from low/middle-income countries are scarce, Hospital, Biochemistry Dept., Istanbul Turkey, 5Marmara University
and there is none from South Asia. This study aimed to determine the Medical Faculty, Public Health Dept., Istanbul Turkey, 6GATA
outcome of premature infants whose mothers received antenatal Haydarpaşa Department of Biochemistry, Istanbul Turkey, and
dexamethasone. 7
GATA Haydarpaşa Ophtalmotology Dept., Istanbul Turkey
Materials and methods: The charts of preterm infants, 24 - 34 weeks by
Ballard Score, delivered at Gov. Celestino Gallares Memorial Hospital
from January 2006 to December 2010 were reviewed alongside the Introduction: Aim: Retinopathy of prematurity (ROP) is the most
charts of their respective mothers. The dose of antenatal dexametha- common disease that cause blindness in preterm patients. Screening
sone given to the mothers was duly noted. The length of survival in criterias of ROP change in all countries, the recommendations of
terms of days after birth was determined. American Academia of Pedaitrics are used in our country. Inadequate
Clinical cases and summary results: Only 65% of mothers in preterm screening may cause blindness in this high risk population. In this
labor were given antenatal dexamethasone. Data gathered showed study, we aimed to develop a clinical risk scoring system in order to
that the administration of dexamethasone, even in incomplete define screening criteria for Turkey.
dosage, improves the length of survival of preterm infants. This is Materials and methods: A prospective, randomized, clinical study was
supported by the p value of 0.001 in the comparison of the length of conducted in Bahcesehir University, Medicl Park Goztepe Hospital
survival of preterm infants with incomplete antenatal dexamethasone Neonatal Intensive Care Unite with total of 127 preterm infants. Blood
against those without antenatal dexamethasone. Moreover, a samples were obtained for Insulin-like growth factor 1 (IGF-1) in the
complete antenatal dexamethasone dosage further improves the 1st day of life, 1st week, 2nd week, 3rd week and 4th week of life. All
length of survival, as evidenced by a p value of 0.000 in the preterms were examined for ROP in the 4th weeks of life and
comparison of the length of survival between preterm infants who demographic characteritics were noted. Risk factors and IGF-1 levels
had complete antenatal dexamethasone against those with incom- were compared on ROP group (ROP+) and non-ROP group (non-ROP).
plete antenatal dexamethasone. The score was established after logistic regression, considering the
Conclusion: Antenatal dexamethasone improves the length of survival impact of each variable on the occurrences of any stage ROP.
of preterm neonates born in Gov. Celestino Gallares Memorial Clinical cases and summary results: Total 127 preterms were included
Hospital. The length of survival is better even if incomplete dosage to the study. 43 had ROP, 84 did not have. Birth weight and
of antenatal dexamethasone is administered. gestational weeks were lower and also severe RDS, BPD, NEC and
nasocomial sepisis were more frequent and duration of mechanical
ventilation and oxygen supplementation were longer and the ratio of
Keywords: Antenatal dexamethasone, length of survival, prematurity
breast milk usage was lower in ROP + group (p50.05). Treatment
required ROP ratio was 4.7%. Serum IGF-1 levels of ROP and non-ROP
Table 3. t-Test of association between the length of survival and the groups were not different. In addition, less than 1000 gr birthweight
antenatal dexamethasone dosage. increases the risk of ROP 2.9 times and IVH and using formule milk
increase 4.7 times respectively.
Decision Conclusion: In conclusion, ROP risk is higher in the preterms,
Variables Mean SD t df p Value at 0.05 gestational weeks are less than weeks, IVH and lack of breast milk
Complete versus 4.833 3.365 6.094 17 0.000 Reject null groups. Preterms that has this risks should be examined earlier and
Incomplete more carefully to prevent ROP devolopment.
Complete versus None 6.278 4.376 6.086 17 0.000 Reject null
Incomplete versus None 1.444 1.617 3.790 17 0.001 Reject null Keywords: Retinopaty of prematurity, IGF-1, risk factors
278 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Keywords: Preterm labor, PAMG-1, PARTOSURE, preterm birth,

114
cervical length
PAMG-1 biomarker test
(PARTOSURE) in combination
with transvaginal ultrasound for
improved assessment of sponta- 137
neous preterm birth in patients Expectant management of
with threatened preterm labor PPROM
A. Konoplyannikov1, I. Lysyuk2, A. Sokolyan3, N. Pipia4, A. Saygı1, U. Keskin2, F. Kıncı2, M. Ulubay2, E. Karasahin2,
S. Apresyan5, and A. Karasova6 and C. Yenen2
1
1 Etimesgut Military Hospital Obstetrics and Gynecology Department,
Paediatric Dept., Russian National Research Medical University
Etimesgut, Ankara, Turkey, and 2Gülhane Military Medical Academy
(RNRMU), Moscow, Russia, 2Obstetrical Dept. of pathology of
and Medical School, Obstetrics and Gynecology Department, Etlik,
pregnancy, City Clinical Hospital1, Moscow, Russia, 3Obstetrical Dept.
Ankara, Turkey
of pathology of pregnancy, City Clinical Hospital15, Moscow, Russia,
4
Delivery Dept., The Center for Family Planning and Reproduction,
Introduction: PPROM occurs in approximately 2% of all pregnancies
Moscow, Russia, 5Obstetrical and Gynecological Dept., F. I.
and responsible for one third of all preterm births. PPROM is an
Inozemtsev City Clinical Hospital, Moscow, Russia, and 6Obstetrical
important cause of prematurity. PPROM is associated with both
Dept. of pathology of pregnancy, F. I. Inozemtsev City Clinical maternal and neonatal morbidity such as chorioamnionitis, preterm
Hospital, Moscow, Russia birth, severe necrotizing enterocolitis, respiratory distress syndrome,
sepsis, placental abruption, retained placenta, postpartum endome-
Introduction: Patients presenting to the hospital with signs and tritis. We report a case with PPROM which managed approximately 8
symptoms of preterm labor undergo cervical length measurement via weeks from 25th gestational weeks.
transvaginal ultrasound (CL) to evaluate the risk of imminent Materials and methods: A 30-year-old woman G1P0 at 25 weeks of
spontaneous birth. However, it has been shown that CL 525 mm gestation admitted to our outpatient clinic for vaginal bleeding and
alone has limited value in prediction of PTB, and may benefit from an discharge of fluid. In ultrasonographic examination, 650 g weighted,
addition of a biomarker when cervical length is equivocal (15-30 mm). appropriate for gestational age, vital fetus was detected. The
PARTOSURE, based on PAMG-1 biomarker, is a novel test that has laboratoary findings of the pregnant were normal. Vital findings
been shown to improve diagnostic accuracy in patients with tPTL and were normal. Firstly, we started prophylactic ampicillin-sulbactam (1 g
a short cervix (530 mm). every 6 hours) for prevention of chorioamnionitis. We also gave
Materials and methods:Patients presenting between 20 and 37 weeks Betamethasone in two doses 24 h apart to stimulate lung maturation
of gestation, with clinically intact membranes and cervical dilation for anticipation of possible preterm delivery. During expectant
53 cm were recruited. CL measurement via TVU was performed as management, the findings of chorioamnionitis were followed, we
standard of care, while clinicians were blinded to the PARTOSURE test did not performed digital examination until active labor. 20 days after
result. Performance metrics were calculated for PARTOSURE to predict the consultation with the infectious diseases specialist oral treatment
delivery within 7 days of presentation, separately for patients of amoxicillin/CA (1 g, two timesper day) and vaginal treatment of 2%
between 24 and 35 weeks of gestation, as well as in combination clindamycin phosphate (twice a day, vaginally) was applied.
with CL stratification. Clinical cases and summary results: Fifty- six days later, a cesarean
Clinical cases and summary results: A total of 71 patients enrolled after section was performed onset of subfebrile fever that continued for
providing informed consent. Average GA at presentation was 28 24 hours and elevated white blood count. APGAR scores of the female
weeks. While 59 (83%) patients had a cervix 525 mm, only 8 (11%) newborn were 7 at 1st minute and 9 at 5th minute, weight. The
delivered within 7 days of presentation, PARTOSURE was positive in weight was 1935g. The patient was discharged on the 3th post-
11 (15%) patients. The positive predictive value (PPV) and negative operative day without any infectious complications. The newborn
predictive value (NPV) for predicting delivery within 7 days for stayed 12 days in the intensive care unit and was discharged from the
PARTOSURE were 55% and 97%, respectively, the PPV and NPV for CL hospital on the 15th postpartum day.
525 mm for the same endpoint were 14% and 100%, respectively. 47 Conclusion: In rare and selected cases, fetal, neonatal and maternal
(66%) patients were between 24 and 35 weeks of gestation, the PPV outcomes can be increased with prolonged intensive expectant
and NPV for delivery within 7 days of testing for PARTOSURE were management.
67% and 100%, respectively, while CL 525 mm for the same endpoint
were 11% and 100%, respectively. 35 (74%) patients in the same Keywords: PPROM, expectant management
group had an equivocal CL (15-30 mm), for which the PPV and NPV for
PARTOSURE were 60% and 100%, respectively, while CL 525mm had
11% and 100%, respectively, for the same end point. 6 (8%) patients
had a cerclage in place at the time of testing and PARTOSURE gave an
accurate result in all 6 cases, with 5 true negatives and 1 true positive.
Conclusion: PARTOSURE is a useful test in predicting preterm birth
and has a higher positive predictive value than cervical length alone.
PARTOSURE is most useful when used in combination with CL
measurement to predict imminent spontaneous delivery in patients
with symptoms of preterm labor and CL 530 mm. A combination of
CL measurement and PARTOSURE may lead to a reduction of
unnecessary hospitalization and treatment by up to 80% compared to
admitting based on a short cervix (525 mm) alone.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 279
Introduction: Pessary is a device fitted into the vagina to provide
172 (CASE REPORT) structural support to pelvic organs. It has been predominantly used as
Delayed-interval delivery in support for pelvic organ prolapse until it was first postulated by Vitsky
in 1961 that the incompetent cervix is aligned centrally, with no
triplet pregnancy: according to support except the nonresistant vagina, and a lever pessary, however,
would change the inclination of the cervical canal deviating it more
a clinical case posteriorly, which in pregnancy, can thereby direct the weight of the
pregnancy more on to the anterior lower segment. (2) This case series
aims to report on three cases in our institution supporting the
N. Abián Franco1, B. Pérez Munárriz1, S. Garcı́a Francés1, effectiveness of pessary in preventing preterm birth.
M. Urtasun Murillo1, J. Barrenetxea Arrinda1, B. Gastón Clinical cases and summary results: This case series aims to report on
Moreno1, A. Safont Gastón1, and C. Larrañaga Azcárate1 three cases in our institution supporting the effectiveness of pessary
in preventing preterm birth.
Complejo Hospitalario de Navarra, Pamplona, Spain CASE 1
C.A.B. is a 35- year-old Gravida 2 Para 0 (0010) pregnancy uterine,
Introduction: Multifetal pregnancies are often complicated by admitted in our institution at 25 weeks and 3 days for short cervical
spontaneous preterm delivery. Typically, all fetuses of a multiple length finding on ultrasound. At 26 weeks age of gestation, a hodge
gestation deliver within a short interval, however, in selected cases, pessary was inserted. Pregnancy was prolonged until 34 weeks 3 days
the preterm birth of one fetus may not require delivery of the other age of gestation and patient delivered to a live preterm male Apgar
fetus. score 9.9 birth weight 2085g birth length 50cm Ballard’s score 35
Clinical cases and summary results: A 35 year-old woman, G2P1, weeks AGA via normal spontaneous vaginal delivery.
dichorionic triamniotic spontaneous triplet pregnancy, refered con- CASE 2
tractions at 23 + 4 weeks gestation. Physical examination revealed first M.J.C is a 34 year old gravida 2 para 1 (0101) pregnancy uterine,
amniotic sac prolapsed in the vagina and first fetus in transverse. admitted in our institution at 31 weeks age of gestation for an
Considering information supplied, parents decided wait-and-see incidental finding of short cervix on ultrasound. Seventeen days after
approach until 24th week. Contractions were vanished, but the pessary insertion, patient at 34 weeks age of gestation, delivered via
rupture of the fist amniotic sac spontaneously occurred, and normal spontaneous vaginal delivery to a live preterm male Apgar
intravenous antibiotic therapy was initiated. At 23 + 5 weeks, a visible score 9.9 birth weight 2010g birth length 44cm Ballard’s score 34
prolapse outside the vulva of the umbilical cord belonging to the first weeks AGA.
fetus was evinced, verifying cardiac beating until three days later. At CASE 3
24 + 1 weeks, fetal pulmonary maturation was performed and the S.B. is a 34 year old gravida 4 para 3 (3003) admitted in our institution
external part of the cord was cut and reduced to minimize at 17 weeks and 6 days for vaginal bleeding. With a finding of short
possibilities of infection. At 24 + 2 weeks, contractions reappeared cervix, a hodge pessary was placed at 19 3/7 weeks age of gestation.
and, once infection excluded, intravenous atosiban and magnesium At 33 2/7 weeks age of gestation, the patient underwent repeat
sulphate was established. Nevertheless, delivery of first dead fetus cesarean section for breech in preterm labor and delivered to a live
was inminent, and a consensus decision was taken to delayed preterm female Apgar score 8.9 birth weight 1950g birth length 44cm
delivery, maintaining atosiban. Clinical and analytical signs of Ballards score 35 weeks AGA.
infection appeared, suspending atosiban. Parents were informed Conclusion: In the search for strategies to prevent preterm birth,
about poor prognosis for survivorship and high risk for severe pessary has promising results. It is an affordable and safe alternative
morbidity due to extreme prematurity. Vaginal delivery was management of preterm birth which may be employed in our setting.
recommended, despite intrapartum mortality. Delivery of both fetus Future clinical trials may be helpful in strengthening this evidence.
occurred also at 24 + 2, with a non significant delayed interval of
12 hours. The first fetus was stillborn, and the second one passed Keywords: Pessary, preterm birth, cervical incompetence
away within the first day of life.
Conclusion: Delayed-interval delivery may be an option when some
fetuses of a multiple gestation at a previable gestational age are in
risk of deliver, and concurrent delivery of fetuses unaffected would
likely result in their death or severe morbidity. Length of latency is
important since achieving an extended time interval, not possible in 193
this case due to subclinical choriamnionitis, between births of siblings
at critical gestational ages is the basis to improve neonatal survival Social class inequalities in
and reduced morbidity.
perinatal health in Umbria (Italy),
Keywords: Delayed-interval delivery, Triplet pregnancy, Extreme
prematurity
2014
L. Fatigoni, V. Viola, L. Minelli, and M. Chiavarini
Department of Experimental Medicine, Public Health Section,
University of Perugia, Italy
183 Introduction: Low birth weight (LBW) and preterm birth (PTB) are the
Cervical pessary in prevention of main determinants for neonatal and infant death. High birth weight
(HBW) is associated with negative outcomes in the long term and in
preterm birth: a case series the adulthood. The objective of this research is to examine social class
inequalities in adverse perinatal events.
Materials and methods: The data was obtained from a population
Hernandez E. G. based study using routine maternity discharge data. This study
consists of 7441 babies born in Umbria, an Italian Region, during
Department of Obstetrics and Gynecology, St. Luke’s Medical Center,
2014. Adverse perinatal events, such as PTB(537 weeks’ gestation),
Quezon City, Philipppines LBW (52500gr) and HBW (44000 gr) in relation to various mother’s
social covariates (citizenship, education) and to various mother’s
clinical covariates (parity, lack of fetal growth, assisted procreation)
280 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

are included too. Logistic regression models were used to analyse the 2.86), placenta previa (OR 5.15, 95% CI 1.1-33.9), preterm delivery (OR
magnitude of each factor with respect to adverse perinatal indicators. 2.06, 95% CI 1.16-3.68), newborn’s low birth weight (OR 2.27, 95% CI
Clinical cases and summary results: There were 517 (6.9%) PTB, 472 1.19-4.36) and elective cesarean section (OR 2.39, 95% CI 1.7-3.4). The
(6.4%) LBW and 474 (6.4%) HBW. In multivariate analysis, the results analysis of the causes of infertility and their influence on gestational
showed that maternal clinical characteristics are highly associated complications did not show any significant relations.
with preterm birth and birth weight. For clinical aspect, PTB was Conclusion: The results of the presented study are in accordance with
found associated with assisted procreation (OR 5.99, 4.43 5IC58.11) latest reports on increased pregnancy complications in IVF singletons.
and lack of fetal growth. LBW was associated with assisted The course of pregnancy after IVF does not differ in many factors from
procreation (OR7.59, 5.585IC510.33), lack of fetal and multiple the pregnancy after natural conception. Preterm birth remains the
pregnancy (OR 34.36, 25.75 5IC5 45.83). HBW was associated with major concern in IVF pregnancies, making them higher risk. Infertility
pluriparous women (OR 0.58, 0.40 5IC 40 years old is LBW, while the treatment is more often associated with an elective CS, which
6.9% is HBW. sometimes seems to result from psychological aspects and anxiety
Conclusion: Social class factors have a substantial impact on the risk of only.
newborns health status. Policies measures aimed at social-demo-
graphic inequalities will reduce adverse perinatal events. Keywords: IVF pregnancy, pregnancy complications, preterm deliv-
ery, high-risk pregnancy, perinatal outcome
Keywords: Social class inequalities, perinatal health, LBW, HBW, PTB,
Italy

210
Premature infant - incidence, risk
factors, complications
D. Iacob1, A. Fratila1, M. Dima1, C. Cojocaru2, I. Enatescu1,
N. Ionita2, and C. Ilie1
1
Neonatology Dept, University of Pharmacy and Medicine Timisoara,
Timisoara, Romania and 2Neonatology Dept, County Emergency
Hospital Timisoara, Timisoara, Romania

Introduction: Prematurity is the leading cause of neonatal morbidity

and mortality. Premature newborn is the child born under 37 weeks
gestational age. The risk factors involved in the occurrence of
209
premature birth include: socioeconomic factors and family, medical
The obstetric outcome of IVF factors (obstetric, acute and chronic maternal and fetal disorders). As
gestational age is lower, the worst may be complications that can
Singletons occur to preterm infants.
Materials and methods: The study was conducted over a 6 year period,
and were included preterm infants with gestational age below 37
I. Szymusik, K. Kosinska-Kaczynska, P. Marianowski, and
weeks, born at the Maternity Bega Timisoara.
M. Wielgos Clinical cases and summary results: Of the total number of 13 976
1st Department of Obstetrics and Gynecology, Medical University of newborns in this period, 1045 were premature newborns. The
incidence depending on gestational age was 24-26 weeks - 5%, 27
Warsaw, Poland
to 29 weeks - 9%, between 30-32 weeks - 25%, between 33-35 weeks -
48% and 36 weeks - 13%. The incidence of preterm birth weight
Introduction: IVF singletons alone have worse perinatal outcome depending was: under 1000g - 7% 1000-1499g - 16%, from 1500 to
when compared to spontaneously conceived singletons, especially in 1999 g - 27%, from 2000 to 2490 - 35% and premature infants
terms of preterm birth and its complications. Underlying cause of weighing over 2500 g were in proportion of 15%. From the total
subfertility seems to be a risk factor of worse perinatal outcome. number of premature births, 105 mothers had hypertension, 41
Materials and methods: Observational retrospective case control study mothers had placenta praevia, 12 presented the HELLP Syndrome, 20
included 644 women in singleton pregnancies who delivered after had premature ruptured membrane, 17 presented infectious pathol-
completed 22 weeks of gestation at the 1st Department of Obstetrics ogy, six mothers had diabetes, two mothers had thrombophilia and
and Gynecology, Medical University of Warsaw, Poland, between 2004 20 cases had other maternal diseases. From the total number of
and 2014. The study group comprised of 336 patients who conceived preterm, 230 were from multiple pregnancies. From the complica-
by means of in vitro fertilization (IVF or ICSI). The control group tions of prematurity, 49 preterm developed retinopathy of prema-
consisted of 308 women who conceived spontaneouslyand delivered turity, 2 preterm had hydrocephalus and 11 presented periventricular
within the same time period. Collected data included maternal leukomalacia.
characteristics (age, parity, pre-pregnancy BMI, gestational weight Conclusion: Premature infants represents a category of newborns with
gain), incidence of pregnancy complications, time and mode of increased risk of morbidity and mortality. It shows a higher incidence
delivery with indications for cesarean section, neonatal outcome at of premature babies between 33-35 weeks gestational age and birth
delivery and the cause of infertility in the study group. weight between 2000 to 2490 g. Maternal risk factors involved in
Clinical cases and summary results: The two study groups were initially causing the premature birth more common are hypertension,
matched by age and parity and were also similar with regard to BMI, placenta praevia and infectious pathology. Complications of pre-
gestational weight gain and the history of hypothyroidism. The maturity increase the risk of sequelae and unfavorable prognosis.
overall rate of pregnancy complications in IVF singletons was 46.4% in
comparison to 40.2% (p=0.13). IVF treatment increased the odds of
Keywords: preterm infants, maternal risk factors, complications
having vaginal bleeding in the first trimester (OR 1.68, 95% CI 1.0-
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 281
240 preterm births. One of the leading causes of provider-initiated
preterm birth is preeclampsia. Indonesia is a low developing country
Predictors of pregnancy that ranked 5th as the greatest number of preterm births. As one of
the tertiary hospital in Indonesia, dr. Cipto Mangunkusumo National
outcomes for emergency cerclage Hospital received many referrals from other hospitals nationwide. We
aim to know the prevalence of preeclampsia in preterm births, its
maternal characteristics, and also its maternal and neonatal outcome.
G.S.R. Lee Materials and methods: This study is a retrospective descriptive study
Obstetrics and Gynaecology Department, St. Vincent Hospital, and was done in Obstetrics and Gynaecology Department of dr. Cipto
Mangunkusumo National Hospital. The inclusion criteria are women
Catholic University of Korea
with singleton live preterm births. Multiple pregnancy and patients
with incomplete data records were excluded in this study. Time of this
Introduction: The aim of the present study was to evaluate the factors study was from January 1st 2015 until December 31st 2015. The data
associated with successful pregnancy (delivery after 34 weeks) obtained were demographic, maternal and neonatal outcome data.
following emergency cervical cerclage in pregnant women with All data were a secondary data collected from medical records. The
single gestations. data were then analyzed using SPSS version 19.
Materials and methods: A retrospective study of pregnant woman who Clinical cases and summary results: A total of 750 women with preterm
underwent emergency cerclage from 2010 to 2014 was performed. births were documented during the year of 2015 in dr. Cipto
The inclusion criteria for the study consisted of (1) a singleton Mangunkusumo National Hospital. The inclusion criteria were met by
pregnancies between 16 + 0 weeks and 27 + 6 gestational weeks, (2) 632 of them. Overall, the prevalence of preeclampsia in all preterm
no regular painful contractions (3) no premature rupture of births documented was 27.2%. Maternal age (Adjusted OR 0.14 95%
membranes, and (4) cervical length was less than 2cm. Successful CI 0.04-0.44) and parity (Adjusted OR 0.65 95% CI 0.45-0.94) was found
pregnancy was defined as delivery after 34 weeks. Univariate and statistically significant in the maternal characteristics. Low Apgar
multivariate logistic regression analysis were used to evaluate the score was found higher in the preeclamptic group (21.5%) rather than
factors associated with successful pregnancy. The cutoff value(s) of in the non-preeclamptic group (15.4%). NICU admission was also
significant factor(s) with successful pregnancy was(were) decided higher in the preeclamptic group (26.2%) rather than in the non-
using Receiver operating curve, and survival analysis and linear preeclamptic group (20%). Maternal outcome such as ICU admission
regression test were constructed for significant factor(s) with (Adjusted OR 26.52 95% CI 11.7-59.96) and mode of delivery (Adjusted
successful pregnancy. OR 0.35 95% CI 0.22-0.54) were found statistically significant.
Clinical cases and summary results: Fifty-nine pregnant women with Conclusion: Preterm births indicated by preeclampsia give worse
complete data were available for analysis. According to univariate maternal and neonatal outcome rather than preterm births caused by
regression analysis, maternal age, BMI, gestational age at cerclage, others. ICU admission and caesarean section as a mode of delivery
cervical length at cerclage and cervical length after cerclage were were found higher in preeclamptic patients with preterm births.
significant factors associated with successful pregnancy. However, by Decision making in the provider-initiated preterm birth by pre-
multivariate logistic regression analysis, cervical length after cerclage eclampsia must be resolve and analyze to minimize poor maternal
was an independent predictor of success pregnancy. Linear regres- and neonatal outcome.
sion analysis showed that there was significant correlation between
gestational age of delivery and cervical length after cerclage
Keywords: Preterm birth, preeclampsia
(p=0.0000). The cutoff value of 1.84 cm in cervical length after
cerclage predicted successful pregnancy with a sensitivity of 73.3%
and specificity of 88.1%. Women with cervix length measuring
51.84 cm after cerclage delivered at an earlier gestational age
compared with women whose cervix length was 1.84 cm according
to the survival analysis (p 50.0001).
Conclusion: Among various factors, cervical length after emergency 288
cerclage was identified as an independent predictor of successful
pregnancy.
Impact of high risk for antenatal
depressive disorders and preterm
Keywords: Emergency cervical cerclage, cervical length, single
pregnancy, predictors of outcomes, successful pregnancy birth
K. Wagner1, G. Vetter1, I. Hösli1, C. Granado1,
S. Schulzke2, and T. Fabbro3
1
Department of Obstetrics and Gynaecology, University Hospital
246 Basel, Switzerland 2Department of Pediatrics, University Children’s
Hospital Basel, Switzerland, and 3Clinical Trial Unit, University
Risk factors and outcome of Hospital Basel, Switzerland
preterm births caused by
Introduction: Preterm birth is defined as birth prior 37 weeks of
preeclampsia gestation. It is the main risk factor for neonatal morbidity and
mortality. In 2013 the rate of preterm birth was 7.2% in Switzerland.
N. Prameswari, C. A. Swastika, R. Irwinda, and A. Sungkar Established risk factors leading to preterm birth are previous preterm
birth, premature rupture of membranes and premature contractions.
Department of Obstetrics & Gynaecology, Dr. Cipto Mangunkusumo Several publications mentioned, that antenatal depressive disorders
National Hospital, University of Indonesia, Jakarta, Indonesia can also be associated with preterm birth. Investigations showed that
new-borns from depressive mothers had worse outcomes with lower
Introduction: Preterm birth is a leading cause of neonatal death birth weight and lower APGAR scores. Aim of this study was to assess
worldwide. It leads to complication not only in early life but also in the association of high risk for depression in pregnancy and preterm
later life. Preterm birth is associated with many pregnancy complica- birth respectively complications that are connected with preterm
tions. Preterm birth is divided into spontaneous and provider-initiated birth.
282 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Materials and methods: Out of a multicentre study including 500 proportionately higher rate of SGA newborns in the M1 compared
symptomatic patients with threating preterm labour and intact to M2 and M3 but the difference was not statistically significant.
membranes we assessed a sample of 104 women between 24 and 34 Conclusion: There appears to be a positive effect of the higher level of
weeks of gestation at the University Hospital Basel. Depression was education of mothers on the birth of AGA newborns in Cyprus. Our
messured by using the Edinburgh Postnatal Depression Scale (EPDS), results are compatible with other international reports. Larger studies
a 10-item self-reporting questionnaire, developed to identify ante- are needed to support our results.
and postnatal depressions. With a sensitivity of 0.955, a specifity of
1.000 and a positı̂ve predictive value of 1.000 we chosed to regard an
Keywords: Birth weight, small for gestational age
EPDS score 10 as indicating depression (Bergant A.M. et al.,
Deutschsprachige Fassung und Validierung der ‘‘dinburg postnatal
depression scale’’, Dtsch. Med. Wschr. 1998, 123: 35-40).
Clinical cases and summary results: Out of 104 included women 83
completed the questionnaire including 20 twin pregnancies and 63
singeltons. 25% (21/83) had an EPDS score 10. Delivery prior
37 weeks of gestation occured in 33% (28/83). There was no 312
difference in age, gravidity, parity and days of hospitalisation between
the collective. We found no significant difference between antenatal
Association of the educational
depressive disorders and rate of birth complications defined as PPH, level of the mothers of the
preeclampsia and amniotic infection syndrom. In our collective 38%
(8/12) with an EPDS 10 gave birth preterm compared to 32% (20/41) hospitalized neonates with the
who gave preterm birth with an EPDS 10. Concerning birth
complications women with an EPDS 410 and EPDS 510 had the degrree of prematurity
same complication rate of 19%. Moreover there was no significant
difference between EPDS scores when compared according to E. Papamichael1, E. Polycarpou1, M. Talias2, and
neonatal out come (24% in both groups).
Conclusion: According to the results of the study we could not
C. Karaoli1
confirm a high EPDS was predictive for preterm birth and maternal 1
Neonatal Intensive Care Unit, Archibishop Makarios III Hospital,
and neonatal complications. Considering the small number of Nicosia, Cyprus, and 2Health Management, Open University of
patients it’s not representative to draw final conclusions. Further Cyprus, Nicosia, Cyprus
studies including higher numbers of symptomatic woman and a
control group with term birth are mandatory.
Introduction: Although the literature recognizes the positive correla-
tion between low socio-economic/educational level and infant health
level, evidence is not clear. The purpose of this study is to investigate
310 the correlation of the educational level of the mother with the degree
of prematurity.
Association of educational level Materials and methods: The study was conducted in the Neonatal
Intensive Care Unit of Archibishop Makarios Hospital from March 2013
of the mother with the birth till March 2014. During that period of time, 312 male (54.60%) and 259
weight of hospitalized newborns female newborns (45.40%) were hospitalized in our NICU. The
educational level of mothers was recorded as follows: elementary-
in the NICU school graduates (M1) n: 67 (10,5%), high school graduates (M2) n:
210 (32,8%), College- University graduates (M3) 281 (43.9%). We
investigated whether there is a correlation between the educational
E. Papamichael1, E. Polycarpou1, M. Talias2, and level of mothers and the gestational age of hospitalized newborns.
C. Karaoli1 Clinical cases and summary results: Mothers M1 gave birth to 0 infants
1
24-26 weeks of gestational age (GA) (0%), 5 27-29 (7.5%), 13 30-32
Neonatal Intensive Care Unit, Archibishop Makarios III Hospital, (19.4%), 25 33-36 (37.3%), 21 37-40 (31.3%) and 3 40-42 (4.5%).
Nicosia, Cyprus and 2Department of Health Management, Open Mothers M2 gave birth to 4 neonates 24-26 weeks (2.0%), 13 27 - 29
Univercity of Cyprus, Nicosia, Cyprus (6.3%), 24 30-32 (11.7%) 99 33-36 (48.3%), 60 37-40 (29.3%) and 5 40-
42 (2.4%). Mothers M3 gave birth to 4 neonates 24-26 weeks (1.5%),
Introduction: We investigated the correlation between the educational 18 27- 29 (6.8%), 40 30-32 (15.0%), 118 33-36 (44.4%), 79 37-40 (29.7%)
level of the mother with the birth weight (BW) of the hospitalized and 7 40-42 (2.6%). M1 mothers appear to give birth to more
newborns at the only tertiary Neonatal Intensive Care Unit (NICU) in premature neonates than M2 and M3 mothers but the difference is
Cyprus. not statistically significant.
Materials and methods: The study was conducted in the Neonatal Conclusion: The educational level of the mother appears to correlate
Intensive Care Unit where all newborns in the country in need of with the degree of prematurity of newborns. In our NICU the better-
intensive care are hospitalized during the period March 2013-March educated mothers give birth to greater gestational age newborns.
2014. The study included 526/640 premature neonates (82.2%). 312 Larger studies are needed to support our results.
male (54.60%) and 259 female newborns (45.40%). Educational level:
Mothers elementary-school graduates (M1) n: 67 (10,5%), high school Keywords: Prematuriy, mother, education
graduates (M2) n: 210 (32,8%), College/University graduates (M3) 281
(43.9%). We investigated whether there is a correlation between the
educational level of mothers and the birth weight of hospitalized
newborns. Neonates were classified into three groups: small
for gestational age neonates (SGA), appropriate for gestational age
(AGA) and large for gestational age (LGA) according to their
birth weight.
Clinical cases and summary results: M1 Group: AGA 45 (69,2%), SGA
18 infants (27.7%) and LGA 2 (3,1%). M2 Group: AGA 151 (74,4%), SGA
43 (21,2%) and LGA 9 (4,4%). M3 Group: AGA 184 (71,3%), SGA 62
(24,0%) and LGA 12 (4,7%). Statistical analysis showed a
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 283
had been admitted to the hospital with a short cervix and signs and
326
symptoms of threatened preterm labor.
Vaginal pH value in prediction of Materials and methods: 45 patients were recruited in this prospective
observational study. Patients presented with symptoms of preterm
preterm delivery in women diag- labor between Jul 2015 - Feb 2016. The patients were between 24 + 0
and 34 + 6 wks of GA, minimal cervical dilation and clinically intact
nosed with preterm labor membranes. Cervical length was measured using transvaginal
ultrasound upon presentation. Patients with a short cervix of
T. Nikolova, N. Nikolova, S. Jovchevski, and M. Micevska 25 mm were admitted to the hospital for observation and/or
treatment based on the standard of care of the hospital. A PartoSure
University Clinic of Obstetrics and Gynecology, Skopje, R. Macedonia test was performed approx..one day after admission and the decision
was made to discharge the patient or keep them at the hospital for
Introduction: Evaluate sensitivity and specificity in prediction of observation. Calculations to determine the performance of the
preterm delivery in 2, 7 and 14 days from the time of the testing in PartoSure test and the associated average length of stay for these
cases diagnosed with preterm labor for vaginal pH value bigger than patients were performed retrospectively.
4,5 and cervical length equal or shorter than 2,5 cm. Clinical cases and summary results: All 45 patients in the analysis had a
Materials and methods: Prospective, observational study performed at short cervix of 25 mm measured using transvaginal ultrasound and
the University Clinic of Obstetrics and Gynecology in Skopje. 83 a PartoSure test was performed approximately one day after
pregnant women between 200/7 and 366/7 weeks of gestation with admission (mean 34 hours, mode 24 hours). 11% (5) of patients had
symptoms of preterm labor, with clinically intact amniotic mem- a PartoSure positive test, 89% (40) of patients had a negative
branes and cervical dilatation 2,5 cm were recruited in the trial. PartoSure test, wherein 60% (24) of patients were not discharged and
Vaginal pH value was determined before the CL measuring and pH continued their stay for extended monitoring and 40% (16) were
44,5 was considered pathologic. Patients were treated according to discharged. Admitted patients were treated based on local guidelines
the protocol with: antibiotics, tocolitics and corticosteroids and the of the facility and clinician judgement: 70% (17) received corticoster-
time from the testing to the delivery was assessed. oid therapy, 100% (24) received tocolytic therapy and 8% (2) received
Clinical cases and summary results: The vaginal pH 44,5 predicted antibiotics and none of these patients delivered within the next 7
delivery within 2 days with 80% sensitivity, 35% specificity, 7% days or 14 days. The PPV for Cervical Length of 25 mm was 7%. The
positive predicted value and 96% negative predictive value. pH 44,5 PartoSure test had a Sensitivity 100%, Specificity 95%, Positive
predicted delivery in 7 days with 91% sensitivity, 38% specificity, 19% Predictive Value 60% and Negative Predictive Value 100% for delivery
positive predicted value and 96% negative predictive value. pH 44,5 within both 7 and 14 days. A retrospective analysis showed the
predicted delivery in 14 days with 83% sensitivity, 39% specificity, average length of stay of the patients who were admitted was of 8.4
28% positive predictive value and 89% negative predictive value. days, mode 13 days.
Conclusion: Vaginal pH 44,5 in patients with symptoms of preterm Conclusion: Patients with tPTL and CL 25 mm are often admitted for
labor, with intact membranes and cervical dilatation 2,5 cm treatment or observation, but majority don’t go into labor, using
indicates that delivery within 7 days is quite probable despite the resources such as bed space and unnecessary treatment. PartoSure
therapy. A normal vaginal pH value, furthermore, indicates that may help to stratify high risk patients and assess their risk of delivery
delivery within 7 days is highly unlikely. within 7 or 14 days. A negative PartoSure in conjunction with clinical
judgment may be useful to identify patients that can be safely
discharged after 24 hrs of observation, reducing their length of stay
Keywords: Vaginal pH, cervical length, preterm delivery
and burden on hospital resources.

Keywords: Preterm labor, PAMG-1, Partosure, preterm birth, cervical

length

384
Utilization of a novel biomarker
test (PARTOSURE PAMG-1) to 389
reduce the length of stay in Peritoneal dialysis in very low
patients with threatened preterm birth weight neonates
labor and a short cervix
V. Stojanović1, S. Bukarica2, J. Antić2, and A. Doronjski1
I. Fatkullin1, A. Akhmetgaliev2, E. Matveeva2, and 1
Institute for Child and Youth Health Care of Vojvodina, Intensive
S. Seeger3 Care Unit, Faculty of Medicine, University of Novi Sad, Novi Sad,
1
Serbia, and 2Institute for Child and Youth Health Care of Vojvodina,
Obstetrics and Gynecology Dept., State Medical University of Kazan, Clinic for Pediatric Surgery, Faculty of Medicine, University of Novi
Kazan, Russia, 2Obstetrics and Gynecology Dept., City Clinical Sad, Novi Sad, Serbia
Hospital No.7 of Kazan, Kazan, Russia, and 3Obstetrics and
Gynecology Dept., Hospital of St. Elisabeth and St. Barbara, Halle-
Introduction: Starting peritoneal dialysis (PD) early also reduces
Saale, Germany mortality and morbidity of newborns with AKI. The goal of this
retrospective study is to evaluate the characteristics of 10 very small
Introduction: Patients with a short cervix of 25 mm via transvaginal birth weight (VLBW) neonates, who are treated with PD.
ultrasound are often admitted to the hospital due to increased risk of Materials and methods: A retrospective study has included 10 VLBW
imminent spontaneous delivery. However, it is well known that the neonates, who required peritoneal dialysis. Intravenous (IV) cannula
majority of patients with a short cervix do not go on to deliver within and umbilical vein catheter were used for the peritoneal access
the next 7 days. The objective of this study was to evaluate the utility Clinical cases and summary results: Mean age in the moment of
of the PartoSure test to reduce the length of stay after these patients starting PD was 14.9 ± 9.32 days. Mean body weight was 825 ±
284 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

215.31g. The average gestational age was 26.3 ± 1.15. The average being diagnosted: prothrombin time, prothrombin time (quick),
duration of dialysis was 20.5 ± 14.75h. The exchanges were done international normalized ratio (INR), activated partial thromboplastin
every 10-60 minutes. The average UF was 7.71 ± 4.19ml/kg/h. In time (APTT), thrombin time, levels of fibrinogen. Linear dependencies
average they had a fluid overload 302 ± 317.93g higher (12%). The were explored using Principal Components Analysis. Artificial neural
dialysate leak was registered in 2 patients, one patient had peritonitis nets, logistic regression and decision trees were used to predict the
and one patient had a blockade of IV cannula. The overall mortality disease.
was 80%. Clinical cases and summary results: Using Principal Components
Conclusion: The timely start of PD is of a crucial importance for the Analysis, distinctions between term and preterm neonates were
survival of newborns in AKI. PD represents one of the transitioning discovered on the following parameters: prothrombin time (quick),
measures until there is a renal function recovery. In acute situations in activated partial thromboplastin time, prothrombin time, interna-
VLBW neonates, PD can be performed by improvised catheters. tional normalized ratio. In the model of logistic regression the
following predictors had the highest discrimination power: pro-
Keywords: IV cannula, peritoneal dialysis, preterm neonate thrombin time, prothrombin time (quick), INR. The most significant
variables in decision tree model: prothrombin time, (APTT), age, INR.
The sensitivity and the specificity of classifiers of term and preterm
neonates according to the coagulative hemostasis parameters built
by three different methods are 75% and 70% for artificial neural nets,
90% and 60% for decision tree, 85% and 90% for logistic regression
accordingly.
Conclusion: Using data mining technique provides precise differential
diagnostics of coagulative hemostasis disorders of term and preterm
neonates and appropriate (early) treatment.

Keywords: Preterm infant, haemorragic syndrome, hemostasis,

hypoxic-ischemic lesion

433 (CASE REPORT)

Recurrent severe metabolic
acidosis in a prematurely born
infant - case report
407 E. Valerieva1, V. Atanasova1, P. Gatseva2, and L. Veskov2
Data mining technique in detec- 1
2
Devision of Neonatology, University Hospital of Pleven, Bulgaria and
Trainee doctors of Medical University of Pleven, Bulgaria
tion of coagulative hemostasis
Introduction: Metabolic acidosis (MA) is not a disease but rather a
disorders of term and preterm biochemical abnormality due to disorder of the acid-alkaline home-
infants with hypoxic-ischemic ostasis. Untreated, severe MA is urgent condition for patients at any
age and can lead to myocardial depression, convulsions, shock, and
lesions of the central nervous multiorgan failure. Common causes of MA in the neonates are sepsis,
necrotizing enterocolitis, hypothermia, asphyxia, intracranial haemor-
system and various manifesta- rhages, persistent ductus arteriosus, shock, and drugs. Rare causes are
inborn errors of metabolism, renal tubular acidosis, increased loss of
tions of hemorragic syndrome bicarbonates through the unstable stools due to malabsorbtion,
starvation.
E. Ivchenko1, A. Pijanzin1,2,3, S. Zhilin3, A. Fedorov2, Clinical cases and summary results: We present a case of severe
recurrent MA in a newborn of risk pregnancy (43-aged mother, in
O. Nazarovskaya1, and Y. Miller1 vitro conception), born prematurely with symmetric intrauterine
1
Altai Region Clinical Children’s Hospital, Barnaul, Russia, 2Altai State growth restriction. The early neonatal period was compromised by
Medical University, Barnaul, Russia, and 3Altai State University, necrotizing enterocolitis with small intestine perforation. Surgery
intervention was performed on the 12th postnatal day (partial small
Barnaul, Russia
intestine resection and outputting of anus praeter iliacus). Congenital
heart anomaly (atrial septal defect) as an accompanying disease
Introduction: Using data mining technique lets determine undetected manifested by cardiac failure in the first weeks. Toxic lever injury with
ties in existing data and carry out expended analysis. It is supposed to cholestasis due to prolonged parenteral nutrition and difficulties in
be one of the most promising directions for the modern medcine enteral nutrition aggravated additionally clinical course. The incidents
development. of decompensate MA came forward after 6th postnatal (41st
Materials and methods: We examined (n=27) term and (n=43) preterm postconceptual) week and high doses of bicarbonate were needed
neonates with various manifestations of haemorragic syndrome (at for adequate correction.
age of 4-7 days after the birth). Investigation of the indicators of Conclusion: After excluding other causes for MA in this patients, its
hemostasis was performed among infants with cephalohematoma, condition was interpreted as result of high bicarbonate losses by
intradermal hemorrhage. The parameters of hemostasis were diarrheic stools through the anus iliacus. The acid-alkaline balance
searched by means of the Automated Blood Coagulation Analyzer was stabilized by administering of regular peroral intake of
CA 1500 (Sysmex Corporation, Japan). The following parameters were
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 285
bicarbonate up to definitively surgery recovery of the normal bowel As there was a high percentage of congenital conjunctivitis - 18
passage at the age of 6 months. (69.23%) and 12 (66.67%) children. In the 2nd subgroup of congenital
conjunctivitis prevailed - in 25 (96.15%) patients, the percentage was
Keywords: Acid-alkaline homeostasis, metabolic acidosis, newborn significantly lower folliculitis 6 (23.08%).

Keywords: preterm birth, sexual transmitted diseases, neotatal

infections

437
The maternal infection and
perinatal outcomes in 447 (CASE REPORT)

preterm birth A case of severe influenza leading

to ards and preterm labour
I. Ignatko, A. Strizhakov, and N. Popova
S. Islam, M. Imsirovic, and M. Khondoker
I.Sechenov First Moscow Medical University
Department of Obstetrics and Gynaecology, Wexham Park Hospital,
Introduction: Infection history of the mother, inflammatory diseases Slough, United Kingdom
during pregnancy, infectious complications of pregnancy affect the
outcome of preterm birth. The main cause of both early preterm Introduction: Influenza carries high risk of morbidity and mortality for
delivery and late spontaneous abortion is the premature rupture of pregnant women and their unborn children. There are risks of
membranes (PROM) with amniorrhea to the onset of labor, which is developing severe pneumonia, meningitis, encephalitis, septic shock
detected in the period 22-37 weeks of gestation in 0.7-2.1% of all and pregnancy complications such as pre term labour, lower birth
flowing delivery. In the structure of preterm labor at a fraction of this weight and perinatal mortality. In the UK between 2009 and 2012
complication, according to various authors, falls from 34.9% to 56%. nearly one in ten women who die during pregnancy were due to flu.
This complication is very dangerous not only for the fetus, but also for Universal flu vaccination is recommended in the UK. The reported
the mother due to the connection or exacerbation of infection and vaccine effectiveness ranged from 50-60% in overall population. Flu
subsequent development placentitis, chorioamnionitis and septic vaccination to pregnant women is up to 92% effective in preventing
conditions that may ultimately lead to the death of the woman. flu in first 6 months of life. Inactivated influenza vaccine is safe in any
Materials and methods: The aim of our study was to identify the trimester of pregnancy. If a pregnant woman is suspected of having
infectious aspects of perinatal CNS lesions in preterm newborns. We influenza, it’s important that she receive prompt antiviral treatment.
especially appreciated the anamnesis 96 women with preterm labor Clinical cases and summary results: A 36 years old Indian woman, BMI
and birth of children with perinatal lesions of CNS varying degrees, 34, para1 (previous normal delivery at term), with history of
pregnancy complications, and infectious complications in children. A hypothyroidism, had a flu jab at 6 weeks of gestation. The woman
control group of 30 women with timely delivery and healthy children developed persistent cough at 26 weeks of gestation and was treated
were included. Pregnant women with preterm labor, depending on with amoxicillin by the GP. But her condition didn’t improve. A throat
the gestational age deliveries were divided into 4 groups: 22-25 + 6 swab was PCR +ve for influenza A. The patient was started on
(days) weeks, 26-28 + 6 (days) weeks 29-32 + 6 weeks, 33-36 weeks. Oseltamivir. She was also diagnosed with gestational diabetes
Attention is drawn to the high rate of chronic inflammatory diseases mellitus at 28 weeks. At 29 weeks she was admitted with pyrexia,
of the respiratory system - 27 (28.1%, OR ¼ 3.22, CI ¼ 0.39-26.6) and tachypnoea, tachycardia, low O2 saturation of 93% in air, uterine
urinary system - 28 (14.28%, OR ¼ 4, 25, CI ¼ 0.32-26.6). contractions and spontaneous rupture of membrane. A chest X ray
Clinical cases and summary results: Diseases associated with confirmed pneumonia. Patient was started on amoxicillin and
Ureaplasma spp. / Micoplasma hominis were diagnosed in 59 clarithromycin along with Oseltamivir. Antenatal steroids were
(38.82%) in pregnant women with preterm labor and in 3 (10%) given. MgSo4 was administered for the foetus. In view of persistent
women in the control group with the association the pathological pyrexia after discussion with a microbiologist amoxicillin was changed
changes of the cervix: cervicitis, LSIL, cervical leukoplakia that to merapenum. On speculum examination cervical os was 3cm
accompanied by a subsequent long-term medical and instrumental dilated. But an ultrasound scan confirmed footling presentation. LSCS
treatment. There is a high percentage of infection for 22-25 weeks was performed under general anaesthesia. Patient was admitted to
and 26-28 weeks. In the structure of the viral infection was more ICU with features of ARDS. After 4 days in the intensive care unit
frequent CMV infection: 1-st subgroup - 6 (23.07%) in the third patient transferred to the ward. Baby was kept under close
subgroup - 4 (22%) in the first sub-4 - 6 (23.07%) the second subgroup surveillance and it did not develop flu morbidity. Maternal condition
- CMV infection is not detected. Ureo- and mycoplasma infection was gradually improved and after 7 days of delivery patient was
significantly more frequent in the 3 rd - 6 (33.33%) and 4 th - 9 discharged home.
(34.62%) subgroups. Only women in preterm labor group 4 and more Conclusion: We noticed rapid deterioration of an influenza infected
marked pregnancy - 43 (21.94%, OR ¼ 5.48, CI ¼ 0.30-98.91) is 4 or pregnant woman with development of pneumonia, ADRS and
more and 14 genera (7.14%, OR ¼ 2.45, CI ¼ 0.29-20.7). In the analysis preterm labour, though, the mother did receive a flu shot early in
and comparison of four subgroups more pregnancies were observed pregnancy. The patient needed multidisciplinary intensive care to
in the 4th subgroup - 14 (53.85%). In 65 (67.86%) cases during ensure optimum recovery for the mother and the baby.
pregnancy, premature birth ended, the woman suffered an infectious
process (in class 1 - 20 (76.92%), the subgroup 2 - 10 (38.46%) in the Keywords: Influenza, ARDS, pretem labour
subgroup 3 - 15 (83.3%) in the subgroup 4 - 22 (84.62%)). In the
structure of infectious diseases in the comparison group deserve
special attention respiratorno-viral infections and genital infections
subgroup 3 - 15 (83.3%) in the subgroup 4 - 22 (84.62%)).
Conclusion: All newborns of all subgroups in the survey revealed signs
of congenital pneumonia, 96 (100%). Patients 3rd, 4th subgroup
infection as realized folliculitis - 20 (76.92%) and 14 (77.78%) of cases.
286 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

456 (CASE REPORT) Autònoma de Barcelona); Medical Statistics Core Facility, IDIBAPS,
Hospital Clı́nic. Barcelona, Spain
Severe complications of osteope-
Introduction: Breastfeeding is one of the major goals in neonates
nia of prematurity in ELBWI - case feeding. Most of prematures admitted in neonatal units (NU) are fed
reports with mother’s milk combined with different amounts of formula,
usually given by bottles. In term infants, bottles are not recom-
mended because of a probably worse latch to breast and it’s thought
St. Hitrova, B. Slancheva, L. Vakrilova, P. Radulova, that spoon could be a better way for getting final direct breastfeed-
A. Popivanova,T. Pramatarova, N. Yarakova, G. Petrova, ing. There’s no evidence for the same affirmation in moderate
N. Jekova, and Z. Emilova premature babies.
The objective of the study was to assess which is the best method to
Departament of Obstetrics and Gynecology, University Hospital of achieve direct breastfeeding, comparing bottle to spoon in moderate
Obstetrics and Gynecology ‘‘Maichin dom’’, Medical University of preterm babies. Initial hypothesis was that using bottle in moderate
Sofia, Faculty of Medicine, Bulgaria prematures did not interfere with breastfeeding success.
Materials and methods: A prospective study was performed in a iiird
level hospital NU from December 2012 to May 2014. Moderate
Introduction: Preterm infants are at increased risk of impaired bone
prematures (from 34,0 to 36,6 weeks of gestational age) who were
metabolism and osteopenia during the neonatal period. We report on
admitted for any reason and who took any amount of mother’s milk
3 ELBW infants with osteopenia of prematurity resulting in fracture of
at discharge were randomized to either spoon or bottle. Informed
the long bones.
consent was signed by parents. The hospital ethics committee
Clinical cases and summary results: 3 ELBWI who were admitted to the
approved the study. Statistical descriptive studies were used.
NICU at University Hospital of Obstetrics and Gynecology ‘‘Maichin
Proportion of milk and administration method were collected at
dom’’ between May 2015 and January 2016 are included.Vitamin D
discharge.
intake starts from 10 day of age in dose1000IU/d. Case1: A baby girl
Epidemiological mother and newborn factors were included. Follow
weighing 410g was born at 28 g.w. She had severe RDS, prolonged
up data were obtained at 1 and 3 months afther discharge by phone
assisted ventilation and nitric oxide therapy.She received ventilatory
calls. Deviation from the study was considered when parents decided
support for a 156 days. During this period severe BPD was
to go out from the randomisation group before discharge.
observed,and she received 3 courses of dexamethasone. During the
Clinical cases & summary results: A total of 46 moderate prematures
11th week of age she had swelling and pain of the both legs. X-ray
entered the study. About two thirds of the mothers had a high
confirmed fractures of both femurs. The biochemical indicators were -
educational level (university). 26,1% of mothers had previous children,
AP538 IU/L, P-1.2 mmol/l, PTH-165.3 pg/ml, 25-OHD - 73.3nmol/l, Ca++
and 90.9% of them had been breastfed. 39,1% of the neonates were
1.5mmol/l. Case 2: A baby boy weighing 930g was born at 28g w. He
twins. The median birth weight was 2190 g and the median
developed severe RDS, assisted ventilation-28 day, nitric oxide
gestational age at birth 35,6 weeks.
therapy. He received due to BPD 2 courses of dexamethasone. At
Discharge took place at a median of 7 days, with a median
13 weeks of age was diagnosed fractura femoris dextra. The changes
postmenstrual age of 36,4 weeks and a median weight at discharge
were: AP-417IU/L, P-1.8mmol/l, PTH - 193.9pg/ml, 25-OHD - 79.8nmol/
of 2145 g. 19 children were randomized to spoon and 27 to bottle.
l, Ca++ 1.2mmol/l. Case 3: a baby boy weighing 560g was born at
At discharge, 89,1% of neonates took combined breastfeeding and
24 g w. He developed severe RDS and assisted ventilation - 48 days.
only 10,9% took exclusive breastfeeding; the methods were spoon in
He received 2 courses of dexamethasone. At 7 week of age was
38,6% and bottle in 61,4%. 7 cases were deviated.
noticed swelling, reduced movement of his right arm. X-ray showed
In 3 months exclusive breastfeeding increased from 0 to 18,4% and
fracture of the right humerus. The changes were: AP-413 IU/L, P -
exclusive formula from 0 to 42,1%. 15,8% of children got direct
1.4mmol/l, PTH - 120.9pg/ml, 25-OHD 111.7nmol/l, Ca++0.7 mmol/l.
breastfeeding and 36,8% got exclusive formula by bottle.
The fractures were treated with extreme caution in handling, and
Spoon showed more coordination problems (p=0,024) and less
increasing the dose of D3 - 1500 IU/d. Satisfactory healing occurred
acceptance among parents (p=0,01) and among nurses (p50,01) than
without sequelae.
bottle. 6 children moved to exclusive breastfeeding (50% from spoon
Conclusion: These three cases demonstrate the fragility of the bones
and 50% from bottle). At 3 months 57,9% of children mantained any
of premature infants. Screening of bone metabolic indicators
amount of breastfeeding.
especially 25-OHD, parathyroid hormone and serum phosphorus
Conclusion: According to the results of that study, the feeding method
can predict osteopenia.
used at discharge in moderate premature babies doesn’t seem to
influence the future quality or amount of breastfeeding at 3 months
Keywords: ELBWI, osteopenia, fractures of age. Parents and nurses feel more confortable with bottles. The use
of spoons or other methods different from bottles doesn’t offer any
significant advantage.
Keywords: Bottle, Spoon, Breastfeeding, Premature

PRETERM BIRTH/THE PRETERM INFANT - 470

Bottle or spoon? Which method is
best to preserve breastfeeding in
moderate prematures after
discharge?
E. Capdevila1, R. Porta1, J. Rı́os2, M. Riba1, V. Sorolla1,
G. Viles1, S. Camacho1, and V. Molina1
1
Department of Pediatrics. Hospital Universitari Dexeus. Barcelona,
Spain, and 2Laboratory of Biostatistics & Epidemiology (Universitat
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 287
kidney injury in newborn from neonatal intensive care unit and to
479 explore the association with perinatal asphyxia
Developmental centered care in Materials and methods: The study was conducted at the Children’s
University Hospital in Skopje, R. Macedonia. It was a clinical,
mexican neonatal units, 2015 an prospective study. In the period of two years (January 2014 to
December 2015) 29 patients hospitalized at the NICU with documen-
approach through social ted neonatal kidney injury were analyzed. Medical data records of
admitted neonates with kidney injury were analyzed. The material was
networks statistically analyzed using methods of descriptive statistics.
Clinical cases and summary results: We evaluated 29 neonates with
JA. Gutiérrez Padilla1, I. Estrada Ruelas2, J. Santiago documented acute kidney injury who at the period of 2 years were
Guevara3, D. Pérez Rulfo4, E. Ángulo Castellanos1, E. Valle treated in NICU. The prevalence of kidney injury was 6.4%. Most of
involved neonates were born at term 66%. Prerenal injury was
Delgado Esperanza1, HA. Garcı́a Hernández5, R. Martı́nez evaluated in 80% of cases. Perinatal asphyxia was the most common
Verónica1, I. Gutiérrez González1, and YG. González predisposing factors for kidney injury in our study revealed in 56%
Barrientos1 cases with predication of term infants and male. Sepsis was present in
1 44% cases, prematurity in 34%, and congenital malformation in 27%
Centro Universitario de Ciencias de la Salud, Universidad de of cases. Mortality rate was 27.5% and it was higher in patients with
Guadalajara, Jalisco, México, 2Consejo Mexicano de Certificación en assisted ventilation and sepsis
Pediatrı́a, México, 3Federación Nacional de Neonatologı́a, México, Conclusion: Perinatal asphyxia is a dominant predisposing factor
4
Coordinación de Enseñanza, División de Pediatrı́a, Hospital Civil de associated with neonatal kidney injury. Often, the occurrence of
Guadalajara Fray Antonio Alcalde, Jalisco, México, and 5Unidad de kidney damage in the neonatal population is multifactorial (more
Cuidados Intensivos Neonatales Externos, Hospital Civil de than 40%) and caused by several associated comorbidities
Guadalajara Fray Antonio Alcalde, Jalisco, México Keywords: Acute kidney injury, newborn, perinatal asphyxia

Introduction: The objective of Developmental Centered Care (DCC) is

to favor the neurosensorial and emotional development of the
newborn and to decrease the stress associated to neonatal care and 488
the pain related to diagnostic tests and invasive treatments.
To describe the implementation extent of the DCC in the Neonatal Mortality and major morbidity in
Intensive Care Units (NICU) in Mexico.
Materials and methods: Cross sectional, observational and descriptive
premature neonates under 28
study. A questionnaire focused on DCC was sent via online to
personnel working in NICUs that attend more than 50 children
gestational age between 2006
weighting less than 1.500 gr every year. and 2015
Clinical cases and summary results: A total of 39 NICUs were studied:
31% use covers as a mean of protection from light, 10% use methods
of noise measurement, 36% employ pain assessment scales. The N. Kasdallah1, D. Falleh1, H. Ben Salem1, H. Kbayer1,
access to the units is 2-3 hours per day (56%); 13% of the units have a K. Ben Ameur2, F.E, Chioukh2, K. Monastiri2, S. Blibech1,
room exclusively for parents available inside the unit, and 36% allow and M. Douagi1
the Kangaroo Care Method to be performed. 1
Conclusion: A lack of strategies is noted to raise the coverage of these Resuscitation and Intensive Care Unit of Neonatology, University
care methods in the NICUs, to improve the education of the parents Military Hospital of Tunis, Tunisia and 2Department of Medical and
respecting the measures used in this program, and to achieve that the Intensive Care Unit of Neonatology, University Hospital of Fattouma
DCC is applied in every region due to its low cost and great benefit. Bourguiba, Monastir, Tunisia
Keywords: Developmental Centered Care, Kangaroo care,
Neonatology, Prematurity Presenter: K. Ben Ameur
Introduction: Extremely preterm (EP) infants (under 28 weeks’ gesta-
tion) are at high risk for mortality, neonatal morbidity and adverse
484 neurodevelopmental outcomes in survivors. Further, the cost of health
care of EP infants in terms of neonatal intensive care and, for some,
Predisposing factors in newborns lifelong support, is weighing heavily on the savings of families and the
with acute kidney injury economy of state in our context. An assessment of management and
outcome of EP infants in our unit was, not yet performed.
Aims: To assess the neonatal care, morbidity and mortality among EP
S. Naunova Timovska, V. Timovski, A. Sofijanova, infants supported at Neonatal Resuscitation and Intensive Care Unit
L.j. Kojik, M. Kimovska-Hristova, R. Muratovska of the Military Hospital of Tunis over the past 10years, in order to
Delimitova, T. Voinovska, H. Mandzukova, and develop a thoughtful management strategy.
Materials and methods: STUDY DESIGN: Prospective and descriptive
S. Neskova study.
Children’s University Hospital, Skopje, R. Macedonia Setting, subjects: We identified infants born at 22 to 27 weeks’
gestation and supported in Resuscitation and Intensive Care Unit of
Neonatology of Military Hospital of Tunis between 2006 and 2015.
Presenter: S. Naunova Timovska; EXPOSURE: Extremely preterm birth.
Introduction: Acute kidney injury is a serious condition which damages Main outcomes and measures: Perinatal characteristics, neonatal care,
the kidney as a central mediator of the homeostasis of bodily fluids morbidities, and survival. Major morbidities, reported for infants who
and electrolytes. It is not a rare problem in the intensive care units, survived more than 12 hours, were hyaline membrane disease
particularly in the neonatal population. Perinatal asphyxia is a necrotizing enterocolitis, infection, bronchopulmonary dysplasia,
common predisposing factor associated to neonatal kidney injury. intracranial hemorrhage, periventricular leukomalacia, and/or retino-
The aim of this study was to determine the characteristics of acute pathy of prematurity.
288 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Clinical cases and summary results: We identified 73 EP infants, 17.8% babies (16%) covered 3rd – 10th percentile and only 2 babies (11%)
were intubated in the delivery room. The average term was 26 reached normal growth indices. All babies below 3rd percentile
gestational age (GA). The mean birth weight was 903 gr. Morbidity suffered from complications of their clinical course while others were
was represented as follows: hyaline membrane disease in 56%. not complicated.
Hemodynamic disorders were noted in 54%. Maternal-fetal infections Conclusion: There is not an ideal formula for ELBW newborns.
were noted in 23%. Nosocomial infection was noted in 36.7% of The anthropometric status of these patients to the discharge depends
survivors more than 3 days. Neurological damage affected 21% of EP. not only on enteral feeding but also on various complications during
The rate of ulcerative enterocolitis necrotizing was 8,2%. Assisted their hospital stay in NICU.
ventilation was used in 71%. The overall survival rate was 19%.
Survival increase between the first and the last five years of study was Keywords: Enteral nutrition, newborn, extremely low birth weight
statistically non significant: 10% [3 of 29] to 25% [11 of 44]; RR 1.2
[95% CI, 0.97-1.48]). All seven infants under 25 GA dead. Survival rate
was 17.4% (19 of 23) in infants aged between 25 and 26 GA, and
23.2% at 27 GA. The average length of stay for survivors was 61 days. 497
The lowest weight and term in survivors were respectively 25 GA and
860 gr. Bronchopulmonary dysplasia was noted in three of 14
Stress biomarkers and psychoso-
survivors more than 28 days. Two EP infants developed cerebral
palsy (2.7%) and one develop retinopathy of prematurity.
cial factors used as predictos of
Conclusion: Limit of this study was the small of sampling. We observed preterm labour
high rates of mortality and morbidity in EP infants. Several axes need to
been promoted in the management of risk pregnancies, neonatal care
and prevention of nosocomial infections. Infants born near the limit of V. Serrano de la Cruz Delgado1, V. Diago Almela1,
viability (22 to 24 GA) are at high risk for death and pose the ethic A.C. Garcia Blanco2, M. Vento Torres2, and A.
problem of therapeutic obstinacy. These findings may be valuable in Perales Marı́n1
counseling families and developing novel interventions. 1
Obstetric Dept, Universitary and Polytechnic Hospital La Fe,
Keywords: Extremely preterm, infants; mortality, morbidity Valencia, Spain and 2Pediatric Dept, Universitary and Polytechnic
Hospital La Fe, Valencia, Spain

493 Presenter: Verónica Serrano de la Cruz Delgado

Enteral nutrition of extremely low Introduction: Psychosocial and biological stress-related factors are
apparently associated with prematurity, which is a primary cause of
birth weight infants neonatal mortality and morbidity. Despite advances in neonatal care
and reduction of preterm infant mortality, morbidity still remains a
considerable challenge for caregivers. Among the causes of preterm
V. Atanasova1, and L. Veskov2 labor, the role of maternal stress has become increasingly relevant in
1 the last decades. Nowadays, the simultaneous influence of both these
Division of Neonatology, University Hospital of Pleven, Bulgaria and
2 factors has not been previously studied. Therefore, prediction of
Trainee doctor of Medical University of Pleven, Bulgaria,
preterm labor based on multiple stress-related factors still remains a
challenge.
Presenter: V. Atanasova Materials and methods: Prospective observational cohort study carried
Introduction: Enteral nutrition of newborns with extremely low birth out during12months in a regional referral center. We recruited101-
weight (ELBW) still presents as a challenge for the clinician. women who were diagnosed preterm labour between24-31weeks
Establishment of good nutritive tolerance requires time and patience gestation and then they were classified in two groups according to
and prolongs parenteral nutrition. Breast milk is an ideal food for all the gestational age at delivery(term or not). Exclusion criteria
newborns including those with ELBW but it is not always available or were:gestational age between32-36 + 6weeks, major medical disor-
is insufficient. Therefore we rely on formulas designed for premature ders or severe obstetric complications during pregnancy. The
infants. These formulas are modified so that their composition is morning after admission, questionnaires addressing social functio-
similar to breast milk and are able to satisfy growth requirements of ning,anxiety,and depression were filled out. Saliva samples to
the preterm infants. The goal is to achieve anthropometric indices determinate cortisol and a-amylase were collected. Mann-
which are relevant to postconceptual age and intrauterine fetal Whitneytest was performed to compare potential diagnosis variables,
growth. and if they showed significance, were introduced in logistic regression
Purpose: To investigate growth rates of ELBW newborns feeding with model to predict the prematurity.
partially hydrolyzed preterm formula. Clinical cases and summary results: Mothers who had a preterm labor
Materials and methods: Nineteen babies with birth weight 1000 g showed higher anxiety trait (p=0.030), lower social support (p=0,016),
were examined. Fenton growth charts for boys and girls, 2013 was lower partner support (p=0,021), and higher cortisol levels (p less
used as fetal growth standard. The following indices were deter- than 0,001) than mothers who had a term labor. Logistic regression
mined: presence of intrauterine growth restriction, duration of model indicated that partner support and cortisol level the morning
parenteral nutrition, development of clinical complication (intraven- of admission to the hospital, were the best predictors of prematurity.
tricular hemorrhage, patent ductus arteriosus, necrotizing enteroco- (R2=0,342, p=0,001).
litis, bronchopulmonary dysplasia, nosocomial infection, osteopenia Conclusion: Psychosocial conditions and stress biomarkers are
of prematurity, toxic hepatitis with cholestasis), time of achievement relevant factors for women who go into threatened preterm labour.
of good nutritive tolerance (100 mL formula/kg/day), postconceptual A combination of these variables related with stress could differ-
age to discharge. entiate between vulnerable women or resilient women. Vunerable
Clinical cases and summary results: Results: The weight gain in the first women are specially related to women who simultaneusly show low
postnatal month was suboptimal (7,3±3,6 g/kg/day) which was partner support and high cortisol level. Therefore, this multivariable
compensated by greater weight gain in the second and third stress model could be taken into account to identify the risk of
month of life (13,7±4,0 and 12,7±2,8 g/kg/day respectively). Despite of prematurity and prompt the initiation of early therapy.
this, the overwhelming majority (14 of 19 babies – 73%) was Keywords: a-amylase, biomarkers, cortisol, prematurity, stress,
characterized by anthropometric indices below 3rd percentile threatened preterm labour
according to Fenton chart data for similar postconceptual age; 3
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 289

551 569
The effect of routine immunisa- Effect of oropharyngeal colos-
tion on heart rate characteristics trum administration in tumor
index necrosis factors-A, interleukin-6
I. Morris, J. Mack, N. MacDermott, S. Edwards, and and interleukin-8 levels in pre-
S. Banerjee term newborns
Department of Neonatal Medicine, Singleton Hospital, Swansea,
United Kingdom E. Martin Alvarez1, L. Serrano López1, M. Peña Caballero1,
J. Diaz Castro2, J.J. Ochoa Herrera2, and J.A. Hurtado
Presenter: Sujoy Banerjee Suazo1
Introduction: Heart Rate Characteristics index (HRCi) is a numerical 1
Paediatric Dept. University Maternal Hospital Virgen de las Nieves,
score derived from a mathematical model of electrocardiogram Granada, Spain and 2Physiology Dept. University of Granada.
analysis of heart rate variability, asymmetry and entropy to predict Instituto de Nutrición y Tecnologı́a de los Alimentos ‘‘José Mataix’’,
clinical deterioration. Displaying the HRCi to clinicians reduced
Granada. Spain
mortality in very low birth weight infants, primarily due to reduction
in late onset sepsis related mortality. However, HRCi can be affected
by a number of other factors including acute respiratory deteriora- Presenter: E. Martin Alvarez
tion, inflammation and drugs. Routine immunisation is known to be Introduction: Very low birth weight (VLBW) newborns have an
associated with respiratory instability and raised inflammatory immature immune system and also disrupted defense natural barriers.
markers but its effect on HRCi is not known. This study examines if Colostrum contains increased concentrations of secretory immuno-
HRCi is significantly affected by immunisation. globulin A, growth factors, lactoferrin, anti-inflammatory cytokines,
Materials and methods: A prospective observational study was pro-inflammatory cytokines and other protective components,
undertaken at Singleton Hospital, Swansea, UK where HRCi monitor- compared with mature breast milk. Preterm colostrum may be
ing is routine. Infants receiving planned immunisation as per the especially protective during the first days of life when VLBW infants
national immunisation schedule between May 2014 and January 2015 are the sickest and at highest risk for acquiring an infection.
were included. Infants were excluded if discharged before the end of This study aimed to evaluate the inmunologic effects of orophar-
the study observation period or if HRCi scores were unavailable. yngeal colostrum adminstration to VLBW infants in their first two
Hourly HRCi and relevant clinical data were recorded 24 hours before weeks of life, by assessing Tumor Necrosis Factors-a (TNF-a),
and after the immunisation. Pre-immunisation median HRCi score Interleukin-6 (IL-6) and Interleukin-8 (IL-8) serum levels evolution up
over 24 hours (baseline) was compared for statistical difference with to one month of life.
post-immunisation median HRCi in 6-hourly epochs by a non- Materials and methods: An interventional, no randomized, controlled
parametric one- way ANOVA test for repeated measures (Friedman) trial recruiting newborns  32 + 6 gestational weeks and/or 5 1500 g
on Graph Pad Prism 7.0 for Windows. A p50.05 was used to indicate at birth was developed. 38 newborns were enrolled. Subjects received
statistically significant difference. 0,2ml of their mother colostrum every 4 hours administered
Clinical cases and summary results: Twelve infants were immunised oropharyngeally. The intervention was started in the first 24 hours
during their inpatient stay. One infant was excluded due to of life, and it followed for a 15 days period. TNF-a, IL-6 and IL-8 serum
inadequate baseline data. The mean gestation and birth weight levels were measured at birth (M1), 3 (M2), 15 (M3) and 30 (M4) days
were 26.1 weeks (95%CI 25.1- 27.2) and 863 grams (95%CI, 742-986) of life using Milliplex MAP technology. Perinatal and neonatal data for
respectively and immunisation was given at a mean gestation of 34.6 the first month of life were registered. Stadistic programa: SPPS vs 20.
weeks (95%CI 33.7-35.5). Clinically notable increase in the HRCi scores Clinical cases and summary results: During colostrum administration a
(2) was noted in 2 infants in the 24 hours after immunisations; both increased of TNF-a serum levels was observed in control group (M1
had concomitant respiratory deterioration. No culture positive sepsis 51,4 pg/ml vs M3 69,7 pg/ml; p50,01), while this concentration
was identified. A post-hoc group comparison following the Friedman remained stable in newborns who recived colostrum oropharyngeally
test showed no statistically significant difference between the (M1 50,1 pg/ml vs M3 57,2 pg/ml; p=0,33). Along the first month of life
baseline median HRCi and any of the post- immunisation epochs. a decrease in IL-6 and IL-8 levels was found in colostrum group (IL-6:
Statistically significant differences (p50.01) in median HRCi were M1 33,3 pg/ml vs M4 5,5 pg/ml, p50,001; IL-8: M1 96,1 pg/ml vs M4
identified between some of the post-immunisation epochs. Very few 58,7 pg/ml, p50,03) and in control group (IL-6: M1 34,0 pg/ml vs M4
HRCi scores reached clinical threshold for concern without associated 12,1pg/ml, p50,001; IL-8: M1 107,7 pg/ml vs M4 85,9 pg/ml, p=0,15).
respiratory deterioration. IL-6 and IL-8 levels were statistically lower in colostrum group,
Conclusion: HRCi was not affected by routine immunisation in regarding control group at one month of age (p=0,01; p=0,02).
neonates unless associated with overt respiratory deterioration. Any Conclusion: Our data suggest that oropharyngeal colostrum admin-
change in HRCi following immunisation must not be ascribed to istration might facilitate the development of immune system in VLWB
immunisation only but other causes of rising HRCi such as sepsis or infants along the first month of life, due to lower TNF-a serum
impending respiratory deterioration must be explored. concentration during the intervention and decreasing IL-6 and IL-8
Keywords: Preterm, immunisation, heart rate characteristics index serum levels at one month. These cytokines play an important role in
pro-inflammatory response.
Keywords: Preterm, colostrum, interleukine 6, interleukine-8, Tumor
Necrosis Factors-a
290 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Clinical cases and summary results: A women in her 29 + 4 gestational

571 week comes to the emergency service because she has ruptured the
Premature rupture of membranes membranes. At the exploration, premature rupture of membranes
(PROM) is confirmed. Cervicometry shows a 18mm cervix. Antibiotic
acording to a clinical case treatment is settled. Once that an infectious outback is discarded
tocolytic treatment is initiated due to contractions. Satisfactory NST.
Contractions have ceased. After 24 hours maternal clinical situation
J. Barrenetxea, B. Gastón, B. Perez, M. Donazar, A. Safont, shows no change (abscence of chorioamnionitis), but a severe
M. Urtasun, and C. Larrañaga oligoamnios is discovered by ultrasonography. In the NST decelera-
tions in the FHR start to occur. Urgent fetal extraction is decided
Complejo Hospitalario de Navarra, Pamplona, Spain
because off risk of loss of fetal wellbeing. A cesarean fetal extraction is
performed.Uterine response is insatisfactory so 1000 mcg of
Presenter: J. Barrenetxea Misoprostol are administrated intrarectally. Even so uterine tone is
Introduction: Membrane rupture before 37 weeks of gestation is poor so a ‘‘B-Lynch’’ mode hemostatic suture is performed. Correct
referred to as preterm premature rupture of membranes (PROM). uterine tone is achieved. The evolution of the patient in the post
Management is influenced by gestational age and the presence of anesthesia recovery unit is correct.
complicating factors, such as clinical infection, labor, or nonreassuring Conclusion: Preterm premature rupture of membranes is a quite
fetal status. An accurate assessment of gestational age and knowl- common obstetrical entity. It forces us to settle antibiotic treatment.
edge of the maternal, fetal, and neonatal risks are essential to Once that infectious outback is discarded, fetal pulmonary madura-
appropriate evaluation, counseling, and care of patients with PROM. tion is important. We also need to check the fetal wellbeing by NST
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 291
and sonography techniques. With a maternal and fetal wellness
584
situation there is no need to finalize pregnancy. If Maternal or fetal
wellbeing can not be guaranteed the end of the gestation by the Safety and success rate of
safest way is the procedure to make.
Keywords: Preterm, rupture of membranes, atony
performing early mris in very
preterm born infants
577 R. van Diepen1, F. Groenendaal MD PhD2,3,
K. Keunen MD2,3, M. Bouman R.N.2, M.J. Benders MD
Twin pregnancy. Gestational age. PhD2,3, L.S. de Vries MD PhD2,3, and A.J. Brouwer PhD
Previous pregnancies matter RN2
1
Department of Radiology, University Medical Center Utrecht,
C. Larrañaga-Azcarate1, J. Zabaleta2, S. Garcı́a3, and Utrecht, The Netherlands, 2Department of Neonatology, University
M. Urtasun4 Medical Center Utrecht, Utrecht, The Netherlands, and 3Brain Center
Rudolf Magnus, University Medical Center Utrecht, Utrecht, N
Complejo Hospitalario Navarra, Obstetrics and Gynecology Dept.
Pamplona-Navarra. Spain
Presenter: R van Diepen
Presenter: C Larrañaga-Azcarate Introduction: Early cerebral MRI scans at around 30 weeks’ post-
menstrual age is becoming standard care for very preterm born
Introduction: Prematutity is common in twin pregnancies. Previous infants. Routine early MRI in preterm infants is restricted to those who
pregnancy could be a factor which matters on the average of age at are hemodynamically stable and do not require more respiratory
delivery of actual twin pregnancy. support than nCPAP. The aim of this study was to evaluate the safety
Materials and methods: A retrospective analysis on 1340 twin and success rate of an early MRI in very preterm infants using an MR-
pregnancies atended at CHN during 10 years (2006-2015). compatible incubator.
Gestational age (GA) at delivery is study depending on previous Materials and methods: A retrospective chart review was conducted to
parity, maternal age and medical induction of labor or spontaneous evaluate the digital data on vital signs of preterm infants (532 weeks
labor. gestational age (GA)) who underwent an early MRI. The digital data
Clinical cases and summary results: 872 (65%) pregnant women are in were collected at six fixed time points from 24 hours before the MRI
their first pregnancy, 646 (35%) had a one or more previous until 24 hours after the MRI with eight-hour intervals. In addition,
pregnancies. 4 women had their parity data loss. Median GA in adverse cardiorespiratory events including apneas, tachypneas,
women without previous pregnancy 248 days, and in those with desaturations, bradycardias and tachycardias that occurred within
another pregnancy before 253 days. The difference between medians the predefined 48-hour period were collected. Additionally, data of
is 4,37 days (95% CI 6,7-2,7) (p= 0,0000). Preterm delivery (537 weeks) the use of oral chloral hydrate and quality of MRI scans were
concern 56% of pregnant women without previous pregnancy versus registered.
48% of those with a previous pregnancy (p=0,000). For deliveries535 Clinical cases and summary results: 98 infants (GA 27.1 (± 1.7) weeks)
weeks the numbers are 36% and 23% (p=0,000) respectively, and for underwent an early MRI at 31.1 (± 1.2) weeks PMA. 54% were sedated
deliveries 530 weeks differences are 10% vs 7% (p=0;000), with oral chloral hydrate (44.2 ± 7.6 mg/kg) during the MRI. The scan
respectively. If the analysis is done for GA 526 weeks, numbers are quality was assessed as good in 47% and sufficient in 53%. There was
0,6% for first pregnancies and 0,4% for women with previous no significant relation between the use of sedation and the quality of
pregnancy, no significant differences (p =0,73). When deliveries start the MRI scan. Respiration rate and rectal temperature showed no
spontaneosly, median GA at delivery is 255 days, and if they are significant difference. Respiratory support was increased in nine
medicaly finish median GA at delivery is 242 days, difference between infants and decreased in one. There was a significant, but not
medians is 12,7 days (95% CI 110,6-14,8) (p0=0000). When analysis is clinically relevant, difference between saturation (median pre 92,
focus in pregnancies which start spontaneously, GA at delivery for median post 91, p=0.041) and heart frequency (median pre 165,
women without previous pregnancy is 238 days, and 248 days for median post 161, p=0.015,). After MRI more infants with tachypneas
those with previous pregnancy, difference between medians 9,5 days (p=.02), desaturations (p=.01), and bradycardias (p=.03) were
(95% CI 5,9-13,1) (p= 0,0000). observed. However, less apneas (p=.001) and tachycardias (p=.01)
Conclusion: Previous pregnancy is a protective factor for prematurity were noted. There was a significant, not clinically relevant, association
in twin pregnancy, and minimizes medical indicated deliveries. between sedation and the number of infants with a relative increase
Keywords: Prematurity, Twin pregnancy of these events after the MRI (p=.02).

N (%) GA delivery (days) 537 w (%) 535 w (%) 535 w (%) 526 w (%) Spont Labour (days)
No Previous P 872 (65) 248 56 36 10 0,6 238
Previous P 646 (35) 253 48 23 7 0,4 248
292 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Conclusion: Early MRI in preterm infants is associated with statistically outcome, a sensitive and effective measuring tool to asses fetal
significant yet small and therefore not clinically relevant, differences activity and wellbeing is needed. Fetal distress can result in a decrease
in vital signs. Baseline characteristics were not significantly different, in fetal motility. Nowadays, kick charts, ultrasound, . . . are used to
indicating that differences may be the result of sedatives. The number measure fetal movement, but they have their limitations. We
of events in sedated infants is significantly higher, but not of clinical previously reported the use off on-body accelerometers to detect
relevance, compared to unsedated infants, whereas scan quality did fetal activity. Based on this, Belli, a wearable sensor with a single
not differ. Therefore, an early MRI without the use of sedation is highly sensitive accelerometer, was developed by Bloom
recommended Technologies. Here we report the use of Belli, to detect fetal
Keywords: Preterm infant, MRI, safety movements and to distinguish between maternal movements.
Clinical cases and summary results: A primigravida was admitted to the
intensive care unit at 34 weeks of gestation. Ultrasound examination
revealed a lateral positioned placenta. Belli was attached beneath the
601 umbilicus, on a supine positioned mother. Figure 1A shows motion
intensity as detected in Belli. During the first 7 minutes, maternal
Monitoring fetal motility using motion was detected by Belli but not identified as fetal activity. Figure
1B shows the output of the algorithm, some false positive fetal
wearable sensors: an activity activities were identified (Fig 1B, green bars). After 7.5 minutes the
tracker for your unborn baby? mother rubbed her belly to wake the baby. This can be seen in Figure
1A and shows an increase in activity. After rubbing an increase in fetal
activity was observed. This activity was annotated by the mother
N. Geusens1, M. Altini2, J. Germeys3, A. van den Hoogen3, based on her perception. The majority of these activities were fetal
D. Lanssens1,3, J. Penders2, L. Grieten1,3, and kicks, the algorithm was able to identify these as such. After
W. Gyselaers1,3 3.5 minutes of intense activity the fetus returned to sleep. The
mother did not annotate any activity from this point on.
1
Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos Conclusion: These results indicate that the Belli sensor, with a single
6, 3600 Genk, Belgium, 2Bloom Technologies, San Francisco, USA, high sensitivity accelerometer can be used to detect fetal kick-activity.
and 3Mobile Health Unit, Faculty of Medicine and Life Sciences, Furthermore, the sensor was able to demonstrate a good sensitivity
Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium and selectivity to detect fetal activity and differentiate from maternal
activity. It is clear that such a novel monitoring technology has the
potential to deliver more information on maternal and fetal health by
Presenter: Nele Geusens
providing quantitative measures which are unavailable today.
Introduction: Activity trackers are used today to quantify the level of
Keywords: Fetal movement, kicks
activity and are able to quantify health status. This concept is
applicable to unborn children. In order to reduce poor perinatal
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 293

604 613
A wearable patch for the Outcome of late preterm infants
detection of fetal activity at the university hospital central
N. Geusens1, M. Altini2, J. Germeys3, A. van den Hoogen3, of Asturias (Spain)
D. Lanssens1,3, J. Penders2, L. Grieten1,3, and
W. Gyselaers1,3 F. Morales Luengo and B. Fernandez Colomer
1
Department of Gynaecology, Ziekenhuis Oost-Limburg, Schiepse Bos Neonatology Service. University Hospital Central of Asturias, Oviedo,
6, 3600 Genk, Belgium, 2Bloom Technologies, San Francisco, USA, Spain
and 3Mobile Health Unit, Faculty of Medicine and Life Sciences,
Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium Presenter: B. Fernandez Colomer
Introduction: Late preterms infants (LP) are those born at a gestational
Presenter: Nele Geusens age between 34 and 37 weeks. This subgroup of premature babies
has taken great interest in recent years because of its increasing
Introduction: Fetal monitoring stays an obstacle in obstetrics. A
incidence. Also LP have a higher morbidity and mortality than term
decrease in fetal movements could be an indication of fetal distress.
infants that implies a higher rate of admission and hospital stay.
It is currently tracked via maternal perception, which is a subjective
Moreover the rate of readmissions in the first months of life is high for
method with a poor reliability. Other techniques (ultrasound -
these children.
tocodynamometry) has limitations. Despite these technologies,
Objective: To determine the outcome of LP at the University Hospital
there is a lack for a sensitive and effective measuring tool to assess
Central of Asturias (Spain) over a 5-year period (2008-2012).
fetal activity and wellbeing, in order to reduce poor perinatal
Materials and methods: A retrospective, descriptive study was
outcome. Accelerometers are proven to be successful, preliminary
performed. Data were extracted from the maternal and neonatal
results, based on a set of 4 analog accelerometers, showed a true
medical records of 996 LP born in the study period. Also the evolution
detection rate range of 78%-80% against ultrasound . Our goal is to
in the first 2 years of life was analyzed.
assess if a single accelerometer patch-type wearable sensor can be
Clinical cases and summary results: There was an overall incidence of
compared to a high-end multi-channel bench-top device.
7.6% (996 LP of 13,113 births), accounting for 67.2% of all preterm in
Materials and methods: A feasibility study was performed where a
our hospital (996/1,483). LP rate decreased from 9.4% to 6.5% in the
wearable patch sensor with a single high sensitive accelerometer
study period and also the percentage of LP respect to the total of
(Belli, Bloom Technologies) was compared to a high end table-top
preterm infant born (71.6% to 65.5%). The 56.7% of LP were admitted
multichannel system (TMSi, The Netherlands). In order to differentiate
to the neonatal unit. Metabolic pathology, mostly jaundice, was the
maternal motion from fetal motion, one accelerometer from the TMSi
most frequently found (51,2% of all LP) followed for respiratory
device was attached on the back while the rest was attached in a star-
diseases, mainly transient tachypnea. Hospital stay was higher at
pattern on the abdomen. The belli patch was attached under the
lower gestational age. Readmission rate beyond the neonatal period
navel area. Expecting, singleton mothers, with a minimum gestational
was 26.7% and bronchiolitis was the cause of almost half of
age of 20 weeks, were included and placed in a supine position and
readmissions (40.9%). There was no statistically significant difference
monitored for a period of 20 minutes. Perception of fetal activity was
in readmission between LP previously admitted to neonatal period
annotated by the mother using an annotation tool. Afterwards data
and those who were not admitted. Mortality rate in our hospital was
was processed and interpreted to detect fetal activity.
0.8% (8/996 LP).
Clinical cases and summary results: In total 22 mothers were included
Conclusion: LP rate in our hospital has decreased from 9.4% to 6.4%
with a mean gestational age of 28w2d (range: 19w1d-39w2d) and an
from 2008 to 2012. Jaundice was the most common pathology
average BMI of 27.6kg +/- 5.9kg. Placenta position was as following: 9
diagnosed. More than a half of LP required admission in the neonatal
placenta anterior, 9 placenta posterior, 1 fundal, 1 lateral, 1 previa and
period. Readmission beyond neonatal period occurred frequently,
1 unknown position.
with Bronchiolitis as the main diagnostic found. No relationship was
After cross-comparison of the ability to detect fetal activity using the
found between neonatal period admission and subsequent
multi-channel, a sensitivity of 77% was observed compared to the
readmission.
single accelerometer with sensitivity of 66% percent. Since maternal
movement impacts the overall performance of the activity sensitive Keywords: Late preterm infant, prematurity, outcome, complications
sensors, a selection was made while the mother was in a steady
position. Positive predicted value (PPV) of the TMSI is 52%, while the
PPV of the sensor is 51%, which is due to an underestimation of the
kicks detected by the patients. 618
Conclusion: Results indicate that accelerometers can be used to detect
fetal kick-activity. However, the system is sensitive to maternal The difference human milk bank
motion. In the ideal condition (i.e. resting positions or sleep) high
quality data was available with already a higher sensitivity than
can make in a baby-friendly
currently used kick chart. Belli is able to match the same performance
as a TMSi. This indicates that Belli could become a useful tool in the
hospital
quantification of fetal activity over time to provide novel insights.
U. Bernatowicz-Łojko1,2, E. Sinkiewicz-Darol1,
Keywords: Accelerometers, fetal movement K. Kaczmarek1, M. Łojko3, A. Wesołowska1,2,
J. Bieganska2, and H. Da˛browska2
1
Human Milk Bank, L.Rydygier’s Provincial Polyclinical Hospital,
Torun, Poland, 2Department of the Newborn and Neonatal Intensive
Care Unit (NICU), L. Rydygier’s Provincial Polyclinical Hospital, Torun,
Poland, and 3Department of Obstetric, Women Diseases

Presenter: Urszula Bernatowicz-Łojko

294 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Introduction: There is still a lack of information on the health benefits nosocomial infection was 29.8%, of anemia requiring transfusion
for preemies and the economic effects, resulting from the imple- 43.6% and 3.5% has presented necrotizing enterocolitis. Chronic lung
mentation of the procedure of donor’s milk supplementation (DMS- disease occurred in 4.8% of survivor infants. The overall survival rate
procedure) in neonatal wards.The main objectives of our research was was 73%. Birth weight less than 750g and nosocomial infection were
to ascertain if the DMS-procedure introduction in neonatal ward the independent risks factors for death.
makes a difference in the health of preterm newborns and in the Conclusion: Antenatal corticotherapy, surfactant and ventilation have
hospital budget. We focused on the baby-friendly hospital(BFH)- contributed to improve the outcome of preterm infants. More efforts
works acording to the recommendations (‘‘Ten steps to successful have to be performed in order to decrease factors leading to IVH and
breastfeeding’’) of the World Health Organization to prevent nosocomial infections which remains the mean cause of
Materials and methods: We investigated two groups of preemies ?33 death.
gestation age, admitted to the Department of the Newborn and NICU
in L.Rydygier’s Provincial Polyclinical Hospital in Torun in 2012-14: Keywords: Preterm birth, epidemiology, outcome
group 1-65 prematures admitted before and group 2-79 prem.
admitted after the implementation of DMS-procedure. We analysed
the length of the period of hospitalization, antibioticotherapy,the
parenteral nutrition, the minimal enteral feeding introduction, the 663
occurrence of the infection, the bronchopulmonary dysplasia(BPD),
the kind of enteral feeding (formula, human milk: mother’s or donor’s Inguinal hernia and prematyrity
milk) during the hospitalization period and at the day od discharge,
We assessed the spending (per one prem,) on antibiotics, immuno- V. Sideri, E. Kapsabeli, A. Daskalaki, M. Mitrogiorgou,
globulins, parenteral nutrition and preterm formula consumption in
N. Podimatas, P. Triantafillidou, P. Mexi-Bourna, and
these groups.
Clinical cases and summary results: In group 2 there was earlier V. Papaevangelou
minimal enteral feeding introduction and shortened parenteral NICU, 3rd Paediatric Dept.,University of Athens, Attikon Hospital,
nutrition duration compared to group 1 (statistically significant).
Athens, Greece
Late onset sepsis was significantly reduced, however we observed
more episodes of milder infections (statistically nonsignificant). There
was one case of necrotizing enterocolitis before and one after DMS- Presenter: V. Sideri
procedure implementation. BPD cases decreased but insignificantly.
Introduction: Inguinal hernia is common in former premature infants,
The percentage of the exclusively human milk feeding prematures
with an incidence of 13% in infants born before 32 weeks of
during the stay in hospital increased, but the percentage of any
gestational age(GA) and up to 30% in infants born less than 1 kg.
mother’s milk-feeding preemies at the day of discharge didn’t change
Premature infants may also have a high risk of recurrence on the
significantly. The expenses on antibiotics, immunoglobulins, parent-
contralateral side.
eral nutrition were significantly reduced. Preterm formula consump-
Factors that contribute to the increased risk for inguinal hernia in
tion decreased by 48%.
premature infants include a persistent processus vaginalis, male sex,
Conclusion: The implementation of DMS-procedure provided tangible
gestational age, low birth weight, and prolonged mechanical
benefits both to prematures’ health and the hospital budget, even in
ventilation.
BFH before.
Materials and methods: Retrospectively, we studied newborns
Keywords: Prematurity, nutrition, donor’s milk, baby-friendly hospital admitted to our iNICU and had inguinal hernia, during 2015.
Clinical cases and summary results: During 2015, 184 neonates
admitted to the NICU. Four neonates had inguinal hernia (2.17% of
all newborns, and 30.8% among premature infants with GA 532
641 weeks).
All, they were boys, with gestational age between 25 + 4 and 29
Early outcome of preterm infants weeks, and birth weight between 700gr - 1285gr. The ƒ of neonates
less than 32 weeks gestational had bilateral hernia.
All neonates due RDS, had received surfactant and the ƒ needed
age in a NICU level III in Tunisia mechanical ventilation.
The ƒ of neonates with bilateral localization had BPD.
The infant with unilateral localization (right) showed a sudden
J. Methlouthi, N. Mahdhaoui, H. Ayech, M. Bellaleh, constriction of the inguinal hernia, during the 51st day of life. The
S. Nouri, and H. Seboui. infant also had RDS and had received surfactant, and remained in n
CPAP for three days. It was the infant with the greatest gestational
Neonatology department, F Hachrd university Hospital, Susah, age and birth weight. All, they successfully treated surgically.
Tunisia Conclusion: There is clearly an increased incidence of inguinal hernia
in very premature newborns, and even the birth weight below 1 kgr.
Presenter: Jihene Methlouthi It appears that RDS, mechanical ventilation and BPD increases the risk
of inguinal hernia. Obviously, the number of cases is limited and
Introduction: Advances in obstetrical and neonatal care have required additional cases for the documentation of findings.
increased the survival of infants born532 weeks of amenorrhea (WA).
Objective: establish the birth rate, mortality and morbidity of Keywords: Premature neonates, inguinal hernia
neonates born 532WA and analyze risk factors associated with poor
outcome.
Materials and methods: Retrospective study including all live born
preterm infants born less than 32 WA, in our NICU, from 1st June 2009 675
to 31 May 2011.
Clinical cases and summary results: 372 infants with gestational age
(GA)532 WA were admitted during the period of the study. The mean
gestational age was 29.7 weeks (range, 26-31.9 weeks). The mean
weight birth was 1420 g (range, 510-2860 g). Respiratory distress
syndrome was occurred in 46.5% of infants and 39.4% of them have
required exogenous surfactant therapy. The overall incidence of
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 295
without their condition being identified, despite routine baby checks.
Where the child is affected by major congenital heart disease that is
Effect of ‘‘early’’ feeding of ELBW essentially unstable, this can lead to haemodynamic compromise and
result in emergency admission. Similarly, access to surgical interven-
and VLBW tion may be delayed, or else undertaken with the patient in a sub-
optimal condition.The aim is to describe mortality rate of patients
prenatally diagnosed with complex congenital heart disease (CCHD)
S.S. Khasanova in the prenatal and postnatal settings and to evaluate the impact of
Republican perinatal center of Uzbekistan associated pathology in Kosovo as country with limited surgical
resources
Materials and methods: Study comprised a retrospective analysis of
Presenter: S.S. Khasanova
database research of 83 patients prenatally diagnosed with CCHD,
Introduction: The incidence of NEC is inversely proportional to birth between January 2002 and December 2015. CCHD were divided in 8
weight. In general, the age of onset is inversely proportional to groups: tetralogy of Fallot (TOF, N6), atrioventricular defect (AVD, N8),
gestation; therefore smaller babies present later. 90% of babies with tricuspid atresia (TA, N14), hypoplastic left heart syndrome (HLHS,
NEC are preterm. The mortality rate of NEC is 20-40%. In spite of N16) transposition of great arteries (TGA, N12) and pulmonary atresia
extensive research, the disease remains unsolved. The aims of this with intact interventricular septum (N11), aortic coarctation (CoAo,
paper are to present the risk factors of NEC and study the role of early N12) and isomerism (N4). In 22 pregnancies (26.5%) amniocentesis
enteral feeding on decreasing NEC. A Cochrane review of early or late was performed and in 16 of them chromosomal abnormalities were
commencement of progressive enteral feeds for preterm infants detected (12 with trisomy 21, all with AVSD and 4 with 22q11.2
published in 2008 identified 3 small trials with 115 participants. All deletion, two with TOF and one TA).
infants were preterm and low birth weight but were not specifically Clinical cases and summary results: In all foetuses diagnosis was made
SGA or IUGR.’’Early’’ feeds were started within 4 days of birth, and prenatally. Overall, HLHS was most frequent (19%), followed by TA
‘‘late’’ feeds between 5 and 10 days. (16.8%), TGA and CoAo (14%). Termination of pregnancy (TOP) was
Materials and methods: No difference was seen in rates of NEC, but the carried out in 33% (all foetuses with chromosomal abnormalities -19%
authors concluded that the available data were insufficient to inform and foetuses with UVH - 14%). The overall survival was 67% with
clinical practice. Unfants with gestation below 32 weeks, birth weight higher survival rate for patients with TGA, TOF, AVSD and TA. In the
below 1500,0g, were randomly allocated to commence enteral feeds reason of absent cardiac surgery services in Kosovo spontaneous pre-
‘‘early,’’ on first 6 hours, or ‘‘late,’’ on day 2 (after 24 hours). Gradual operative death was noted in 7 neonates (three with HLHS and four
increase in feeds was guided by a ‘‘feeding prescription’’ with rate of with CoAo). Successful Rashkind procedure in ICU, followed by echo,
increase the same for both groups. Primary outcomes were time to was done in 17 neonates. 48 patients underwent surgical treatments
achieve full enteral feeding sustained for 72 hours and NEC.In our abroad Kosovo with an overall survival of 95%.
study early feeds started in first 30 min after birth -a few drops of Conclusion: The overall survival rate after diagnosis and surgical
colostrum put for cheek, then it repeated in 3 hours and bolus feeds intervention was 55% with important differences between pathology
started in a 6 hours after birth. Control group -start feeds after groups. Prenatal diagnosis is associated with a high incidence of TOP.
24 hours after birth (this practice we had several years ago) Despite insufficient organisation of prenatal screening for CHD and
Clinical cases and summary results: 68 infants were randomly assigned absent of surgical services in Kosovo survival rate after surgery was
from Republican Perinatal center of Uzbekistan (34 to each group). high
Median gestation was 29 weeks. Full, sustained, enteral feeding was
Keywords: Complex congenital heart disease, prenatal diagnosis,
achieved at an earlier age in the early group: median age was 19 days
chromosomal abnormalities
compared with 30 days (hazard ratio: 1.36 [95% confidence interval:
1.11-1.67]). The incidence of NEC was 18% in the early group and 21%
in the late group (relative risk: 1.2 [95% confidence interval: 0.77-
1.87]). Early feeding resulted in shorter duration of parenteral 680 (CASE REPORT)
nutrition, lower incidence of feeding intolerancy
Conclusion: Early introduction of enteral feeds in preterm infants with Pregnancy with large
ELBW and VLDW results in earlier achievement of full enteral feeding
and does not appear to increase the risk of NEC. intraabdominal tumor
G. Bushinoska- Ivanova1 and J. Ivanov2
676 1
UK JZU Gynecology-Obstetrics Clinic Skopje, Macedoniaand 2Clinical
Mortality and impact of prenatal Hospital Acibadem Sistina, Skopje, Macedonia

diagnosis of severe complex con- Presenter: Gabriela Bushinoska-Ivanova

genital heart disease in a country Introduction: In some cases, pregnancy can occur with large tumor
mass in the abdomen. This compromises the pregnancy and asks for
with limited surgical resources premature delivery or abortion, depending on when the tumor mass
is diagnosed. The abdominal tumors which occur during pregnancy
may be of gynecologic origin, other abdominal tumors, lymphomas
R. Bejiqi1 R. Retkoceri1, N. Zeka1, A. Gerguri1, or other undiagnosed abdominal masses. These masses need to be
A. Vuiterna1, H. Bejiqi2, and Rinor R. Bejiqi2 operated as soon as the pregnancy ends. It’s often difficult to
1 diagnose them unless there are symptoms like pressure on the
Pediatric Clinic, University Clinical Centre of Kosovo and 2Main
bowels, ileus, vomiting, weight loss and circulation problems.
Centre of Family Medicine, Prishtina, Republic of Kosovo
Clinical cases and summary results: Pregnancy with large abdominal
tumor, diagnosed in 32 g.w. Pacient with symptoms including
Presenter: Ramush Bejiqi collapsing, and sudden and extreme vomiting.
Introduction: Complex congenital heart disease(CCHD)are a leading She was hospitalized at the Clinic of Obstetrics and Gynecology in
cause of infant mortality and morbidity in developed countries. Skopje, after collapsing, abdominal pain and extreme vomiting.
Neonates without an antenatal diagnosis are at risk of discharge Anemia, Leucocitosis and Trombocitosis with elevated CRP was
296 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

presented. Eutrophic fetus in normal amniotic fluid, placenta on the

682
front wall of the uterus and normal Doppler flow. A large intra-
abdominal tumor mass - 165 X 105 mm - above the uterus and below Effect of oropharyngeal colos-
the gaster was diagnosed, with hyper-echogenic tracks inside and
splenomegalia. trum administration on immuno-
 Serologic and infective disease examination - negative.
 Tumor markers: Increased Ca 72-4 = 231,4 U/ml. globulin a, lactoferrin and resistin
MRI-A large polycystic tumor mass was detected in the central and
left part of the abdomen. This mass (165x135x105mm), located under
levels in preterm newborns
the liver and gaster, Doppler with mixed internal and pathologic
signals. L. Serrano López1, E. Martı́n Álvarez1, M. Peña Caballero1,
A pretermdelivery was planned with a surgeon after maturation of J. Dı́az Castro2, J.J. Ochoa Herrera2, and J.A. Hurtado
fetus. The patient gave birth 21 days after her hospitalization with a
Suazo1
cesarean section She gave birth to a living 2200 g male, 44 cm long
with APGAR score 7/8. 1
Paediatric Dept. Neonatology Dept. University Maternal Hospital
The cesarean section was followed by abdominal tumorectomy.When Virgen de las Nieves, Granada, Spain, and 2Physiology Dept.
tumor was removed, anastomosis of the intestines was conducted University of Granada. Instituto de Nutrición y Tecnologı́a de los
and the tumor mass was sent to pathohystologic examination.
Alimentos ‘‘José Mataix’’, Granada. Spain
The pathohystologic diagnosis was:Adenocarcinoma intestini crassi
pTNM pT4pNo pMx G2 L1 V1 NG2
Conclusion: Good primary Health care service were future mothers are Presenter: Laura Serrano López
regularly examined, The entire pregnancy period should be carefully Introduction: Very low birth weight (VLBW) newborns have an
observed, too, since the symptoms can sometimes lead to immature immune system and also disrupted defense natural barriers.
interdisciplinary examinations and consultations with other specia- Colostrum contains increased concentrations of secretory immuno-
lists. Up to her 32nd g.w. the patient in this case report was only globulin A, growth factors, lactoferrin, anti-inflammatory cytokines,
examined by her local gynecologist and was not submitted to pro-inflammatory cytokines and other protective components,
secondary or tertial obstetrics examination, hence her condition compared with mature breast milk. Preterm colostrums may be
couldn’t be diagnosed sooner especially protective during the first days of life when VLBW infants
Keywords: Pregnancy, Abdominal Tumor, Preterm delivery are the sickest and at highest risk for acquiring an infection.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 297
This study aimed to evaluate the immunologic effects of orophar- Objective: The study wants to establish the impact of procedures in
yngeal colostrums administration to VLBW infants in their first two the neonatal intensive care unit on the neurological status of
weeks of life, by assessing IgA serum, lactoferrin and resistin levels newborn with extreme low birth weight.
evolution up to one month of life. Materials and methods: The study was carried out in our Department
Materials and methods: An interventional, no randomized, controlled over a period of 2 years .
trial recruiting newborns 32 + 6 gestational weeks and/or51500g at The study included a group of 213 premature babies and a control
birth was developed. 38 newborns were enrolled. Subjects received group consisting of 88 term newborns.
0,2ml of their mother colostrums every 4 hours administered Clinical cases and summary results: The study confirmed the impact of
oropharyngeally. The intervention was started in the first 24 hours immediate neonatal adaptation and of certain techniques and
of life, and it followed for a 15 days period. IgA, lactoferrin and resistin therapeutic procedures in the general neonatal management on
serum levels were measured at birth (M1), 3(M2), 15(M3) and 30(M4) the neurological outcome of premature newborn.
days of life by ELISA-Kit for Immunoglobulin A and Milliplex MAP There are significant differences between the 4 groups according to
technology. Perinatal and neonatal data for the first month of life the presence of neurological complications. In the group of ELBW
were registered. Stadistic programa: SPPS vs 20. preterm the rate of complications was present in a proportion of
Clinical cases and summary results: Along the first month of life an 85.7%
increase in IgA levels was found in colostrums group (M1 5,84 mg/ml Conclusion: The objective analysis of the particularities of premature
vs M4 30,34mg/ml, p0,001) and in control group (M1 12,48mg/ml, M4 newborns leads to the early interpretion of the warning signs in a way
22,48mg/ml, p0,001). IgA serum levels were statistically increased in that detecting neurological complications allows promptly clinical
colostrums group, regarding control group at one month of age (p and therapeutic approach.
0,026). During the intervention lactoferrin levels were increased in
both groups (colostrum: M1 784,58ng/ml vs M3 1406,33 ng/ml Keywords: Premature, intensive care, neurological complications
(p50,01); control:M1 795,33ng/ml vs M3 306,39ng/ml (p50,01). A
significant decrease in lactoferrin concentration was observed in
control group at one month; at these moment lactoferrin levels in
701
colostrums group were significantly higher (p=0,014).Resistin levels
increased in both groups at 3 days of life, this difference was Case report: closure of patent
statistical significantly only in intervention group (colostrum: M1
20 ng/ml vs M2 26,1 ng/ml, p50,01; control M1 19,7ng/ml vs M2 ductus arteriosus with oral para-
24,9ng/ml, p=0,06).Not differences in resistin concentration were
registered at 15 days and 1 month. cetamol in extreme prematurity
Conclusion: Our data suggest that oropharyngeal colostrums admin-
istration might facilitate the development of immune system in VLWB G. Fernandes1, I. Firmino2, G. Garcia1, A. Silva1, A. Vale1,
infants at one month of age, by increasing IgA and lactoferrin serum
and R. Melo1
levels. Regarding our results, this intervention might play a role in
1
resistin concentration, wich has been related with inflammatory Universidade de Brası́lia, Brası́lia- DF, Brazil and 2HRS - Secretaria de
response in preterm infants. Estado da Saúde, Brası́lia - DF, Brazil
Keywords: Preterm infants, immune system, colostrum, lactoferrin,
resistin, Inmunoglobulin A Presenter: Geraldo Fernandes
Introduction: Case report of an extremely premature newborn with
patent ductus arteriosus with contraindication to the use of
686 ibuprofen. Extremely premature female newborn, born in the
Regional Hospital of Sobradinho (HRS), Brası́lia - Brazil, on 27/01/
The importance of intensive care 2016. Primiparous mother, 18 years-old, 24th gestational week
according to the last menstruation period (LMP). Born from natural
management in neurological birth, cephalic presentation, rupture of membranes during labour,
birth weight of 850g, Apgar score 7/9.
complications of premature Clinical cases and summary results: The mother began premature
newborns labour without defined cause, didn’t receive corticosteroide or
antibiotics. The newborn received profilatic pulmonary surfactant
(100ml/kg), therapy with Ampicilin and Gentamicin, IV hydration
A.M Manea1, D. Cioboata2, F. Doandes2, O. Bilav2, and therapy, analgesia and general care. Due to hypotension, on the 12th
M. Boia1 hour of life the newborn received dopamine, which maintained the
hemodynamic stability for the first five days. On the 5th day, the
1
University of Medicine and Pharmacy, Timisoara, Romania and persistence of hypotension and the development of systolic murmur
2
Emergency Clinical Hospital for Children Timisoara, Romania and bounding pulse led to the association of dobutamine, furosemide
and hydric restriction. On the 7th day, an echocardiogram revealed
Presenter: A. M. Manea Patent Ductus Arteriosus (1.4mm) with moderate hemodynamic
repercussion. The use of Ibuprofen was contraindicated due to
Introduction: Premature birth, is one of the most important cerebral hemorrhage, so a three-day therapy with oral paracetamol
determinants of neonatal morbidity and mortality with long-term (15 mg/kg every 6 hours) was started. On the 11th day of life, the
negative consequences. newborn was hemodynamically stable without vasoactive drugs and
Development of modern methods in neonatal intensive care led to the echocardiogram revealed a closed ductus arteriosus.
increased survival rates among premature newborns. Conclusion: Paracetamol has been reported as an alternative
These procedures that generally aim the survival and immediate treatment for patent ductus arteriosus in the contraindication of
recovery of the premature are known to have a negative impact on Ibuprofen. Further clinical studies are needed to confirm this
cerebral blood flow at very low premature and can generate hypoxic/ association.
ischemic modification at the level of CNS, with potential for lesions,
leading to neurological complications with major impact on neonatal Keywords: Premature, ductus arteriosus, paracetamol
mortality.
298 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

702 712
Validation of outpatient man- Comparison of two nifedipine
agement of preterm premature formulations for inhibition of
rupture of membranes preterm labor
L. Giménez, V. Serrano, C. Sánchez, J. Dası́, M. Gurrea, L. Salazar, C. De Guirior, Escura S., Migliorelli F., and
V. Diago, and A. Perales M. Palacio
Obstetric Dept., University Hospital La Fe, Valencia, Spain Department of Maternal-Fetal Medicine, BCNatal (Hospital Clı́nic and
Hospital Sant Joan de Déu), University of Barcelona, Barcelona, Spain
Presenter: L. Giménez
Introduction: Preterm premature rupture of membranes (PPROM) Presenter: LAURA SALAZAR
refers to rupture of membranes without uterine contractions before Introduction: The relative safety, maternal tolerance, ease of admin-
the 37 weeks of gestation. Multiple etiologies are probably involved istration and reduction in adverse neonatal outcomes by significantly
(intra-amniotic infection, uterine distention, invasive procedures, etc.), delaying delivery, support the use of nifedipine as a first choice for
but the pathogenesis is not well understood. PPROM complicates 1- inhibition of preterm labor. Recently, the Spanish Agency of
4% of all pregnancies and is often followed by spontaneus delivery or Medicines and Devices (AEMPS) approved a new oral solution of
labor induction, so it is associated with significant maternal, fetal and nifedipine specially designed to be used in preterm labor manage-
neonatal morbidity and mortality. ment. The aim of this study was to compare the use, perinatal
The optimal approach to clinical management remains controversial. outcomes and side-effects between these two nifedipine formula-
In selected circumstances outpatient management can be considered, tions used in the clinical practice
so we analized ambulatory management after intravenous antibiotic Materials and methods: Retrospective study in a tertiary center
treatment in our center. between January 2012 and December 2015 including women
Materials and methods: We designed a retrospective observational admitted because of preterm labor, in which nifedipine was the
study. We recruited 69 patients with PPROM in our center from first tocolytic agent used. Only singleton pregnancies were included.
January 2013 to December 2015. Maternal and perinatal outcomes were compared based on whether
All the women were treated with intravenous antibiotic during 7 days nifedipine capsules or nifedipine oral solution were used for tocolysis.
and received corticosteroids for lung maturation. 46 patients (group A descriptive study was carried out on qualitative and quantitative
1) remained admitted at hospital after antibiotic treatment, and 23 variables to characterize the study population. X2 tests or two-sided
(group 2) received outpatient management. Fisher test and Student’s t-test or Mann-Whitney U-test, were used
We included pregnancies between 24 + 0 and 33 + 0 weeks with fetal when appropriate.
cephalic presentation and maximum pool of amniotic fluid 410mm. Clinical cases and summary results: 98 women were evaluated (65
The exclusion criteria were fetal malformation, chorioamnionitis, treated with nifedipine capsules and 33 treated with nifedipine oral
metrorrhagia and non-cephalic presentation. solution). No differences in gestational age, percentage of rupture of
Clinical cases and summary results: We didn’t observe differences membranes, mean cervical length and cervical dilatation at admission
between women age, positive culture and leukocytes levels at the were found between both groups. Rate of previous preterm delivery
moment of the PPROM in both groups. Mean gestational age in was similar in both groups too.
weeks at PPROM was earlier in group 2 (26 + 6) than in group 1 There were 2 cases in each group in which tocolysis was discontinued
(30 + 6), p50.001 because of suspected chorioamnionitis or loss of fetal wellbeing. No
The period of time until delivery was significantly higher in women statistical differences were found in the need of an alternative
with outpatient management than in the group admitted at hospital tocolytic therapy; neither in the need of rescue doses within the first
(p50.001). The presence of neonatal sepsis in women with outpatient 6 hours or the total dose of medication received during admission.
management (21.7%) was higher than in the other group (6.5%), but No differences in gestational age at delivery or perinatal outcomes
the days admitted in neonatal intensive care unit (NICU) rate was were observed. The maternal side effects in the nifedipine capsules
similar in both groups. We didn’t observe differences in leukocytes group were 36,9% and in the nifedipine oral solution were 12.1%,
levels control, gestational age and fetal weight at delivery between which showed a statistically significant difference (p=0.01). No serious
both groups. maternal complications were observed in any of both groups.
Conclusion: Women with outpatient management presented PPROM Conclusion: In this retrospective study both nifedipine formulations
earlier than patients admitted at hospital, and the time until delivery appear to be equally effective for acute tocolysis. The maternal side
was higher in this group. effects were higher with nifedipine capsules.
Although the presence of neonatal infections after outpatient
management was higher, the mean of days admitted in NICU was Keywords: Preterm labor, tocolysis, nifedipine
similar in both groups and there wasn’t any death due to sepsis.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 299

administration time: 1.92 hr). In 19 of the 80 VLBWIs (23%) CC was

715 administered after 4 hours, with a mean of 15.4 hrs. A CC ‘‘loading
Caffeine usage in Vlbw infants: a dose’’ was inconsistently given and was often given in 2 divided
portions at a 12-hour interval (66.2% of cases). A maintenance dose at
survey of practice at a single 10 mg/kg/day is adhered to in all cases. Despite a clear unit policy,
there is no clear line of practice in the unit on when and how the CC
neonatal unit dose was to be increased. Furthermore, the timing of discontinuation
of CC was very variable, ranging between 31 and 41 weeks gestation.
K. Belkhatir1, H. Lumgair2, S. Zivanovic3, and C.C. Roehr4 Conclusion: In spite of the current evidence and clear practice
recommendations, there is still significant variation in CC prescription
1
Department of Neonatology, John Radcliffe Hospital, Oxford practices amongst neonatologists at our unit. Comparisons with other
University Hospitals, Oxford, United Kingdom, 2Department of units’ practices would help to highlight what the prescription practice
Neonatology, John Radcliffe Hospital, Oxford University Hospitals, in the ‘‘real world’’ looks like. Comparisons of outcomes between
Oxford, United Kingdom, 3Department of Neonatology, John infants receiving very early CC with those who received CC later seem
warranted.
Radcliffe Hospital, Oxford University Hospitals, Oxford, United
Kingdom, 4Department of Neonatology, John Radcliffe Hospital,
Oxford University Hospitals, Oxford, United Kingdom, and University
of Oxford, Department of Paediatrics, Children’s Hospital, John 746 (CLINICAL CASE)
Radcliffe Hospital, Oxford, United Kingdom; Department of
Neonatology, Charite University Medicine Berlin, Berlin, Germany
Acute tocolisys with atosiban
after high misoprostol oral dosis
Presenter: Charles Roehr
Introduction: Caffeine has become the most commonly used M. Navarro, O. Vaquerizo, J. Adánez, F. Moreno, and
respiratory stimulant in preterm infants. However, there is still S. Fernandez
variability in its usage amongst neonatologists worldwide. Current
evidence suggests that starting caffeine early (53 days of life) has Obstetrics Department, Asturias Central University Hospital, Oviedo,
beneficial effects on neonatal outcomes. The aim of this study was to Spain
establish the compliance with current guidelines and assess the time
of initiation of caffeine therapy in preterm infants. Presenter: M. Navarro
Materials and methods: We performed a retrospective chart review in
one of the UK largest regional Level III Neonatal Intensive Care Unit Introduction: Unsafe abortion is associated with increase maternal
(NICU), the John Radcliffe University Hospital, Oxford, UK. All very low morbidity and mortality, and has large economic cost. Reality shows
birth weight infants (VLBWIs) (birth weight 5 1500g) who were that when women want to terminate an unwanted pregnancy, taking
admitted between April and December 2014 were included. We misoprostol is one of the most common method to use. When that
analyzed the timing of initiation and discontinuation of caffeine as happens in late second trimester or early third trimester when the
well as dosage regimens. fetus is viable, the consequences may be dramatic. Induced
Clinical cases and summary results: Between April and December 2014, tachisitolia may result in fetal hipoxemia, acidosis and the preterm
80 VLBWIs were treated as inpatients at our NICU. In our local NICU, delivery of an early neonatal death or very damaged infant.
caffeine was consistently administered as caffeine citrate (CC) to all Atosiban is a selective oxytocin-vasopressin receptor antagonist.
VLBWIs by giving a ‘‘loading dose’’, followed by a maintenance dose Theoretically, atosiban should be more effective at later gestational
(10mg/kg/day). CC was initiated within the first 4 hours of life (mean
300 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

ages since oxytocin receptor concentration and uterine responsive-

ness to oxytocin increase with advancing gestation.
764
Clinical cases and summary results: A 28 weeks pregnant came to the Utilization of conventional radio-
emergency department after ingestion of 20 tablets of 200
micrograms of oral misoprostol three hours ago. She presented graphy in a regional neonatal
nausea, vomits, abdominal pain and signs of agitation. Formerly, the
pregnancy coursed with a selective feticide of one twin with a severe intensive care unit in Ireland
brain malformation. In the Emergency, positive cardiac activity was
documented on ultrasound. Fetal cardiotocography test showed M. Crealey1, L. Bowden2, E. Ludusan1, M. Pathan1,
tachysistolia, fetal tachycardia, absent variability late and variable
decelerations (NICHD, Category III). Two 6,75 mg atosiban bolus and
B. Kenny3, A. Hannigan4, and R. Philip1
posterior 300 mcg/min infusion were administrated with an acute 1
Division of Neonatology, Department of Paediatrics, University
tocolisys intention. Ten minutes later after the first bolus tachysistolia Maternity Hospital Limerick (UMHL), Ireland, 2Department of Medical
began to diminish and category III converted to category II and
Physics and Bioengineering, St. James’s Hospital, Dublin, Ireland.,
category I. Simultaneously, corticosteroid therapy for reduction of 3
Department of Radiology, University Hospital Limerick (UHL),
neonatal morbidity was administrated. Seven hours later, the woman
delivered vaginally. Neonatal general appearance and vital signs were Ireland, and 4Graduate Entry Medical School (GEMS), University of
normal according to fetal gestational age.Posterior evolution was Limerick, Ireland
satisfactory with no severe impairment at one year.
Conclusion: Manage of tachysistolia secondary to overdose of Introduction: Conventional radiography is widely used in neonatal
misoprostol is a difficult clinic setting with an unpredictable units for the initial patient evaluation, assessment during acute
evolution. clinical deterioration and in specific clinical situations such as after
Atosiban showed as an effective acute tocolytic to revert a NICHD III intubation, placement of umbilical lines or per-cutaneous indwelling
fetal heart rate category, secondary to tachysistolia. venous access.
Atosiban was not effective enough to stop preterm labour for more There is very little published literature available on the demand of
than 48 hours, after high doses of oral misoprostol in early third conventional radiography in neonates especially involving premature
trimester. infants. Extremely premature and very sick infants are often exposed
to multiple X-rays during their stay in intensive care units.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 301
This study quantifies the demand and direct operational cost for the Mycobacterium tuberculosis in both sputum and urine culture was
provision of conventional radiography on a 24/7 basis for a European detected on day 15 and 17 of incubation. Her brain MRI showed
regional neonatal unit in a stand-alone university maternity hospital. innumerable small ring-enhancing lesions in both cerebral and
Materials and methods: A retrospective observational study was done cerebellar hemispheres consistent with TB.
of all radiographs performed on newborn infants admitted to the Immediately after discovery of maternal TB infant had full screening
NICU in UMHL for two years (1st April 2013 to 31st March 2015). for TB (repeated AFB culture of blood, CSF, endotracheal aspirates,
Information was obtained from the prospectively recorded and gastric aspirates, urine and stools and started on course of isoniazid,
manually entered neonatal radiography record book, X-ray software rifampin, pyrazinamide, and ethambutol . Even all cultures were
package - National Integrated Medical Image System (NIMISÕ ) used to negative, decision was done to complete 2 months course of 4 anti
order and view radiographs and the patient admission record in NICU. -TB medications, and continue with 10 months of isoniazid and
Pearson’s and Spearman’s correlation coefficients were used to rifampin. At the age of 36 weeks of CGA he grows appropriately,
measure the strength of the association between numeric variables. doesn’t have active clinical issues except for chronic lung disease
A 5% level of significance was used for all hypothesis tests.Approval CPAP
to conduct the study was obtained from the Maternity Hospital audit Conclusion: This case report underlines the need to rule out the
committee. diagnosis of TB in an infertile woman, as well as establishing timely
Clinical cases and summary results: 1405 radiographs were performed therapy in neonate. Genital TB is a known cause of infertility in
on 506 infants. 153.5 radiographs per 1000 live births was the women belonging to high-risk ethnic groups. With rise of global
observed demand and 44% were done out of hours. 29 infants (5.7%) migration incidence of TB grow in the developed countries. IVF is a
were 5 1000g (Extremely Low Birth Weight, ELBW) and 54 (10.7%) common treatment for infertility;number of babies conceived
were between 1000-1500g (Very Low Birth Weights, VLBW). 47% of through IVF is increasing. it is not routine practice to evaluate
radiographs were performed on infants 5 1500g. Median number of women from high-risk groups for possible TB.
radiographs per infant was one (IQR 1- 2). Significant negative
correlation was observed between number of radiographs and Keywords: IVF, placental pathology, extreme prematurity,
gestational age. Mean lung radiation doses estimated using tuberculosis
published values for normal weight (42500g), VLBW and ELBW
infants based on the median number of chest X-rays were 31.7mGym
84.66mGy and 232.75mGy respectively.
Conclusion: Conventional radiography remains a key diagnostic tool in 229
neonatology and is invaluable in supporting timely clinical decision
making. Clinicians should be aware of the cost and potential hazards
Vitamin D binding protein in
of neonatal radiography, limit unnecessary usage and seek out
opportunities for alternative imaging modalities such as sonography.
cervicovaginal fluid as predictors
Keywords: Neonatal intensive care unit (NICU), X-ray, radiation, very
of intra-amniotic infection and
low birth weight (VLBW), extremely low birth weight (ELBW), health
economics
impending preterm delivery in
preterm labor or preterm prema-
ture rupture of membranes
770
Congenital tuberculosis after in J. A. Jang, K. H. Park, E. Y. Jung1, S. H Cho1, and
H. N. Yoo1
vitro fertilization: case report
Departments of Obstetrics and Gynecology, Seoul National University
1 1 1
Mugarab-Samedi V. , Rabi J , Yusuf K. , and Kurek K . 1 College of Medicine, Seoul National University Bundang Hospital,
Seongnam, Korea
1
Neonatal -Perinatal Medicine, Faculty of Pediatrics, University of
Calgary, Calgary, Canada, 2Neonatal Intensive Care Unit, Foothills Introduction: To determine whether vitamin D binding protein (VDBP)
Medical Centre, Calgary, Canada, and 3Alberta Children Hospital, in cervicovaginal fluid (CVF) is predictive of intra-amniotic infection
Calgary, Canada and imminent spontaneous preterm delivery (SPTD) in women with
preterm labor with intact membranes (PTL) or preterm premature
Introduction: Congenital tuberculosis (CTB) is a rare manifestations of rupture of membranes (PPROM).
this dangerous disease.We report a case of CTB in an infant born at 24 Materials and methods: This is a single-center retrospective cohort
weeks of GA to mother with uncontrolled seizures during preterm study. CVF samples for VDBP assays were obtained and maternal
labor. Maternal TB was initially verified by placental pathology, and serum C-reactive protein (CRP) were determined immediately after
later confirmed by isolation of Mycobacterium tuberculosis in urine, amniocentesis in consecutive women with PTL (n=148) or PPROM
gastric aspirates and sputum. Full screening was performed on the (n=103) between 23.0 and 34.0 weeks of gestation. CVF VDBP levels
newborn, and treatment for TB with a four-drug regimen was started were determined by ELISA kits. The primary outcome measures were
in both the mother and infant. positive amniotic fluid cultures (defined as intra-amniotic infection)
Clinical cases and summary results: 37-year-old woman with normal and SPTD within 48 hours of sampling.
medical history underwent an IVF. At 24 + 3 weeks of GA she Clinical cases and summary results: In the multivariable analysis,
presented with a generalized seizure and went to precipitous labour. elevated levels of CVF VDBP in PTL women were significantly
Male infant was delivered by spontaneous vaginal delivery with associated with intra-amniotic infection and delivery within
APGAR scores on 4, 6, and 6 minutes respectively. 48 hours, even after adjusting for potential confounders (e.g.,
Resuscitation of infant included intubation, ventilation with up 100% gestational age at sampling, parity and serum CRP). However, these
oxygen, surfactant administration. High Frequency Oscillation relationships were not found in women with PPROM. In women with
Ventilation (HFOV) was started in the case room. preterm labor, the areas under the curves of CVF VDBP for predicting
Mother was admitted to Intensive Care Unit and had thorough intra-amniotic infection and imminent preterm delivery were 0.66 and
workup of her seizures. Initial diagnosis of TB was done by placental 0.71, with cut-off values of 1.76 mg/mL (sensitivity of 64.3% and
pathology that showed necrotizing granulomatous deciduitis and specificity of 78.4%) and 1.37 mg/mL (sensitivity of 64.3% and
subchorionitis with acid-fast bacilli (AFB) inclusion. Growth of
302 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

specificity of 72.6), respectively. CVF VDBP levels were significantly

higher in women with PPROM than those with PTL.
191
Conclusion: VDBP in the CVF is independently but moderately Neonatal intermediate care unitat
predictive of intra-amniotic infection and imminent preterm delivery
in women with PTL, whereas in women with PPROM it is not the hospital Estadual da Mãe-
associated with increased risks of these two outcome variables.
Mesquita-RJ-Brazil
Keywords: VDBP, Cervicovaginal fluid, preterm labor, preterm
premature rupture of membrane C. Tobias, F. Melino, V. Neves, R. Sarmento, C. Feitosa,
and A. Cunha
Hospital maternidade terezinha de jesus, mesquita,rio de janeiro,
Brazil

QUALITY IMPROVEMENT AND PERINATAL Introduction: The Federal Government decided for the policy of
NETWORKS - 147 building two big maternities (45000 births/year each), one for low
and medium risk pregnancies: Hospital Estadual da Mãe (Motheŕs State
Kazakhstan’s experience in Hospital) - RJ - Brazil and another for high risk pregnancies: Hospital da
reducing infant and child Mulher (Womeńs Hospital) - RJ - Brazil, in Baixada Fluminense, an area
with 3 500 000 inhabitants and 11 counties - Rio de Janeiro State - BR.
mortality Materials and methods: Cross-sectional study, assessing the preva-
lence of neonatal who needintermediate care and the characteristics
of the newborn.
M. Embergenova, T. Chuvakova, and B. Karin Clinical cases and summary results: In 2015, from January to
September, 5628 deliveries were assisted at the Hospital Estadual
Neonatology Center, Branch of Corporate fund ‘‘University medical
da Mãe and 424 (7.53%) need intermediate neonatal care. The
center’’ National Research Center for Maternal and Child Health newborn were 171 (40.33%) female, 206 (48.58%) male and 47 (11%)
were missing. The range of the gestational age was from 24 to 42
Introduction: Attaching special importance to the timely achievement weeks, the weight ranged from 636 to 4380 g, the nutritional
of the Millennium Development Goals (MDGs), Ministry of Healthcare evaluations showed 259 (61.08%) adequate for the gestational age,
of the Republic of Kazakhstan analyzed the causes of infant and child 39 (9.19%) small for the gestational age, 11 (2.59%) big for gestational
mortality in the country on results of 2000. Results of the analysis age and 115 (27.12%) missing. The newborn didn’t show any
have been the starting basis for further reforms in the field of associated disease in 262 (61.79%), but 162 (38.20%) showed some.
maternal and child health, ‘‘State Programm Development and The mother didńt show any intercurrence in 134 (31.60%) cases, but
Reforming of Healthcare in the Republic of Kazakhstan for 2005- they showed some in 241 (56.83%), with interference with the baby,
2010’’ approved by the Decree of the President of the Republic of and 49 (11.55%) were missing. The babies were asphyctic (Apgar
Kazakhstan dated September 13, 2004, No. 1438 and ‘‘Programmes to index57 at 5 minutes) in 18 (4.24%). After a mean period of 5.11 days
reduce maternal and child mortality in the Republic of Kazakhstan for (range 0-49), 252 (252/424=59.43%) babies were discharged, 151
2008-2010’’, approved by the Government of the Republic of (151/424=35.61%) were transferred to different neonatal intensive
Kazakhstan dated December 28, 2007 No. 1325. care units(NICU) and 15 died (15/424=3.53%). The rate of death from
Clinical cases and summary results: In accordance with the Plan of the transferred was unknown.
realization the State program, in 2007 was completed its 1st stage, Conclusion: Although the maternity is reference for low risk
aimed at massive investment in the industry: technical modernization, pregnancies, as it accepts patients from other hospital and even in
infrastructure development, were solved the problems of strengthen- emergency, the profile is not so easy to deal with. Besides, the
ing primary care, formation of healthy lifestyle, improving the quality neonatal intermediate care unit is not provided with all the facilities,
of medical services. Generally, Kazakhstan has created an adequate what justify the transferences and not so good results
legislature and the regulatory framework and the full commitment of
the Government to provide the reducing child mortality in the Keywords: Neonatal intensive care: preterm, neonatal network
country by 2015 by 65%.
Conclusion: Healthcare reforms contributed to the implementation of
MDG 4 in Kazakhstan, which was confirmed by conclusion of
Interagency United Nations Evaluation Group of assessment of 192
mortality rate (2014): ‘‘Kazakhstan, since 1990, made significant
progress in reducing infant and child mortality by 64% and 65%, Pharmaceutical care implementa-
respectively. The country has fulfilled the MDG 4 on reducing child
mortality from 0 to 5 years by 2014‘‘.
tion in the Hospital da Mãe
Keywords: Neonatal and child mortality, medical services, healthcare A. Queiroz, L. Da Silva, and A. Cunha
reforms
Hospital maternidade therezinha de jesus. rio de janeiro, rj, Brazil

Introduction: In mid-2013 Mother of Hospital Pharmacists team saw

the need of the newborn monitoring in antibiotic use for the purpose
of adherence to treatment, rational use of antibiotics and to identify,
resolve and prevent the occurrence of pharmacotherapeutic pro-
blems. Today we aim to achieve 100% of patients in the unit.
Keywords: Goals: elucidating the actions for implementing the
clinical pharmaceutical service in Hospital da Mãe in Mesquita - Rio de
Janeiro, aiming at reaching 100% of the patients in this unity.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 303
Materials and methods: Participation of the entire team of pharmacists Conclusion: These positive perinatal indicators are result of strict
from the hospital in the medical rounds, prescription analyses, having centralization of high risk pregnancies, in-utero transport of fetuses at
pharmacists visit the patients, collecting data through the medical risk and individual management of each patient with appropriate
records and clinical examinations, the filling in of pharmaceutical decisiveness in line with EBM guidelines led to deliveries of
attention forms to be electronically available on the MVPEP system, ‘‘perspective‘‘ neonates, even many times at the edge of viability.
the evolution of each visited patient available on the system as well,
implementing the pharmaceutical follow-up for mothers and babies Keywords: Perinatal care, improvements
who have syphilis, neurosyphilis, toxoplasmosis and HIV, by means of
visiting them in order to give proper orientation about the usage of
medication and taking part in their discharges. 300
Clinical cases and summary results: Expected Results: fostering the
rational use of the medicine available in the institution, maximizing the Developmental dysplasia of hips
clinical effects of medication, that is, using the most effective treatment
for each type of patient, minimizing the risks of side effects and in newborns
medication incompatibilities, providing the medical staff with informa-
tion about the medications, promoting the medication reconciliation M. Ali, A. Mohammedi, J. Byrne, and B. Allagoa
and reducing the hospitalization time. Demonstrating that the clinical
pharmaceutical action is significant for the promotion of adequate use Mid Yorkshire Hospitals NHS Trust
of drugs, which results in the improvement of the pacient’s quality of
life and the management of costs associated with health care. Introduction: DDH is an important asymptomatic neonatal congenital
Conclusion: We expect to improve health care with this approach. condition which should be detectable during routine screening
examination at birth.
Keywords: Pharmaceutical care, drugs management, cost Incidence: around 1.5/1000 births in the UK
effectiveness Aims:
(1) To ensure all babies with clinically detectable hip problems (and
those at high risk) are identified.
(2) To find out if local guidelines and time-frames are being adhered
248 for appropriate investigations and referrals needed for probable
interventions.
The impact of EBM in clinical Objectives:
practice on improvement of (1) To evaluate our ability to detect/suspect DDH in the newborn on
the basis of hip screening examination and by identification of risk
perinatal indicators: the factors.
(2) Ensure appropriate orthopaedic referral within time limits
northern-slovakia experience (3) To identify true positive DDH patients with associated risk factors
and the number of false negatives
over the period 2006-2015 Materials and methods: Sample: Population at risk of DDH identified
using PAS and data collected from Euroking, Windip and ICE
P. Zubor1, M. Zibolen2, K. Matasova2, S. Krivus1, databases
Sample size 130
P. Kasajová1, and J. Danko1 Time frame audited: 01/04/2010 to 31/03/2015 (5 years)
1
Department of Obstetrics and Gynecology JLF UK and UNM, Martin Exclusions were made for patients who were duplicated in the PAS
and 2Neonatologic clinic JLF UK and UNM, Martin system
Analysis done by using Microsoft excel
Clinical cases and summary results:
Introduction: The symbiosis in organization of health care, basic and Total number of patients minus duplicates : 130
applied clinical research together with improved technical equipment Detection:
and introducing guidelines into obstetric praxis has prepared the Number of abnormal 1st exams: 57 (36 dislocated/dislocatable, 21
background which led to immense improvement in the perinatal clicky)
outcomes in the northern part of Slovakia during the last two Proportion of these which were radiologically confirmed: 39 (68%)
decades. Precautions in clinical management together with appro- Dislocatable hips seen by senior: 22 out of 36 (61%)
priate decisiveness led to deliveries of ‘‘perspective‘‘ neonates, even No of recorded senior paediatric reviews: 28 (49%)
many times at the edge of viability. Such prepared deliveries in line Also Noted:
with modern technical equipment in neonate resuscitation, ventila- Total number of radiologically confirmed hip DDH (from PACS): 58
tion or circulatory support could result in decrease of perinatal (45%)
mortality and neonatal morbidity. Of these, how many were abnormal on 1st exam: 37 (63%)
Materials and methods: Authors in retrospective analysis present Investigation:
detailed view on main perinatology outcomes for last decade (2006- Babies who required 2 week USS and orthopaedic referral according
2015) and point on their positive experiences in perinatal outcome in to trust guidelines (i-e those with clinically dislocated /dislocatable
Northern part of Slovakia, Zilina district, managed through the Martin hips) : 36
perinatology center. Babies who received USS within 2 weeks : 28 (78%)
Clinical cases and summary results: A 68 459 births have been Referral:
reviewed. Over the time we have observed decrease in perinatal and Babies who received 2 wk referrals to orthopaedics : 18(50%)
early neonatal mortality from 6.61 to 3.6%, and 2.57 to 0.85%, Babies without adequate follow up : 2 (1st exam midwife led. No
respectively, significant shortening of mechanic ventilation from 14 to further follow up recorded)
4.5 days, decrease in need for mechanic ventilation, incidence of Conclusion: Trust guidelines in terms of senior review are either not
necrotizing enterocolitis and bronchopulmonary dysplasia in preterm being adequately followed or not adequately recorded. 63% of
neonates (p 50.05). Additionally, we have noted decreasing trend in children with clinically confirmed DDH were detected at their first
operative deliveries in last 5 years (p 50.05), and stable rate of exam. The remaining 37% were either picked later, suggesting that it
preterm labor varying about 6%. Moreover, when compared regional was missed by the examining clinician. Of the 57 abnormal first
data with similar ones to Slovak republic, a difference in quality exams, 68% were radiologically confirmed.
management was observed.
304 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Investigation + Referral: 78% of those deemed to require 2 week USS

as per local hospital guidelines were scanned within that time frame 381
Interactive medical intelligence in
Keywords: Developmental dysplasia of hips
obstetrics
G. Pregenzer
Robert Wood Johnson University-Somerset Medical Center,
Somerville, NJ, USA

Introduction: The report by the Institute of Medicine in 2000, ‘‘To Err is

Human, building a safer Health System’’ indicated that up to 90,000
Americans die from medical errors. The vast majority of electronic
medical systems today are used to track billing, and inventory issues.
No system has a checking system to assist the clinician in determining
if a medical mistake has occurred or to identify medical risks for the
fetus or mother. An interactive medical intelligence (IMI) has the
ability to assist the clinician to accurately, and efficiently deliver
obstetrical care and dramatically reduce, medical errors by using
evidenced based algorithms in real time during the pregnancy. Risks
are identified and reminders issued. An IMI system was able to
identify 388 errors out of 1000 pregnancies.
Materials and methods: Seven busy obstetrical practices were selected
to transfer the patient clinical information from their system, both
paper and electronic based, into the interactive medical intelligence
system. Over a 1000 pregnancies were followed until delivery. The
number of omissions or inactions identified by the interactive medical
intelligence system were determined and tabulated. These were
compared to the risks identified by the traditional methods and some
of the standard commercial electronic medical record systems.
Clinical cases and summary results: Seven obstetrical practices and
1,000 patients were enrolled into the study. 388 errors or omissions
were detected when patient records were transferred to an IMI
system. This would extrapolate to 1,668,400 obstetrical error annually
in the USA. One can only imagine what this number might be if
extrapolated globally.
Conclusion: 4.3 million births each year in the United States, with
1 668 000 omissions or inactions occur in the care of the pregnant
patient. The dream has been to utilize computer technology to help
humans identify mistakes and take corrective actions. An IMI collects
data during the history and physical exam. Risks are identified and
diagnostics are suggested. The system never forgets, and reminds the
clinician of outstanding results or if another test needs to be ordered.
Quality is improved.

Keywords: Interactive medical intelligence

DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 305
(without an obstetrical indication) rates, meconium staining of
amniotic fluid, need for neonatal intensive care unit (NICU), duration
of stay at NICU and fetal/neonatal loss.
Clinical cases and summary results: Among 100 patients meeting the
inclusion criteria of the study, 57 (57.0%) were diagnosed to be ICP, 42
(73.7%) were mild and 15 (26.3%) were severe. The ‘‘not-ICP’’, ‘‘mild
ICP’’ and ‘‘severe ICP’’ groups were statistically similar in terms of
maternal age, number of gravida, fetal gender, gestational week at
the time of diagnosis, coexistence of chronic maternal diseases,
preeclampsia and gestational diabetes and duration of newborn stay
at NICU if needed. Coexistence of elevated transaminase levels,
preterm (537 weeks) and early preterm (534 weeks) delivery cases,
cesarean delivery rates without obstetrical indication upon maternal
request or physician anxiety, meconium staining of amniotic fluid and
need for admission of the newborn to NICU were documented to be
increasing in frequency in not-ICP, mild ICP and severe ICP groups
respectively and the differences were statistically significant (Table 1).
Median gestational week at delivery was 35.6 (29.4-39.6) weeks in
severe ICP group and this was significantly lower than the other
groups (p 50.001). There was no case of fetal/neonatal demise in all
groups.
Conclusion: The results support that ICP, depending on severity, is
associated with a higher incidence of some perinatal problems when
compared not only to normal non-problematic pregnancies, but also
to a selected group risky for hepatic disturbance. Recent debate in
literature about the late preterm or early term delivery of ICP patients
seems to aggravate physician and thus patient anxiety leading to
increased preterm and cesarean delivery rates.

443 Keywords: Intrahepatic cholestasis of pregnancy, perinatal outcome,

serum bile acids
Perinatal comparison of patients
with and without intrahepatic
cholestasis of pregnancy among
women presenting with symp- 564
toms and signs implicative of a Health status surveillance system
hepatic problem of neonates with diffrent clinical
D. C. Katlan1, B. Konuralp Atakul2, T. Yüce1, A. Koç1, and
forms of perinatal defeats of the
F. Söylemez1 central nervous system when
1
Ankara University Faculty of Medicine, Department of Obstetrics transporting
and Gynecology, Ankara, Turkey, and 2Kızıltepe State Hospital,
Mardin, Turkey E. Ivchenko, A. Pijanzin1,2,3, S. Zhilin3, A. Schaudurov3,
and S. Sukhanov2
Introduction: Intrahepatic cholestasis of pregnancy (ICP) is the most
1
common pregnancy specific liver disease classically presenting in the Altai Region Clinical Children’s Hospital, Barnaul, Russia, 2Altai State
third trimester with pruritus, abnormal liver function tests and raised Medical University, Barnaul, Russia, and 3Altai State University,
serum bile acid (sBA) levels, the latter being the most sensitive and Barnaul, Russia
specific marker for diagnosis. Gestations with ICP are associated with
higher incidence of adverse pregnancy outcomes when compared to
Presenter: E. Ivchenko
non-problematic normal ones. However, there is hardly any data
regarding the effect of ICP in a group of patients presenting with Introduction: Health status of neonates with diffrent clinical forms of
symptoms and signs highly implicative of a hepatic problem such as, perinatal defeats of the central nervous system must be constantly
incidental detection of elevated liver enzymes, pruritus in the absence monitored during their transportation. This problem becomes
of a rash or intractable abdominal discomfort together with nausea especially important when it is a case of a long distance and long
and vomiting unattributable to other causes. time of care delivery.
Materials and methods: Patients who were admitted to Ankara Materials and methods: Full term and preterm neonates with different
University Obstetrics Clinic between May 2010 and September 2015 clinical forms of perinatal defeats of the central nervous system.
were retrospectively evaluated. Among those, women presenting Health status surveillance system includes Principal Component
with symptoms and signs implicative of a hepatic problem with Analysis, Artificial neural networks, logistic regression, cloud comput-
documented sBA levels and perinatal outcomes were selected. They ing, 35 measures of Hematology Analyzer, 32 clinical signs of mother’s
were grouped into three according to sBA levels (mmol/L): Not-ICP and neonate’s health status. A maximum distance of neonates
(510.0), mild ICP (10.0-39.9) and severe ICP (40.0) groups. The transportation is 475 kms, while maximum time - 7 hours.
groups were compared in terms of maternal demographics, obstetric Clinical cases and summary results: Using health status surveillance
and medical history, biochemical parameters (transaminases, bilirubin system of neonates with different clinical forms of perinatal defeats of
levels), pregnancy outcomes, preterm birth and cesarean section the central nervous system during their transportation lets decrease
306 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

expenses on medical maintenance twice due to the modern

computer technologies.
624
Conclusion: Health status monitoring survey of neonates during their 5 years of ERT - quality assurance
transportation based on different computer technologies is a
promising branch of perinatal medicine. in east-tallinn central hospital,
gestational diabetes
595 F. Szirko, and A.-L. Kruutmann
Study of stress biomarkers and Perinatal Centre, East-Tallinn Central Hospital, Tallinn, Estonia
way of delivery in term pregnan-
Presenter: Ferenc Szirko
cies. a prospective observational
Introduction: The comission on ERT (Ebasoovitavate Ravitulemuste
study komisjon) was founded five years ago in order to investigate in depth
the near miss cases in obstetrics and gynaecology and to answer the
treatment related complaints of the patients. A detailed list was
V. Serrano de la Cruz Delgado1, V.J. Diago Almela1, A.C. created of cases to report to the commission. It includes deliveries
Garcı́a Blanco2, M. Vento Torres2, and A. Perales Marin1,2 with new-borns with low pH, trauma, NICU hospitalisation or stillbirth;
1
Obstetric Dept. Univeritary and Politechnic Hospital La Fe Valencia, blood loss over 1500 ml, eclampsia or other severe maternal
morbidities (rare or requiring ICU treatment); surgical complications
and 2Paediatric Dept. Univeritary and Politechnic Hospital La Fe
- unplanned organ removal, neighbouring organ injury or electro
Valencia surgery complications; patients treatment related complaints.
Materials and methods: In 2016 a survey on the screening of
Presenter: Verónica Serrano de la Cruz Delgado gestational diabetes (GD) was carried out to look into effectiveness
of prevention of births with large for gestation age new-borns. In
Introduction: Nowadays more obstetricians say yes to maternal
ETCH glucose tolerance test is performed in the first trimester based
request for elective caesarean section, but at the moment evidence
on anamnestic and anthropometric findings. If negative, the test is
is not enough to talk about it as a safe practise. An increasing number
repeated in the second trimester.
of expectant mothers want to avoid the traumatic experience of birth,
Clinical cases and summary results: During 2014-2015 611 cases of GD
and this has led to the wide acceptance of elective caesarean section.
were diagnosed, 10,8% of all pregnant delivered in the hospital. The
Vaginal birth and caesarean have advantages and disadvantages, but,
yield of first trimester testing was 37%, the second - 41% and the third
most guides claim vaginal birth is the first option to finish pregnancy.
22% respectively. Ten term babies were born weighing over 4,5 kg -
Once morbidity and mortality have been reduced, mental health is
1,8%. At the same time the ratio of large babies born to healthy (or
becoming more and more outstanding. Pregnancy is a stressing
undiagnosed with gestation diabetes) was 2,4%.
situation for woman and sometimes this stress can go to the bad birth
Conclusion: Because shoulder dystocia is a potentially life threatening
outcomes. Elucidate if vaginal birth or cesarean is more stressfull is
event, a third trimester foetal weight estimating ultrasound screening
gaining importance in the middle of this controversy.
commencing is currently under discussion.
Materials and methods: We designed a prospective observational
descriptive study. We recruited low risk patients in their 38 week of Keywords: Gestational diabetes, large for gestation age
pregnancy, who have carried out anodyne gestations, from February-
September 2015, and we got 101patients(82 vaginal deliveries-18
intrumented-,19 cesarean). We studied our sample characteristics:age,
conception, parity, way of delivery and startup type of delivery. We 626
mesured 48h after delivery mothers’ stress with biomarkers in blood
as: cortisol, acute stress biomarker; and a-amylase, chronic stress 5 Years of ERT - quality assurance
biomarker. Furthermore we measured psychosocial stress in inter-
views and by questionnaires, but we have not had conclusions yet
in east-tallinn central hospital,
because we are still analysing the obtained figures. Our objective was
elucidating which of the delivery ways is more stressfull.
SGA
Clinical cases and summary results: Mothers who finished pregnancy
by cesarean (8,173±6,931?g/dl) had cortisol levels higher than L. Tammemae, T. Angerjas, and F. Szirko
mothers whose delivery was vaginal (5,631±6,075 ?g/dl)(p=0,020)
Perinatal Centre, East-Tallinn Central Hospital, Tallinn, Estonia
fourty-eight hours after delivery. Either instrumented or spontaneous
deliveries had similars levels of cortisol and a-amylase (Espontaneous:
cortisol 5,631±6.075?g/dl and a-amylase 90,289±66,110 U/L; instru- Presenter: Ferenc Szirko
mented: cortisol 6,673±5,361 ?g/dl and a-amylase 74,83±85,677 U/L)
Introduction: East-Tallinn Central Hospital is the largest maternity
fourty-eight hours after delivery.
home in Estonia with number of deliveries reaching 4000 per year. It
Conclusion: Patients who deliver by cesarean show higher levels of
was recognized that apart of morning rounds, ex consilio and
blood cortisol (acute stress biomarker) than those patients who finish
perinatal meetings a body is needed to work on quality improvement.
pregnancy by vaginal spontaneous or instrumental birth. However,
The commission on ERT (Ebasoovitavate Ravitulemuste komisjon) was
with blood a-amilasa (chronic stress biomarker), it is exactly the
founded five years ago in order to investigate in depth the near miss
opposite, levels are higher when the delivery is vaginal. We do not
cases in obstetrics and gynaecology and to answer the treatment
find any differences between spontaneous and instrumental vaginal
related complaints of the patients.
birth.
Materials and methods: In 2015 a survey on the diagnosis of SGA was
Keywords: Stress, biomarkers, vaginal birth, cesarean carried out to find out, whether there is room for improvement. Five
doctors accessed the relevant electronic patient record and collected
the data on delivery details including gestation at delivery, mode of
delivery, last ultrasound examination, weight of the newborn and the
Apgar score.
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 307
Clinical cases and summary results: Out of 3798 new-borns 112 (3%) any of the three pragmatic markers (Apgar score at 5 minutes less
were diagnosed SGA, of them 75 below 5-th percentile (2%). There than 7 points, birth weight less than 1750 grams and gestational age
were 8 pairs of twins among them (11,4% of 70 pairs of twins born less than 33 weeks) the probability of neonatal death is higher (OR
2014). In 58,7% of the cases the diagnosis was established before, 145.95; CI 45.23 - 470.99), thus, this test has high sensitivity (Se 93,5%)
respectively in 41,3% after delivery. In two thirds of undiagnosed and specificity (Sp 91,1%).
cases an ultrasound examination was performed on 33-38-th Conclusion: Thus, the analysis of the three markers (birth weight less
pregnancy week. than 1750 grams, Apgar score at 5 minutes of life less than 7 points,
Conclusion: The commission decided to initiate negotiation with the and gestational age at birth less than 33 weeks) in our study showed
hospital laboratory to start serum PlGF testing to incorporate it in that the presence of one of the three pragmatic markers in newborn
preeclampsia and SGA first trimester combined screening along with increases the risk of death by 145.95 times. The sensitivity Se 93,5 of
PAPPA and uterine artery PI measurement. Another survey was this test shows that these symptoms may be the main criteria for
performed later in order to evaluate the skills of obstetricians in prediction of neonatal death.
performing ultrasound examination.
Keywords: Neonatal near miss, Apgar score, birthweight, neonatal
Keywords: Quality assurance, small for gestational age, foetal mortality, neonatal intensive care unit
ultrasound

763
726
Pragmatic criteria of ‘‘Neonatal Development of analytical meth-
near miss’’ odology to determination of
endocrine disrupting chemicals in
V.A. Bushtyrev2, I.O. Bushtyreva1, N.B. Kuznetsova1, V.V. human milk: preliminary results
Barinova1, and M.P. Dmitrieva2
1
Rostov-on-Don State Medical University Ministry of Health of Russia, L. Serrano López1, LM. Iribarne Durán2, M. Peña
and 2Rostov-on-Don State Perinatal Center Caballero1, F. Vela Soria2, I. Jimenez Dı́az2, N. Olea
Serrano2, and JA. Hurtado Suazo1
Presenter: V.A.Bushtyrev
1
Paediatric Dept., Neonatology Dept., Virgen de las Nieves University
Introduction: The number of newborns that were affected by serious Hospital. Granada. Spain, and 2Laboratory of Medical Investigations,
diseases and survived are always several times more than the number
San Cecilio University Hospital University of Granada.Spain
of died. This heavy contingent of newborns received the name
‘neonatal near miss’. Currently there is still no standard definition of
‘neonatal near miss’ - ‘almost died’, but, by analogy with the Introduction: Endocrine Disrupting Chemicals (EDCs) are substances
definition of near miss in obstetrics, these include neonates, who able of inducing changes to endocrine system due of its estrogenic
nearly died but survived, overcoming serious complications during character. The population is continually exposed to EDCs: As
pregnancy, childbirth or within the first 7 days of extrauterine life bisphenols (A, F and S), parabens (MP, EP, PP and BP) and
[Pileggi-Castro C., et al., 2014]. Model of ‘Neonatal near miss’ is benzophenone (BP- 1 to BP-8 and 4-hydroxybenzophenone) due to
considered to be a tool to determine the risk factors associated with its presence in products such as cosmetics. Breast milk is considered
neonatal mortality. the main way of exposure to EDCs in neonates.
Materials and methods: We conducted a prospective study in Rostov The aim of the study was to validate an analytical methodology to
State Perinatal Center for the period from 2011 to 2014, in which quantify levels of a selection of EDCs in breast milk. Results of a pilot
17267 infants were included (17089 of them were born in Perinatal study in samples of donor milk to a Milk Bank.
Center and 178 were evacuated from other health facilities). The Materials and methods: Human milk samples were donated by 15
number of neonatal deaths in the early neonatal period was 46 (2.67 donor milk, which was applied an epidemiological questionnaire. A
per 1000 live births) for 4-year period. We used pragmatic markers of new procedure based on a sample treatment by dispersive liquid-
‘neonatal near miss’ proposed by Pileggi-Castro C. et al, 2010: liquid microextraction(DLLME) for the extraction of three bisphenols,
birthweight less than 1750 grams, Apgar score at 5 minutes of life less four parabens and six benzophenones in human milk samples
than 7 points, and gestational age at birth less than 33 weeks. All followed by high performance liquid chromatography-tandem mass
infants who survived the neonatal period and have at least one of the spectrometry (HPLC-MS/MS) analysis was validated. The method was
selected variables were classified as cases of neonatal ‘near miss’ satisfactorily applied for the determination of target compounds in
(1540 newborns). Logistic regression statistical method was used. human milk samples from 15 randomly selected individuals.
Clinical cases and summary results: Among 17276 newborns with 5- Clinical cases and summary results: The method Dispersive liquid-
minute Apgar score less than 7 points, 41 children died and 1260 liquid microextraction was validated and optimized.
survived; among children with 5-minute Apgar score more than 7 The following data were obtained: (table 1)
points, 15961 survived and only 5 newborns died. The statistical The compound MP was detected more frequently in the analyzed
analysis revealed that the newborn evaluated by Apgar score at samples milk (11/15), followed by BP-3 (9/15), PP(6/15), EP(5/15), BPA
5 minutes less than 7 points had a 103.87-fold higher risk of death in (4/15) and BP and BP-1 (1/15). No samples showed detectable levels
the early neonatal period (OR=103.87, CI 40.97-263.32). The sensitivity of BPS, BPF, BP -2, BP -6, BP -8 or 4 - OHBP.
of this pragmatic marker was 89.1%, specificity - 92.7%. The Conclusion: A new analytical method for quantification of endocrine
probability of neonatal death of neonate with birthweight of 1750 disruptors non-persistent chemicals in human breast milk samples
grams is 102.67 times higher. The sensitivity of this marker is 87%, was achieved. The results of the initial study show frequent exposure
specificity - 93.5%. The chance of neonatal death of neonate with to certain EDCs. Future studies to deep the study of the levels of
gestational age of 33 weeks is 95.84 times higher (CI 40.55-226.53). exposure in the general population, as well as the possible effects of
This marker has the same sensitivity and specificity as well as body it are needed.
weight less than 1750 grams (Se 87.0%, Sp 93.5%). If a newborn has
308 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

types of vascular anastomoses, we also compare PFR among the 4

groups.
Clinical cases and summary results: In the normal McT group, TTTS
group and sIUGR group, PFR were correlated with the total diameter
of all the anastomoses respectively (Spearman = 0.413/0.514/0.583,
P=0.003/0.001/0.000). PFR in the normal McT group was larger than
that in the TTTS group and TAPS group(2.35(0.88, 12.44) vs 1.03(0.12,
15.17) vs 0.75(0.29, 2.40), p=0.000/0.008).
Conclusion: We consider PFR correlates with the total diameter of all
the vascular anastomoses in monochorionic twin placentas and could
be a good indicator representing the efficiency of vascular
anastomoses.

Keywords: Vascular anastomoses, monochorionic twins, placenta,

twin to twin transfusion syndrome, selective intrauterine growth
restriction

038
TWINS - 027 Frequency of premature births in
A new indicator representing the twin pregnancies in Kosovo
efficiency of vascular anasto- A. M. Gashi
moses in monochorionic twin University Clinical Center of Kosovo, Obstetrician and Gynecological
placentas Clinic (OGC) Pristine, Kosovo

Aim: To determine the frequency of premature births in twin

W. Xueju, Z. Yangyu, and W. Yuan pregnancies.
Obstetrics and Gynecology Department, Peking University Third Keywords: Materials and Methods: This was a retrospective study, of
Hospital, Beijing, China twin births, undertaken from December 2013 back to January 1, 2013,
in Obstetrics and Gynecology Clinic/University Clinical Centre of
Introduction: We established the ratio of placental territory discor- Kosovo.
dance ratio and fetal weight discordance ratio in monochorionic twin Clinical cases and summary results: Out of 10 286 the births in
placentas (PFR), and study whether PFR represents the efficiency of Obstetrics and Gynecology Clinic, 270 (2.63%) were twin pregnancies.
vascular anastomoses in monochorionic twin placentas. The incidence of twin pregnancies was, 26.3 twins per 1000 births.
Materials and methods: 172 monochorionic diamniotic placentas were Fifty three percent (n=143) of infants were born at term, while 47%
studied with dye injection in Peking University Third Hospital from 1st (n ¼ 127) of infants born preterm or before 37 weeks of gestation.
April 2013 to 1st May 2015. We set 4 study groups: A. 49 placentas of Thirty per cent of the twin pregnancies were conceived through the
nMcT, B. 52 placentas of sIUGR, C. 38 placentas of TTTS and D. 8 use of assisted reproduction technology, while 70 percent were by
placentas of TAPS. We conduct a spearman correlation analysis spontaneous conception. The average maternal age was 30.8 years,
between PFR and the number as well as the diameter of different while the average gestational age at birth was 32.9 weeks. About
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 309
7.8% (n=10) were born before week 28 gestational, 23.6% (n=30) matrix, cerebellar volume loss in hypovolemic donor, extensive
before 32 weeks, 68.6% (n=87) were born between weeks 32 and cerebral parenchymal thinning, abnormal decreased signal in the
36 + 6 gestation. Averages birth weight of the premature twins was basal ganglia. Associated anomalies diagnosed by complementary
2010 grams, 8.9% (n=24) were born with less than 1000 grams, 14.1% contribution of the MRI to US: upper urinary tract abnormalities
(n=38) 1500 grams, 53.7% (n=145) 2500, and 23.3% (n=63) 2500 (n=11, 64.7%), lung abnormalities (5.88%).
grams. Sixty-three percent were delivered through section caesarean, Conclusion: NT is a good predictor for the development of TTTS. NT
while 37% were through vaginal delivery. The Apgar test scoring above the 95th centile in one of fetuses predispose to severe TTTS
average for the group: Gem I was 6.5, while for group: Gem II was 6.4. with brain injuries. MRI is helpful in TTTS induced brain lessions. MRI
The most common pathologies associated with premature births sometimes contributes decisively to the diagnosis of extracerebral
were: preterm premature rupture of membranes (27.5%), status post lesions TTTS induced. MRI may be an important component in
section caesarean with pain (13.4%), maternal hypertensive disease counseling prior to intervention in TTTS. MRI is complementary to US.
(12.5%), death of the fetus in utero (10%), and cervical insufficiency To the extent that the costs will emerge as more accessible, MRI will
(9.5%), and other pathologies in small percentages: IUGR, umbilical become a more useful and friendly equipment in the assessment of
cord accidents, abruption placenta, polyhydramnios etc. maternal-fetal outcome in multiple pregnancy.
Conclusion: The frequency of 47% premature births in twin
pregnancies in Kosovo. Sixty three percent of the preterm twin Keywords: Multiple pregnancy, cerebral, hemorrhage, outcome
pregnancies were delivered through section caesarian. The average
gestational age at birth was 32.9 weeks, while averages birth weight
of the premature twins was 2010 grams.
122
Keywords: Preterm births, twin pregnancies, Kosovo
Perinatal outcomes of twin and
singleton pregnancies
M. G. F. N. Alexandre1, S. K. Silveira2, G. F. Locks3, and O.
041 H. M. Feuerschuette4
The prenatal ultrasound and mri 1
Maternidade Carmela Dutra, Florianópolis, Brazil, 2Hospital
Universitário/UFSC and Maternidade Carmela Dutra, Florianópolis,
for the assessment of fetal brain Brazil, 3Hospital Universitário/UFSC and Maternidade Carmela Dutra,
damage in twin-to-twin transfu- Florianópolis, Brazil, and 4Hospital Universitário/UFSC and Unisul,
Brazil
sion syndrome
Introduction: The rate of twin pregnancies is increasing worldwide.
C. Berceanu1, E. Brătilă2, S. Vlădăreanu3, M. M. Cı̂rstoiu2, Twin pregnancies are usually at greater risk of maternal, fetal and
neonatal complications. The aim of this study was to compare the
C. Mehedinţu2, V. Gheorman4, I. A. Gheonea5, D.
perinatal outcomes of twin and singleton pregnancies at a single
Comandaşu2, and S. Berceanu1 institution in Brazil.
1
Department of Obstetrics-Gynaecology, University of Medicine and Materials and methods: We performed a case-control study. All twin
pregnancies born between January 2010 and December 2012 were
Pharmacy of Craiova, Romania, 2Department of Obstetrics-
included as case. For the control group we considered 2 pregnant
Gynaecology, ‘‘Carol Davila’’ University of Medicine and Pharmacy, women who gave birth immediately after the case.
Bucharest, Romania, 3Department of Obstetrics-Gynaecology, ‘‘Carol Clinical cases and summary results: During the study period, there
Davila’’ University of Medicine and Pharmacy, Bucharest, Romania, were 10 734 births. 130 patients had twin pregnancy, whose data
4
Department of Psychiatry, University of Medicine and Pharmacy of were compared with 260 patients with single pregnancy. Among
Craiova, Romania, and 5Department of Obstetrics-Gynaecology, twins, 91 were dichorionic, 28 monochorionic diamniotic, and 2
‘‘Iuliu Haţieganu’’ University of Medicine and Pharmacy, Cluj- monochorionic monoamniotic. In 9 cases the chorionicity was not
Napoca, Romania reported. There was no statistical difference between groups with
respect to demographic variables except age, in which pregnant
Introduction: Twin-to-twin transfusion syndrome (TTTS) is a specific women in twin group were older (27.2 versus 25.2 years old (p=0.004).
complication of monochorionicity, based on the imbalanced interfetal Twin pregnancies had more complications during pregnancy (OR 4.1,
blood flow, chronic feto-fetal transfusion and increased risk of chronic 95% CI 2.6-6.4, p=0.001), especially preeclampsia (24% versus 10.3%,
brain damage, both in the donor and the recipient. The purpose of OR 2.7, 95% CI 1.6-4.8, p=0.001), intrauterine growth restriction (10.1
the study is to assess the improvement that MRI brings to ultrasound versus 2.7%, OR 4.1, 95% CI 1.6-10.5, p=0.003) and preterm labor
(US) examination in order to evaluate TTTS complications. (27.9% versus 5.4%, OR 6.8, 95% CI 3.5-13.2, p50.001), and required
Materials and methods: The study is conducted in five tertiary care more cesarean sections (84.6% versus 45.1%, OR 0.15, 95% CI 0.08-
referral centers for a period of three years, including 17 cases of twin 0.25). Neonatal outcomes were also significantly worse in twins. There
pregnancies with TTTS. Diagnosis and classification of TTTS were was a higher proportion of premature infants less than 37 weeks of
made according to Quintero, Cincinnati or combined criteria. First pregnancy (63% versus 11.7%, OR 15.38, 95% IC 9.54-24.77, p50.001)
trimester screening for all cases. Maternal-fetal Doppler hemody- and also less than 34 weeks (26.8% vs 1.6%, OR 23.58, 95% IC 8.46-
namic profile assessment in all cases. Second trimester ultrasound 65.71, p50.001), lower birth weight (2.234g ± 634 versus 3.261g ±
scanning and fetal MRI after diagnosis of TTTS. 588, p50.001), more newborns with 5 minutes Apgar score  7 (5.8%
Clinical cases and summary results: MRI evaluation followed second versus 1.9%, OR 3.12 95% IC 1.12-8.72, p50.001), higher need for
trimester ultrasound. US and MRI findings: overall brain abnormalities resuscitation (36.5% versus 14.1%, OR 3.13 95% IC 2.03-4.83, p50.001),
- 5 cases (29.41%). Ventriculomegaly in donor twin (n=3, 17.64%), and increased admission to the neonatal ICU (47.3% versus 10.3%, OR
cerebral ischemia and hemorrhage (n=2, 11.76%), porencephaly in the 7.71 95% IC 4.84-12.31, p50.001). There were 2 stillbirths and 8
recipient twin (n=1, 5.88%), perhaps by ischemic flow and thrombotic neonatal deaths in the the twin group and 1 neonatal death in the
showers, cerebral venous sinus dilatation (n=3, 17.64%). Other MRI control group.
findings: white matter necrosis, hemorrhage along the germinal
310 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

Conclusion: The results of this study confirm a higher rate of adverse

perinatal outcomes in twin pregnancies compared to singleton. These 436 (CASE REPORT)
pregnancies require a differentiated perinatal care.
Donor demise in twin-to-twin
Keywords: Twin pregnancy, neonatal outcome transfusion syndrome: better of
the worst
377 D. C. Katlan, B. Yakıştıran, A. Koç, and F. Söylemez
Amniotic bands, anorectal and Ankara University Faculty of Medicine, Department of Obstetrics and
bladder agenesis an unique Gynecology, Ankara, Turkey
Introduction: Twin-to-twin transfusion syndrome (TTTS) complicates
association in a twin pregnancy 10-15% of monochorionic multiple gestations with an incidence of 1-
3 per 10 000 pregnancies. TTTS results from progressive unbalanced
with fetus papyraceus blood sharing from donor to recipient through placental vascular
anastomoses. TTTS typically arises in the second trimester between 15
C. A. Ionescu, F. D. Călin, M. C. T. Dimitriu, M. Bănacu, I. and 26 weeks and carries a high perinatal mortality reaching up to
90% if left untreated. Fetoscopic laser photocoagulation of anasto-
Târcomnicu, Z. Ceausu, T Vladescu, and A. Calin 3 moses is the first line treatment modality. However, approach to
1
Department of Obstetrics and Gynaecology, Clinical Emergency single intrauterine fetal demise, at gestational weeks when the
Hospital ‘‘St. Pantelimon", University of Medicine and Pharmacy surviving co-twin is accepted to be viable, is under debate. Hereby,
we present spontaneous donor demise in TTTS providing us the
‘‘Carol Davila’’, - Bucharest, Romania, 2Department of
necessary time to re-evaluate the recipient and get prepared for
Anatomopathology, Emergency Clinical Hospital ‘‘St. Pantelimon",
peripartum interventions.
Bucharest, Romania, and 3Dunarea de Jos University of Galati, Clinical cases and summary results: 28-year-old gravida 4 woman was
Emergency County Hospital Sf Apostol Andrei Galati followed biweekly due to a monochorionic diamniotic twin preg-
nancy. Serial evaluations were unproblematic including detailed mid-
Introduction: Poor cloacal development and an inadequate septation trimester scan. Sonographic evaluation at 25 weeks revealed stage 1
can generate a wide range of genitourinary and terminal portions of TTTS which rapidly progressed to stage 2 in one week. Umbilical cord
the digestive tract malformations. The bladder agenesis is an of the donor was adhering to the very edge of common anterior
extremely rare congenital genitourinary anomaly. Successful treat- placenta. She was hospitalized and antenatal steroid prophylaxis was
ment and the long-term prognosis are usually poor because of the administered. The parents refused laser and 2100 ml of amniodrai-
associated abnormalities. nage was performed. At 27 weeks 6 days, she applied due to absence
Clinical cases and summary results: We report an uncommon case of fetal movements for 24 hours. The donor was dead. Doppler of the
relating to cloacal maldevelopment, a complex association of recipient depicted absence of diastolic flow in umbilical artery,
urogenital and hingut abnormalities in a tween pregnancy with reverse a-wave in ductus venosus and increased peak systolic velocity
fetus papyraceus (mummified) and amniotic bands. A twin pregnancy in middle cerebral artery (1.94 MoM) interpreted as recipient
with one fetus stopped evolving at 12 weeks of gestation and another myocardial dysfunction together with anemia due to exsanguination
fetus that has continued to develop up to 23 weeks. The birth into donor. Following preparations, 970 g male baby was born via
occurred at 23 weeks and we extracted a mummified fetus of 45 cesarean seciton with a hemoglobin value of 10.7 g/dL. He died 12
grams and a nonviable female fetus weighed 420 g with multiple days postpartum due to cardiac dysfunction and prematurity.
malformations. Clinical, anatomopathological evaluation and embry- Placental macroscopy revealed several vascular anastomoses, the
ological review are made to explain the concomitant occurrence of major of which is arteriovenous, and marginal semi-velamentous
these rare malformations. Survival will depend on the extension of insertion of donor umbilical cord being a prognostic indicator
the cloacal exstrophy and the genitourinary and intestinal defect. endangering donor survival (Figure 1).
Conclusion: Early prenatal diagnosis is required, serial scans are Conclusion: In TTTS cases ineligible for laser therapy, clues threatening
necessary and it is also helpful to plan the appropriate perinatal the fetuses should be thoroughly evaluated. Donor death may offer a
management. The surgical management is typically undertaken in the favorable prognosis for the recipient. Doppler scans may be helpful
postnatal period (48 to 72 hours) as a multidisciplinary approach for evaluating myocardial performance and anemia of the surviving
involving neonatologists, pediatric surgeon, pediatric urologist, recipient but not for placental anastomoses. Although donor death
pediatric neurosurgeons, genetic specialist. The prognosis of infants may provide considerable time for re-evaluation of the recipient, the
with cloacal abnormalities is variable, depending on the severity of angioarchitecture of monochorionic placenta is the deciding author-
the structural defects. ity on the fate of surviving twin.

Keywords: Bladder agenesis, ectopic ureter, OEIS complex, amniotic Keywords: Twin-to-twin transfusion syndrome, donor death
bands, twin pregnancy with fetus papiraceus
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 311

528
Prenatal diagnosis of hemiacar-
dius acephalus: a rare presenta-
tion of twin reversed arterial
perfusion sequence
D.C. Katlan, K. Koyuncu, R. Aytaç, A. Koç, and F. Söylemez
Ankara University Faculty of Medicine, Department of Obstetrics and
Gynecology, Ankara, Turkey

Presenter: D. C. Katlan
Introduction: Twin reversed arterial perfusion (TRAP) sequence, occurs
in 1/35,000 births and 1% of monozygotic twins. Defective early
TWINS - 512 (CASE REPORT) embryonic placental vascular development leads one twin to lose its
own placental share and to become solely dependent on the
Delayed-interval delivery in retrograde flow of deoxygenated blood of its co-twin through its
umbilical arteries. The perinatal outcome is poor if left untreated.
dichorionic twin pregnancies- Under sonography one fetus appears normal and other one lacks
two case reports apparent cardiac structures. Acardiac twins are classified into 4 types:
Acephalus (presence of lower body), Anceps (well-developed body
and partially formed head), Acormus (presence of only head) and
M. Marinho, D. Vila Real, C. Soares, J. Silva, and M. Pinho Amorphous (no recognizable anatomy). Hereby, we report a rare
presentation of TRAP sequence with a functioning heart in an
Obstetrics Department; Centro Hospitalar Vila Nova de Gaia/Espinho; anomalous twin of acephalus type.
Porto, Portugal Clinical cases and summary results: A 17-year-old primigravid woman
was referred due to a twin gestation complicated by an anomalous
Presenter: Marcia Marinho fetus. Detailed sonographic examination at 18th week confirmed the
presence of monochorionic diamniotic female twins one of which had
Introduction: The emergence of assisted reproductive techniques an unremarkable anatomic survey. The other co-twin was severely
(ART) increased the number of delayed- interval delivery (DID) cases in deformed. The upper body parts including the head, thorax and
multiple pregnancies. upper extremities were completely absent. Anomalous spine, ending
Reports have shown that such pregnancies can be continued with with bi-cystic fluid-filled sacs, was reaching up to lower thoracal
good outcome when properly managed. Each case is an unique segments; lower extremities were motile but deformed; some of the
medical situation that must be individually managed. abdominal viscera like kidneys, intestines were vaguely visible and an
Prolonged bed rest, cervical cerclage, tocolysis, antibiotic prophylaxis anechoic, probably cystic, area reaching to defective anterior
and corticosteroids are managing possibilities but frequently abdominal wall was noticeable. A single-artery-umbilical cord was
debatable issues. originating from a very adjacent area to the placental insertion site of
There is no consensus still on how to best manage DID of remaining the cord of normal co-twin. Doppler imaging revealed a reversed
fetus/fetuses because such cases are still relatively rare. pulsatile flow in that umbilical artery. A rudimentary but pumping
Gestational age at delivery is an important factor in neonatal survival, heart with visible blood flow under Doppler scan was localized at the
as well as prolonged delayed birth of the second twin.’’ upper edge of the half-developed trunk. The parents opted for
Clinical cases and summary results: We report two cases of DID of termination of pregnancy. Postpartum examination confirmed pre-
dichorionic twin pregnancies conceived after ART, admitted to our natal findings (Figure).
emergency department at 19 weeks and 24 + 2 weeks of gestation. Conclusion: Although the majority of perfused co-twins are really
In both cases first twin’s placenta was left in place and high ligament acardiac, some may have rudimentary cardiac tissue (hemiacardius)
of umbilical cord was performed. There was no first twin survival. Both most of which are nonfunctional. Almost all, of the few reports of
patients received antibiotic therapy and bed rest was instituted. This hemiacardius twins are anceps. Presence of a functional heart in
approach allowed a delaying duration in delivery of the remaining acephalus type of perfused twin is an unexpected coincidence which
twin of 125 and 10 days, respectively. Both second twins survived may be misclassified or misdiagnosed. Recognizing the spectrum of
with good outcome. potential sonographic appearances is important to prevent misclassi-
Conclusion: Preterm delivery is the most common complication of fication, and thus, misleading counseling.
multiple gestations. Although delivery of the first fetus is inevitable,
successful delaying of the co-twin is sometimes feasible and
lifesaving.
Management of DID represents a great challenge to clinicians by its
paucity and the inexistence of an universally accepted management
protocol. It allows better neonatal outcomes for the second twin. Our
cases illustrate the variability on the mean duration of delay, as
described in the literature.
Keywords: Delayed-Interval Delivery; twin pregnancy
312 Abstracts - Poster J Matern Fetal Neonatal Med, 2016; 29(S1): 1–317

both cephalic presentation CS (46,4% vs 37,9%;; p50,001). We

555 observed no differences in neonatal composite morbidity for first or
Active second stage management second twin outcomes (1,1% vs 0,67%) in the overall twin deliveries or
after the exclusión of pregnancy complications (0,78% vs 0,33%).
in twin deliveries improves Combined vaginal cesarean delivery was reduced (6,5% to 0%) if an
obstetrician used to internal maneuvers was present.
obstetrics outcomes Conclusion: A protocol that includes active management in twin
deliveries assistance achieves a significant higher rate of vaginal
J. Adánez1, M. Navarro2, S. Fernández3, O. Vaquerizo4, deliveries not only in cephalic non cephalic presentation but also in
both cephalic presentation.
and F. Ferrer5 The presence of an obstetrician used to internal maneuvers reduces
Obstetrics Department.; Asturias Central University Hospital, Oviedo, combined vaginal cesarean deliveries.
Spain (HUCA) Delivery training programs on internal maneuvers skills achieve an
increase in successful twin vaginal delivery
Presenter: J. Adánez
Introduction: Our objective was to compare obstetric and neonatal
outcomes in twin deliveries in two different periods with different 596
obstetrical practices. In the first period we attempted a trial of vaginal
delivery when the presentation of both twins were cephalic. In the
A case of early pprom in twins
second period, a cephalic presenting first twin was enough to indicate
a planned vaginal delivery. To achieve this goal, we implemented a P. Domashev and E. Kaleja
protocol that included active management of the second twin.
Competency in obstetric maneuvers were acquired after adequate Fetal Medicine Unit, Riga Maternity Hospital, Riga, Latvia
training on birth simulator. The presence of a formerly trained expert
on internal maneuvers was always required. Presenter: P. Domashev
Materials and methods: A retrospective cohort study of 276 twin
Introduction: Brief amniotic fluid leaking has been detected at 15w3d
deliveries was undertaken in a level III University Maternity. We
of gestation in MCDA twins on day 3 after laser treatment for TTTS
included all the twins deliveries 32 weeks, assisted in our hospital
stage III. At 17 gestation weeks marked fluid loss in ex-recipient has
between January 2008 and March 2016. We established two different
renewed and has been lasting for 3 weeks. Subsequently the
periods 2008-2010 (A) and 2010-16 (B) considering that our protocol
pregnancy developed without complications unless 31w2d when
was implemented in May 2010. During 2012 and 2013 the protocol
PPROM has happened again. At 31w3d two boys have been born- F1
was not applied. The protocol included the presence of an skilled
(ex-recipient) 1628g., Apgar score 7/7, F2 (ex-donor) 1502 g., Apgar
expert on active second stage management of the second twin, or
score 6/7. Now they are 3,5 months old and are developing normally.
availability on and on-call expert. A delivery training program on
Clinical cases and summary results: At 30 y.o. G2, P1 woman in
internal maneuvers skills that included didactic sessions and
spontaneous MCDA twin pregnancy TTTS stage III was detected at
simulation training was required before the procedure was practiced
14w0d and laser treatment was made at 15w0d. In 3 days after
on theatre. Active second stage management included complete
successful laser coagulation brief fluid leaking was detected.
breech extraction of a second breech or transverse lie twin, and
Chorionic membrane dissociation with good AFI for both fetuses
internal versión of a non engaged cephalic second twin followed by a
were detected. At about 17w0d marked fluid loss from ex-recipient
complete breech extraction.
started. Conservative management was chosen due to woman did
Clinical cases and summary results: 127 twin deliveries were assisted in
not show signs of inflammation, laser treatment was successful, AFI
period A and 149 in period B. We observed no differences on mean
was good in both fetuses and cervix remained long. At 20w fluid
age (33 vs 35,5) pregnancy complications (15,1 vs 16,57) or nulliparity
leaking stopped. Subsequently pregnancy developed without com-
(76,2 vs 82,9).The fetal position before delivery were both cephalic
plications except secondary cardiomyopathy (right ventricle hyper-
(48,8 vs 54,4%), cephalic/noncephalic (25,2 vs 22,1%) and breech/
trophy, TVR, PV stenosis) in ex-recipient at 23w5d. At 31w3d due to
other (26 vs 23,5%). After the implementation of the protocol we
PPROM the day before two boys have been born by CS. F2 (ex-donor)
observed a significant reduction in twin cesarean rate (CS), (71,8% vs
- 1502 g., Apgar score 6/7. F1 (ex-recipient) 1628g. by weight and 7/7
47,7%; p50,001). This reduction was observed in the cephalic/
noncephalic presentation CS (92,8% vs 26,1%; p50,001), and also in
DOI: 10.1080/14767058.2016.1191212 Abstracts - Poster 313
by Apgar score was referred to Cardiologic clinic for surgery. Now the group of spontaneous DC-DA twins. Ultrasound examination is very
twins are 3,5 months old and are developing normally. important for surveillance of all types of twins - for establishing
Conclusion: Early PROM is not a fatal condition. correct diagnosis and adjusting obstetric management.
Keywords: PROM twins Keywords: Twins, assisted reproductive technologies, pregnancy,
delivery

668
709
Comparison of pregnancy and
labor course in spontaneous and Monochorionic discordant twins
related to placental insufficiency
art-conceived twins
and velamentous ombilical cord
N. Skrypchenko, O. Shamayeva, G. Grebinichenko, insertion
S. Mogilevska, and Vl. Podolskiy
SI ‘‘Institute of Pediatrics, Obstetrics and Gynecology of NAMS of M. Pintilie2, RM. Sima1,2, I. Iuriet2, and L. Ples1,2
Ukraine’’ 1
The ‘‘Carol Davila’’ University of Medicine and Pharmacy,
Bucharestand 2‘‘Bucur’’ Maternity, ‘‘St. John’’ Hospital, Bucharest,
Presenter: N. Skrypchenko
Romania
Introduction: There is a strong evidence of higher rate of perinatal
complications in twin pregnancy, including preeclampsia, antenatal Presenter: RM. SIMA
fetal death, poor neonatal outcome, increased rate of preterm
delivery, cesarean section etc. At the same time there is a significant Introduction: Lately we experience an increased incidence of multiple
increase in the amount of multiple pregnancies during recent years pregnancies in the developed countries due to advanced maternal
due to assisted reproductive technologies and advanced maternal age at childbirth and the extended availability of infertility treatments.
age. The level of perinatal mortality in twins is mostly determined by Monochorionic twin pregnancies and dichorionic triplet pregnancies
chorionicity: in monochorionic twins it is about 2.5 times higher than carry higher risks because the fetuses share a common placenta,
in dichorionic. That’s why it is important to have an early diagnosis of which is associated with an increased risk of discordant growth and
the fact of twin pregnancy, and to determine correctly the type of twin-twin transfusion syndrome. Discordant growth reflects the
chorionicity and amnionicity, as this data will define obstetric difference in birth weight between the largest and smallest infant
management and intensity of monitoring. in a multiple pregnancy. Increasing discordant growth is associated
Materials and methods: Objective of the study was to assess with augmented risk of poor pregnancy outcome, fetal and neonatal
pregnancy and labor course in women with twin pregnancies, who death, and neonatal morbidity. Ultrasound scan is the gold standard
conceived either spontaneously or with the help of assisted to evaluate the chorionicity and fetal growth.
reproductive technologies (ART), taking into account chorionicity Clinical cases and summary results: We present the case of 32 years
and amnionicity. 51 women with twin pregnancies, who were patient, with naturally obtained twin pregnancy, investigated in our
hospitalized to our Institute in 2014-2015, participated in the study: unit. The first trimester ultrasound scan performed at 12 weeks plus 3
28 (54.9%) had spontaneous conception (group 1) and 23 (45.1%) indicated a monochorionic, biamniothic, and a growth difference of 1
conceived by ART (group 2). According to the type of placentation, in week between the twins. The growth discordance between the twins
group 1 35.7% (n=10) were dichorionic diamniotic (DC-DA), 53.6% increased with pregnancy progression. One month later that
(n=15) monochorionic diamniotic (MX-MA) and 10.7% (n=3), mono- discordance was about two weeks. At 33 weeks of gestation one
chorionic monoamniotic (MC-MA). In group 2 all twins were DC-DA. girl had an estimated weigh of 2000 grams and the other girl about
Clinical, statistical and mathematic methods were used. 1000 grams with obvious signs of severe IUGR but still normal
Clinical cases and summary results: High incidence of complications Doppler indexes. The premature rupture of membranes imposed C
was found in both groups. In group 2 rate of threatened abortion was section at 34 weeks of gestation. Two girls were extracted one of
1.7 times higher, and rate of preeclampsia 7 times higher than in 2100 gr the other one of 1000 gr. The neonatal outcome was
group 1 (P5 0.05). Incidence of placental dysfunction and fetal favorable for both of them. The particularity of this case is the
distress were similar in both groups (39.3% in group 1 and 34.8% in macroscopic display of the placenta. It appeared as a single placenta
group 2). Among 15 MC-DA twins rate of selective growth restriction with two accessory lobes. Those lobes corresponded to the placental
(sIUGR) was 40%, rate of twin-to-twin transfusion syndrome (TTTS) part of the small twin. The enlarged part of the placenta belonged to
was 26,7%, single antenatal fetal death was in 2 cases (one in TTTS, the big twin and the umbilical cord had a velamentous insertion. No
the other - sIUGR), antenatal death of both twins (in TTTS) was in 3 vascular anastomoses were noticed between the two circulations.
cases. Among MC-MA twins there were 1 case of TTTS, 1 case of Conclusion: The particularity of this case is the favorable outcome in
congenital heart defect in one twin, but otherwise unremarkable twin pregnancy with risk factors such as monochorionicity. For one
pregnancy and 1 twin pair with normal development and good twin the reduced placental tissue determined intrauterine growth
outcome. Births were preterm in 79.6% in group 2. In group 1 the rate restriction as a consequence of placental insufficiency. The additional
of preterm births was 2 times less - 39.3% (p 50.05). Rate of risk factor was the velamentous umbilical cord insertion identified
spontaneous delivery was 60.7% in group 1, by C-section were after delivery. The differential diagnosis of the twin discordance were
delivered 78.3% of patients in group 2. TTTS and TAPS which were excluded considering the normal Doppler
Conclusion: Type of pregnancy complications in twins depends on in MCA or umbilical teritory.
type of conception. Patients after ART showed higher rates of
threatened abortion, preeclampsia and preterm delivery; complica-
tions in spontaneous twins were mostly due to specific pathology of
MC twins - TTTS, sIUGR, antenatal fetal death. Best outcome was in