Jun 30, 2017 - treatment for HLH during pregnancy, meanwhile high- dose IVIGs, cyclosporine ...... postpartum depression incidence with vaginal delivery and cesarean ..... 20 IU oxytocin in 1 liter fluids with 60 drop/min from first IV line was ...
J. Obstet. Gynaecol. Res. Vol. 43, No. S1: 56–82, June 2017
doi:10.1111/jog.13388
MATERNAL MEDICINE 0006 Clinical features of preeclampsia superimposed on chronic hypertension with or without proteinuria Sayuri Nakanishi, Shigeru Aoki, Ami Nagashima, Kazuo Seki Yokohama City Medical Center, Yokohama, Japan Introduction: In 2014, the International Society for the Study of Hypertension in Pregnancy (ISSHP) revised the definition of preeclampsia(PE). However, there is no report on the incidence of PE superimposed on chronic hypertension without proteinuria, which is not mentioned in the conventional diagnostic criteria, as well as pregnancy outcomes. Objective: We aimed to evaluate the validity of the diagnostic criteria for PE superimposed on chronic hypertension without requiring proteinuria. Methodology: This retrospective study included 142 women with essential hypertension diagnosed at ≤20 weeks of gestation, managed at a tertiary center. They were divided into three groups (non-PE group; PE with proteinuria group; and PE without proteinuria group) to compare pregnancy outcomes. The non-PE group was further divided into two subgroups (controlled and uncontrolled hypertension subgroups) Results: There were 87 women in the non-PE group, 47 in the PE with proteinuria group, and 8 in the PE without proteinuria group. Median gestational age at delivery was 38.7 weeks in the non-PE group, 30.4 in the PE with proteinuria group, and 28.4 in the PE without proteinuria group. In three of the eight women in the PE without proteinuria group, the condition fulfilling the diagnostic criteria was liver involvement (complicated by thrombocytopenia in one woman). Although the remaining five women had uteroplacental dysfunction, the validity of their PE diagnosis was questionable because their blood pressure was well controlled throughout pregnancy. The 87 women in the non-PE group were divided into a controlled hypertension subgroup of 75 women and uncontrolled hypertension subgroup of 12. In the uncontrolled HT subgroup, the pregnancy outcomes were significantly poorer than those in the controlled HT subgroup. Conclusion: Although exclusion of proteinuria from the essential diagnostic criteria for PE superimposed on chronic hypertension is valid, the criteria might need to include uncontrolled hypertension instead of uteroplacental dysfunction.
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0020 Maternal magnesium sulfate treatment and infant outcomes Ting-Chun Lai, Chi-Yuan Liao Mennonite Christian Hospital, Hualien, Taiwan Introduction: To prevent risk of the sometimes fatal complications of preeclampsia, magnesium sulfate is the recommended drug of choice for both prevention and treatment of eclampsia. Risk to infants from maternal magnesium sulfate exposure remains unclear, however, as earlier studies found an association with increased admission to neonatal intensive care and special care units, while more recent studies have found no associated risk of intensive resuscitation and other adverse neonatal outcomes. Objectives: Our study aims to elucidate the association between maternal magnesium sulfate exposure and neonatal risk. Methodology: This 12-year retrospective cohort included women diagnosed with preeclampsia who delivered at >=37 weeks’ gestation. Women who received treatment with magnesium sulfate were categorized into the exposure group and all others into the non-exposure group. The primary outcomes investigated were neonatal intensive care unit admission and special care unit admission; the secondary outcomes were neonatal adverse effects. We used multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CIs). Results: No differences in 5-minute Apgar and muscle tone scores were found between infants exposed to magnesium sulfate and those unexposed. One-minute Apgar and muscle tone scores were lower in the MgSO4-exposed neonates, although the observed difference did not reach statistical significance. The neonate SCBU admission rate was significantly higher in the exposed group (OR=5.02, 95%CI: 1.98-12.70), whereas no difference in the NICU (OR=3.90, 95%CI: 0.49-30.99) admission rates was found. Additionally, the rate of delayed adaptation was higher in the MgSO4-exposed neonates, but again the difference was not statistically significant. Conclusion: In conclusion, no significant association was observed between maternal exposure to magnesium sulfate for prevention and treatment of eclampsia and severe adverse effects on neonates. However, exposure to magnesium sulfate might increase
© Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology. Copyright of individual abstracts remains with the authors.
Maternal Medicine
the neonate delayed adaptation rate and the admission rate to the special care baby unit. 0024 The diagnostic and therapeutic challenge of managing hemophagocytic lymphohistiocytosis during pregnancy Meng Lu, Lan Qi, Yinyan He Shanghai First Aid Center of Maternal Near Miss affiliated with Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe clinical syndrome associated with poor prognosis. It is rarely described during pregnancy and may be mistaken for other pregnancyrelated disorders such as HELLP syndrome, due to the shortage of characteristic clinical manifestation. Furthermore, management appears to be complicated and inconsistent in the limited reported cases. Case: We report two HLH cases during pregnancy, with the similar presentations (persistent fever, bicytopenia, liver dysfunction) but of different outcomes. The first case describes a 24-year-old woman who developed Salmonella and herpes zoster virus-induced HLH combined with autoimmune hemolytic anemia (AIHA). Although her clinical course was inconsistent and refractory, we administered IVIGs in addition to high-dose methylprednisolone after delivery, which finally resulted in a favorable outcome. Our second case involves a 22-year-old women, given the diagnosis of NK-T cell lymphoma-associated HLH. After a cesarean section, her general condition rapidly worsened and all active treatment failed to induce any improvement. Methods: We summarize the characteristics of 16 reported HLH cases during pregnancy to date, including associated factors, major clinical findings, treatments, and outcomes. We discuss the role of pregnancy in HLH and the merits of different therapies. Results: HLH should be suspected when encountering unexplained fever and cytopenia during pregnancy, and a careful diagnostic work-up should be performed subsequently. Corticosteroids may be a first-line treatment for HLH during pregnancy, meanwhile highdose IVIGs, cyclosporine A and cytotoxic drugs are other therapeutic options. In refractory cases, timely termination of the pregnancy should be considered and may induce improvement. Conclusion: Early diagnosis, by recognizing signs and symptoms, and appropriate treatment of HLH during pregnancy is critical for achieving a better outcome.
0025 Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy - a randomized control trial Khushboo Srivastav, Shailaja Chhetri Shrestha, Ajay Agrawal, G.P. Rauniar B.P Koirala Institute of Health Sciences, Dharan, Nepal Introduction: Anemia in pregnancy is a significant public health problem. Globally, the prevalence of anemia in pregnancy is 55.9 %. Objectives: The aim of this study was to compare the efficacy and safety of intravenous iron with oral iron in the treatment of iron deficiency anemia of pregnancy. Methods: A randomized experimental study was conducted at BPKIHS, Dharan in 2014-15 involving 70 pregnant women between 16 -34 weeks period of gestation with iron deficiency anemia with hemoglobin level between 7-10 g/dl or ferritin level < 15μg/L . In the intravenous group (IV group), the iron dose was calculated from the following formula: Weight before pregnancy (kg) x (12 g/dl – Actual hb[g/dl]) x 0.24 + 500 mg. The oral group (PO group) received 100 mg of elemental iron thrice a day for 6 weeks. Hemoglobin was reviewed at baseline, 2, 4, and 6 weeks. Serum ferritin level was measured at baseline and 6 weeks. Side effects seen in each group were evaluated. MannWhitney test and Chi-square test were applied. Results: The change in hemoglobin and serum ferritin levels from baseline was significantly higher in the intravenous group than the oral group at each measurement (P140 mm of Hg and 73.43% (n=105) had diastolic BP >90 mm of Hg. Both loading and maintenance dose of magnesium sulfate were given in 78.32% (n=112). BP was controlled. 68.63% (n=70) pregnancy were terminated by LSCS. 80.39% (n=82) neonates were alive. 97.90% (n=140) fully recovered. ICU support was required in 3.50% (n=5). 19.58% (n=28) needed transfusion. 27.97% (n=40) stayed at hospital for 7 days. Conclusion: Awareness among rural women, appropriate ANC, early identification of pre-eclampsia, efficient referral system & multidisciplinary approach including ICU is essential for management of these critical patients. 0103 Clinical significance of ultrasonic placental grading during third trimester in hypertensive disorders in pregnancy Atima Bharti1, Anubha Vidyarthi2 1 Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India, 2Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
© Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology. Copyright of individual abstracts remains with the authors.
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Maternal Medicine
Introduction: Hypertension is one of the most common complications in pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Placenta is an important foetal organ which is an intermediate link between foetus and mother. Owing to delicate and important nature of the placenta, it is sometimes referred to as “mirror of the perinatal period which has not been sufficiently polished” [1]. Placenta being a foetal organ shows the same stress and strain, to which the foetus is exposed. Any disease affecting mother and foetus has a great impact on placenta. Wellbeing of foetus is affected by many factors but healthy placenta is the single most important determinant in producing a healthy baby. Foetal outcome is directly related to the maturation of placenta. Compromised placental perfusion from uterine vasospasm, a major culprit in the genesis of increased perinatal morbidity and mortality associated with pregnancy induced hypertension [2]. Abnormalities of placenta and umbilical cord are the most culpable cause of abnormal foetal outcome and even death. Sonography remains the imaging morality of choice for placental evaluation. Petrucha and associate reported 100% correlation between L/S ratio and grade III placenta [3]. Objectives: To study placental grading by Ultrasonography in pregnancy complicated with hypertension and compare it with placental grading in normotensive gravidas. Methodology: 100 pregnant women in 3rd trimester with pre-eclampsia as study group. 100 normotensive pregnant women as control group. Result: Incidence of foetal distress with grade III placenta was 11.6% as compared to 3.2% in control group. Perinatal morbidity was 4.7% in study group, nil in control group. Perinatal mortality was 33.3% with grade I placenta. Conclusion: Intrauterine growth retarded babies were observed with grade III placenta in study group 34.9% as compared to 6.5% in control group, which was statistically significant. 0104 Pregnancy induced hypertension as a risk factor for cardiovascular and renal system in later life Khurshid Jahan, Fatema Jebunnesa Patuakhali Medical College, Barisal, Bangladesh Background and aims: Pregnancy Induced hypertension (PIH) known to be a major cause of maternal and fetal morbidity and mortality. In addition, PIH is claimed to create greater risk of hypertension (HTN) and chronic kidney diseases (CKD) at later life
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of the women. The present study was explored to what proportion of women with history of PIH develops HTN and CKD in later life. Materials and methods: Under an observational casecontrol design 133 women with previous history of PIH [the PIH group; Age (yrs), Median (range) 31 (2545), and BMI (kg/m2, (Mean±SD) (25.2±2.1) were compared with 113 women without history of PIH (Non-PIH group), Age (yrs) Median (range) 34 (25-45), and BMI [(kg/m2, Mean±SD) (25.8±2.9)] for the development of HTN (SBP >130 mmHg; DBP >90 mmHg; or MBP >105 mmHg) and CKD (as measured by total urinary protein and elevated UPCR). Urinary protein by strip and urinary creatinine measured by alkaline picrate method. Results: Out of the 133 subjects in the PIH group 43 (32.3%) developed HTN and 41 (30.8%) developed CKD. In the Non-PIH group 17 (15%) developed HTN and 16 (14.2%) developed CKD. SBP, DBP and MBP, all were significantly higher in the PIH compared to the Non-PIH group. PIH subjects had 4 times higher chance of developing HTN (Odds Ratio 4.2). In parallel to the findings on HTN the PIH group showed a significantly higher proportion of CKD . Both UTP and UPCR were significantly higher in the PIH group as compared to the Non-PIH group. The PIH subjects had almost 3 times chance of developing CKD compared to the Non-PIH group. Conclusions: About one-third of women with a previous history of PIH develop HTN in later life and the proportion is 2 times higher. About 8% of women with previous history of PIH develop CKD in later life. 0106 The importance of systemic lupus erythematosus remission status in pregnancy: an Indonesian case control study Manggala Pasca Wardhana1, Fitria Khusnul Khotimah2, Khanisyah Erza Gumilar1, Muhammad Ilham Aldika Akbar1, Budi Wicaksono1, Ernawati Ernawati1, Agus Sulistyono1, Aditiawarman Aditiawarman1, Hermanto Tri Juwono1, Erry Gumilar Dachlan1 1 Maternal Fetal Medicine Division, Obstetrics & Gynecology Department, Faculty Medicine of Airlangga University, Dr. Soetomo General Hospital - Airlangga University Hospital, Surabaya, East Java, Indonesia, 2Obstetrics & Gynecology Department, Faculty Medicine of Airlangga University, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia Introduction: Majority of Systemic Lupus Erythematosus (SLE) cases occurred in childbearing age of women. Therefore, the disease frequently found
© Editorial material and organization © 2017 Japan Society of Obstetrics and Gynecology. Copyright of individual abstracts remains with the authors.
Maternal Medicine
in pregnancy. One of the problems in developing country like Indonesia was ignorance of SLE diagnosis and treatment which contributes in complicated situation of SLE pregnant women. Objectives: To analyse risk factors, obstetric outcome, progression of SLE (flare) and the benefit of SLE remissions status. Methodology: Case control study using medical record on pregnant women complicated by SLE in major East Java tertiary referral hospital over 2.5 years. Results: 4808 pregnant women was admitted, with 36 cases (0.75%) had SLE. Majority of cases occurred in maternal age of 20-35 y.o (80%), multiparity (58%). Two cases (8%) had miscarriage and 48% delivered by cesarean. Sixty eight percent patient had low birthweight and majority of cases had low apgar score. Thirteen cases (36%) suffered flare, 8% had preeclampsia and 11% encountered nephritic lupus. Unfortunately, three were three maternal mortality due to multiple organ failure in SLE flare status during pregnancy. Fetal Growth Restriction and prematurity increased significantly in SLE patients compared with non-SLE patients (p
