Sildenafil therapy was associated with a significant improvement in the echocardiographic markers of PAH and a reduction in FiO2. The medication was well tolerated.

DJ. Comparing second-line tests to assess fetal wellbeing in Labor: a feasibility study and pilot randomized controlled trial.

Acute pancreatitis can be a life-threatening condition at any stage of life. It is seen in up to 3 in 10 000 pregnancies, with high rates of preterm delivery and maternal mortality rates of up to 3%. Diagnosis in pregnancy can be more challenging, and its aetiology is distributed differently to that of the nonpregnant population. When managing pregnant patients, consideration of implications for the fetus poses an additional challenge. Pregnant patients with chronic pancreatitis need careful assessment, paying attention to nutritional and exocrine needs, pain management and the development of diabetes mellitus. Learning objectivesKnow the symptoms, signs and causes of acute pancreatitis in pregnant women, as well as methods of investigation and classification. Understand how to manage acute pancreatitis. Appreciate the challenges faced by women with chronic pancreatitis and how to manage them, including pregnancy outcome.

BackgroundPregnancy outcomes in women with pre-existing coronary artery disease (CAD) are poorly described. There is a paucity of data therefore on which to base clinical management to counsel women, with regard to both maternal and neonatal outcomes.MethodWe conducted a retrospective multicentre study of women with established CAD delivering at 16 UK specialised cardiac obstetric clinics. We included pregnancies of 24 weeks’ gestation or more, delivered between January 1998 and October 2018. Data were collected on maternal cardiovascular, obstetric and neonatal events.Results79 women who had 92 pregnancies (94 babies including two sets of twins) were identified. 35.9% had body mass index >30% and 24.3% were current smokers. 18/79 (22.8%) had prior diabetes, 27/79 (34.2%) had dyslipidaemia and 21/79 (26.2%) had hypertension. The underlying CAD was due to atherosclerosis in 52/79 (65.8%), spontaneous coronary artery dissection (SCAD) in 11/79 (13.9%), coronary artery spasm in 7/79 (8.9%) and thrombus in 9/79 (11.4%).There were six adverse cardiac events (6.6% event rate), one non-ST elevation myocardial infarction at 23 weeks’ gestation, two SCAD recurrences (one at 26 weeks’ gestation and one at 9 weeks’ postpartum), one symptomatic deterioration in left ventricular function and two women with worsening angina. 14% of women developed pre-eclampsia, 25% delivered preterm and 25% of infants were born small for gestational age.ConclusionWomen with established CAD have relatively low rates of adverse cardiac events in pregnancy. Rates of adverse obstetric and neonatal events are greater, highlighting the importance of multidisciplinary care.

BackgroundA Rheumatology Obstetric Combined Clinic (ROCC) has been running in our trust since 2013 for patients with any musculoskeletal (Msk) rheumatological disease. Observing pregnant ladies in this clinic it became noticeable that patients with msk diseases do not always go into remission during pregnancy.ObjectivesTo register their perception of disease activity during pregnancy and from their memory of that disease activity before pregnancy. A secondary aim was to assess whether the remission (or flare) during pregnancy was disease specific or trimester specific.MethodsPatients with Msk disorders attending ROCC were given 2 different 10 cm visual analogue scales (VAS) asking them to grade the current (at the time of the assessment in ROCC) disease activity and their perceived disease activity prior to pregnancy. The recorded diseases were: (1) Lupus and other Connective Tissue Diseases= 18 [(33.3%) of whom 13 were having Lupus and 5 Sjogren’s syndrome, (2)SPAs =16 [(28.6%) of whom 4 had Ankylosing Spondylitis (AS) and 12 Psoriatic arthritis (PsA)], (3) Rheumatoid Arthritis (RA) =9 (16.7), Antiphospholipid Syndrome (APS) =7 (13%) and other =4 (7.4%). In the “other” group there was 1 patients with sarcoidosis, 1 with Adult Onset Still’s disease, 1 JIA which progressed to CREST, 1 knee pain. The last group was excluded from the analysis. SPSS was used for statistical analysis and chi square to assess the difference between the 2 groupsResultsWe analyzed data from 50 patients who attended the ROCC. At the time of presentation mean age ( ±sd) was 33.4 years (± 4.29) range 22-43y while age of disease presentation was 25.5 ( ±8.06). The weeks (w) of pregnancy during the time of assessment were (mean) 22.2 (±8.6) range 8-37 w. ESR (mean in mmHg) was 27 (± 21.7), CRP 13.6 ( ±14.18). Disease activity at presentation on a VAS was 4.24 (± 2.8) while reported disease activity prior to pregnancy was exactly the same of 4.24 ( ± 3.07).Looking at groups of diseases RA and SpA patients showed reduction in the reported disease activity during pregnancy while CTDs and APS showed an increase, both of which however was not statistically significant (ss (table1)Diseases (nr of patients)Disease activity during pregnancy[mean (± sd)]Disease activity before pregnancy[mean (+sd)]Statistical significanceCTDs (18)4.5 ( 2.6)3.93 ( 2.40.6SpAs (16)4.6 (2.8)5.8 (3.9)0.8RA (9)4.13 (2.5)4.75 (2.5)0.9APS (7)2.2 (3.1)1 (1.7)0.4Looking at DA according to trimester, it was in the 1st trimester (up to week 13) that patients were reported remision. (table 2 and figure 1).Trimester(n= number of patients)ESRCRPDisease activity (current)Disease activity (before)Ss (chi square)1st (n=14)6 ( 6.9)20 (30) 1.64 ( 2.09) 2.5 (2.7) 0.02 2nd (n=19)30.2 (35.5)16.8 (SD +13.5)4.4 (3.6)4.2 (3.5)0.23rd (n=18)17.3 (20.3)3.9 (sd +5.5)3.67 (2.56)3.4 (3.14)0.4Abstract AB1229 Figure 1shows DA according to trimester before and during pregancyConclusionIn our group of pregnant patients with Msk diseases the overall disease activity is the same during pregnancy and bef...