BackgroundThough insulin resistance (IR) is common in polycystic ovary syndrome (PCOS), there is no agreement as to what surrogate method of assessment of IR is most reliable.Subjects and methodsIn 478 women with PCOS, we compared methods based on fasting insulin and either fasting glucose (HOMA-IR and QUICKI) or triglycerides (McAuley Index) with IR indices derived from glucose and insulin during OGTT (Belfiore, Matsuda and Stumvoll indices).ResultsThere was a strong correlation between IR indices derived from fasting values HOMA-IR/QUICKI, r = −0.999, HOMA-IR/McAuley index, r = −0.849 and between all OGTT-derived IR indices (e.g. r = −0.876, for IRI/Matsuda, r = −0.808, for IRI/Stumvoll, and r = 0.947, for Matsuda/Stumvoll index, P < 0.001 for all), contrasting with a significant (P < 0.001), but highly variable correlation between IR indices derived from fasting vs OGTT-derived variables, ranging from r = −0.881 (HOMA-IR/Matsuda), through r = 0.58, or r = −0.58 (IRI/HOMA-IR, IRI/QUICKI, respectively) to r = 0.41 (QUICKI/Stumvoll), and r = 0.386 for QUICKI/Matsuda indices. Detailed comparison between HOMA-IR and IRI revealed that concordance between HOMA and IRI was poor for HOMA-IR/IRI values above 75th and 90th percentile. For instance, only 53% (70/132) women with HOMA-IR >75th percentile had IRI value also above 75th percentile. There was a significant, but weak correlation of all IR indices with testosterone concentrations.ConclusionsSignificant number of women with PCOS can be classified as being either insulin sensitive or insulin resistant depending on the method applied, as correlation between various IR indices is highly variable. Clinical application of surrogate indices for assessment of IR in PCOS must be therefore viewed with an extreme caution.

Strain elastography of the uterine cervix may be useful in the diagnosis and prediction of obstetric complications. The inability to obtain quantitative results, with only the possibility of visual semiquantitative evaluation of the obtained elastograms, has been the limitation of the method thus far. E-Cervix is a software program that uses intrinsic compression to excite tissue and allows the evaluation of quantitative parameters on the basis of pixel distribution in an elastogram. The aim of this study was to assess the repeatability and reproducibility of quantitative cervical strain elastography (E-Cervix) of the uterine cervix and to assess the correlation of the obtained parameters with selected clinical features of patients in the third trimester of pregnancy. In total, 222 patients participated in the study. We assessed 5 ultrasound parameters: elasticity index (ECI), hardness ratio (HR), internal os strain (IOS), external os strain (EOS) and IOS/EOS ratio. Each study was performed according to a predetermined standardized protocol. For all assessed elastographic parameters, we obtained good intra- and interobserver reproducibility. The interclass correlation coefficient (ICC) ranged from 0.77 to 0.838 for intraobserver variability and from 0.771 to 0.826 for interobserver variability. We demonstrated a significant correlation of some obtained elastographic parameters with the basic clinical features of patients, such as age, the number of previous caesarean sections, pregnancy weight and BMI. In each case, the correlation was very low. Quantitative elastographic assessment with the use of E-Cervix is characterized by good repeatability. Some clinical features may affect the value of the parameters obtained. The clinical relevance of this interference requires further investigation.

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Abstr AC tPCOS is widely accepted as associated with an increased cardiovascular risk, however, without convincing evidence of an increased cardiovascular mortality. We assessed prevalence of obesity, glucose intolerance, and dyslipidaemia in 490 women with PCOS, aged 24.75 ± 8.05 years, diagnosed according to the Rotterdam consensus criteria. Fifty-two percent of women had BMI < 26 kg/m 2 , 81.8 % had total cholesterol < 200 mg/dl, 82.8 % had LDL cholesterol < 130 mg/dl (48.3 % < 100 mg/dl), 81.4 % had triglycerides < 150 mg/dl, 96.08 % had fasting glucose < 100 mg/dl, 90.3 % had glucose < 140 mg/dl at 120′ of OGTT. The most frequent abnormality was low HDL cholesterol, as only 33.9 % had LDL > 60 mg/dl. Combination of several risk factors related to dyslipidaemia was, however, relatively rare, for example, a combination of raised total cholesterol and LDL cholesterol was present only in 2.9 % of subjects. An increase in BMI, total cholesterol, LDL-cholesterol, and glucose concentrations at 120′ of OGTT was more pronounced in women, who had raised concentrations of at least two androgens (n = 172, 35.1 %), yet there was no increase in insulin resistance parameters, that is, HOMA-IR, QUICKI, McAuley, or Belfiore index. Contrary to common belief, over 50 % of women with PCOS have normal body weight, and with exception of lower HDL cholesterol, most have no significant dyslipidaemia or glucose intolerance. Women with normal or borderline abnormal androgens, who form the majority of PCOS subjects, seem to have more healthy metabolic profile. This might be one of the reasons for the absence of evidence of an increased CV mortality in women with PCOS.

Objectives: The primary objective was to compare point-of-care ultrasound (POCUS) and routine third trimester ultrasound versus routine antenatal care in reducing the incidence of undiagnosed breech presentation in labour. Methods: We included data from St. George's (SGH) and Norfolk and Norwich University Hospitals (NNUH). Pregnancies were grouped according to whether they received routine third trimester scan (SGH) or POCUS (NNUH). Women with multiple pregnancy, preterm birth < 37 weeks, congenital abnormality and those undergoing planned Caesarean section for breech presentation were excluded. Undiagnosed breech presentation was defined as: a) women presenting in labour or with ruptured membranes at term subsequently discovered to have a breech presentation; b) women attending for induction of labour at term found to have a breech presentation before induction. The primary outcome was undiagnosed breech presentation in labour. Secondary outcomes included mode of birth and neonatal adverse outcomes. Results: Before and after the implementation of routine third trimester scan or POCUS, there were 16,777 and 7,351 births in SGH and 3,974 and 4,522 in NNUH, respectively. The rate of breech presentation in labour was consistent across all groups (3-4%). The rates of undiagnosed breech in labour were 1.0 (95% CI: 0.2-1.7) and 4.9 (95% CI: 3.8-6.0) per 1,000 births with and without routine third trimester scan. There were ∼4 fewer undiagnosed breech cases per 1,000 births with routine scanning (p < 0.0001). A similar effect was observed with routine POCUS: undiagnosed breech fell from 7.6 (95% CI: 4.9-10.3) to 0.7 (95% CI: 0.0-1.4) per 1,000 births. Neonatal outcomes were generally poorer in undiagnosed breech: higher rates of Apgar score < 7 at 5 th minute (9.5 versus 0.7%, P < 0.0001), need for resuscitation (34.8% versus 1.35%, P < 0.0001) and neonatal unit admission (9.0 versus 1.2%, P < 0.0001). Conclusions: Routine third trimester scan or POCUS reduces the rate of undiagnosed breech in labour.OP08.