Abstract:Objective: The aim of this study was to establish the physiologic changes in hemostasis during pregnancy and to fi nd the association between the factor V Leiden mutation and adverse pregnancy outcome. Methods: We investigated blood samples of 148 pregnant women during each trimester of pregnancy. We measured their serum concentrations of factors I, II, V, VII, VIII, IX, X, XI, XII, D-dimers, prothrombin time, INR, aPTT, activity of protein C and S, antithrombin III and platelet count. The pregnancy outcome of women with factor V Leiden mutation was compared to those without congenital thrombophilia. Results: Prothrombin time, INR and aPTT were signifi cantly shorter. We found signifi cantly higher plasma concentrations of fi brinogen and d-dimers and higher levels of activity of factor VII and X in the third trimester. No signifi cant difference was found in protein C and antithrombin III activity. The protein S activity was lower in the second trimester and it increased in the third trimester. Although most of the clotting factors were rising during the pregnancy, there was no evidence of fi brinolytic overactivation. In our study, the carriership of factor V Leiden mutation did not affect the incidence of preeclampsia, eclampsia, intrauterine fetal death and venous thromboembolism. Placental abruption was rare. Conclusion: Hemostatic changes in pregnancy are signifi cant and essential, and have the potential to cause adverse pregnancy outcome. In addition, hypercoagulable state during pregnancy is considered to be physiological (Tab. 4, Ref. 36). Text in PDF www.elis.sk.

BACKGROUND: Our objective was to identify the risk factors associated with placenta accreta. METHODS: Cases of peripartum hysterectomy at University Hospital of Bratislava were identifi ed in the period from January 1st 2008 to December 31th 2013. Included were only those cases which had a histological evidence of placenta accreta. RESULTS: Fifty patients, who underwent peripartum hysterectomy were included in the study. Between 2008 and 2013 eight cases of placenta accreta were identifi ed. Five (62.5 %) of these were suspected before delivery. The overall incidence of PA was 0.19 per 1000 deliveries. Median gestational age at delivery was 37 weeks (range 25-41 weeks). Six of eight (75 %) women with placenta accreta had a previous caesarean delivery or curettage. In 5 patients both placenta praevia and prior Caesarean delivery were present. Among the 50 women who underwent peripartum hysterectomy, 8 (16 %) were patients with both prenatally diagnosed placenta praevia and previous caesarean delivery, placenta accreta was suspected in 4 of these (50 %) compared with 10 of 42 (24 %) without this combination of risk factors. CONCLUSIONS: Those in whom placenta accreta was suspected were delivered earlier than 37 weeks of gestation and were less likely to have emergency delivery. Placenta accreta is the second most common indication for an emergency peripartum hysterectomy. There is a high suspicion of placenta accreta in patients with placenta praevia and after previous Caesarean section (Tab.

Summary:Objective: The aim of this prospective study was to find the association between the factor V Leiden mutation and adverse pregnancy outcomes. Methods: This study is an analysis of a prospective observational study of the frequency of placenta-mediated complications of factor V Leiden mutation carriers. We compared pregnancy outcomes of 11 women with a heterozygous form of the factor V Leiden mutation with 41 women of a control group. Results: All pregnancies ended with delivery of a living infant. None of the 52 pregnancies were complicated by venous thromboembolism. There were a few significant differences regarding placenta-mediated complications. The gestational age at delivery showed small significant differences. There was a significant difference in the birth weight deviation in percentage between FVL carriers and controls. The incidence of blood loss exceeding 1000 ml was higher in the control group. Conclusions: Carriership of the factor V Leiden mutation did not affect the incidence of preeclampsia. Adverse pregnancy outcomes such as placental abruption were rare. Eclampsia, intrauterine fetal death and venous thromboembolism did not occur. Our results provide evidence that the maternal heterozygous FVL mutation did not increase the risk of an adverse pregnancy outcome.

Short oral presentation abstracts prenatal clinic setting. Maternal levels of PAPP-A were measured at the time of the first prenatal visit (9 to 13+6 weeks) as part of the combined ultrasound and biochemical screening study. Low PAPP-A was defined as the lowest 5% of values for gestational age (< 0.4 MoM) and high AFP was defined as the top 5% of values for gestational age (> 1.9 MoM). Intrauterine growth restriction was defined as birth-weight ≤ 3 th centile according to our local customized charts. The risk of IUGR in women with a low PAPP-A and normal AFP was compared with a control group with low PAPP-A and high AFP. No results were reported to either the obstetrician or patient. Results: A total of 5617 pregnant women were attended for prenatal care in our institution between January 2010 and December 2011. Of the 301 patients with a PAPP-A < 0.4 MoM, 141 had a determination of AFP done between 15 and 18 weeks and perinatal outcome is known for 96 of these patients. Women with a low PAPP-A were not more likely to have elevated levels of AFP. Only 4 patients (4.2%) had a low PAPP-A and high AFP. We had 6 cases of IUGR (6%): 3 cases (3.2%) in the group of low PAPP-A and normal AFP and 3 cases (75%) in the group of low PAPP-A and high AFP. The odds ratio for delivering a baby with IUGR for women with low PAPP-A and high AFP was 89 (95% confidence interval [CI] 7-1127). Conclusions: Although the small numbers of the study, this preliminary data suggest that low maternal levels of PAPP-A between 8 and 13+6 weeks and high levels of AFP between 15 and 18 weeks are highly associated with IUGR. OP31.02Single nucleotide polymorphism in pre-eclampsia prediction Objectives: Sonography predicts pre-eclampsia (PE) due to Doppler flowmetry in early pregnancy in some cases (1). On the other hand, evaluation of single nucleotide polymorphism (SNP) may put women at risk of developing PE in advance before starting the pregnancy (2). Many observations have revealed that a decreased level of HLA-G in the maternal serum correlates with pregnancy disorders, such as recurrent spontaneous abortion and PE (3). Methods: Using PCR we analyzed DNA samples from 15 PE women admitted to our department from 9/2010 to 2/2012 and 88 healthy women as out-patients. We evaluated the heterozygous and homozygous HLA-G genotype +14/−14, −14/−14 and +14/+14 in PE patients and in a control group (Fig. 1a). Results: In relation to 14 bp polymorphism screening, we determined frequencies of three HLA-G genotypes: the heterozygous genotype +14/−14 was revealed in 40% of PE patients versus 51.14% of a control group, the homozygous genotype −14/−14 was found in 20% of PE patients versus 28.41% of a control group and the homozygous genotype +14/+14 was found in 40% of PE and in 20.45% of a control group. Calculating the p-value revealed the highest statistical differences of homozygous genotype +14/+14 frequencies between pre-eclamptic women and a control group (P = 0.1094) (Fig.1b.). Conclusions: Our preliminary results have shown the association of 14 ...