The aim of this study was to compare maternal cardiac function in a cohort of women who were high risk for early (<34 weeks) pre-eclampsia (ePET) and subsequently had normal or adverse outcomes. Methods: This was a prospective study of maternal cardiac function in women deemed high risk of ePET by first trimester screening at 12 weeks. Serial echocardiographic assessment (Accuvix XG, Samsung Medison with P2-4BA probe, Seoul, Korea), of maternal cardiac output (CO) and total peripheral resistance (TPR) were calculated at 14, 18, 24 and 30 weeks. Pregnancy outcomes were recorded and defined as being normal or adverse (the development of hypertension, delivery of an infant of low birthweight (<5th centile) or preterm birth (<37 weeks' gestation). The cardiovascular parameters were compared between the two groups. Results: 31 women who had a high risk ePET screen participated; 18 with a normal and 13 (42%) with an adverse pregnancy outcome. The adverse outcome group included 3 (9.7%) pre-eclampsia, 3 (9.7%), gestational hypertension, 4 (12.9%) preterm birth and 4 (12.9%) infants with low birthweight. Mean CO (L/min) values were significantly lower in those with an adverse outcome; 4.99 vs 4.17: P=0.04 at 14 weeks and 5.35 vs 4.61: P<0.01 at 30 weeks gestation. The mean TPR (dyne/sec/cm-5) was significantly higher in the adverse outcome group at 14 weeks (1431 vs. 1722: P=0.04), 24 weeks (1316 vs. 1577: P<0.01) and 30 weeks (1323 vs. 1658: P<0.01) gestation. Conclusions: Women who are high risk for ePET and subsequently have an abnormal outcome have evidence of abnormal cardiac function with lower CO and higher TPR as early as 14 weeks gestation. These parameters may be useful as a second tier screening tool for pregnancies deemed 'high risk' by first trimester screening and may help reduce the false positive rate and increase the positive predictive value of the screening process.
Oral communication abstractsObjectives: Precise imaging diagnosis of ovarian tumor is a major issue for operative management. A combination of magnetic resonance imaging (MRI) images with real time high-resolution ultrasound known as fusion imaging may improve gynecologic pathologies investigations such as ovarian tumors. This study was undertaken to evaluate the feasibility of using fusion of MRI and ultrasound (US) in ovarian tumor characterisation. Methods: This prospective bicentric study included 25 patients referred for ovarian tumor diagnosed by US. All cases underwent 1.5 Tesla MRI protocol including at least 3 T2-weighted planes, with diffusion sequence and dynamic series. The Digital Imaging and Communications in Medicine volume dataset was then loaded into the US system for manual registration of the live US image and fusion imaging examination. The results of the fusion were then compared with US and MRI results alone. Results: Ovarian tumors could be investigated by fusion imaging. US was more efficient to characterise small vegetations whereas T2-weighted MRI was limited by the size of the vegetations. The use of the color Doppler added a vascular criteria which could help the interpretation of the fusion imaging. The diagnosis of malignant tumor was improved by the use of the fusion thank to the complementarity of US and MRI and the addition of the malignant criteria. Conclusions: Multimodality fusion imaging is feasible to investigate ovarian tumors, as US and MRI are complementary. The combination of real time MRI and US image fusion could help to characterise ovarian tumors when the interpretation was difficult by isolated US and MRI.OC03.02 * Does HE4 improve the diagnosis of pelvic masses in non-experienced examiners? Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, HungaryObjectives: To determine the additive diagnostic value of HE4 tumor marker to in the IOTA's three step strategy for managing adnexal masses focusing on non-experienced examiners. Methods: Imaging properties of ovarian masses were evaluated preoperatively using the IOTA terms and definitions. Two groups of patients were made: 1: premenopausal (PEM); 2: postmenopausal (POM). In both groups adnexal masses were characterised by the 'easy descriptors' and in cases where these were not applicable the IOTA Simple rules had been used. US results then were matched with the preoperative CA125 and HE4 tumor marker levels and histological findings. Results: Overall 285 patients with ovarian masses were recruited in the analysis (average: 42.0 yrs; range: 12-82 yrs). In the PEM group we had 199 cases (69.82%; range: 12-53 yrs; average: 33.12 yrs), * This presentation is eligible for the Young Investigator award (to be presented in the closing plenary).in the POM group 86 cases were involved (30.18%; range: 48-82 yrs; average: 63.09 yrs). In the PEM group 104 patients had the diagnosis based on easy descriptors (52.26%) while 76 patient of the rest fulfilled the requirements for the simple rules. In the POM grou...
Large fetal weight alone in Robson-1 parturients doesn't translate into a risk of Caesarean delivery higher then that of a vaginal birth Abstract Objective The authors analysed the Caesarean section rate as a function of birth weight among Robson-1 parturients and compared with that among the unselected obstetric population. Study design A retrospective analysis of birth weight, maternal height and the route of delivery was carried out in an unselected obstetric population of 26012 parturients. The authors compared birth weight centile distributions of vaginally, and that of abdominally delivered fetuses between Robson-1 parturients as well as those of the total obstetric population. ResultsThe 90th birth weight centile of fetuses delivered at 37, 38, 39, 40, 41, and 42 weeks gestation were 3960 g, 3960 g, 4000 g, 3950 g, 4000 g and 3820 g, respectively. Among Robson-1 parturients, 677 fetuses weighed >4000 g, and 448 patients (66%) were delivered vaginally. Maternal height did not influence either the birth-weight-percentiles or the Caesareanrates substantially. Above the birth weight of 4000 g, the Caesarean-rate among Robson-1 parturient rose similarly to that of the total obstetric population. In the knowledge of the most accurately estimated fetal weight, the odds of a Caesarean delivery among Robson-1 parturients was not different from that of the total obstetric population. Among pregnancies with fetuses weighing less than 5000 g, the Caesarean-rate was below 50% in both Robson-1 parturients and the total obstetric population of 10 years. ConclusionEven the best possible estimation of fetal weight cannot give a valid reason to downplay the intent of vaginal birth based on the fetal size above 3900g that would be associated with increased odds of Caesarean delivery.Large fetal weight alone in Robson-1 parturients doesn't translate into a risk of Caesarean delivery higher then that of a vaginal birth
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