A. Y. Weintraub

Puerperal ventral epidural hematoma after epidural labor analgesia

Serious complications in obstetric anesthesia are a rare occurrence. High neuraxial block, respiratory arrest in labor and delivery, and an unrecognized spinal catheter are among the most frequently reported serious complications. A serious complication occurs in approximately 1:3000 obstetric patients. Neuraxial hematoma after obstetric epidural analgesia or anesthesia is extremely rare. We present a case of a puerperal spinal epidural hematoma following epidural labor analgesia. The patient presented with foot drop, which resolved after conservative treatment. We reviewed the epidemiology, clinical manifestations and treatment options for this rare complication.

P08.09: Umbilical artery peak systolic velocity in IUGR fetuses

was to determine the performance of screening for PE in singleton pregnancies during routine clinical practice. Methods: Between 2011–2012 measurements of UtA-PI were performed at 11–13+6 weeks, and mean pulsatility index (PI) was calculated. Doppler, maternal history and biometry variables (age, ethnic origin, method of conception, BMI, parity, smoking, family or personal history of hypertension or PE, blood pressure) were combined with first trimester PAPP-A to assess the risk of PE. Astraia Software 2.3.2 was used in risk calculation. Results: 2552 women were recruited after informed consent to the study, and outcome data were available in 950 (37.2%) cases. PE occurred in 36 (3.8%) patients. The overall detection rate of early and late PE was 44.4% (16/36) with a false positive rate (FPR) of 12.3% (112/914). There were only 2 cases with early PE, the detection rate was 50% (1/2), with a FPR of 18.7% (178/948). The detection rate of the late PE (delivery at 34th weeks or after) was 44.1% (15/34), with a FPR of 9.5% (87/914). Conclusions: Combining risk factors in the mother’s history with UtA-PI allows calculation of patient-specific risk for the development of PE. Because of the small number of early PE cases in our study population our detection rate can not be taken into consideration. The detection rate (44%) of late PE in our study is comparable with the published retrospective data (60%). The Astraia software used only serum PAPP-A for risk calculation. Further biochemical markers might improve the detection rate. Follow-up of our recruited cases is still going on.

OP08.04: Cervical length measurements in patients presenting with preterm contractions at 28–32 weeks gestation

Objectives: Uterine cervix changes shortened and softened during pregnancy. Although cervical length has been studied and known sufficiently as a predictor of preterm birth, cervical consistency has still not been studied and understood well because its measurement like elastography requires special equipment and instrument. This study aimed the difinition of the new simple index to evaluate cervical consistency using transvaginal B-mode ultrasonography. Methods: This study was a prospective study conducted from September 2011 to March 2012. Manual examination and transvaginal ultrasonography of the uterin cervix in regular checkups at our clinic from sixty-four singleton pregnant women without any complications were allocated for the study. ‘‘Cervival deformityconsistency index (DCI)’’ was defined as follows: cervival length in trace length (L) and thickness (D) were measured by tranvaginal B-mode ultrasonography; the cervix was consecutively compressed by the probe at the side and then the trace length (L′) and the thickness (D′) were measured; DCI was given as (L/D)/(L′/D′) ×100. DCI was compared to manual examination and studied about the relationship to premature labor. Results: DCI was smaller when cervix was manually diagnosed soft than when firm. DCI showed significantly smaller value between 28th and 32nd week among the women with premature labor than among ones following normal course (54.2 ± 13.1 vs. 65.1 ± 12.6; P < 0.01). Conclusions: DCI was demonstrated as an objective value of cervical consistency. As DCI of premature labor women showed smaller values, simple evaluation of cervical consistency as important as uterine contraction has got available to be concerned. DCI is simple and easy to obtain and is therefore to be discussed about its availability with more data accumulated.

OP09.10: Early postpartum uterine artery Doppler velocimetry among patients with severe pre-eclampsia compared to normotensive controls

Objectives: Uterine Doppler is used in screening for placentaassociated diseases, such as pre-eclampsia and intrauterine growth restriction of the fetus (IUGR). The aim of this study was to examine the predictive value of second trimester uterine Doppler in pregnancies complicated by systemic lupus eritematosus (SLE). Methods: Observational study on 55 pregnancies in women with SLE treated at our Unit from 2000 to 2008. The Doppler examination was performed between 23+0 and 25+6 weeks of gestation. The mean uterine artery pulsatility index (UtA PI) was calculated. Results: The median (interquartile range, IQR) UtA PI was 1.00 (0.90–1.20). Three patients had a mean uterine artery PI above the 95th centile for gestational age. All these patients developed pre-eclampsia and IUGR. No cases of pre-eclampsia or IUGR were observed in patients with the mean uterine artery PI below the 95th centile for gestational age. The sensitivity was 100% (95% CI 0.44–1.00), specificity was 100% (95% CI 0.93–1.00). Conclusions: In our series, the mean uterine artery PI was an excellent predictor for pre-eclampsia and IUGR in women with SLE.

P30.20: Cervical length in women undergoing induction with balloon catheter device

Objectives: Although screening ultrasound for detection of major fetal anomaly is usually done in mid-trimester, fetal anomalous structure can be also found in the third trimester during subsequent routine ultrasound. To objective of this study is to evaluate the frequency and spectrum of fetal anomalies diagnosed in the third trimester. Methods: Cases with fetal anomalies in singleton pregnancy which were confirmed by postnatal diagnosis was evaluated between Jan 2008 and Dec 2009 in Seoul National University Hospital. The gestational age of detection of fetal anomaly was classified as 1st/2nd trimester and 3rd trimester. We excluded cases in which routine screening ultrasound for detection of major fetal anomaly in mid-trimester was not done. Results: There were a total of 162 cases of fetal major anomalies during the study period. Twenty-nine cases (18%) of fetal anomalies were diagnosed subsequently in the third trimester, and 14 cases (48%) had CNS (central nervous system) or heart anomalies. In 6 cases with CNS anomalies, 4 cases were those with intracranial hemorrhage or destructive lesion and 2 cases were Dandy-Walker variant. Among 11 cases with heart anomalies, 4 cases were those with arrhythmia, 2 cases with coarctation of aorta/hypoplastic left heart syndrome, and 1 case with pulmonary stenosis. Three cases has both CNS and heart anomalies. Conclusions: Even though the result of routine ultrasound in midtrimester is normal, fetal anomalies can be additionally detected in about 20% of cases during the third trimester. About half of these anomalies diagnosed in third trimester are CNS or heart anomalies, and spectrum of anomalies might be different from that diagnosed in the first/second trimester.

OP21.04: Association between 1st trimester vaginal bleeding and uterine artery Doppler measured at 2nd and 3rd trimesters of pregnancy

Mean CRL was 63.03 ± 8.30 mm. Mean gestational age was 12.55 ± 0.63 weeks. Fetal placental sites and ratios were as following; Anterior location 48.1%, Posterior location 40.9%, Lateral location 5.4% and fundal location 3.6%. Left and right uterine artery PI values according to placental sites are shown in the Table 1. There were no statistical significant differences among placental sites. Unilateral or bilateral uterine artery notch was present in 350 pregnant women (19%). Uterine artery notch laterality ratios according to placental sites are as following; in anterior location (n = 168) 65% bilateral, 24% left sided, 11% right sided; in posterior (n = 122) 68% bilateral, 18% left sided, 13% right sided; in lateral (n = 39) 62% bilateral, 28% left sided, 10% right sided and in fundus (n = 21) 58% bilateral, 28% left sided, 14% right sided. The ratios did not show significant difference. Conclusions: The placental site does not seem to have effect on uterine artery PI values and the laterality of uterine artery notch.