András Molnár

Placental three-dimensional power Doppler indices in mid-pregnancy and late pregnancy complicated by gestational diabetes mellitus

The aim of our study was to evaluate placental three‐dimensional power Doppler indices in diabetic pregnancies in the second and third trimesters and to compare them with those of the normal controls.

Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction.

To examine placental vascularization using three‐dimensional power Doppler (3DPD) ultrasonography in pregnancies complicated by intrauterine growth restriction (IUGR).

P25.07: Three-dimensional power Doppler ultrasound examination in pregnancies complicated by intrauterine growth restriction

Objectives: To compare published reference charts of Umbilical Artery (UA), Middle Cerebral Artery (MCA) Doppler and Cerebroplacental Ratio (CPR), in order to assess the clinical impact in management arising from the variation between different reference charts. Methods: MEDLINE was searched for all the studies published between 1988 and 2016 whose only aim was to create fetal Doppler reference values. The search yielded 725 possible citations, of which 21 studies reporting normal Doppler reference values were finally included in the review for Umbilical Artery (11), Middle Cerebral Artery (12) and Cerebroplacental Ratio (3). The differences between Pulsatility Index (PI) cut-off values at clinically relevant centiles were expressed in percentage form by subtracting the lowest from the highest PI and dividing by the highest. A simulation analysis was performed on a historical cohort of SGA fetuses (n= 617) to evaluate the impact of this variability on clinical management. Results: Wide discrepancies in reported Doppler references values were found. Middle cerebral artery showed the greatest differences between clinically relevant PI cut-off values: for the 5th centile of MCA PI there was up to 47.2% variation between published references at 36-37 weeks of gestation. Differences between the 95th PI umbilical artery cut-off centile were above 20% at 28-38 weeks. For the CPR the 5th centile values varied from 17% (at 39 weeks) to 35% (at 37 weeks). Simulation analysis showed that, depending on the chart used, the prevalence of abnormal UA, MCA and CPR varied in our historical cohort from 18.2% to 2.1%, 0.7% to 22.6% and 4.3% to 26.5% respectively. Conclusions: Large differences exist in current fetal Doppler reference charts at clinically relevant cut-offs. The choice of chart used could lead to a significant change in clinical management. Therefore, an attempt to standardise fetal Doppler reference ranges is mandatory, as this variability may lead to suboptimal outcomes in clinical practice and research.

OP21.07: From when can we detect an alteration in fetal weight to placental volume ratio in pregnancy complicated by diabetes mellitus?

Methods: A prospective cohort study was conducted at Korle Bu Teaching Hospital, Ghana over a six-month period. SCD patients at 34 weeks gestation or more were recruited to undergo weekly Doppler assessment until delivery. The CPR was calculated and participants were categorised into two study arms based on a CPR<1.1 or >1.1. Adverse perinatal outcomes including IUGR, stillbirth, low birth weight and NICU admissions were compared between the two groups. Results: There were five fetuses with CPR<1.1 and 25 adverse perinatal events: 2 stillbirths, 10 low birth weight neonates, 12 NICU admissions and 1 APGAR score below 7 at 5 minutes. A CPR<1.1 had positive and negative predictive values of 100% and 72% respectively for predicting composite adverse perinatal outcomes. The sensitivity and specificity for predicting stillbirths were 100% and 93% respectively and 40% and 97% respectively for low birth weight. There was no significant difference in perinatal outcomes between the two major sickle cell genotypes (SS and SC). Mothers in the CPR< 1.1 group were also more likely to have severe anemia, blood transfusions and acute malaria during their pregnancy. Conclusions: A CPR <1.1 was shown to be significantly associated with adverse perinatal outcome especially low birthweight (<2.5kg) and antenatal stillbirths in fetuses of women with sickle cell disease.

A háromdimenziós power Doppler-indexek és a perinatalis kimenetel vizsgálata méhen belüli növekedési restrikcióval szövődött terhességekben

Absztrakt: Bevezetes: A mehen beluli novekedesi restrikcio (IUGR) kialakulasa az esetek egy reszeben anyai vagy magzati okokra es szamos esetben lepenyi okokra (csokkent lepenyi keringes) vezethető vissza. Celkitűzes: Celkitűzesunk a csokkent lepenyi erezettseg/keringes es a csaszarmetszesarany, illetve a klinikai kimenetel kozotti osszefugges vizsgalata volt, tovabba megfelelően hitelesitett es reprodukalhato modszer hasznalata a placenta in vivo funkcionalis vizsgalatara, amely kesőbb a rutin-terhesgondozasba is beepithető. Modszer: Prospektiv eset-kontroll vizsgalatunkba 254, masodik es harmadik trimeszterben levő varandost vontunk be, akiknel vascularisatios indexet (VI), aramlasi indexet (FI) es vascularisatios aramlasi indexet (VFI) mertunk 3 dimenzios power Doppler- (3DPD) technikaval. Eredmenyek: A VI-kozepertek 3,7% (3,2%–4,2%) volt az IUGR- es 10,1% (8,6%–10,9%) a kontrollcsoportban (p = 0,001). Az FI kozeperteke 40,0 (39,7–42,5) volt az IUGR- es 45,1 (44,1–53,1) a kontrollcsoportban (p = 0,012)...

Intraoperative Surgical Treatment of Undiagnosed Placenta Percreta

Background: To describe a case of a 38-year old pregnant woman with an intraoperative diagnosis of placenta percreta complicated by central placenta previa. The ultrasound scan did not show signs of any type of abnormal placental invasion, just central placenta previa was visualized. Methods: At 36 weeks of gestation, she underwent an elective cesarean section combined with peripartum hysterectomy with bladder wall resection under general anesthesia because of antenatally undiagnosed placenta percreta. Results: The therapy was provided by a multidisciplinary team, and the patient was in relatively good condition. Intraoperative blood loss was 2500 mL. A total of 10 units of red blood cells and 3 units of fresh frozen plasma were used. Anesthesia time was 2 h and 15 min. The postoperative course was adequate. A live, premature male baby (2420 g) was born 8 min after the beginning of the operation with Apgar scores 8 and 7 at 1 minute and 5 minutes. Conclusion: We want to emphasize that, in spite of the absent typical symptoms and absent typical ultrasound signs of placenta percreta, we have to be cautious in the presence of risk factors. If we have a suspicion for adherent placenta, an MRI scan should be performed.

Placental volume relative to fetal weight estimated by sonography in diabetic pregnancies

Abstract Objective: Our purpose was to analyze the fetal weight and placental volume (PV) ratio in diabetic pregnancies during mid-pregnancy. Method: One hundred and forty nine diabetic pregnancies [75 gestational diabetes mellitus (GDM) and 74 diabetes mellitus type I (T1DM) with good glycemic control] and 232 healthy patients were analyzed by three-dimensional sonographic volumetry of the placenta, while fetal weight was estimated by two-dimensional technique. Results: The gestational age-specific estimated fetal weight (EFW) [EFWGDM: 1840.8 ± 932.82 g; EFWT1DM: 1475.6 ± 914.7 g (mean ± standard deviation) and placental ratio (PR)] was significantly higher (p < 0.05) in pregnancies complicated by GDM and T1DM (PRGDM: 5.5 ± 1.67 g/cm3, PRT1DM: 4.56 ± 3.2 g/cm3) compared to control group (Q) (EFWQ: 532 ± 186.49 g; PRQ: 2.2 ± 0.8 g/cm3), whereas PV was significantly higher (p < 0.05) only in GDM (PVGDM: 334.3 ± 111.5 cm3) compared to control data (PVQ: 232 ± 78.9 cm3). In contrast to GDM, T1DM with good glycemic control did not predispose to any changes in placental sonographic volumetric differences compared to control values. Conclusions: Fetal weight related to the PV is already elevated in second trimester in pregnancies complicated by gestational diabetes mellitus and type I diabetes mellitus compared to normal pregnancies.

Synthesis of Phosphopeptides on Solid Phase Using tert-Butyl-H-phosphonate Salts

The phosphorylation of proteins is probably the most important reversible element of the cell regulation. The involvement of tyrosine residue in this process is well known, and a similar controlling mechanism concerning serine/threonine containing proteins was recently discovered [1]. The isolation of phosphorylated peptides from biological sources for functional or conformational studies is usually not feasible, therefore there is a need for efficient chemical phosphorylation methods. Although many papers on phosphopeptide synthesis were published in the past, a universal method, which can be applied with high efficiency in all cases does not exist. In several cases, after incorporation of the phosphate moiety, the molecule can undergo different side-reactions [2]. To overcome these problems, one of the most widely used and favorable methods makes use of monoprotected phosphate-containing building blocks of Tyr, Ser and Thr [3]. Another alternative is the use of an asymmetrically protected amidite reagent [4,5] or the use of H-phosphonates (phosphonic acid monoesters) that have been applied successfully in oligonucleotide synthesis.