Brazert J

Placental Doppler velocimetry in gestational diabetes mellitus

Abstract Objective: To evaluate if maternal glucose level and growth of the fetus were related to placental vascular impedance in pregnancy complicated by gestational diabetes mellitus. Material and methods: A retrospective study of 146 gestational diabetic women of which 117 needed insulin therapy. Glycosylated hemoglobin (HbA1c) was evaluated as well as umbilical and uterine artery Doppler velocimetry. The results were related to adverse outcome of pregnancy including newborn birthweight. Results: Abnormal umbilical artery blood flow velocity was seen in 5% of the cases and abnormal uterine artery flow in 16%. Uterine and umbilical artery vascular impedance was significantly lower in macrosomic newborns. There was a poor correlation between HbA1c, vascular impedance and birthweight. There were 11 cases that developed preeclampsia, all having abnormal uterine artery Doppler and two abnormal umbilical artery Doppler. Conclusion: Uterine and umbilical artery vascular impedance in pregnancies complicated by gestatinal diabetes is related to birthweight and placental weight, but not to maternal HbA1c levels. Placental Doppler ultrasound does not seem to be of clinical value for fetal surveillance in these pregnancies unless the pregnancy is complicated by preeclampsia and/or intrauterine fetal growth restriction.

Multiple daily injections of insulin versus continuous subcutaneous insulin infusion for pregnant women with type 1 diabetes.

The aim was to evaluate the outcome of pregnancies with type 1 diabetes (T1DM) treated from the first trimester with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI).

Maternal hyperglycemia according to IADPSG criteria as a predictor of perinatal complications in women with gestational diabetes: a retrospective observational study

Abstract Objective: We investigated the association between abnormal maternal glucose levels according to International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and perinatal complications. Materials and methods: Retrospective observational study of data of 492 women in singleton pregnancy and gestational diabetes (GDM) diagnosed according to WHO criteria. Perinatal outcome and maternal characteristics were compared between normo- and hyperglycemic patients using IADPSG criteria and odds ratios calculated for particular outcomes. Results: Maternal fasting hyperglycemia (≥5.1 mmol/L) was associated with significantly higher proportion of birth weight ≥ 4000 g (19.3% versus 9.7%, p = 0.004, OR: 2.2; 95% CI: 1.3–3.8), gestational insulin therapy (27.7% versus 9.1%, p < 0.001, OR: 3.8; 95% CI: 2.3–6.5), poor long-term metabolic control (HbA1c at diagnosis ≥ 6.5% [48 mmol/mol]: 19.9% versus 4.6%, p < 0.001, OR: 5.2; 95% CI: 2.5–10.9). Pre-pregnancy obesity (BMI ≥ 30 kg/m2, 26.0% versus 11.9%, p < 0.001, OR: 2.6; 95% CI: 1.6–4.3) and positive family history of diabetes (45.2% versus 30.8%, p < 0.002, OR: 1.8; 95% CI: 1.3–2.7) was more frequent in women with fasting hyperglycemia. Two-hour post-load hyperglycemia was only associated with increased prevalence of gestational hypertension (5.1% versus 11.4%, p = 0.046). Conclusions: Women with fasting but not 2-h hyperglycemia according to IADPSG criteria are at significantly elevated risk of perinatal complications.

Concentration of chemokines in peripheral blood in first trimester of diabetic pregnancy

Background. Several types of regulators (i.e. chemokines and metalloproteinases) are considered to play a crucial role in pregnancy by local modulation of the immune system at the level of peripheral leukocytes. The aim of this study was to determine whether changes in chemokines (interferon‐gamma‐inducible protein (IP‐10), monocyte chemotactic peptide‐1 (MCP‐1), cytokines regulated upon activation normal T cell expressed and secreted (RANTES) and matrix metalloproteinase‐9 (MMP‐9)) concentrations in diabetic patients could affect the course of pregnancy. Methods. The study group consisted of 65 diabetics in the first trimester of pregnancy. Some 47 pregnancies were successfully continued to delivery, 18 were terminated with spontaneous miscarriages. Twenty healthy women matched for gestational age served as a control group. Results. Glycated haemoglobin (HbA1C), vascular complications and lipoproteins (cholesterol, HDL‐cholesterol, low density lipoprotein (LDL)‐cholesterol and triglicerides) concentrations in maternal blood did not influence the chemokines concentrations. Lower RANTES level and higher MMP‐9 concentrations were found in diabetic women. MCP‐1 and RANTES levels differed significantly between pregnancies with good and poor perinatal outcome. A logistic regression model revealed that not only duration of diabetes, age of patients, HbA1C and insulin requirements, but also MMP‐9, RANTES, MCP‐1 and LDL‐cholesterol levels seem to be involved in first trimester metabolism. Conclusions. Our results suggest the possible role of chemokines in early pregnancy development, especially in well‐controlled diabetic patients, when hyperglycaemia is unlikely to be the main reason for an unfavourable outcome. Our results show that MCP‐1 and RANTES might serve as predictive factors for an unfavourable outcome in diabetic pregnancy, whereas MMP‐9 seems to be a marker of immunological changes related to mild hyperglycaemia. However, the open question of how the modulation of chemokines concentrations might be applied to prevent miscarriage in diabetic patients remains.

OC204: Placental Doppler velocimetry in pregnancies complicated by pre‐gestation diabetes mellitus

Introduction: Cerebral hypoxic and ischaemic changes have been implicated in the aetiology of the characteristic seizures that signify the end-progression of pre-eclampsia. Until recently, neuronal dysfunction secondary to ischaemic causes or functional impairment has been difficult to study in adult humans due to the relative inaccessibility of the cerebral circulation. Doppler ultrasound now provides a means of assessing the normalcy of blood flow velocity, and has demonstrated consistency in the evaluation of severe vascular stenosis 1. Differences in systemic peripheral resistance between normotensive and preeclamptic pregnant women have also been demonstrated using calibrated carotid pulse tracings 2. Objective: To measure peak Carotid blood volume flow in a group of prospective mothers at high-risk of pregnancy hypertension and preeclampsia following uterine artery Doppler screening. Methods: Carotid artery velocimetric and blood volume flow profiles were evaluated using standardised techniques in 31 pregnant women at 24–28 weeks gestation. Results: Blood volume flow measurement showed a 75% sensitivity for elevated blood pressure in later pregnancy, 60% sensitivity for the development of preeclampsia and 100% sensitivity for preterm preeclampsia. Conclusion: The measurement of blood volume flow in the Carotid circulation in high-risk pregnant women merits further investigation as a second-tier screening test for pregnancy hypertension and preeclampsia.

OC51: Chorion volume measurements in 3D‐USG between the 10th and 14th week of gestation in normal pregnancy

Results: Four variables (patient age, EGA by LMP, endometrial thickness and βHCG) were found to be significant in the prediction of normal IUP (ROC curve c = 0.86 and Hosmer–Lemeshow Chisquare analysis P = 0.74). As the patient’s age, EGA and βHCG increased, the likelihood of a normal IUP decreased. As the endometrial thickness increased, the more likely the outcome of a normal IUP. For each millimeter increase in endometrial thickness, the odds increased by 27% that the patient would have a normal IUP. With the use of this model, the outcome of 89.1% of all subjects was correctly identified.

P11.01: Diagnostic accuracy of IOTA ADNEX and IOTA LR2 model compared with subjective assessment ( SA) in differentiating benign and malignant ovarian masses

Objectives The aim of this research was to systematically examine the placenta in congenital anomalies. Methods: The placental pathological section was examined in 217 cases with congenital fetal anomalies including 87 cases with congenital heart diseases, 41 cases facial abnormalities, genitourinary abnormalities, 62 cases with neurologic abnormalities. Results: Placental infarction or villus degeneration was observed in 4 cases and chorangiosis was found in 12 cases with congenital heart diseases corresponding to the overall placental disease rate being 16.1%; chorangiosis was observed in 5 cases with facial abnormalities corresponding to the placental disease rate being 12.1%; chorangiosis was found in 2 cases with genitourinary abnormalities corresponding to the placental disease rate being 7.4%. In addition, chorangiosis was observed in 10 cases with neurologic abnormalities corresponding to the placental disease rate being 14.5%. Conclusions: Relative to other system abnormalities the placental disease rate was more higher in cases with congenital fetal heart anomalies.

Chronic and gestational metabolic disorders have a different impact on late-pregnancy endothelial function in pregnant women

OBJECTIVES We investigated how maternal endothelial function is affected by pregestational (Type 1) diabetes mellitus (PGDM) or gestational diabetes mellitus (GDM) and/or chronic hypertension (chHT) or gestational hypertension (PIH). METHODS We conducted a prospective, observational study involving 78 participants with GDM, PGDM and/or hypertension (PIH-16, GDM + PIH-14, PGDM + chHT-8, PGDM-20, GDM-20) in the third trimester of a singleton viable pregnancy. Twenty healthy women with uncomplicated pregnancies matched for gestational age served as controls. We analysed maternal data, disease history and serum concentrations of E-selectin and Vascular cell adhesion molecule 1 (sVCAM-1). RESULTS Only the maternal serum concentration of sVCAM-1 differed significantly among the subgroups (p< 0.0001), with the highest levels evident in women with PIH or GDM + PIH and the lowest in women with PGDM alone or PGDM + chHT. CONCLUSIONS Pregestational or pregnancy associated disorders, although sharing similar clinical symptoms, have a different impact on endothelial function in pregnant women.

P18.09: Establishing the usefulness of sonographic biometric formulas for estimating fetus weight in the diabetic LGA and macrosomic pregnancies

angiogram and bilateral uterine artery embolization (UAE) was performed which stopped the bleeding. During the next pregnancy, a scan at 32 weeks showed left sided placenta accreta implanted above the level of the bladder. At 32+5 weeks she presented with ruptured membranes. Given the scan findings and high risk of haemorrhage, a classical Caesarean section above the upper margin of the placenta was performed. Due to the poor obstetric history, the placenta was left in-situ to avoid hysterectomy. Six weeks post delivery, patient presented with severe sepsis and a sinus (discharging pus) between the skin and the uterine cavity was demonstrated on MRI. The placenta was removed under ultrasound guidance. A small part was left in situ as it was still adherent. The patient recovered following the evacuation and was discharged home after five days. Acquired AVM is a rare complication of Caesarean section and can present with PPH, abnormal vaginal bleeding or menorrhagia. The diagnosis can be made on colour Doppler ultrasound and confirmed with CT angiography. Bilateral UAE in symptomatic patients can avoid hysterectomy however it is associated with an increased risk of morbidly adherent placenta in subsequent pregnancies. Successful pregnancy outcome after UAE for fibroids and congenital AV malformation has been reported however there is no data about pregnancy outcome after UAE for acquired uterine AV fistulae post Caesarean section. This case demonstrates the role of ultrasound in the diagnosis and management of acquired uterine AVM and subsequent morbidly adherent placenta.

P07.15: Doppler ultrasonography of eyeballs and orbits blood vessels in fetus—diagnostic possibilities (preliminary report)

elective and emergent Cesarean), non-reassuring fetal heart rate status, fetal weight at birth (lower) and neonatal admission with pathologic PI MCA. Non-significant differences were observed in amniotic fluid quantity by ultrasound examination, neonatal sex, arterial and venous pH at birth. Significant differences were observed in Apgar score with pathologic CPR, but not with pathologic PI MCA. Conclusions: There is a correlation between MCA Doppler study and perinatal outcome in IUGR fetuses. Therefore, it is important to carry out a complete fetal Doppler study when we find an IUGR fetus. This helps us to decide the optimum moment to finish the pregnancy, getting a better perinatal outcome.