M. Jakó

Postnatal outcome and placental blood flow after plasmapheresis during pregnancy

Abstract Purpose: Plasmapheresis in pregnancy adversely affects maternal hemodynamics, however there are studies suggesting it to reduce pregnancy loss in immunological diseases when medication is more harmful to the fetus. The overall optimal plasmapheresis treatment protocol remains unknown. Materials and methods: A pregnant with neuromyelitis optica was followed up after receiving six volumes of fresh frozen plasma via plasmapheresis. Results: The placenta compensated the hemodynamic change until the 33rd week of gestation, resulting a small for gestational age, otherwise healthy girl. Conclusions: More research is needed on plasma exchange during pregnancy because in our observation placental circulation can adapt to the change in blood pressure.

Monitoring of fetal heart rate via iPhone

Recording of fetal heart rate can be reassuring for the mother about the fetus’ wellbeing. Our smart phone application can detect, record and evaluate fetal heart rate at any time. This method is based on sound wave thus free from the effects of ultrasound, and can be used all day without harming the fetus. It does not require medical assistance and easy to use at home. It reduces the queue at outpatient care units, helps pregnant women to relieve stress by listening to their unborn baby’s heartbeat. It improves mother-child relationship yet sends an alarming message if further examinations are needed to prevent the consequences of hypoxia.

Lyme disease associated neuroretinitis — Case report

We describe a rare case of Lyme disease complicated by unilateral neuroretinitis in the right eye. We report a case of a 27-year-old woman with blurred vision on her right eye. Because of the suspicion of optic neuritis (multiplex sclerosis) neurological examination was ordered. Surprisingly, computer tomography of the brain revealed incomplete empty sella, which generally results not monocular, but bilateral optic nerve swelling. Opthalmological examination (ophthalmoscopy and optical coherence tomography) indicated not only monocular optic nerve, but retinal oedema next to the temporal part of the right optic disk. Visual evoked potentials (VEP) demonstrated no P100 latency delay and mild differences between the amplitudes of the responses of the left and right eye. Optical coherence tomography (OCT) demonstrated the swelling of the optic nerve head and oedematous retina at the temporal part of the disk. Suspicion of an inflammatory cause of visual disturbance blood tests was ordered. Doxycycline treatment was ordered till the result of the blood test arrived. The Western blot and ELISA test were positive for Borrelia burgdorferi sensu lato. Following one week corticosteroide and ceftriaxone treatments, the patient displayed a clinical improvement. Unilateral neuroretinitis with optic disk swelling due to neuroborreliosis is a rare complication and in many cases it is difficult to distinguish between inflammatory and ischemic lesions. Further difficulty in the diagnosis can occur when intracranial alterations such as empty sella is demonstrated by CT examination.

P05.03: Correlation between placental vascularisation indices and histological findings of placentas in pregnancy hypertension

males. (Mean fetal weight: 0,65g vs 0,84g, p<.001 at ED17,5 and 1,01g vs 1,14g, p=.02 at ED18,5). Measured by ultrasounds, uterine artery resistance index (RI) was higher in late gestation in transgenic group. (mean RI: 0,63 vs 0,58, p= .029). In 29 mice studied by BOLD MRI, change in T2* differed significantly between STOX 1 and wild type in placental inner layer (8.2 msec vs 5.8 msec; p < .025), placental outer layer (6.1 msec vs 3.07msec; p < .005), and fetal brain (5.29 msec vs 9.09 msec; P = .004). There was no significant difference in the fetal liver (2.42 msec vs 2.5 msec; P = .25). Conclusions: STOX1-overexpressing mice constitute a reliable model of PE. BOLD MRI has the potential to pick up placental changes in such mice pre-eclamptic pregnancies as compared to normal ones.

EP14.25: Placental weight and volume related to birthweight and third trimester maternal blood sample in normal and IUGR pregnancies

Objectives: To investigate human long bone development in fetuses with intrauterine growth restriction (IUGR) by analysing distal femoral epimetaphyseal structures and bone morphometrics on prenatal MR imaging. Methods: This retrospective study included 14 fetuses (mean gestational age, 26 weeks 2 days; range, 21 weeks 3 days to 33 weeks) with IUGR caused by placental insufficiency, without other brain or body abnormalities, as well as a total of 192 age-matched normal fetuses. On 1.5-T echo-planar MR images, diaphyseal and epiphyseal morphometric measurements were assessed, and, using a grading system, the cartilaginous epiphyseal and metaphyseal shape, secondary ossification, and the perichondrium were qualitatively analysed. Student’s t-testing was used to compare the morphometric measurements of IUGR fetuses with normal fetuses, and descriptive statistics were used to compare the qualitative bone characteristics. Results: The morphometric measurements of the IUGR fetuses did not exceed the minimum normative measurements at any gestational age (diaphyseal length: p <0.0001 0.0053; epiphyseal length: p <0.0001 0.0022; epiphyseal width: p <0.0001 0.0032). Overall, the same grading for cartilaginous epiphyseal shape as observed in IUGR fetuses was found in 28.6% 100% of normal fetuses, for the metaphyseal shape in 7.1% 94.4%, for secondary ossification in 16.7% 100%, and for the perichondrium in 12.5%91.7%. Conclusions: On prenatal MR imaging, fetuses with placental-based IUGR exhibit long bone shortening, whereas their qualitative bone characteristics appear within normal limits. Consequently, the presence of qualitative bone abnormalities should include the differential diagnosis of various fetal skeletal disorders.

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)...

Use of Infertility Handling Among Women of Reproductive Age

Our primary objective was to develop a mobile application for monitoring the changes of menstrual cycle for clinical treatment planning. Participating woman can use the application called “Infertility Handling”, which will be soon available from Google Play Store for general public. This Android-based application provides basic biological and physiological information to women using the application at different stages of the cycle. They will receive useful help and advice concerning their health. The application provides also quick and convenient information gathering for short and long-term management of patient’s treatment and excellent tool for the personal medical monitoring. In this paper we present a short summary of the developed application.

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.

EP23.01: Postive postnatal outcome in pregnancy with neuromyelitis optica.

24 gestational weeks) and bilateral cleft lip (fetus with 27 gestational weeks). Both fetus ware listed on the figure below. An ultrasound machine GE/Voluson E6 was used in the exam and images were processed by 4D View software. The images were rebuilding with three renderisation methods: Surface, Surface 1 and HDLive Smooth. Accordingly to the fetal pathology, the specific RM improves the quality of images, diagnosis and severity case comprehension not only to the health team but also to the pregnant. The team, guided by the full understanding of the malformation severity images, can offer a human attendance to the pregnant. It promotes family’s acceptance and active participation in the therapeutic plan. In anencephalic fetus, for religious reasons, she opted to prolong pregnancy. In cleft lip case, the accurate diagnosis of fetal deformity drove family’s understanding of newborn surgical repair needed. As to rendering methods, there is not a mode more appropriate to presents the 4D picture, we must decide the frame in each case.

[Low rate of oropharyngeal human papillomavirus infection among women with cervical lesion. Preliminary results from the South-Eastern Hungarian population].

Absztrakt Bevezetes: Bar a cervicalis es az oralis human papillomavirus-fertőzes jelenletet intenziven vizsgaltak az elmult evekben, a virus azon kepessege, hogy egyazon szemelyben megfertőzi az oralis es genitalis nyalkahartyat, meg nem teljesen tisztazott. Celkitűzes: A szerzők cervicalis laesioval rendelkező del-magyarorszagi nőkben az oropharyngealis human papillomavirus-fertőzes jelenletenek vizsgalatat tűztek ki celul. Modszer: A vizsgalatban osszesen 103 nő vett reszt 2013. marcius 1. es 2015. januar 1. kozott. A garatnyalkahartya-sejtek gyűjtesere specialis mintavevőt hasznaltak. A human papillomavirus-DNS-t polimeraz lancreakcioval, a virusgenotipust Amplicor line blot teszttel hataroztak meg. Eredmenyek: Oropharyngealis human papillomavirus-fertőzest 2 esetben (3%) mutattak ki, amelyek a 31, 40/61 es 73 genotipusba tartoztak. Kovetkeztetesek: Az eredmenyek arra utalnak, hogy a mehnyakelvaltozasok mellett ritkan fordul elő oropharyngealis human papillomavirus-fertőzes. Orv. Hetil., 2016, 157(2), ...INTRODUCTION Although the natural history of cervical and oral human papillomavirus infection has been intensively investigated in the past years, the ability of this virus to infect oral and genital mucosae in the same individual and its potential to co-infect both cervical and oral mucosa are still unclear. AIM The aim of the authors was to assess the presence of oropharyngeal human papillomavirus infection in women with cervical lesions in the South-Eastern Hungarian population. METHOD The total of 103 women have been included in the study between March 1, 2013 and January 1, 2015. Brushing was used to collect cells from the oropharyngeal mucosa. Human papillomavirus DNA was detected using polymerase chain reaction, and Amplicor line blot test was used for genotyping. RESULTS Oropharyngeal human papillomavirus infection was detected in 2 cases (3%). The detected genotypes were 31, 40/61 and 73 in the oropharyngeal region. CONCLUSIONS The results indicate that in women with cervical lesions oropharyngeal human papillomavirus infection rarely occurs.