R. Bartkowiak

Autonomous adrenocorticotropin reaction to stress stimuli in human fetus

The aim of the study was to determine whether human fetuses show ACTH response to stress stimuli, to define the gestational age from which these reactions may be present and to analyze the relationship between hormone concentrations and their changes, both in fetuses and in pregnant women. The study included 81 intrauterine transfusions carried out in 19 pregnant women. 52 procedures were performed directly into the umbilical vein, which is not innervated, so neutral for the fetus (the PCI group) and 29 transfusions into the intrahepatic vein -which puncture is stressful for the fetus (the IHV group). ACTH and cortisol concentrations in fetal and maternal plasma obtained during the procedures were assayed. The initial mean plasma ACTH concentration in the PCI group equaled 18.94pg/mL, but in the IHV group it was significantly higher and amounted 75.17pg/mL (p<0.001). There was no significant change in the hormone concentration during the transfusion both in the IHV group (95.8pg/mL, p>0.05) and in the PCI group (22.36pg/mL, p>0.05). The observed hormonal response in the IHV group proves the existence of fetal pituitary reaction to stress. The initial fetal ACTH concentration in the IHV group correlated with the number of transfusions performed on a single fetus (R=0.41; p=0.04). No correlation with parity, gestational weeks or the volume of transfused packed red blood cells was found. There was also no correlation between fetal and maternal ACTH concentrations in any group. Presented data suggest that the human fetus shows autonomous ACTH reaction to stress stimulation.

OC048: Comparison of conventional and three‐dimensional sonohysterography in the assessment of submucous uterine myomas before their hysteroscopic resection

Objectives: To evaluate to what extent removal of focal intracavity lesions results in cessation of abnormal uterine bleeding. Methods: Prospective observational study. From a cohort of 402 women presenting with abnormal uterine bleeding, 124 patients were referred for operative hysteroscopy after diagnosis of a focal intracavity lesion seen at hydrosonography and/or hysteroscopy. A telephone survey was conducted two years later asking patients about their bleeding pattern. The symptoms before and after surgery and the results of histology were compared. Results: There were 112 patients, with the mean age of treatment at 52.2 years, with 47% being premenopausal. In 14 patients (12.5%) the endometrial thickness at ultrasound was below 5 mm. The histology of the resected tissue were endometrial polyps in 60.7%, submucous myomas in 21.4%, with focal endometrial hyperplasia in 4.5%. For those women with endometrial polyps and intracavity myomas confirmed on histology, 97% and 83%, respectively reported an improvement in bleeding pattern. For those with polyps and myomas there was a definitive cure rate of 76% and 79%, and a transient improvement in 21% and 4%, respectively. Conclusions: The vast majority of women complaining of abnormal uterine bleeding and with a focal intracavity lesion will benefit from removal under hysteroscopic guidance.

Laparoscopy in pelvic inflammatory disease

Zapalenie miednicy mniejszej obejmuje procesy infekcyjne górnych dróg rodnych w postaci zapalenia endometrium, zapalenia jajowodów, ropnia przydatków i zapalenia otrzewnej miednicy mniejszej. Większość infekcji ma wstępujący i wielopatogenny charakter, najczęściej związany z drobnoustrojami przenoszonymi drogą płciową. Z uwagi na szeroki wachlarz objawów diagnostyka stanów zapalnych miednicy mniejszej jest trudna. Niewłaściwe rozpoznanie bądź nieadekwatne leczenie może doprowadzić do wielu groźnych konsekwencji. W latach 2006–2010 operowanych laparoskopowo z powodu ropni miednicy mniejszej na oddziałach ginekologiczno-położniczych w szpitalach w Sierpcu i Gostyninie było 6 pacjentek. W połowie przypadków operacja miała charakter zachowawczy i polegała na odessaniu treści ropnej, przepłukaniu jamy brzusznej, uwolnieniu zrostów i drenażu. U pozostałych 3 pacjentek konieczne było usunięcie patologicznie zmienionych przydatków. Po zabiegach pacjentki leczono skojarzoną antybiotykoterapią parenteralnie. U żadnej z pacjentek nie obserwowano powikłań w przebiegu pooperacyjnym. Słowa kluczowe: laparoskopia, stany zapalne miednicy mniejszej, ropień przydatków.

OC17.02: Cervical bacterial colonization and cervical length in women with threatening preterm labor

with no evidence of LAM avulsion. 75% of women with evidence of LAM trauma at the first exam had normal LAM at the later exam. However, 10% of women with normal first exam were found to have evidence of LAM injury in the later exam. Women reporting three or more subjective complaints of pelvic floor incompetence were significantly more likely to have abnormal 3DTUS (44.4% vs. 13%, P < 0.02). Conclusions: 3DTUS examination of the levator ani should be deferred from the immediate post-partum for at least three-six months. Sonographic evidence of LAM injury is associated with subjective symptoms of pelvic floor incompetence.

OP27.08: Thrombocytopenia in neonates treated by repeated intrauterine transfusions

Results: The first procedure was performed at 25 weeks of gestation, but during this time LV/RV ratio decreased to 0.70; the baby was born as HLHS and died after a hybrid procedure. The other 3 cases were performed between 21 and 29 weeks of gestation (x: 23) with a LV/RV ratio >/=1; all three maintained LV size, but case 2 and 3 failed to recover LV contractility. In the second case parents decided to interrupt pregnancy. The 4th case showed gradual LV contractility recovering during pregnancy. Both cases 3 and 4 were born biventricular and an aortic valvuloplasty was performed the 1st day of life with immediate improvement of LV contractility and a significant increase in aortic flow. The remaining 9 of the 13 pts evolved to HLHS. Conclusions: Recognition of patients with severe aortic stenosis at risk to progress to HLHS is essential to select them for fetal aortic valvuloplasty in the second trimester of pregnancy, being the only opportunity to have two ventricles for them.

OP13.05: Is mid-gestational cervical length measurement as sensitive prediction factor of preterm delivery in IVF as in spontaneous singleton pregnancies?

OBJECTIVES To verify the relation between pregnancy duration and cervical length (CL) at 22-24 wks of spontaneous and IVF singleton gestations and to assess its predictive value for preterm delivery (< 37 wks). MATERIAL & METHODS CL at 22-24 wks was performed according to FMF recommendations in 344 women who conceived spontaneously and in 107 IVF singleton pregnancies. The results of CL in both groups were divided into subgroups: ≤ 29 mm, 30-34 mm; 35-39 mm; 40-44 mm; 45-49 mm and ≥ 50 mm. They were subsequently correlated with mean durations of gestation within subgroups and parameters of accuracy were calculated. Correlation and regression analysis was performed. RESULTS The average age of women in both groups was 28.1 y.o. (SD=4.2 years) and 33.4 y.o. (SD=4.1 years), respectively. The mean gestation age at delivery was 38.9 wks (SD=2.1 wks) vs. 37.9 wks (SD=2.3 wks) and the rate of prematurity equaled 7% vs. 15%, respectively. Regardless the method of conception there is a positive correlation between the CL and the duration of gestation. The regression analysis showed that the significant increase in pregnancy duration was correlated with CL ≥ 35 mm (correlation coefficient greater for spontaneous vs. IVF: rxy=0.418 vs rxy=0.341; p<0.001). All CL parameters of accuracy were better for spontaneous in comparison to IVF pregnancies. CONCLUSIONS IVF singleton pregnancy carries additional risk factors for preterm delivery. Therefore mid-gestational cervical length is less sensitive predictor than in spontaneous singleton gestations.

P17.04: The evolution of indications for amniocentesis—four years experience after introduction of skrining programme

Methods: Retrospective chart review for a full two-year period (1/08–12/09) in a university hospital referral centre. Results: A total of 411 invasive procedure were performed (202 AC and 209 CVS) and 38 aneuploidies detected (38/411 = 7.8%): T21 n = 15; T18 = 7; T13 = 5; Turner = 4, other (gonosomal, structural) = 7. During the study period, 1560 first trimester scans were done (mean maternal age 32 yrs, 29% > = 35 yrs). 5.4% of NT measurements were above the 95th centile. In 13 cases there were previous trisomies 21. ‘Increased NT only’ resulted in 77/411 (19%) of all invasive procedures. There were 14 AC and 63 CVS. The overall yield of aneuploidies was 16.9% (13/77, 1 in 6), for AC 14.3% (2/14, 1 in 7) and for CVS 17.5% (11/63, 1 in 6). Abnormal combined test resulted in 75/411 (19%) of all invasive procedures. There were 24 AC and 51 CVS. The overall yield of aneuploidies was 6.7% (1 in 15 procedures), for AC 8.3% (1 in 12) and for CVS 6% (1 in 17). Structural anomalies detected at screening ultrasound resulted in 102/411 (25%) invasive procedures. There were 82 AC and 20 CVS. The yield of aneuploidies in this group was 13.9% (14/101, 1 in 7), for AC 9.8% (8/82, 1 in 10) and for CVS 28.6% (6/20, 1 in 3). Conclusions: With effective screening, even if adopted only for part our population, the numbers of invasive procedures per year have decreased, but the positive predictive value of abnormal screening tests now is high: 1 in 17 for ‘increased NT only’ and 1 in 15 for abnormal combined test, compared to 1 in 7 for ‘structural anomalies’.

OP09.03: NT‐proBNP concentrations and MCA velocimetry in fetuses severely affected by feto‐maternal isoimmunisation—preliminary report

Methods: The study was performed with 383 pregnancies, 255 chorionic villus sampling and 128 amniotic fluid sample respective, that was applied QF-PCR test to obtain the fetal karyotype. The mean of maternal age was 33 (range 24–45), so the common indications were advanced maternal age, 247 cases (64,4%); anxiety, 114 cases, (29,7%), nuchal translucency enlarged, 9 cases (2,3%); 7 cases (1,8%) with fetal structural anomalies and two cases (0,5%) of biochemical risk. The mean of weeks was 11 + 3 days for the chorionic villus sampling, and 16 week for the amniocentesis. Results: Tests results were compared with those obtained by conventional cytogenetic analyses. Aneuploidies involving chromosomes 21, 18, 13 x and y were detected in about 100% of the cases, except for one case which had the fetal karyotype 46, xy, inv 2, moreover polimorphic variant detected 7 aneuploidies (2,7%), in the first trimester by CVS and 5 cases (3,9%) by amniocentesis. Conclusions: The criteria of using of rapid aneuploidy tests as a stand-alone test in prenatal diagnosis are currently discussed. This testing strategies proved to be efficient and its routine application resulted in a significant reduction of reporting time, the method provides diagnosis of common aneuploidies in a few hours after sampling with a high throughput, very low error rates and low cost.

OP23.11: Placental measurements in the first trimester and adiponectin, leptin and insulin plasma concentrations

were weighed and measured immediately after delivery. Data was collected and analyzed using SPSS to calculate Spearman’s rho (rs) and significance. Results: There was a significant correlation between estimated placental weight (EPW) and actual placental weight (rs = 0.74, P < 0.001). Subgroup analysis of preterm gestations (n = 9) revealed even a more significant correlation (rs = 0.87, P < 0.001), likely due to the improved visualization of placental width in a single view. Conclusions: Placental weight can be accurately predicted by twodimensional ultrasound with volumetric calculations. This method is simple, rapid and accurate, making it practical for routine prenatal care, as well as high-risk cases with decreased fetal movement and IUGR. Routine EPW surveillance may decrease the rates of perinatal complications and unexpected IUFD.

OC225: Estimation of fetal circulatory insufficiency with fetal serum NT-pro BNP concentration in Rh-disease

important for fetal viability, supplying the fetal brain and heart with oxygen and glucose. The objective of the study was to investigate the glucose uptake in fetal organs using PET during acute and chronic hypoxia. Methods: In 12 fetal sheep PET imaging was performed on a highresolution PET scanner (Siemens ECAT/EXACT, Germany). Blood flow volume in the umbilical vein (UV) and ductus venosus (DV) was measured using color Doppler ultrasound systems and the umbilical supply to the liver was calculated. For acute hypoxia, oxygen was reduced in the ventilated gas mixture. Fetoscopic coagulation of major placental vessels was performed using a 30◦ endoscope and bipolar forceps (Karl Storz, Germany) in three pregnant ewes (GA 85 ± 8 days, mean ± SD) for chronic hypoxia. FDG uptake in fetal brain and liver was estimated using dynamic PET imaging over 60 min. Input functions were derived from arterial and venous blood samples of mother sheep scaled by fetal blood samples taken from the umbilical cord vein by cordocentesis under ultrasound guidance to determine gas values in the UV. Results: During hypoxia fetal pH, BE and umbilical liver blood supply were reduced significantly. FDG uptake of the heart increased during hypoxia, but was not changed significantly in the liver.