Sakol Manusook

Antimullerian Hormone Changes after Laparoscopic Ovarian Cystectomy for Endometrioma Compared with the Nonovarian Conditions

Laparoscopic ovarian cystectomy is recommended for surgical procedure of endometrioma. The negative impact on ovarian reserve following removal had been documented. Little evidence had been reported for nonovarian originated effects. Objective. To evaluate the impact of laparoscopic ovarian cystectomy for endometrioma on ovarian reserve, measured by serum antimullerian hormone (AMH), compared to nonovarian pelvic surgery. Materials and Methods. A prospective study was conducted. Women who underwent laparoscopic ovarian cystectomy (LOC) and laparoscopic nonovarian pelvic surgery (NOS) were recruited and followed up through 6 months. Clinical baseline data and AMH were evaluated. Results. 39 and 38 participants were enrolled in LOC and NOS groups, respectively. Baseline characteristics (age, weight, BMI, and height) and preoperative AMH level between 2 groups were not statistically different. After surgery, AMH of both groups decreased since the first week, at 1 month and at 3 months. However, as compared to the LOC group at 6 months after operation, the mean AMH of the NOS group had regained its value with a highly significant difference. Conclusion. This study demonstrated the negative impact of nonovarian or indirect effects of laparoscopic surgery to ovarian reserve. The possible mechanisms are necessary for more investigations.

P46.11: Changes of the ductus venosus in intrauterine growth restriction fetuses during maternal hyperoxygenation

of fetal deterioration. Abnormal DV flow patterns have been associated with adverse fetal outcomes and increased perinatal mortality. We describe pathological ductus venosus waveforms with intermittent reverse-flow in the presence of otherwise normal Doppler measurements in severely growth-restricted fetuses with normal echocardiography. Methods: We performed repeated detailed fetal monitoring including Doppler and CTG in two cases with severe IUGR from 26 weeks of gestation onwards. Perinatal outcome was obtained in both cases. Results: Fetal size was below the 3rd percentile (abdominal circumference) in both cases. There were no signs of fetal abnormalities and no chromosomal abnormalities. Doppler measurements revealed a markedly increased uterine resistance in both cases. However, umbilical artery and fetal arterial Doppler were normal at the beginning of the monitoring period. Computerized CTG analysis registered normal short-term variations. DV waveforms showed considerable variation in the pulsatility index including intermittent reverse flow during atrial contraction in the first case, and persistent reverse or zero flow during atrial contraction in the second case. Over the course of several weeks we observed a flattening of the fetal growth curve and arterial redistribution. In both cases elective Cesarean section was performed at 37 and 33 weeks of gestation with birthweights of 1604 g and 690 g, respectively. The infants were admitted to the neonatal ICU for further management. Conclusion: While we still strongly believe that the flow measurements of the ductus venosus are an important and useful indicator of the fetal situation, these cases are an example of rare exceptions in which the pathology of the DV should not be interpreted as a sign of fetal decompensation, if other fetal Doppler findings are contradictory.

P46.10: Changes in the ductus venosus in fetuses with growth restriction

of fetal deterioration. Abnormal DV flow patterns have been associated with adverse fetal outcomes and increased perinatal mortality. We describe pathological ductus venosus waveforms with intermittent reverse-flow in the presence of otherwise normal Doppler measurements in severely growth-restricted fetuses with normal echocardiography. Methods: We performed repeated detailed fetal monitoring including Doppler and CTG in two cases with severe IUGR from 26 weeks of gestation onwards. Perinatal outcome was obtained in both cases. Results: Fetal size was below the 3rd percentile (abdominal circumference) in both cases. There were no signs of fetal abnormalities and no chromosomal abnormalities. Doppler measurements revealed a markedly increased uterine resistance in both cases. However, umbilical artery and fetal arterial Doppler were normal at the beginning of the monitoring period. Computerized CTG analysis registered normal short-term variations. DV waveforms showed considerable variation in the pulsatility index including intermittent reverse flow during atrial contraction in the first case, and persistent reverse or zero flow during atrial contraction in the second case. Over the course of several weeks we observed a flattening of the fetal growth curve and arterial redistribution. In both cases elective Cesarean section was performed at 37 and 33 weeks of gestation with birthweights of 1604 g and 690 g, respectively. The infants were admitted to the neonatal ICU for further management. Conclusion: While we still strongly believe that the flow measurements of the ductus venosus are an important and useful indicator of the fetal situation, these cases are an example of rare exceptions in which the pathology of the DV should not be interpreted as a sign of fetal decompensation, if other fetal Doppler findings are contradictory.