BREASTFEEDING SELF -EFFICACY IN PREGNANT ADOLESCENTS

(1)

4. POSTERS

Brought to you by | Cukurova Üniversitesi Authenticated Download Date | 7/26/19 9:18 AM

(2)

(3)

P-0001 | POSTER | BPD

InvESTIgaTIOn Of changES Of vThf undER TwO hIgh fREquEncy vEnTIlaTIOn SySTEmS

Matsuo, K.; Kubota, M.; Takahashi, A.; Watabe, S.; Waki, K.; Arakaki, Y.

Kurashiki Central Hospital, Kurashiki, Japan

Abstract:

Background: It has been reported that the initial setting of high frequency ventilation (HFV) (Babylog 8000plus, Drägerwerk AG & Co. KGaA、Moislinger Allee 53–55,Lübeck, 23558) should be set for a VTHf of 1.5-2.0 ml/kg. But there are few reports about the optimal VTHf for HFV in extremely low birth weight infants (ELBW). In our hospital ventilation is undertaken at pCO2 40-60mmHg in BPD infants to protect the lungs from high ventilation condition. We have previously examined the change of VTHf in Babylog 8000plus and Babylog VN500 (Drägerwerk AG & Co. KGaA、Moislinger Allee 53–55,Lübeck, 23558), and the association of pCO2 with steroid dosage.

methods: We analyzed the data of 13 ELBW infants (gestational age 25±1.4weeks, birth body weight 705±181g) who underwent HFV from April 2013 to June 2014. VTHf in HFV was 2.2±0.4 ml/kg, and pCO2 was 47.7±5.7mmHg, within the hospital defined range. Eleven patients required steroid administration for respiratory state exacerbation, from which nine patients experienced a decrease in VTHf.

Results: We considered that 2.0-3.0ml/kg in VTHf was necessary in ELBW when we aimed for pCO2 40-60mmHg. The patients in which there was no decrease of VTHf resulting from steroid administration suffered from breathing management in BPD, and extubation was delayed, and it was thought that the change of VTHf was useful in predicting breathing convalescence. The accumulation of further cases is needed for further examination of optimal VTHf in order to utilize HFV effectively in ELBW.

(4)

nEOnaTal uREaPlaSma uREalyTIcum cOlOnIZaTIOn IncREaSES PulmOnaRy and cEREBRal mORBIdITy dESPITE TREaTmEnT wITh macROlIdE anTIBIOTIcS

Resch, B.; Gutmann, C.; Urlesberger, B.

Medical University of Graz, Graz, Austria

Abstract:

Objective: To evaluate the influence of Ureaplasma urealyticum (UU) colonization on neonatal pulmonary and cerebral morbidity.

methods: Single-center case-control study including all preterm infants with positive UU tracheal colonization between 1990 and 2012. Cases were matched with controls by birth year, gestational age, birth weight, and sex. All cases had received macrolide antibiotics for UU infection starting at the time of first positive culture results from tracheal aspirates. Main outcome parameters included presence and severity of hyaline membrane disease (IRDS), duration of ventilation, bronchopulmonary dysplasia at 36 postmenstrual age and neurological morbidities (seizures, intra-/ periventricular haemorrhages-I/PVH, periventricular leukomalacia-PVL).

Results: Of 74 cases identified 8 died and 4 had to be excluded, thus, 62 preterm infants were compared to 62 matched controls. UU was significantly associated with IRDS (79% vs. 61%, p=0.015), BPD (24% vs. 6%, p=0.003), seizures (23% vs. 5%, p=0.002) and I/PVH (45% vs. 24%, p=0.028). Cases had longer duration of mechanical ventilation and total duration of invasive and non-invasive ventilation (median 11 vs. 6 days p=0.006 and 25 vs. 16.5 days p=0.019, respectively).

conclusion: UU was found to be significantly associated with pulmonary short- and long-term morbidity and mild cerebral impairment despite treatment with macrolide antibiotics.

(5)

PERInaTal RISK facTORS aSSOcIaTEd wITh BROnchOPulmOnaRy dySPlaSIa In PRETERm InfanTS Of lESS Than 32 wEEKS gESTaTIOnal agE

Zeballos Sarrato, S.; Ramos Navarro, C.; Zeballos Sarrato, G.; Villar Castro, S.; Gonzalez Pacheco, N.; Navarro Patiño, N.; Sanchez Luna, M.

Hospital Universitario Gregorio Maraño, Madrid, Spain

Abstract:

Introduction: Bronchopulmonary dysplasia (BPD) is the most common morbidity associated to very premature birth. BPD has a multifactorial etiology and perinatal factors may have a major impact.

Objective: To identify perinatal risk factors associated with BPD.

methods: This case-control study included all preterm infants born between 22-31+6 gestational weeks and admitted to the NICU between 2008-2014. We collected maternal and pregnancy characteristics, perinatal interventions and some neonatal data. BPD was defined as the need of supplemental oxygen at 36 weeks´ postmenstrual age. Multivariable logistic regression analysis was used to identify significant risk factors associated with BPD.

Results: 656 preterm infants were included in this analysis. 154 (23,4%) were alive and diagnosed of BPD (cases). We did not find any differences between cases and controls in mean maternal age, control of pregnancy, diseases before and during pregnancy, assisted reproductive techniques, multiple pregnancy, cesarean, premature rupture of membrane, maternal antibiotic and prenatal steroids administration. The group with BPD had a significant lower mean gestational age (26+6w vs 29+4w, p<0,001. BPD by gestational age: 23-26w: 66,1%, 27-28w: 29,4% ≥29w: 5,8%), lower mean birth weight (830 gr vs 1305 gr, p<0,001), and lower 1 and 5 minute Apgar scores (6/8 vs 7/9, p0,001). They also had higher incidence of: pathologic fetal echography (44,8% vs 27,5%, p<0,001), chorioamnionitis (29,8% vs 19,7%, p0,008), low birth weight for gestational age (15,5% vs 5,3%, p<0,001), CRIB Index>3 (63,6% vs 11,3%, p<0,001), and need for intubation in the delivery room (32,6% vs 16,5%, p<0,001). Independent risk factors associated with BPD were pathologic fetal echography (HR: 1,85 ; 95% CI 1,1-3,17), lower gestational age (23-26w HR: 24,5 ; 95% CI 11,11-54,01 and 27-28w HR: 7,05 ; 95% CI 3,55-14,02), low birth weight for gestational age (HR: 4,56 ; 95% CI 1,82-11,38), intubation in the delivery room (HR: 2,92 ; 95% CI 1,41-6,06) and CRIB>3 (HR: 2,87 ; 95% CI 1,63-5,05).

conclusions:

• Moderate to severe BPD was diagnosed in 23,4% of preterm infants <32 weeks of gestational age.

• Perinatal independent risk factors associated with BPD remain difficult to control because they are strongly associated with extreme prematurity.

(6)

EffEcT Of fREquEncy IncREaSES On ThE dISTal TRanSmISSIOn Of ThE PRESSuRE amPlITudE duRIng hIgh-fREquEncy OScIllaTORy vEnTIlaTIOn cOmBInEd wITh vOlumE guaRanTEE

González-Pacheco, N. (1)_{; Blanco-Coronil, A.} (2)_{; Orden-Quinto, C.} (3)_{; Santos-González, M.} (3)_;

Tendillo-Cortijo, F. (3)_{; Sánchez-Luna, M.} (1)

(1) _{Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain;}

(2) _{Anesthesia Division, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain;}(3) _Medical

and Surgical Research Unit, Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Abstract:

Background and aims: High-frequency oscillatory ventilation (HFOV) has been described as a rescue therapy in severe respiratory distress syndrome with a potential protective effect in immature lungs. Recently, the use of volume guarantee (VG) during HFOV has demonstrated an independent effect of the frequency on tidal volume (VThf) to increase CO₂ elimination, according to the DCO₂ equation. However, in order to sustain VThf at higher frequencies, higher oscillation pressure amplitude (ΔPhf) in the circuit is needed, which can be potentially transmitted to the alveoli, resulting in lung injury. The aim of the study was to evaluate the distal transmission of the pressure amplitude with increasing frequencies on HFOV with and without a constant VThf.

methods: Five anesthetized 2-day-old Landrace-Large White piglets were used. Animals were ventilated on HFOV with increasing frequencies of 5, 8, 11 and 14 Hz, both with and without VG. The amplitude of pressure transmission was measured with two pressure transducers positioned between the endotraqueal tube and the end of the ventilator tubing (proximal pressure) and at the end of the trachea, into the carina (distal pressure). Also, VThf, ΔPhf, DCO₂and pCO₂ were analyzed in each situation.

Results: DCO₂ increased and pCO₂ decreased with higher frequencies on HFOV combined with VG, whereas the opposite was seen on conventional HFOV without VG. Interestingly, in spite of the increase of the proximal pressure with increasing frequencies when VG was used, the distal pressure at the trachea remained stable and negligible (figure).

conclusions: HFOV combined with volume guarantee allows using higher frequencies with a greater efficiency in CO₂ clearance and without an increase in distal pressure amplitude, with the aim of minimize lung injury.

(7)

uSE Of vERy hIgh fREquEncIES duRIng hIgh fREquEncy OScIllaTORy vEnTIlaTIOn cOmBInEd wITh vOlumE guaRanTEE TO PROTEcT ThE ImmaTuRE lung

González-Pacheco, N.; Ramos-Navarro, C.; Sanz-López, E.; Maderuelo-Rodríguez, E.; Arriaga-Redondo, M.; Rodríguez-Sánchez De La Blanca, A.; Navarro-Patiño, N.; Sánchez-Luna, M.

Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Abstract:

Background and aims: Invasive mechanical ventilation is a known causative factor for neonatal lung injury, and HFOV has been proposed as potential protective ventilation.

Recently, HFOV combined with volume guarantee (VG) has demonstrated an independent effect of the frequency on tidal volume (VThf) to increase CO₂ elimination and using lower delivered tidal volumes and high frequencies have been proposed to improve ventilation efficacy while minimizing lung injury.

The aim of the study was to evaluate the feasibility of using this strategy in the clinical practice.

methods: Newborn infants with severe respiratory insufficiency on HFOV were prospectively included. After adequate ventilation using standard HFOV strategy, the tidal volume was fixed on volume guarantee and decreased while the frequency was gradually increased until the highest possible to maintain a constant CO₂ diffusion measurement (DCO₂) to keep a constant PCO₂. Both situations, pre and post highest frequency with constant DCO₂, were compared.

Results: 23 newborn infants were included with a mean gestational age of 28.8 weeks. It was possible to increase the frequency while decreasing the tidal volume in all the infants. Maintaining a similar DCO₂, all newborn infants were well ventilated so, the mean PCO₂ after highest frequency was lower than initial mean PCO₂. High frequency tidal volume was significantly lower, 2.20 ml/ kg before, vs. 1.59 ml/kg at the highest frequency. Interestingly, ∆Phf did not increased after the maximal frequency was achieved (table).

conclusions: Lower high frequency tidal volumes and higher frequencies on HFOV combined with VG can be used with adequate ventilation to allow reducing lung injury.

ventilator settings Initial Final p

mPaw (mbar) 13.6 ± 4.0 Frequency (Hz) 10.39 16.70 0.000 Tidal volume (ml/kg) 2.20 1.59 0.000 ΔP (mbar) 21.86 22.00 0.915 DCO₂ (ml2_/sec) _141.09 _119.13 _0.129 FiO₂(%) 47.87 37.91 0.020 Patient´s records PAM (mm Hg) 36.04 37.26 0.492 HR (bpm) 143.43 140.57 0.424 SpO₂ (%) 90.70 93.35 0.030 PCO₂ (mm Hg) 51.22 46.04 0.013

PAM: mean arterial blood pressure; HR: heart rate, SpO2: oxygen transcutaneous saturation. PCO2: partial pressure of carbon dioxide.

(8)

OuTcOmES Of PalIvIZumaB PROPhylaXIS fOR RESPIRaTORy SyncyTIal vIRuS (RSv) InfEcTIOn In PRETERm chIldREn wITh BROnchOPulmOnaRy dySPlaSIa In a cOunTRy wITh nO SEaSOnal RSv PEaKS

Quek, B.H.; Khoo, P.C.; Tan, P.L.

KK Women’s and Children’s Hospital, Singapore

Abstract:

Background

Singapore has no seasonal peaks of Respiratory Syncytial Virus (RSV). However RSV related illnesses accounted for about 50% of respiratory related admissions in preterm babies, and significant higher need for respiratory support. We introduced palivizumab for very low birth weight (VLBW) preterms with chronic lung disease since November 2011. This study aims to look at the effectiveness of palivizumab in prevention of RSV infection and associated morbidities.

methods

Between December 2011 to December 2013, we started the Palivizumab prophylaxis program for VLBW preterms with chronic lung disease diagnosed at 36 weeks gestational age. Total of 5 doses were given, with the first dose usually given just before hospital discharge. Consent was taken prior to administration. They were compared with historic controls born in January to December 2010. The primary objective was RSV-related hospitalizations, and secondary endpoints included non-RSV related respiratory admissions and resource utilization such as ICU stay and ventilation. Those with major congenital malformation and death before hospital discharge were excluded from analysis.

Results

Of the 197 born born in 2010, 180(91%) survived and 84(47%) babies needed rehospitalisation. Respiratory illnesses accounted for admission in 48(27%) babies. 24(50%) had RSV bronchiolitis and they were associated with significantly higher need for assisted ventilation [9/24(38%) vs 2/24(8%) (p<0.01)].

57 infants were enrolled between December 2011 to December 2013 for Palivizumab prophylaxis. 48 infants completed all 5 doses. Among this group that completed all 5 doses, 3 were readmitted for RSV related illness (6.2%). This is compared to 13.3% in the 2010 cohort (p<0.05). Of the RSV related admissions, only one required ICU stay and ventilation. 22 infants (38.6%) were admitted for non RSV related causes such as chronic lung exacerbations.

conclusion

Palivizumab prophylaxis significantly reduced the frequency of RSV-related hospitalization and morbidities in preterm children with CLD in region with no seasonal peaks of RSV.

(9)

vITamIn d STaTuS In PRETERm InfanTS wITh chROnIc lung dISEaSE

Bhayat, S.; Gowda, H.

NHS, Luton and Dunstable University Hospital, United Kingdom

Abstract:

Introduction: Neonatal chronic lung disease (CLD) is an important cause of morbidity and mortality. Vitamin D is known for its role in bone metabolism, but physiology suggests it influences lung fibroproliferation, remodelling and function. There is evidence implicating vitamin D’s association with chronic lung diseases like asthma. An animal study speculates that decreased vitamin D levels may contribute to the pathogenesis of bronchopulmonary dysplasia. The aim is to determine if there is an association between vitamin D levels in preterm neonates and chronic lung disease.

methods: Retrospective observational study on a preterm neonatal population (<37 weeks), over 18 months from Nov 2013 to Mar 2015 in a tertiary NICU. Preterm infants with vitamin D levels within the first 3 months of life were included. Vitamin D levels were only done if the Alkaline Phosphatase was high, or rapidly rising. In neonates with vitamin D levels measured, chronic lung disease status was identified. The definition of chronic lung disease used is the requirement of oxygen for more than 28 days. Analysis was done using the SPSS version 19. Parametric t-test was used to compare the means in both groups.

Results: A total of 29 infants were included in the study. In the studied population, 25 infants had CLD, and 4 did not have CLD. The mean levels of vitamin D calculated in both groups independently, were lower than the normal reference range. Mean vitamin D levels were lower in the CLD group (mean vitamin D level= 52.64, SD= 12.42) than in the group without CLD (mean vitamin D level= 57.75, SD= 14.97). However, comparison of mean vitamin D levels between both groups was not statistically significant (p=0.463, parametric t-test).

CLD (n=25) No CLD (n=4)

Gestation mean 26.08 32.25

Weight mean 766.44 1703.75

Age of testing mean 41.56 36.25

Mean Vitamin D levels 52.64 57.75

Table 1. Comparison of CLD and No CLD group.

conclusion: Preliminary result shows vitamin D levels were lower in the chronic lung disease group; the results were not statistically significant. Future aim would be to do prospective studies with larger numbers. In order to detect a statistically significant difference (power=80%, p<0.05), the number needed is 232 patients.

Reference:

Mandell, E., Seedorf, G., et al Vitamin D treatment improves survival and infant lung structure after intra-amniotic endotoxin exposure in rats: potential role for the prevention of bronchopulmonary dysplasia. Am. J. Physiol. Lung Cell. Mol. Physiol. 306, L420–8 (2014).

(10)

EvOluTIOn Of InITIal RESPIRaTORy SuPPORT In PRETERm In a 10-yEaRS PERIOd

Ramos Navarro, C.; Sanz Lopez, E.; Maderuelo Rodriguez, E.; Zeballos Sarrato, S.; Bernardo Atienza, B.; Franco Fernandez, M.L.; Marsinyach Ross, I.; Sanchez Gomez De Orgaz, M.C.; Caballero Martin, S.; Blanco Bravo, D.; Sanchez Luna, M.

Gregorio Marañón Hospital, Division of Neonatology, Madrid, Spain

Abstract:

Background: Mechanical ventilation (MV) is one of the main factors associated to bronchopulmonary dysplasia (BPD) development in preterm infants so avoiding intubation is nowadays the ultimate purpose in respiratory management at birth. Current recommendations for delivery stabilization includes nCPAP support and selective surfactant administration in order to prevent from intubation. In our institution nCPAP is applied preventively at birth in preterm infants since 2004.

The aim of the study is to review the evolution in respiratory management at birth of infants born with less than 32weeks of gestation (<32w GA) in a 10-year period and to assess the impact in BPD development.

methods: Observational retrospective comparison of data of respiratory management and outcomes in preterm infants <32w GA between 2004-2006 with those born between 2012-2014.

Results: A total of 657 patients were analyzed, 329 in the first period and 328 in the last one. There is a decreased trend in rate of infants exposed to MV for more than 1 hour in the first two hour of life in the second period (fig 1). These infants have a significant higher rate of mortality or BPD (type 2 or 3) than infants in which ventilation is not applied or is needed later (fig2). When controlled for GA being ventilated for more than 1 hour has a significant increased risk of BPD development (OR 8,895; 3,218-24,584)P <0,002.

Survival free BPD (SF-BPD) has mildly increased in the second period when is grouped for GA (fig 3). As the main risk factor for BPD development is lower GA ( OR 11,291 for <26w compared to > 29W (4,362; 29,227; p<0,02) and the rate of infants born with less than 26w has increased in the second period (fig4) global SF-BPD rate remains constant (64,2%in the first period and 61% in the last one).

conclusions: The evolution of respiratory support of preterm infants at birth is turning to a less invasive management reducing the rate of MV exposure. MV in the first 2hours of life is associated with less SF-BPD.

(11)

BROnchOPulmOnaRy dySPlaSIa afTER aPPlIcaTIOn Of mInImal InvaSIvE SuRfacTanT ThERaPy /mIST, lISa/ TO PREmaTuRE InfanTS wITh BIRTh wEIghT uP TO 1,500g

Pramatarova, T.; Yarakova, N.; Sluncheva, B.; Radulova, P.; Hitrova, S.; Vakrilova, L.; Emilova, Z.

University Hospital of Obstetrics and Gynaecology - Maichin Dom; Medical University Sofia, Bulgaria

Abstract:

Objective: Invasive mechanical ventilation (MV) unlocks non-infectious inflammatory response during the first hours of ventilation. The activation of the inflammatory cytokines is a leading risk factor for the occurrence of bronchopulmonary dysplasia (BPD). The purpose of the research is to establish the effectiveness of MIST and the frequency of BPD in premature infants after MIST.

materials & methods: The research is prospective. In the case of 40 premature infants with spontaneous breathing on nIPPV, a surfactant (Curosurf) is insufflated endotracheally by gastric tube in a 200 mg/kg dose. It is applied a stimulation of the breathing activity with Kaffeine citrate during the first 20 minutes after the birth. The success rate of the method, the average continuation of the non-invasive MV and the frequency of BPD, are all analyzed.

Results: gestational age 29,92±1,57; birth weight 1083,10g ±275,48. In the case of 13.3% of the infants, intubation and IPPV were needed. In two of the cases the reason was pulmonary hemorrhage; in one – pneumothorax. The success rate of the method is 93.4% for the group without complications. The average continuity of nIPPV is 2,06±1,37 days. The total frequency of BPD is 16.6% and for the not intubated is 11.5%.

conclusion: MIST has a good success rate in cases of premature infants with spontaneous breathing and gestational age 29,92±1,57. The low continuity of the non-invasive MV can hypothetically decrease the frequency of BPD, if it is taken into account that MV unlocks and non-infectious inflammatory response, a risk factor for BPD. This conclusion can be made only after a bigger and randomized research.

Keywords: BPD, MIST/LISA.

(12)

gamma gluTamyl TRanSfERaSE In nEOnaTES: REfEREncE RangE and aSSOcIaTIOn wITh BROnchOPulmOnaRy dySPlaSIa and chOlESTaSIS

Lim, G.; Kim, D.B.; Lee, M.S.; Jeon, S.B.; Lee, S.J.

Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea

Abstract:

Objective: We aimed to establish a GGT reference range in first week of life at each gestational age (GA) and to define the association of GGT with bronchopulmonary dysplasia (BPD) and cholestasis.

Study design: This retrospective study included infants born and admitted before 7 days of age with no apparent congenital liver disease. Early GGT levels measured at 3–7 days of age were analyzed according to GA. Among infants with GA < 31 weeks, early GGT, GGT at 28 days of age, and at postmenstrual age (PMA) of 36 weeks, and maximum values were analyzed according to the presence of BPD and cholestasis.

Results: We analyzed 1639 early GGT measurements. The reference range was much higher in neonates than adult levels, 162.1 ± 113.9 IU/L. GGT values gradually increased up to GA 33–34 weeks and gradually decreased to term age. Among infants with GA < 31 weeks, early GGT was significantly higher in those with BPD after adjustment for GA, and maximum GGT was significantly higher in infants with cholestasis.

conclusion: Early GGT values were much higher in neonates, especially preterm infants with GA 33– 34 weeks. Early GGT was associated with BPD, and maximum GGT was associated with cholestasis.

(13)

ThE InfluEncE Of maTERnal cORTIcOSTEROIdS On PRETERm InfanTS

Iacob, D. (1)_{; Fratila, A.} (2)_{; Iacob, E.R.} (3)_{; Ilie, C.} (3)

(1) _{University of Pharmacy and Medicine Timisoara, Timisoara, Romania;}(2) _{Emergency County Hospital}

Drobeta Turnu Severin, Timisoara, Romania; (3) _{University of Medicine and Pharmacy Timisoara,}

Timisoara, Romania

Abstract:

The administration of antenatal steroids in women at risk of preterm birth is the most effective medication treatment. Respiratory distress syndrome is one of the most common respiratory diseases in newborns, especially premature infants.

The goal of this therapy is to prevent respiratory distress syndrome and to reduce neonatal morbidity and mortality. Glucocorticoid therapy help accelerate fetal lung maturation by increasing production and elimination of surfactant.

Objectives: This paper aims to highlight the incidence and severity of appearance respiratory distress syndrome,but also the factors that worsen in a group of premature infants whose mothers received prophylactic corticosteroids.

material and method: A retrospective study was performed between January 1, 2010 and December 31, 2012 conducted in 200 premature infants whose mothers received antenatal corticosteroids. Results: Premature coming by Caesarean section have a higher prevalence, 81% compared to those coming through natural birth 19%. Most cases were between 31-33 weeks - 42%, between 28 to 30 weeks - 23%, between 34-36 weeks - 19% and 25-27 weeks - 16%. In the studied group, preterm had at birth Apgar score between 1-3 17%, 4-6 - 33% and between 7-9 - 50%. Pathogens present in the highest proportion in the study group were: Candida albicans - 12 cases and 13 cases Staphylococcus coagulase- negative.

conclusions:

1. The administration of corticosteroids to pregnant women at risk of preterm birth lowers risk of respiratory distress syndrome.

2. The combination of risk factors: low gestational age, low birth weight, low birth Apgar score, presence of infections, caesarean section, increase the risk of RDS.

Keywords: neonatal respiratory distress syndrome, prematurity, prenatal corticosteroids, surfactant.

(14)

SuRfacTanT admInISTRaTIOn TO PRETERm InfanTS

Iacob, D. (1)_{; Fratila, A.} (2)_{; Iacob, E.R.} (1)_{; Ilie, C.} (1)

(1) _{University of Pharmacy and Medicine Timisoara, Timisoara, Romania;}(2) _{Emergency County Hospital}

Drobeta Turnu Severin, Drobeta Turnu Severin, Romania

Abstract:

Objectives: This study want to show the importance of surfactant administration in a randomisez group of preterm newborn.

material and method: In this study were taken 1045 preterm newborn under 37 weeks of gestation born to Bega Maternity Timisoara in six years.

Results and discussions: From the study group, a total of 122 patients received surfactant. 40 newborn had under 1000g at birth, 55 between 1000-1500g, 21 between 1500-2000g and 6 between 2000-2500g. A total of 107 newborn required mechanical ventilation. 50 % of the preterm infants had infection pathology associated. Unfavorable evolution had 42 from this preterm newborn.

conclusions:

Surfactant administration is often necessary to the preterm newborn due to lung immaturity. Frequently preterm newborn needs ventilatory support.

Using surfactant makes prognosis in this group of infants favorable in most cases.

(15)

P-0013 | POSTER | Cesarean delivery: perinatal consequences and long-term prognosis

PREdIcTIvE mOdElS fOR RISK Of cESaREan SEcTIOn In PREgnanT wOmEn afTER InducTIOn Of laBOuR

Hernandez, A.; Pascual, A.; Moreno-Cid, M.; García, J.; Rubio, A.; Rodriguez, M.J.

SESCAM, Hospital Mancha Centro, Spain

Abstract:

Objective

To develop a predictive model for evaluating the risk of cesarean section in pregnant women undergoing induction of labour.

methods

We conducted a retrospective cohort study of 861 induced labours between 2009 and 2011 at our institution. Two predictive models were designed. Model A predicts the outcome at the time the woman is admitted to the hospital, before the labour induction method was established. Model B predicts the outcome at the time the woman is definitely into the labour room. Maternal, fetal and obstetrics variables were collected. To determine the predictive ability of these models in order to assess the risk of cesarean section, a multivariate analysis with binary logistic regression and areas under the ROC curves was used. In each of these models a subgroup analysis was performed and the predictive ability was also studied across these groups: previous caesarean section, use of prostaglandins and main reasons for labour induction (maternal diabetes, prolonged pregnancy and premature rupture of membranes).

Results

The predictive factors in the final model were: maternal height, body mass index, nulliparity, Bishop score, gestational age, macrosomia, gender of fetus, and the obstetrician´s overall cesarean section rate.

The predictive ability of the model Model A was 0.77 (95% CI 0.73–0.80) and the Model B was 0.79 (95% CI 0.76–0.83). The predictive ability for pregnant women with previous cesarean section with Model A was 0.79 (95% CI 0.64–0.94), and with Model B was 0.80 (95% CI 0.64–0.96). For a probability of estimated cesarean section ≥ 80% the model A and B presented a positive likelihood ratio (+LR) for cesarean section of 22 and 20, respectively. Also, for a likelihood of estimated cesarean section ≤ 10% presented a +LR for vaginal delivery in 13 and 6, respectively.

conclusion

These predictive models have a good discriminative ability in order to assess the risk of cesarean section both, overall and for all subgroups which were studied. Therefore, these models could be a helpful tool in clinical practice mainly for pregnant women with previous cesarean section and diabetes.

(16)

aSSESIng ThE RISK Of InTRauTERInE gROw RESTRIcTIOn afTER a PREvIOuS caESaREan SEcTIOn

Octavian Gabriel, O. (1)_{; Ileana, C.} (1)_{; Anca Daniela, S.} (1)_{; Catalina Monica, P.} (2)

(1) _{UMF Carol Davila, Bucuresti, Romania;}(2) _{INGG Ana Aslan, Bucuresti, Romania}

Abstract:

Introduction

Starting from the 1980s we are witnessing a significant and continuous growth of percentage of births by caesarean section. This constantly evolving phenomenon has multiple consequences. Some authors have identified caesarean section as a risk factor for intrauterine growth restriction in a future pregnancy.

Objective of the study

Was to identify if there is a statistically significant increase in the number of diagnosed cases of IUGR in women with uterine scar after caesarean section.

material and methods

We performed a retrospective study that included all women with a uterus scar after caesarean section who gave birth in our maternity hospital in the last 10 years. This group was compared to another group consisting of pregnant women who have no previous caesarean section and who gave birth in the same period. Data were obtained from observation charts of pregnant women and of the newborns, respecting the definition of IUGR newborns - birth weight less than 10 percentile of weight for gestational age of pregnancy and by excluding the newborns small for gestational age by other causes.

Results and discussion

In the last 10 years we are seen a continuous increase in the percentage of births by caesarean section in our maternity, from 32.5% in 2005 to 53.35% in 2014. At the same time the percentage of women with a uterus scar that who gave birth in our maternity also increased from approx. 3.9 to 5.9%. In the mentioned period there were a total of 23,250 births of which 1216 cases were from womens with uterus scar. The proportion of IUGR was about 5.9% in both groups.

conclusion

In this study we do not find statistically significant differences to justify classification of caesarean section as risk factor for IUGR. We consider that prospective studies is needed to confirm this findings.

(17)

vagInal BIRTh afTER cESaREan SEcTIOn fOR faIluRE TO PROgRESS OR maTERnal and fETal dISTRESS

Jurado Español, R.; Romero Nieto, I.; Pomares Toro, E.; Ruiz-Roso Muñoz-Torrero, C.M.; De La Torre González, A.J.; Chacón Parejo, E.; Arjona Berral, J.E.

Reina Sofia University Hospital, Córdoba, Spain

Abstract:

Objectives

To analyze the vaginal birth in pregnant women after cesarean section for failure to progress and fetal distress. And to assess, as if the beginning of the current trial of labor was induced or spontaneous, the incidence of vaginal birth or a second cesarean.

materials and methods

We conducted a retrospective study in the period of 2014 on the way of delivery of a new pregnancy in women with a previous cesarean for failure to progress and maternal and fetal interest of the Gynaecology and Obstetrics Reina Sofia University Hospital in Córdoba. We used the databases of the labour room and consultation room of Fetal Pathophysiology.

Results

61,7% of women who underwent trial of labor after a previous cesarean for failure to progress have completed a vaginal delivery (they were vaginal the 53.65% and 46.34% instrumental). While 38,3% of pregnancies ended in repeat cesarean section, of which 50% was again by failure to progress. In 67,6% of cases, the onset of labor was spontaneous and 32,4% of pregnant women underwent induced labour.

Women with previous cesarean section for maternal and fetal interest have ended in vaginal delivery in 83,3% of cases and caesarean section in 16,7% of cases. The onset of labor was spontaneous in 33,3% of pregnant women and induced in 66,7%.

conclusions

In women with cesarean for failure to progress and for maternal and fetal interest we must insist on trying vaginal delivery because more than half the cases, delivery it´s possible.

(18)

ThE EffIcacy Of PRE-dElIvERy PROPhylacTIc TRanS-caThETER aRTERIal BallOOn OccluSIOn Of BIlaTERal InTERnal IlIac aRTERy In PaTIEnTS SuSPEcTEd wITh PlacEnTal adhESIOn

Kim, S.Y.; Cho, Y.J.; Kim, J.H.; Byun, S.S.; Kim, J.Y.

Gachon University,Gil Hospital, Incheon, Republic of Korea

Abstract:

Objective: The prophylactic transcatheter arterial balloon occlusion (PTABO) before cesarean section(C/S) of placenta previa totalis has introduced to prevent massive hemorrhage. To evaluate the clinical usefulness of PTABO, we investigated antepartum risk factors and perinatal outcomes in women with placenta previa totalis.

methods: Between Jan. 2012 and Sep. 2014, 74 patients with placenta previa totalis were enrolled in this study. 17 patients were placed PTABO before C/S and another 57 patients were underwent C/S without PTABO. In PTABO, after baby was out, ballooning occlusion of internal iliac artery were performed for 10 min. And after hemostasis, deflation of balloon was done. Placental adhesion were defined by ultrasound(USG) which were showed irregular, thin uterine wall, prominent placental vessels and lacunae sign in placental spaces, and to confirm the placenta accreta pelvic MRI was performed.

Results: In PTABO group, there showed more advanced maternal age, longer in gestational weeks at delivery and more common previous C/S history. There were more common in placenta adhesion, abnormal Doppler findings and frequency of transfusion in PTABO group. But there were no significant difference in estimated blood loss, amount of transfusion, neonatal outcome. It had occurred 3 case of hysterectomy and 1 case of uterine artery embolization after C/S in PTABO group.

conclusion: Close surveillance of antepartum risk factors for placental adhesion using USG and MRI is important to present massive hemorrhage during C/S. PTABO before C/S might be reduced blood loss and transfusion requirement during operation.

(19)

BaKRI POSTPaRTum BallOOn fOR ThE managEmEnT Of POSTPaRTum haEmORRhagE

Agustín Oliva, A.; Roriguez Lázaro, L.; Diaz Rabasa, M.B.; Laborda Gotor, R.A.; Rodrigo Rodriguez, M.; Redrado Giménez, O.; Ruiz Sada, J.; Moreno Pérez, R.; Andrés Orós, P.; Rodriguez Solanilla, B.

H.U. Miguel Servet, Zaragoza, Spain

Abstract:

Introduction:

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide. Several guidelines for PPH management include intrauterine balloon as an effective option when uterotonic drugs are not effective.

Objectives:

Main objective: to determine the effectiveness of intrauterine balloon for management of PPH in our hospital in cases where medical treatment failed.

Secondary objectives:

• Maternal and fetal characteristics and risk factors for PPH in the patients that required balloon tamponade.

• Type of birth, placental abnormalities and bleeding in these patients. • Administration of uterotonics drugs previously to balloon placement.

• Need for another method of rescue to stop bleeding, maternal mortality and the admission in the Intensive Care Unit (ICU).

materials and methods:

Retrospective descriptive study of patients who required balloon intrauterine (n = 89) to stop the PPH. Data about maternal and fetal characteristics, medical treatment and risk factors for PPH were collected during the period between July 2010 and February 2015 from the clinical history.

Results:

During the study period there were a total of 19,586 births in our hospital, 1,566 PPH and 89 women required balloon taponade(0.46%). These patients had a mean age of 33 years (21-45), delivery at 38 weeks on average (25-42) and their newborns had an average weight of 3149g (890-4850g). The following risk factors for PPH were found: multiple gestation 27% (n = 24), induction labour 39% (n = 35), delivery expulsive period prolonged (> 3h) 16.9% (n = 15) and did not present risk factors 37.1% (n = 33). The more frequent type of delivery was eutocic (51.68%) followed by cesarean section (31.46%) and instrumental (28.85%). There were placental abnormalities in 5 patients: 4 accretisms and 1 placenta previa. The mean decrease of hemoglobin levels was 4 g/dl, 61.8% of the patients required blood transfusion. As medical treatment oxytocin and rectal misoprostol were used in all of them, prostaglandins in 50.6% (n = 45) and methylergometrine 80.9% (n = 72). The balloon was effective in 95.5% of patients (n = 85) and four patients required rescue method: 1 uterine artery embolization and subsequent puerperal hysterectomy, 2 puerperal hysterectomy and one uterine capitonnage. Required ICU admission 8.98% of patients (n = 8) and there was no maternal death.

conclusions:

Recognize risk factors for PPH optimizes the treatment. Bakri balloon is an effective technique to treat PPH unresolved with uterotonics. It prevents in most cases the need for surgery or embolization.

(20)

TyPE Of BIRTh afTER PREvIOuS cESaREan. STudy Of a cOhORT Of 182 BIRThS

Sánchez Rivadulla, L.; Rivera Trobo, A.; Montes Prieto, C.; Fuentes Ricoy, L.; Dominguez Olivera, N.; Veiga Tuimil, M.A.

SERGAS, Hospital Ferrol, Spain

Abstract:

Objectives: Getting to know epidemiological details of pregnancies after previous cesareans in our health area.

methods: A cohort of 182 pregnancies after previous cesareans between 2013 and 2014 were studied. The details were retrospectively gathered from the informatic register of births and the clinical histories of the hospital. All age, nationality, weight, parity, indications of previous cesareans, acceptance or not of vaginal birth, type of birth of the studied pregnancy and indications in the case of cesareans were studied.

Results: The incidence of pregnancies after previous cesareans in our health area is 9,1% of the total pregnancies. The distribution of age ranges (16-20, 21-25, 26-30, 31-35, 36-40, 41-45 and 46-50) is of 0,97%, 0,97%, 12,62%, 41,75%, 37,86%, 5,83% and 0% respectively. 85,44% are Spanish women, 7,77% are Latinamericans and 6,79% are of other nationalities. In our series, 77,7% of the women weighed less than 80Kg. Considering parity, 9,71% of the pregnant women had two previous cesareans and 4,85% had a previous vaginal birth. The indications of previous cesareans are shown in the following chart:

PREvIOuS cESaREan IndIcaTIOnS numBER Of caSES %

STATIONED BIRTH 18 17,48 INDUCTION FAILURE 13 12,62 BREECH PRESENTATION 13 12,62 FETAL DISTRESS 26 25,24 PELVIC-FETAL DISPROPORTION 11 10,68 FETAL MACROSOMIA 6 5,83 MEDICAL INDICATIONS 8 7,77 OTHERS 8 7,77

66,48% of the women accepted vaginal birth attempt, 18,68% didn´t accept it and in the other 14,84% that possibility was not contemplated due to our protocol (breech presentation, two previous cesareans,…). Of all the pregnancies, 56,59% ended in cesarean and 43,41% in vaginal birth. The indications of current cesareans are shown in the following chart:

CURRENT CESAREAN INDICATIONS numBER Of caSES %

VAGINAL BIRTH WITHDRAWAL AFTER CESAREAN 34 33,01

STATIONED BIRTH 13 12,62 INDUCTION FAILURE 6 5,83 BREECH PRESENTATION 6 5,83 FETAL DISTRESS 8 7,77 PELVIC-FETAL DISPROPORTION 9 8,74 FETAL MACROSOMIA 2 1,94 MEDICAL INDICATION 8 7,77 OTHERS 7 6,79 2 PREVIOUS CESAREANS 10 9,71

conclusions: The most frequent age in pregnancies after previous cesareans is in the age range of 31-35. The mother´s nationality is Spanish in its majority and the weight is less than 80Kg. Most of the women accepted vaginal birth attempt after cesarean. A cesarean is more frequent after another previous cesarean than after a vaginal birth. Among the indications of previous cesareans,

(21)

ROuTE Of dElIvERy afTER a PREvIOuS cESaREan SEcTIOnfOR nOnREaSSuRIng fETal STaTuS and fOR PREEclamPSIa

Romero Nieto, I.; Pomares Toro, E.; Alcolea Santiago, J.; Duro Gómez, J.; De La Torre González, A.J.

Reina Sofia University Hospital, Cordoba, Spain

Abstract:

Objective: To analyze the route of delivery after prior transverse low-segment cesarean section for nonreassuring fetal status and for preeclampsia in pregnant women who underwent trial of labor in our hospital. And to assess, as if the beginning of the current birth was induced or spontaneous, the incidence of vaginal birth or a repeat cesarean.

material and methods: We have conducted a retrospective study in the period of 2014 on the route of delivery of a new pregnancy in women who had one prior cesarean of the Obstetrics and Gynecology Reina Sofia University Hospital. We have used the databases of the labor room and consultation room of Fetal Pathophysiology.

Results: We have examined 77 women undergoing trial of labor after cesarean section for nonreassuring fetal status and for preeclampsia who have no contraindication for vaginal birth. The overall success rate of vaginal delivery for women who attempted trial of labor after cesarean delivery ranged 74% (57 cases). A failed trial of labor after cesarean section resulting in a repeat cesarean delivery during labor was 26%.

58,4% of pregnant women (45 cases) underwent spontaneous trial of labor, among which the rate of vaginal birth was 73%.

In 41,6% of pregnant women, the onset of labor was induced, finishing in vaginal birth in 69 % cases.

conclusions: In women with previous cesarean birth for nonreassuring fetal status and for preeclampsia, it should be encouraged for vaginal delivery, since 70% of cases ended in a successful vaginal birth safely.

(22)

ThE RElaTIOnShIP BETwEEn clInIcal cOuRSES Of cESaREan SEcTIOn and ThREaTEnEd PRETERm laBOR In nEXT PREgnancy

Higuchi, S. (1)_{; Asaka, R.} (1)_{; Ono, M.} (1)_{; Nakajima, M.} (1)_{; Tanaka, K.} (1)_{; Takatsu, A.} (1)_{; Ohira, S.} (1)_{; Kanai,}

M. (2)_{; Shiozawa, T.} (1)

(1) _{Shinshu University School of Medicine, Matsumoto, Japan;}(2) _{Shinshu University School of Health}

Sciences, Matsumoto, Japan.

Abstract:

Backgrounds

Recently, the rate of cesarean section has been increased. We experienced two cases of preterm labor with a history of emergency cesarean section after the onset of labor. According to these cases, we hypothesized that previous cesarean section might increase the risk of preterm birth in the next pregnancy. Therefore in this study, we examined the effect of previous emergency cesarean section after labor onset on the course of the following pregnancy.

methods

This is a retrospective analysis performed at Shinshu University Hospital from January 2009 to December 2011. Of 155 women who had an emergency cesarean section after labor onset during the study period, following pregnancies of 34 women were managed in our hospital. The relevant clinical factors between the outcome of the following pregnancies and previous cesarean sections were examined.

Outcomes

Of the 34 following pregnancies, three cases needed hospitalization for threatened premature labor. Multivariate analysis for clinical settings in previous cesarean section was performed between the group without treatment of preterm labor (31 cases) and the group with treatment of preterm labor (3 cases). Postoperative fever (37.6 ± 0.5 ℃ vs 38.3 ± 1.0 ℃, P=0.043), cervix dilatation (5.7 ± 2.7 cm vs 9.3 ± 1.2 cm, P=0.031), and station of fetal head (Sp -1.6±1.4 vs Sp +0.7 ±1.5, P=0.013) showed significant differences. There were no significant differences in maternal age, time from onset of labor until the expulsion, gestational weeks of the delivery, and period until the next pregnancy.

conclusion

Postoperative fever, cervix dilatation, and station of fetal head in previous cesarean section were associated with subsequent threatened premature labor in the following pregnancy. If delivery was performed by caesarean section during the labor, careful observation for preterm labor might be necessary in the next pregnancy.

(23)

cESaREan RaTE analySIS accORdIng TO ROBSOn’S claSSIfIcaTIOn

Redondo Aguilar, R.; Aisa Denaroso, L.M.; Manrique Fuentes, G.; González Acosta, V.; Aceituno Velasco, L.; De La Fuente Pedrosa, R.

SAS, Huércal-Overa, Spain

Abstract:

Introduction: In recent decades there has been a dramatic increase in cesarean section rate in all developed countries. The cesarean section rate in Spain, registered by the Ministry of Health, was 24.9% in 2012. The classification described by Robson et al defines 10 different groups based in four obstetric concepts: pregnancy, obstetric history, labor and delivery, and gestational age at delivery.

Objective: To analyze cesarean section rate in Inmaculada Local Hospital, using Robeson’s classification to compare it with other hospitals, both at national and international level and establish potential interventions to reduce such rate.

material and methods: A cesarean section rate retrospective audit was performed according to Robson´s classification, from 1st_{January 2006 to 31}st_{December 2013.}

Results: 9337 deliveries and 1507 cesareans were analyzed on that period of time. The cesarean rate was 16.14%. Nulliparous women with a singleton pregnancy in cephalic presentation at 37 weeks or more and undergo a labor induction before the onset of labor represent the first group of the cesareans with 25.2%of the total.

In second place comes multiparous women with at least one previous cesarean section with a singleton pregnancy in cephalic presentation, 37 weeks or more, representing 19.4% of the total cesareans. This group had a 42.2% cesarean rate.

In third place (17.4%) we had nulliparous women with a singleton pregnancy in cephalic presentation, 37 weeks or more, who have started labor spontaneously.

Conclusions Increased cesarean section rate in recent years required audits using a classification system, like Robson´s one, to establish the groups in which it is possible to reduce the number of cesareans. In our case the group that contributes the most to the cesarean rate is number 2 on

Robson´s classification:

Nulliparous women with a singleton pregnancy in cephalic presentation at 37 weeks or more and undergo a labor induction before the onset of labor (25.2%), this represent a similar rate shown in other studies but we think this group could be reduced.

We must analyze every single elective cesarean case at clinical sessions and review induction indications to reduce the number of cesareans.

(24)

maTERnal mORBIdITy In cESaREan SEcTIOnS

Redondo Aguilar, R.; Manrique Fuentes, G.; Aisa Denaroso, L.M.; De La Fuente Pedrosa, R.; Sanchez Fernandez, M.; Sanchez Barroso, T.

SAS, Huércal-Overa, Spain

Abstract:

Introduction: Complications of cesarean sections(CS) range from 12-15%. CS is associated with an increased risk of complications such as bleeding, need for blood transfusion, infections, injury to the bladder and bowel, and deep vein thrombosis of the lower limbs

Objective: To analyze maternal morbidity at CS during a period of six years.

methods: In this descriptive cross-sectional study (case series) maternal morbidity associated with caesarean section was determined in all pregnant pacients operated in Hospital “La Inmaculada” of Huercal-Overa (Almeria-Andalucia) between January 2008 and December 2013.

Results: During the analyzed period CS represent 17.44% (1336) of total births(7646). We observed 11.5% of complications after cesarean. Maternal morbidity rates after cesarean section have remained stable over the years, being slightly below 9.90% in the last year. Maternal morbidity after vaginal delivery was 5%. We found that the most frequent complication associated with CS was the obstetric hemorrhage requiring blood transfusion (4.1%), followed by infections (4%). It should be noted the most serious complications in CS: a case of pulmonary embolism, obstetric hysterectomy in 4 cases (1.8%) and 3 cases of puerperal curettage for retained products (1.35%).

The rate of pregnant women with previous cesarean was 9.70%, which has increased more than one point in recent years. The complications are greater and more serious in cases with previous cesarean: a case of paralytic ileus, a case of bladder opening, 2 cases of dehiscence of hysterotomy and more frequent blood transfusions.

comment and conclusions: The number of caesarean sections is increasing significantly worldwide in recent decades while the number of complications also increases. As previously described in scientific literature, the two leading causes of maternal morbidity are obstetric haemorrhage and infections in Hospital La Inmaculada. Therefore, we must establish measures to prevent these causes. The most effective measure is to adjust indications of cesarean sections to guidelines. Trying to avoid caesareans on demand, we will diminish the iterative caesarean sections and complications from them.

(25)

vagInal vERSuS cESaREan dElIvERy fOR BREEch PRESEnTaTIOn

Rodrigo Rodriguez, M.; Diaz Rabasa, B.; Laborda Gotor, R.; Ruiz Sada, J.; Agustin Oliva, A.; Redrado Gimenez, O.; Rodriguez Solanilla, B.; Rodriguez Lazaro, L.; Lapresta Moros, M.

Hospital Universitario Miguel Servet, Zaragoza, Spain

Abstract:

Objective: Breech presentation occurs in 3 to 4% of pregnancies at term. For most breech fetuses at term, the best approach by which to deliver is controversial. The aim of this study is to evaluate neonatal and maternal outcomes in term singleton vaginal breech deliveries compared with cesarean delivery in our Hospital during a 9 years period.

methods: A retrospective study including women with a singleton live fetus in breech presentation at term (> 37 weeks of gestation) from January 2006 until December 2014 in our Hospital in Spain. Maternal and neonatal outcomes were compared according to delivery method.

Results: Of 937 singleton breech presentation deliveries, 732 of them met inclusion criteria. Cesarean section was performed in 590 cases (80,6%) and there were 142 vaginal breech deliveries (19,4%). Regarding caesarean, 53,56% of them were planned and the rest were performed urgent. In 13 cases of assisted vaginal breech deliveries, a Piper Forceps was applied to the after-coming head. Nulliparity was significantly higher in the vaginal deliveries (80,6% vs 19,4%, p< .001). No significant differences in maternal age or gestational age at delivery were found. Regarding perinatal outcomes, statistically significant differences in 5-minutes Apgar ≤ 7 and umbilical cord pH at birth were found. However, no statistically significant differences were found in the incidence of neonatal acidosis.

conclusions: The decision about the mode of delivery of breech presentations should depend on the experience of the physician. Fetuses in breech presentation at term, suitably selected, get correct perinatal outcomes for both modes of delivery. Vaginal delivery remains an acceptable option for breech delivery in selected cases.

(26)

vagInal BIRTh afTER cESaRIan: OuR RESulTS

Stankovic, J.; Jankovic Raznatovic, S.; Rakic, S.; Zecevic, N.

Department of Gynecology and Obstetrics Narodni Front, Belgrade, Serbia

Abstract:

Background. We wanted to examine the trends, incidence and safety of vaginal birth after cesarean (VBAC).

methods. We included 703 singleton pregnancies, with a prior cesarean who are eligible for a trial of labor (TOL) or elective repeat cesarean delivery (ERCD). Repeated Cesarean delivery (RCD) had 625 (88,9%) patients and 78(11,1%) of them had VBAC. We examined anamnestic and peripartal data for mothers and for children. For the statistical analysis we used Student t test, the chi-square test and the Fisher's exact test.

Results. In the group of the patients with RCD we identified 498 (79,7%) patients with ERCD and 127(20,3%) of patients with TOL who undergo ERCD.Statistical analysis shows high statistical difference (p<0.01) between the groups. There is no statistical difference between postpartal complications, postpartalhysterectomy, blood transfusion and neonatal mortality and morbidity. In the literature, the range for TOL and VBAC rates was large (28–82% and 49–87%). Predictors of women having a TOL were having a prior vaginal delivery and settings of higher-level OB/GYN care centers. TOL rates in U.S. studies declined in studies initiated after 1996 from 63 to 47 percent, but the VBAC rate remained unimproved. Hispanic and African American women were less likely than their white counterparts to have a vaginal delivery.

conclusions. Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase. This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean delivery.

(27)

ROuTE Of dElIvERy afTER a PREvIOuS cESaREan SEcTIOn fOR cEPhalOPElvIc dISPROPORTIOn

Romero Nieto, M.I.; Ruiz-Roso Muñoz-Torrero, C.; Arenas Farrona, B.; Nieto Pascual, L.; Alcolea Santiago, J.

Reina Sofia University Hospital.Cordoba, Cordoba, Spain

Abstract:

Objective: To analyze the route of delivery after prior transverse low-segment cesarean section for cephalopelvic disproportion in pregnant women who underwent trial of labor in our hospital. To assess, as if the beginning of the current birth was induced or spontaneous, the incidence of vaginal birth or a repeat cesarean.

material and methods: We have conducted a retrospective study in the period of 2014 on the mode of delivery of a new pregnancy in women who had one prior cesarean for cephalopelvic disproportion of the Obstetrics and Gynecology Reina Sofia University Hospital. We have used the databases of the labor room and consultation room of Fetal Pathophysiology.

Results: We have examined 82 women undergoing trial of labor after cesarean section for cephalopelvic disproportion who have no contraindication for vaginal birth.

The overall success rate of vaginal delivery for women who attempted trial of labor after cesarean delivery ranged 65,8 % (54 cases). A failed trial of labor after cesarean section resulting in a repeat cesarean delivery during labor was 34,2 % (60% of them recurrent indication for the prior cesarean delivery).

67,1 % of pregnant women (55 cases) underwent spontaneous trial of labor, among which the rate of vaginal birth was 70,9 %.

In 32,9 % of pregnant women, the onset of labor was induced, finishing in vaginal birth in 57,7% cases.

We have not identified obstetric or fetal factors such as intrapartum interventions (eg, labor induction or augmentation of labor) and estimated fetal weight (about or similar than the fetal weight of the previous cesarean delivery) to predict which women will have a successful or unsuccessful trial of labor ending in vaginal delivery, although this group is not assessable due to sample size (26 cases).

conclusions: In women with previous cesarean birth for cephalopelvic disproportion, it should be offered for vaginal delivery, since more than half of cases ended in a successful vaginal birth safely, reaching 70% in women with spontaneous labor.

(28)

ROuTE Of dElIvERy afTER PREvIOuS cESaREan BIRTh fOR faIluRE TO InducTIOn

Romero Nieto, M.I.; Jurado Español, R.; Nieto Pascual, L.; Lorente González, J.; Rios Castillo, J.E.

Reina Sofia University Hospital. Cordoba, Spain

Abstract:

Objective: To analyze the route of delivery after prior transverse low-segment cesarean section for failure to induction in pregnant women who underwent trial of labor in our hospital. To assess, as if the beginning of the current birth was induced or spontaneous, the incidence of vaginal birth or a repeat cesarean.

material and methods: We have conducted a retrospective study in the period of 2014 on the procedure of birth of a new pregnancy in women who had one prior cesarean of the Obstetrics and Gynecology Reina Sofia University Hospital. We have used the databases of the labor room and consultation room of Fetal Pathophysiology.

Results: We have examined 21 women undergoing trial of labor after cesarean section for failure to induction who have no contraindication for vaginal birth.

The overall success rate of vaginal delivery for women who attempted trial of labor after cesarean delivery ranged 57,1% (12 cases). A failed trial of labor after cesarean section resulting in a repeat cesarean delivery during labor was 42,9 % (over half of them recurrent indication for the prior cesarean delivery).

47,6% of pregnant women (10 cases) underwent spontaneous trial of labor, among which the rate of vaginal birth was 90%.

In 52,4% of pregnant women, the onset of labor was induced, finishing in vaginal birth only in 27,3% cases.

conclusions: In pregnant women with previous cesarean birth for failure of induction, it should be encouraged for vaginal delivery, since 90% ended in a successful vaginal birth safely in women with spontaneous labor. But if the beginning of the trial of labor was induced, almost 75% of the cases finished in a repeat cesarean (and the indication for it was failure of induction again).

(29)

InducTIOn Of laBOuR cOmPaREd TO EXPEcTanT managEmEnT In PREgnancy BEyOnd 41 wEEKS

Rosati, P.; Buongiorno, S.; Ciliberti, P.; Tintoni, M.; Viggiano, M.; Ciardulli, A.; Cavaliere, A.F.; Guariglia, L.

Policlinico A.Gemelli, Rome, Italy

Abstract:

Objective: To compare outcomes in prolonged pregnancy undergone to labour induction (I group) versus expectant management (II group).

method: Retrospective analysis of prolonged pregnancies in a 2-year period.

In I group, induction of labour was performed with dinoprostone applied (1 time or more) in the posterior fornix. In the II group, women at 41 0/7 or more gestational weeks were checked every 2 day until 41 6/7 weeks. Labour was induced in case of abnormalities in fetal cardiotocography or in amniotic fluid index or in any case at 41 6/7 gestational weeks.

Results: We included 231 women: 48 (20.8%) consisted in the induction group, while 183 (79.2%) in the expectant management.

The spontaneous delivery rate was respectively 35.4% and 80.9% in the I and in the II group (p<0.001), whereas the operative vaginal delivery rate was 8.3% and 1.6% in the two groups (p<0.05).

Caesarean sections were performed in the induction and expectant management group respectively for: fetal cardiotocography abnormalities in 81.5% versus 50 % of cases, “failure to progress” in labour for mechanical reasons (i.e. cephalopelvic disproportion, malposition of the fetal head or cervical dystocia) in 7.4% versus 50%, and dynamic dystocia 11.1% versus none case.

In cases underwent to caesarean section in the 2 groups considered, statistical significance was revealed in “failure to progress” in labour (p<0.05), whereas not in fetal cardiotocography abnormalities (p=n.s.) or dynamic dystocia (p=n.s.).

conclusion: In prolonged pregnancies, caesarean section and operative vaginal delivery rate, are higher in labour induction group than in expectant management. Moreover “failure to progress” is the most common indication for caesarean section in women with spontaneous onset of labour (expectant management).

(30)

cEREBRal vEnOuS ThROmBOSIS afTER cESaREan SEcTIOn: caSE REPORT

Karaiskakis, P.; Petsa, A.; Stamatelou, F.; Papadopoulos, K.; Siampalioti, G.; Siampani, N.; Alexopoulos, E.; Polou, N.; Peitsidou, K.; Kastrinakis, K.; Exarchos, Z.; Kasimatis, K.

Department of Obstetrics – Gynecology, Alexandra Hospital, Greece

Abstract:

Introduction:

The annual incidence of this disease is estimated at 3-4 cases per million. The 3 out of 4 cases concern women and one in eight women will succumb to death or will develop a disability as a result of cerebral venous thrombosis. The pathogenesis remains unknown. Risk factors are thrombophilia, blood disorders, infections, malignancies, and other rare causes. However, in 25% of the patients, the cause is never found.

Objective:

To present the management of a 30-year old woman who presented with postpartum cerebral venous thrombosis after cesarean section, despite receiving antibiotic and anticoagulant therapy during puerperium.

material and methods:

30-year old woman (GI, P0) was admitted to our hospital at the gestational age of 39 weeks and one day, in labor.

Results:

Because childbirth evolution did not evolve normally, she was submitted to a caesarean section and gave birth to a female (weight 3900gr). Postpartum, she had a smooth postoperative course. In puerperium, analgesic treatment was administered, as well as antibiotics (Cefuroxime), anticoagulation factors (Tinzaparin), iron and calcium. In the 20th_{day postpartum, despite receiving}

antibiotic and anticoagulant therapy, she presented seizures at home – without other accompanying or prodromal symptoms, such as headache, earache, vomiting and blurred vision – and was transferred to a hospital for further investigation and treatment. In laboratory tests, no inflammation markers were found. In the imaging procedures (brain MRI and brain magnetic resonance angiography), cerebral venous thrombosis was found.

conclusions:

Cerebral venous thrombosis, though rare, can happen. The clinical presentation and evolution of the disease show great diversity. So the diagnosis may be difficult. The average delay time of diagnosis to the start of symptoms is 7 days. However, development in imaging techniques has led to greater sensitivity and specificity in the diagnosis of this disease.

(31)

ThE SOnOgRaPhIc aPPEaRancE Of PlacEnTa accRETa

Tsankova, M.; Nikolov, A.; Marinov, B.; Markov, P.; Popova, B.

University Hospital Maichin Dom, Sofia, Bulgaria

Abstract:

In this report we shall describe eight cases of pl.accreta, accurately diagnosed sonographically antenatal in the early third trimester. We used the following six sonographic markers for pl.accreta: 1. Irregulary shaped placental lacunae “Swiss cheese“ appearance within the placenta-eight cases; 2. Thinning of myometrium, overlying the placenta less than 1mm- 8 cases; 3. Loss of retro placental “clear zone”- eight cases; 4. Irregularity and width or loss of uterine serosa - bladder loss interface - 7 cases; 5. Bridging vessels in the placenta - 5 cases; turbulent blood flow through the lacunae on Doppler- 6 cases. The age group of the patients is 20-35 years.

Seven patients had previous SC and more than one interruptions and only one patient – first pregnancy. Six cases were with placenta praevia anterior, one-low lying placenta and one-placenta anterior and placenta succentoriate with vasa praevia. The outcome of cases was – 7 Laparohyserectomies and one SC with resection of anterior wall of the uterus. In three cases we had invasion of the bladder and resection of the later.

The patient with low lying placenta delivered vaginally in 30 gestational week and postpartum heavy bleeding and hemorrhagic shook developed with more than 5 l blood loss. The blood loss was less than 1 l in three cases and between 2-3l in four cases. All cases are hystologically approved (placenta accreta).

The frequency of placenta accreta for our hospital for the period 2011-2015 is 0,05%. There is an associated risk between placenta accreta and the following risk factors: 1. previous SC 2. placenta praevia 3. previous abortions.

We used two-dimensional imaging, color-flow Doppler and power Doppler in assessing this condition. As placenta accrete is associated with high risk of maternal exsanguination, we found that sonography is an important and reliable tool in diagnosing it.

(32)

RElaTEd facTORS Of vagInal BIRTh afTER cESaREan SEcTIOn

Laborda, R.A.; Lahoz, I.; Diaz, B.; Rodrigo, M.; Lapresta, M.; Andres, P.; Agustin, A.; Ruiz, J.; Redrado, O.; Cotaina, L.; Castan, S.

Hospital Universitario Miguel Servet, Zaragoza, Spain

Abstract:

Introduction: A female who has had a prior cesarean section is a high risk patient. Therefore, it could be three options of delivery: onset of labour which ends vaginally, onset of labour which ends in urgent cesarean and elective cesarean.

The aim of our study is to perform a comparative analysis of patients who started labor to find predictors of vaginal delivery.

methods: Retrospective descriptive analytic study to evaluate factors related to vaginal delivery in patients initiating labor and have a history of a previous cesarean section.

Results: A total of 4124 deliveries were attended during the study period. Of these, 325 patients have had a prior cesarean.

Fifty nine patients with an elective cesarean section were excluded. Of the remaining 266 patients whose labor was initiated, five patients were excluded because they were twin pregnancies.

We performed statistical analysis with 261 pregnant women with a history of previous cesarean, singleton pregnancies and in which labor began. 189 patients had a vaginal birth (72.4%) and 72 patients had an urgent cesarean (27.6%).

They reached statistical significance for vaginal delivery lower birth weight, the presence of previous vaginal births and spontaneous onset of labor, widely described factors in the literature.

In addition, also they reached statistical significance for vaginal delivery increased score in the Apgar score, both minute and five minutes, which could be justified because in the cesarean group were included those made to present, after starting labour delivery, risk of loss of fetal wellbeing, which have on average a lower Apgar at birth (20 patients).

Finally, both diabetes and the fetal macrosoma is associated with a lower likelihood of vaginal delivery, which could be justified by the relationship between these two factors and described less likelihood of vaginal delivery with a higher birth weight.

conclusion: Although vaginal birth after previous caesarean section is safe, more studies should be conducted to conclude what factors are predictors of success.