Oral and Poster Presentations

400 MULTIFETAL GESTATION AND PREGNANCY OUTCOME

C. Berceanu, S. Berceanu, A. Patrascu, S. Stoian, R. Capitanescu

University of Medicine and Pharmacy Craiova, Obstetrics and Gynecology, Craiova, Romania

Introduction: multifetal gestation is occurring in approximately 1 at 70 to 80 deliveries. Risk factors may include ovarian stimulation, assisted human reproduction, prior multifetal pregnancy, or advanced maternal age. Our research is targeting to evaluate pregnancy outcome for patients with twin and triplet gestations.

Material and Methods: our study has been developed on a lot of 17 pregnant women with multifetal gestations. There have been diagnosed 2 triple pregnancies and 15 twin pregnancies. Our patients have been strictly clinically supervised and ultrasonographic evaluated in order to diagnose possible pregnancy complications.

Results: we have been diagnosing twin-to-twin transfusion syndrome (TTTS) in 5 cases–1 triple pregnancy and 4 twin pregnancies. In one twin pregnancy with TTTS one of the fetuses was born died and mummified. For the other 4 pregnancies with TTTS there have been significant differences in the birth weight of the fetuses. Intrauterine growth restriction has been diagnosed for 11 of the pregnancies. One triple gestation transformed into a twin pregnancy, one of the embryos ceased living early in gestation–vanishing twin syndrome. The incidence of preeclampsia was of 23.5%. We have diagnosed 1 case of gestational diabetes for a twin pregnancy. Premature birth occurred for the triple pregnancy and for 9 of the twin pregnancies from our lot. Other pregnancy complications: oligoamnios, polyhydramnios, placenta praevia or fetal complications because of prematurity.

Conclusions: pregnancy outcome in multifetal gestation is strongly influenced by the incidence of maternal and fetal complications. Pregnancy morbidity is significantly higher than in singleton pregnancy.

401 INTRAUTERINE FETUS DEATHS IN PERIOD FROM 2003 TO 2007–OUR EXPERIENCE

A.M. Bojovic, I. Bojovic

Clinical Hospital, Belgrade, Serbia and Montenegro

The objective of our works is ana analysis of birth diagnosed with intrauterine fetus death.

Methods: retrospective birth analysis of medical documentation in the period from 01.01.2003. to 31.12.2007. shows there were total number of 11693 births, out of which were 42 (3.6 on 1000 births) FMU.

Results: it was mostly about primipara 18 (42.86%), aged 16 to 44, with the peak between 26 and 30 years (11 patients), and 31–35 years (11 patients). Fourteen births were inducted. There were 34 vaginal births (80.95%), while 8 women had the cesarean operation.

The gestation was mostly 38–40 weeks–12 (27.91%), while the number of post term pregnacies was 4, one of them prolonged. Both sexes were equally represented.

Fourteen patients had a placenta abruption, while 7 had the umbilical cord wreapped around the child's neck. One patient had a postpartum hysterectomy because of changes in the uterus. Fetus anomalies were diagnosed with one baby–anencephalus (uncontrolled pregnancy) (we did not take into consideration pregnacies where feticide was performed because of diagnosed fetus anomalies). Pato-histological changes on the placenta were verified in 15 patients (placenta infarcts).

Conclusion: We can conclude that it is important to follow-up adequately the whole pregnancy course and the completion of pregnancies in their term at the latest or a few days after delivery term, as well as reducing the risk factors which could bring to the intrauterine feus death.

402 FIRST TRIMESTER PAPP-A LEVEL IS CORRELATED WITH BIRTH WEIGHT, LENGHT AND PREGNANCY COMPLICATIONS

B. Dane¹, I. Afacan¹, C. Dane¹, H. Seval², A. Cetin¹

¹Haseki Training & Research Hospital, Department of Gynecology & Obstetrics, Istanbul, Turkey;²Haseki Training & Research Hospital, Department of Biochemistry, Istanbul, Turkey

Objective: The aim of this study was to determine the relationship between first trimester PAPP-A levels and birth weight, length and pregnancy complications.

Study design: The study included 137 singleton pregnancies at 11–14 weeks of gestation. Gestational age was assessed by crown-rump length (CRL) and blood samples were collected after the sonographic examination. Preterm birth, abortus, intrauterine fetal death and pregnancy induced hypertension are termed as pregnancy complication. Comparison of the data was done with Spearman's correlations and ROC analysis.

Result: There was a significant correlation between PAPP-A levels and birth weight and length (r: 0.265, 0.39 and P = .0026, P < .0001 respectively). A cut- off level < 0.55 MoM predicted small for gestational age babies with 68% sensitivity and 65% specificity (AUC 0.64, P = .02). Twenty two of the pregnancies had various complications. A cut off level < 0.37 MoM predicted pregnancy complications with 40% sensitivity and 87% specificity (AUC 0.62, P = .047).

Conclusion: Fetal weight and length are determined, at least in part, during the first 10 weeks of pregnancy. The risk of pregnancy complications may also be determined by the biochemical parameters of placental function at first trimester.

403 EVALUATION THE FREQUENCY OF INTRACRANIAL HEMORRHAGE IN THE HOSPITALIZED NEONATES

F. Eghbalian, A. Monsef

Hamadan University of Medical Sciences, Department of Paediatrics, Hamadan, Iran

Objective: The improvements in perinatal care during last decade have changed clinical presentation of intracranial hemorrhage (ICH) among full-term newborns. New imaging techniques allow for diagnosis of ICH even in asymptomatic babies. Intraventricular hemorrhage (IVH) is a major complication of preterm birth. Large hemorrhages are associated with a high risk of disability and hydrocephalus. The aim of the present study was to evaluate the prevalence of ICH and its types in hospitalized neonates.

Methods: In this descriptive, cross-sectional study 34 seizured newborns hospitalized in Neonatal Intensive Care Unit were analyzed. Data such as cranial Sonographic findings, brain CT scan findings, cerebrospinal fluid analysis, age, sex, birth weights were entered into the questionnaires and data were analyzed using SPSS 13.

Results: ICH was diagnosed in 7 (20.6%) newborns with neonatal seizure.4 (57.1%) had subarachnoid hemorrhage, 2 (28.57%) had intraventricular hemorrhage and 1(14.28%) had periventricular hemorrhage. Multifocal bleeding was more frequent (71.4%) than bleeding only to one brain compartment (28.57%). The mean age was 14.03 ± 10.05 days (1–29 days). 25 (73.5%) neonates were boys and 9 neonates (26.5%) were girls.

Conclusions: In present study the most common type of the Intracranial hemorrhage was subarachnoid hemorrhage and multifocal bleeding was more frequent. Because subarachnoid and subdural space are not easy visible by head ultrasound, the CT or MRI scans are recommended in newborns with ICH.

Keywords:Intracranial hemorrhage, newborn, frequency

404 UMBLICAL CORD PROLAPSUS RESULTS AT DICLE UNIVERSITY

M. Erdemoğlu¹, A. Kale², N. Akdeniz², U. Kuyumcuoğlu¹

¹Dicle University School of Medicine, Diyarbakir, Turkey;²Dicle University, Diyarbakir, Turkey

Objective: Presentation of part of the umbilical cord ahead of the fetus is a rare emergency condition that complicates pregnancy. Our aim is to evaluate the outcomes of umblical cord prolapsus cases at our clinic.

Material and Methods: Seventy two vaginal deliveries complicated with umbilical cord prolapsus which were underwent cesarean operation were evaluated retrospectively at Dicle University, Department of Obstetrics and Gynecology clinic through January 2000 to January 2008.

Results: There were 72 cases complicated by umblical cord prolapsus during this eight years period. The mean age, the mean gestational age and the mean weight of neonates were 31.3 ± 5.5 (year), 35.2 ± 3.7 (week) and 2711.9 ± 955.5 (gram) respectively. 9 (12%) of cases had preterm premature rupture of membranes (PPROM). The malpresentation rate was 25 (34.7%). The mean Apgar score of neonates at 5. minutes after the delivery was 7.0 ± 2.0 minutes. There were three fetal mortality due to prematurity.

Conclusion: Umblical cord prolapsus is rare condition, but this condition has adverse maternal and fetal outcomes. So the obstetrician should be as quick as possible to decrease maternal and fetal outcomes.

405 CORRELATION OF PAPP-A LEVELS IN MATERNAL SERUM AND BIRTH WEIGHT

M. Gatterer¹, C. Worda¹, H. Gregor², E. Krampl¹, P. Husslein¹

¹Medical University Vienna, Obstetrics and Gynecology, Vienna, Austria;²Standort Semmelweis Frauenklinik der Krankenanstalt Rudolfstiftung, Obstetrics, Vienna, Austria

Introduction: The aim of the study was to investigate the correlation of PAPP-A and ßHCG levels in maternal serum in the first trimester screening and birth weight.

Material and Methods: We included 1930 patients with singleton pregnancies without chromosomal or structural abnormalities. The mean maternal age was 33.28 ± 4.54, the mean body mass index (BMI) was 22.51 ± 3.40. The birth weight was 3303.72g ± 523.68 at 39.15 ± 1.74 weeks of gestation. Maternal serum PAPP-A and ßHCG levels were analysed at the time of first trimester screening at week 11 to 13 + 6 according to the FMF guidelines.

Results: The PAPP-A levels correlate significantly (p = 0.001) with the birth weight. The ßHCG showed no significant correlation to the weight of the newborn. The birth weight depended as expected also on other parameters as sex, maternal BMI and gestational age.

Conclusion: PAPP-A levels correlate, besides gestational age, sex, and maternal BMI significantly with the birth weight. The levels of the ßHCG at the first trimester screening did not show any influence on the birth weight.

406 THE INCIDENCE OF PLACENTAL ABNORMALITIES, MATERNAL AND CORD PLASMA MALONDIALDEHYDE AND VASCULAR ENDOTHELIAL GROWTH FACTOR LEVELS IN WOMEN WITH GDM AND NON-DIABETIC CONTROLS

A. Gezer, R. Madazli

Cerrahpasa Medical Faculty, Obstetrics and Gynecology, Istanbul, Turkey

Background and Aims: To evaluate the incidence of placental abnormalities, cord plasma EPO levels and NRBC counts, maternal and cord plasma MDA and VEGF levels in women with GDM and nondiabetic controls.

Methods: Twenty-twowomen with GDM, diagnosed according to current criteria of American Diabetes Association, were compared with 22 controls. Maternal and cord blood and placental samples were obtained from all pregnant women. Cord plasma EPO levels and NRBC counts, maternal and cord plasma MDA and VEGF levels were determined. Placental tissues were examined histologically.

Results: Maternal and cord plasma levels of MDA and cord plasma EPO levels and NRBC counts were significantly high in GDM pregnancies (p < 0.01). The presence of villous immaturity, chorangiosis and ischemia were significantly increased in the placentas of women with GDM (p < 0.05). The maternal and cord plasma levels of MDA increased (p = 0.007 and p = 0.001 respectively), wheras VEGF decreased (p = 0.046 and p = 0.001 respectively) with the presence of villous immaturity.

Conclusion: Complex process of villous development and maturity might be influenced by maternal and fetal oxidative and angiogenetic milieu. The placenta that shows abnormalities in angiogenesis and maturation may lead to fetal hypoxia and compromise.

407 OUTCOMES IN UNCOMPLICATED MONOCHORIONIC/DIAMNIOTIC TWIN PREGNANCIES

C. Smith¹, W. Giles²

¹Royal North Shore Hospital, Women's Children's and Family Health, St Leonards, Australia;²University of Sydney, Women's Children's and Family Health, St Leonards, Australia

Background: Recent reports have supported the elective early preterm delivery of otherwise uncomplicated monochorionic diamniotic (MC/DA) twin pregnancies because of an incidence of 1 in 23 of such pregnancies being complicated by an unexplained intrauterine fetal death (IUFD) after 32 weeks (Barigye et al, 2005).

Methods: We undertook a retrospective review of all MC/DA twins seen at our tertiary referral Maternal Fetal Medicine Unit from June 2001 to December 2007. We routinely diagnose MC/DA twins by ultrasound criteria and review these women at 4 weekly intervals with ultrasound to assess fetal growth, amniotic fluid, umbilical artery Doppler and any other indications of complications.

Results: 88 cases of MC/DA twin pairs were diagnosed antenatally by ultrasound. The maternal and neonatal data was sourced from the OBSTET and OBSTETRIX database used in the unit. 31 were complicated by IUGR (15), Non-viability (3), Triplets (2), fetal anomalies (3) and polyhydramnios/TTTS (8). There were 57 uncomplicated MC/DA twin pairs. In this group there was 1 IUFD at 27 weeks gestation. There were no missed cases of complications.

Conclusions: From our data we would not support the elective preterm delivery of otherwise uncomplicated MC/DA twins after 32 weeks. Our only case of IUFD occurred well before 32 weeks. We believe that 4-weekly surveillance is appropriate for such antenatally diagnosed uncomplicated MC/DA twin pregnancies.

408 FETUS COMPENSATION OF HIGH RESISTENCE BY MAKEING ANEURISM

M. Gojnic¹, M. Brankovic², B. Vasiljevic³, A. Fazlagic⁴, S. Dugalic⁵

¹High Risk Pregnancies, Institute for Gynecology and Obstetrics, Belgrade, Serbia;²Internistic Department, Hospital Bezanijska Kosa, Belgrade, Serbia;³Neonatological Ward, Institute for Gyn and Obs, Belgrade, Serbia;⁴Hospital Narodni Front, Belgrade, Serbia;⁵Medical Devision, Part for Natural Science, Njegoseva, Belgrade, Serbia

Aneurisms of the umbilical artery are extremely rare. In 34 week of gestation, the fetus was still at the level of 30 wg. From more than 7 weeks the amounts of fetal frowth were disturbing low. After 27th weeks of gestation, as we found higher resistant index, the patients was given, the aspirin 100g per os were persuaded, as the oxygen supliment, and bed rest. We found the aneurism of the umbilical cord, and considered it as the fetus struggle for better oxygen and nutrition supplement.

During whole pregnancy patient was under large amounts of progesterone, as the 3 spontatneous abortions, and polycystic ovarii syndrome, as mycrocystic displasion of the bresta, having acnes on her face, and longer menstrual period as markers for progesterone deficit.

Delivered by cesarean section, after artifitial maturation with dexametason scheme, at clinical 34 wg, weight of 1470g, male sex, Apgar 6/7, with no amnion meconial, and without infectios. There was no need for intubation, or surfactant.

The time of delivery was almost made by fetus itself, because after existing tachycardia, possible made with high fetus movements, for spending acidosis matherials, the bradicardia came, as the umbilical cord masses with fetus body.

Placenta was 320g, with Villitis destruens et calcifications instertio marginalis cum aneurism of one of arterial vessels in the part of insertion.

Make Conclusion: large amounts of progesterone, oxygen supliment.

409 THE INVESTIGATE OF THE FACTORS INFLUENCING NEWBORN LOW BIRTHWEIGHT INFANTS

T. Güner¹, M. Yurdakul²

¹Mersin Univercity, Mersin Univercity School of Health, Mersin, Turkey;²Mersin Univercity, Mersin, Turkey

Objective: In this study aim it is investigate of the factors influencing newborn low birthweight infants.

Methods: 88 women who birthing of the lowbirthweight Mersin Woman and child hospital between the dates january 1-march 30, 2008 were subjected for evaluation. questionnarire applied to the participants by face to face interwiev technique and the data obtanied have been evaluated by SPSS 13.0 program.

Results: In this study most of the women were primary school graduate and housewife. The women's mean age were 27 years, the newborn mean weight 2130 gr birth weight respectively. Mode of delivery was vaginal 45.5% and ceserean delivery in 54.5% women.İt was found out that 58% of the women had 1 children and 65.9% had never aborted removed. The women's 13.6% low income level. Most of the women has health insurance. Of the women, 20.5% active, 67.3% passive cigarette smoking in pregnancy. İn this study 19.3%, of the womens children between years than the less two years.İn this study to take women's 83.0% iron vitamin support during pregnancy, Women's 59.1% low hemoglobin level. The mother's 19.3% gain in pregnancy weight than less 9 kg.

Conclusion: There were no statistically significant relationship between mean newborn birth weight and maternal age, educational, number of birth, weight gain in pregnancy.

Keywords:Low birth weight infant, factors influencing

410 FETAL MONITORING WITH ST ANALYSIS VERSUS CTG ALONE IN THE PREDICTION OF A LOW APGARSCORE

Y. Jacquemyn¹, H. Hosseini¹, S. Palit², G. Palit¹

¹Antwerp University Hospital/ UZA, Obtsterics and Gynaecology, Antwerp, Belgium;²Antwerp University Hospital/ UZA, Anaesthesiology, Edegem, Antwerp, Belgium

Aim: To compare the use of ST analysis (STAN) and cardiotocography (CTG) alone in the prediction of low (<7) Apgarscore in term neonates in cephalic position after vaginal delivery.

Material and Methods: A retrospective case control study, comparing women with a term vaginal delivery and 1 minute Apgarscore < 7 with the first term vaginal delivery in the same maternity with a 1 minute Apgarscore > 7. In both groups the use of STAN or CTG alone, induction of labour versus spontaneous labour, locoregional anaesthesia, oxytocin use, forceps or ventouse are registered, as are parity and birthweight.

Results: There are 46 women in each group. STAN was used in 52% (n = 24) in the study group versus 48% (n = 22)in the control group (P:0.677;OR:0.917,CI: 0.609–1.380). Induction of labour was in 39% (n = 18) in the low Apgar group versus 26% (n = 12) in the controle group (OR: 0.666, CI: 0.364–1.221). Epidural anaesthesia 43% (n = 20) versus 50% (n = 23)(OR: 1.150, CI:0.742–1.783). Forceps or ventouse 26% (n = 12) versus 28% (n = 13) (OR: 1.083, CI: 0.554–2.117). There were no differences for parity or birthweight.

Conclusion: There was no significant difference in the use of STAN between both groups, but indiction of labour seems to have a detrimental influence on Apgarscore. This does not mean that STAN does not make a difference, as this study is not randomized and selection bias, e.g. having high risk patients in the STAN group with more careful follow up and better outcome can not be excluded.

411 MATERNAL AND CORD BLOOD LEPTIN AND FETAL GROWTH

F. Javadzadeh¹, M. Rafeey²

¹Shiraz International Medical University, Dentistry, Kish, Iran;²Tabriz Medical University, Pediatrics, Liver and Gastrointestinal Research Center, Tabriz, Iran

Leptin is a protein secreted mainly by the adipocyte in proportion to fat mass. In the present study, we investigated whether umbilical and maternal serum leptin concentrations correlate with fetal growth. We studied 100 newborn infants (48 female and 52 male; gestational age, 34–40 weeks) and their mothers at Alzahra hospital in Tabriz city. Serum leptin concentrations were measured by ELISA and linear regression analysis was used to evaluate correlation. In the results, there was no significant correlation between umbilical and maternal leptin concentrations (r = 0.011; p = 0.459) in all study groups. There was a correlation between umbilical leptin concentration and birth weight of newborns (r = 0.278; p = 0.003) and correlation with body mass index (BMI) of the newborns (r = 0.249; p = 0.006). Maternal leptin concentrations correlated with maternal weight and BMI (r = 0.277; p = 0.003, r = 0.290; p = 0.002, respectively). There was no correlation between maternal leptin concentrations and birth weight (r = - 0.162; p = 0.054) and with BMI of the newborns (r = - 0.158; p = 0.058). There was gender difference in leptin concentrations in the newborns (r = 0.331; p = 0.00025) with greater level in females. In conclusion, we have shown that the association between umbilical serum leptin and birth weight in this and other studies suggests a pivotal role of fetal leptin in regulating fetal growth and development.

412 CARDIOTOCOGRAPHY (CTG) AS THE SCREENING METHOD OF FETAL CONDITION ASSESSMENT

M. Kapidzic, Z. Fatusic, I. Serak, F. Klempic

University Clinical Center Tuzla, Gynecology-Obstetric Clinic, Tuzla, Bosnia and Herzegovina

A basic function of fetal monitoring is an analysis of fetal cardiac action. Cardiotocography (CTG) cannot provide all necessary information for assessment of the fetal condition as it is not sufficiently reliable and gives a large number of false positive results that increase the number of cesarean sections. An objective of this work was to establish CTG reliability as a method for assessment of intrapartal fetal condition. Based on CTG parameters (baseline fetal heart rate, fetal heart rate variability, oscillations and decelerations) 100 pathological CTG records, collected at Obstetrics and Gynecology Department of the Tuzla University Clinic Hospital were identified. Using binomial distribution they were classified as non-pathological (indicating absence of asphyxia) and pathological (indicating possible presence of asphyxia). After the delivery the condition of newborns was assessed according to the Apgar score. Based on comparison between certain pathological parameters of CTG records and newborns' conditions at birth the results indicated high positive predictive values whereas sensitivity and accuracy were low. Apgar score 1. from 7 upwards was given to 96 (96%) newborns whereas Apgar score 2 from 7 upwards was given to all the newborns with previous pathological CTG records. Results have confirmed that CTG can be used only as a screening method for assessment of intrapartal fetal condition.

413 GOOD PREGNANCY OUTCOME AFTER PRENATAL EXPOSURE TO BLEOMYCIN, ETOPOSIDE AND CISPLATIN FOR OVARIAN IMMATURE TERATOMA: A CASE REPORT AND LITERATURE REVIEW

M. Karimi Zarchi¹, N. Behtash², M. Modares Gilani²

¹Shahid Sadiughi, Obstetrics & Gynecology, Tehran, Iran;²Tehran University, Tehran, Iran

Aim: The administration of bleomycin plus etoposide and cisplatin during pregnancy is rare.

Materials and Methods: We describe a case with good pregnancy outcome after exposure to these chemotherapeutic agents at the third trimester of pregnancy.

Results and Discussion: A pregnant woman with stage IIIc immature teratoma underwent surgical staging, and received two cycles of bleomycin, etoposide and cisplatin from the 29^th week of pregnancy until delivery. The patient did not have any evidence of recurrence of ovarian cancer for 1.5 years. Her infant did not have any evidence of minor or major malformations, and showed normal neurological development during 1.5 years of follow-up.

414 RISK FACTORS FOR MECONIUM ASPIRATION IN MECONIUM STAINED AMNIOTIC FLUID

S. Khazardoost¹, D.R. Shafaat², M. Shafaat³

¹Tehran University of Medical Sciences, Imam Khomeini Hospital, Perinatology Department, Tehran, Iran;²Imam Khomeini Hospital, Perinatology Department, Tehran, Iran;³Tehran University of Medical Sciences, Tehran, Iran

Objective: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disease in infants born through meconium stained amniotic fluid (MSAF). The purpose of this study was to determine risk factors for MAS in the newborns of mothers who had meconium stained amniotic fluid in labour.

Methods: A retrospective study of all full-term pregnancies with MSAF from May 2003 to October 2004 was designed at a teaching hospital. Development of MAS was the primary outcome. Maternal details, mode of delivery and neonatal details (Apgar score, reassuring or non-reassuring fetal heart rate tracing and birth weight) were evaluated.

Results: During the study period, there were 2.603 deliveries of whom 302 (11.6%) had MSAF. MAS developed in 64 of these infants (21.1%). Compared with healthy neonates with MSAF, those with MAS had higher rate of non-reassuring fetal heart rate (FHR) tracing, thick meconium and Apgar score < / = 5 at 5 min. The neonatal birth weight was lower in the MAS group, maternal age, parity, gestational age and mode of delivery were not significantly different in the two group.

Conclusion: We found the severity of meconium, low Apgar score at 5 min and non-reassuring FHR tracing was associated with MAS in MSAF pregnancies.

415 CORRELATION BETWEEN SECOND TRIMESTER ALPHA-FETOPROTEIN, HUMAN CHORIONIC GONADOTROPIN, UNCONJUGATED ESTRIOL LEVELS AND UTERINE ARTERY DOPPLER INDICES

M. Kiray¹, B. Dane¹, C. Dane¹, H. Seval², A. Cetin¹

¹Haseki Training & Research Hospital, Department of Gynecology & Obstetrics, Istanbul, Turkey;²Haseki Training & Research Hospital, Department of Biochemistry, Istanbul, Turkey

Objective: The aim of this study was to assess the correlation between second trimester maternal serum levels of alpha-fetoprotein (AFP), human chorionic gonadotrophine and unconjugated estriol (uE₃) and uterine artery Doppler measurements.

Study design: Serum levels of AFP, hCG and uE₃ are determined between 16–18 weeks of gestation. Doppler ultrasound examination was performed at 22–24 weeks in 142 cases. Uterine artery mean resistance index (RI), pulsatility index (PI), and number of early diastolic notches were noted. Comparisons were done with Spearman's correlation, ANOVA and ROC analysis.

Results: In this group, hCG and uE3 did not significantly correlate with uterine artery RI or PI. Only the serum level of AFP had a negative correlation with uterine artery RI (r: − 0.22, P = .0079). The presence of bilateral early diastolic notch was not related with the levels of the biochemical markers. A cut-off level < 1.61 MoM for uE3 predicted the presence of at least one notch with 79% sensitivity and 43 specificity (AUC: 0.607, P = .028). The mean uE₃ level was significantly lower in the cases with at least one notch (1.2 MoM vs. 1.5 MoM, P = 0.038).

Conclusion: In this unselected group AFP and uE₃ were found to have correlation with uterine artery Doppler indices and the presence of early diastolic notch. The relationship between these markers and uterine artery Doppler indices should be examined in a larger study group.

416 THE ANTENATAL ADMINISTRATION OF BETAMETHASONE IN TERM ELECTIVE CESAREAN SECTIONS

B. Kurt, S. Etiz Sayharman, N. Aka, G. Köse, C. Tüfekçi

Haydarpasa Numune Education and Research Hospital, Obstetrics and Gynecology, Istanbul, Turkey

Objective: To assess the use of antenatal administration of betamethasone in term elective cesarean sections to reduce the risk of neonatal respiratory distress syndrome and transient tachypnea of the newborn.

Material and Methods: In our prospective study, we include 50 term pregnant patients who were given birth by elective cesarean section between January 2007 and March 2008 in Haydarpasa Numune Education and Research Hospital, Department of Obstetrics. We used betamethasone every 12 hours for 2 doses (totally 12 mg) antenatally in 25 patients. We carried out cesarean sections 24 hours after the last dose. The other group was the control group in which no drug was administred. The newborns were evaluated for the first and fifth minute Apgar Score, transient tachypnea and neonatal respiratory distress syndrome.

Results: In our study, 2 newborns were diagnosed as transient tachypnea of the newborn. But there was no statistically significant difference between the two groups.(p > 0.05) and no respiratory distress syndrome was seen.

Conclusion: There should be more patients and multicenter studies to assess the antenatal use of steroids in elective cesarean sections because fetal morbidities should always be considered in these situations.

417 GENERAL ANAESTHESIA, LOCO-REGIONAL BLOCKADE AND ITS FAILURE IN ELECTIVE CESAREAN SECTIONS: EFFECTS ON NEONATAL SHORT-TERM OUTCOME. A PROSPECTIVE, RANDOMIZED STUDY

A. De Vivo, A. Giacobbe, D. Laganà, R. De Dominici, L. Maggio Savasta, A. Mancuso

University of Messina, Department of Gynecological, Obstetrical Sciences and Reproductive Medicine, Messina, Italy

The aim of this study was to compare the neonatal short-term outcome in patients who underwent spinal anaesthesia, general anaesthesia and conversion from the spinal to the general one. 81 pregnant women with uncomplicated singleton pregnancy at term underwent general anaesthesia, 90 regional blockade and 63 required conversion to narcosis. No differences were found in umbilical artery pH among the three groups (p = 0.35), while the need of oxygen therapy differed significantly (p = 0.001). The Apgar score at 1 min was 8.93 ± 0.78 in SG, 7.37 ± 1.6 in GG and 8.24 ± 1.26 in CG, with a significant difference for all comparisons (p = 0.001). At 5 min the Apgar score became 9.7 ± 0.5 in the SG, 9.4 ± 0.6 in GG and 9.7 ± 0.4 in CG, with a significant difference between GG and both SG (p = 0.001) and CG (p = 0.001). Analyzing the factors that compose the Apgar score, at 1 min a higher score for each parameter was found in the SG with respect to GG, while the CG and the GG differed for“ activity”, “grimace” and “respiration” that were higher in the CG. The SG and CG showed a difference only for “appearance”. At 5 min, a significant difference was found between SG and GG and between GG and CG only for “activity”. Our study suggests that all kind of anaesthesia are safe for the infants, but the loco-regional blockade shows more advantages on the neonatal short-term outcome also when a conversion to general anaesthesia is necessary.

418 MORBIDITY AND MORTALITY OF DISCORDANT TWINS

S. Maia, N. Cruces, S. Soares, M. Sobral, J. Alves, V. Ribeiro, I. Lobo, H. Neves, O. Viseu

Hospital Central Faro, Obstetrics and Gynecology, Faro, Portugal

Introduction: Discordant twins have higher rates of perinatal morbidity and mortality. Several pathomechanisms may be responsible for the weight difference in twins including a different genetic growth potential in dizygotic fetuses, placenta insufficiency and twin-to-twin transfusion syndrome. The aim of our study was to analyze the perinatal and neonatal outcome of discordant twins.

Material and Methods: Retrospective analysis of the twins followed in our department between January 2000 and December 2007 was performed. According to the percent difference in infant birth weight defined as ([birth weight of larger twin-birth weight of smaller twin]/birth weight of larger twin)×100, twins were stratified into five categories: <10%, 10% to 15%, 15% to 20%, 20% to 30%, and >30%.

Results: Results will be presented later based on relationship between different birth weight categories and the perinatal and neonatal outcome.

Conclusion: The use of the birth weight difference to define twin discordance is clinically relevant in identifying those infants at risk for adverse perinatal outcome.

419 EVALUATION OF TWIN PREGNANCIES OUTCOMES IN THREE YEARS SAMPLING

A. Mitreski¹, M. Bogavac², N. Curcic³, B. Ivkovic³

¹Private Unit of Obs/Gyn, “Minerva”, Novi Sad, Serbia;²Clinical Centre Vojvodina, Department of Obstetrics and Gynecology, Novi Sad, Serbia;³Dept Obs/Gyn of Center for Preventive Care, “Signal”, Novi Sad, Serbia

Aim of the Study: To present results of retrospective analysis of 23 twin pregnancies in our Unit.

Meterial and Methods: Incidence of multiple pregnancies in our material was 4.05%. Pregnancies were evaluated continuously with bimanuel examinations, ultrasound tracking and laboratory testing.

Results: Our patients with twin pregnancies were of 22–37 years of age, with average age of 31.6 years. Incidence of monochorial and monoamnial twins was 4.54%, monochorialand biamnial was 9.09%, and all other pregnancies were bichorial. Of all twin pregnancies diagnose of vanished twin was found in 9.09%, miscarriage in 18.18%, premature delivery in 18.18%, while 59.59% had term termination of pregnancy. Complications of pregnancy were: pregnancy induced hypertension found in 13.63% and preeclampsia in 4.54%. Extreme prematurity was present in one pregnancy (4.54%), but both babies are alive. No congenital malformations in our sample were found.

Discussion and Conclusions: Incidence of perinatal mortality is about 5 times higher in twin pregnancies because of prematurity, high incidence of congenital anomalies, because of twin to twin transfusion syndrome in the case of existance of arterial-venous shant in monochorial pregnancies and consecutive aoutput of arterial blood into the venous circulation of the recipient twin. In our material we did not have this complication in late pregnancies. Pregancy induced hypertension was effectively corected with antihypertensive drugs, and except in one case with preeclampsia in which we finished pregnancy in 34th gestational week, all other complicated pregnancies had a good outcome. Gemellar pregnancies should be evaluated with maximum care and in the case of complications they should be resolved promptly.

420 AN ABRUPT ONSET OF SEVERE TWIN-TWIN TRANSFUSION SYNDROME: A CASE REPORT

Y. Miura¹, T. Matsuda¹, R. Kitanishi¹, T. Hanita¹, T. Watanabe², H. Ohta³, K. Okamura³, S. Tsuchiya¹

¹Tohoku University Hospital, Pediatrics, Sendai, Japan;²Miyagi Children's Hospital, Pediatrics, Sendai, Japan;³Tohoku University Hospital, Obsterics & Gynecology, Sendai, Japan

The pathogenesis of twin-twin transfusion syndrome (TTTS) has been recognized as blood transfusion via placental vascular anastomoses, which usually consist of superficial arterio-arterio or venous-venous connections and a deep arterio-venous connection through a whole cotyledon. We reported a unique placental hemodynamics of TTTS patients who had no superficial but only deep anastomoses. A 29-year-old pregnant woman diagnosed as monochorionic-diamniotic placentation had been weekly confirmed that twin fetuses had no signs of TTTS until 25 weeks' gestation. Simultaneously with preterm labor at 26 weeks' gestation, recurrent bradycardia and left heart collapse in a fetus and increased cardiac preload in the other fetus were suddenly found. Male infants weighing 794 g and 732 g were born by emergent cesarean section. In the placental examination, there were no vascular anastomoses in the placental surface layer but a velamentous insertion of the umbilical cord of the former fetus was found. The former fetus died at 36 days after birth because of deteriorated general circulation and serious multiple organs failure soon after birth. The later fetus showed moderate hypovolemia after birth and developed ischemic enterocolitis at 5 days after birth, but well recovered after the operative management. The disturbed umbilical venous return by velamentous cord insertion in preterm labor seemed to play an essential role as a cause of circulation failure in both fetuses because their circulatory blood volume was probably maintained by two or more deep arterio-venous anastomoses with opposite direction of blood flow, coming and going through cotyledons between the fetuses.

421 A COMPARATIVE STUDY OF LOW 5- MINUTE APGAR SCORES IN NEWBORNS OF WANTED VS. UNWANTED PREGNANCIES IN SOUTHERN TEHRAN

L. Moghaddam Banaem¹, M. Lamyian², N. Alianmoghaddam¹

¹Tarbiat Modares University, Midwifery, Tehran, Iran;²Tarbiat Modares University, Faculty of Medicine, Midwifery & Reproductive Health Department, Tehran, Iran

Objective: To compare low 5-minute Apgar scores in newborns of wanted versus unwanted pregnancies.

Methods: This longitudinal cohort study included 1800 pregnant women attending urban and rural health centers in southern Tehran for routine prenatal care. The subjects were divided into 2 equal sized groups of wanted and unwanted pregnancies and were followed up through their prenatal care to their delivery. Low Apgar was defined as a score of <8. Various conditions with possible effect on Apgar score, were assessed by logistic regression.

Results: We found 4 cases of low 5? Apgar (0.4%) in wanted pregnancies and 15 cases (1.7%) in unwanted pregnancies. The difference between the two groups was significant (P value = 0.011). In logistic regression analysis, unwanted pregnancy status had a significant independent relationship with low Apgar, increasing the risk 3-fold. The attributable risk in unwanted pregnancies was 0.54 (CI_0.95 = 0.132–0.813) which means that with 95% confidence, between 13/2% to 81.3% of low 5-minute Apgar scores among newborns, could have been prevented if unwanted pregnancies had been eliminated.

Conclusion: In addition to the well-established maternal complications of unwanted pregnancy (e.g. emotional stress, illegal abortions, etc) it is now clear that such pregnancies endanger the infant´s health too. It is possible that many pregnant women, especially those with unwanted pregnancies, are not attending health centers for prenatal care. Further studies with active case finding are recommended to confirm these findings.

422 THE OBSTETRIC AND PERINATAL OUTCOME OF TYPE 1 DIABETES IN FLANDERS, BELGIUM

G. Palit¹, G. Martens², S. Palit³, Y. Jacquemyn¹

¹UZA/Antwerp University Hospital, Obstetrics, Antwerp, Belgium;²Study Center for Perinatal Epidemiology/ SPE, Brussels, Belgium;³UZA/Antwerp University Hospital, Anaesthesiology, Antwerp, Belgium

Aim: To describe the obstetric and early neonatal outcome and perinatal complications of pregnancies in women with type 2 diabetes in the region of Flanders, Belgium, as compared to non-diabetic mothers.

Methods: A population-based prospective cohort study.

Results: Between January 2001 and December 31, 2005 data on all hospital-based deliveries (>99% of deliveries in the region) were collected. In the period studied 3146 type 1 diabetic pregnancies were recorded and compared to 237230 non-diabetic controls. Hypertensive complications were more frequently encounterd (RR 3.31; 95%CI 3.04–3.60; p < 0.0001) and there were more preterm births before 34 weeks (RR 1.71; 95%CI 1.37-2.12; p < 0.0001) but not before 28 weeks (p = 0.81). There was no difference in fetal, early neonatal and perinatal mortality between groups, although infants from diabetic mothers more often needed neonatal intensive care (RR 2.70; 95%CI 2.41-3.02; p < 0.0001). There was no difference for operative vaginal deliveries, but more caesarean sections were performed in the diabetic group (RR 1.81; 95%CI 1.71-1.90; p < 0.0001).

Conclusion: Rates of preterm birth (but not early preterm birth <28 weeks), hypertensive disorders and need for neonatal intensive care are still higher in diabetic mothers as compared to non-diabetic controls, but this does not result in a significant increase in perinatal mortality.

423 SKL LEVELS IN UMBILICAL CORD INVERSELY CORRELATE WITH ENDOTHELIN-1 LEVELS AND MAY BE INVOLVED IN FETUS MATURATION AND UTERUS CONTRACTION

K. Pappa¹, N. Anagnou², S. Mesogitis¹, V. Koubis¹, A. Antsaklis¹

¹First Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra University Hospital, Athens, Greece;²Foundation for Biomedical Research of the Academy of Athens (IIBEAA) and Laboratory of Biology, University of Athens School of Medicine, Athens, Greece

Objectives: The aim of the study was to clarify the roles of endothelin-1 and c-kit ligand (sKL) in normal pregnancy and their implications during normal labor.

Study design: The sKL and ET-1 levels were investigated in umbilical cord and maternal plasma on the day of normal delivery in 50 pregnant women aged 20 to 35 years and in 50 non-pregnant women of comparable age, using ELISA methods.

Results: In umbilical cord plasma, the levels of sKL ranged from 535.48 to 1657.80 pg/mL. These values were significantly higher than those in maternal plasma (P = .0019) and higher than the values in the plasma of non-pregnant control women (P < .0001). The levels of cord plasma ET-1 ranged from 0 to 19.41 pg/mL and did not differ statistically from those found in maternal plasma (P = .7758), but they were significantly lower than those in the plasma of non-pregnant control women (P < .0001). A highly significant inverse correlation was noted between the values of cord plasma ET-1 and the values of cord plasma sKL (r = −0.6269, P = .0054).

Conclusions: These data are consistent with mechanisms involving the preparation for the transition of the fetus to the neonatal stage. Although the role of ET-1 is less profound in normal pregnancy, our data imply that elevation of sKL can accelerate mobilization and maturation of red cells and immature mast cells, which through a series of biochemical events lead to the induction of cervical ripening, facilitating the normal labor process.

424 ONE CASE OF MONOAMNIOTIC TWIN WITH CORD ENTANGLEMENT AND FETUS SURVIVAL AT 32 + 4 WEEKS BY CESAREAN SECTION AFTER SUCCESSFUL MEDICAL AMNIOREDUCTION AND INTENSIVE ULTRASOUND SURVEILLANCE

H.R. Park, H.C. Kim, M.J. Baek, M.J. Moon, E.H. Ann, S.W. Chang

Pochon University, Bundang Cha Hospital, Department of Obstetrics and Gynecology, Seongnam-si, Korea

Introduction: Monoamniotic twin pregnancies are relatively rare, but perinatal mortality is high about 30–70%. The major causes of fetal death are cord accident, congenital anomalies and TTTS. So the active management of monoamniotic twins to reduce the complication of cord entanglement is important. This is a case of monoamniotic twin with cord entanglement and both fetuses were delivered by cesarean section at 32 + 4 weeks after medical amnioreduction and intensive fetal surveillance.

Method: A 30-year-old woman, nulliparous, with a natural period pregnancy, monoamnionic twin pregnancies were diagnosed at IUP 6 + 4 weeks by TVS. Until 28 weeks fetal weight, fluid volume, cord entanglement and so on were evaluated by ultrasound every 2∼3 weeks in outpatient. Other abnormal findings were not detected. She was admitted for intensive surveillance and medical amnioreduction at 28 weeks. Sulindac 200mg twice daily to reduce in amniotic fluid and stabilize the fetal movement was started. And intensive fetal monitoring was done daily. At 31 + 3 weeks it was detected that the cord was entangled several times by color Doppler and AFI was reduced to 8 cm. We scheduled the delivery by cesarean section at 32 + 4 weeks after the use of betamethasone.

Results: The healthy babies were delivered, one weighting 2160g and the other 1995g. Apgar scores were one 6, 7, and the other 7, 9. The cords were entangled 13 times. The babies did not have anomalies and complications.

Conclusion: Our experience suggests that medical amnioreduction by sulindac is effective treatment to reduce AFI and stabilize the fetal movement.

425 NON-INVASIVE DIAGNOSIS OF FETAL ANEMIA IN PREGNANCY COMPLICATED BY RHESUS ALOIMMUNIZATION BY COLOR DOPPLER

D. Pavlovic¹, V. Mandic², Z. Mikovic², R. Vugdelic¹, J. Lakicevic², R. Nikitovic²

¹Ob/Gyn University Clinic ‘Narodni Front’, Belgrade, Serbia;²Ob/Gyn University Clinic ‘Narodni Front’, High-Risk Pregnancies, Belgrade, Serbia

The invasive diagnosis of fetal anemia is associated with complications, so, noninvasive method is needed. In anemic fetuses increased velocities in MCA are registered.

Our aim was to determine changes in MCA blood velocity of the anemic fetuses and relationship of these changes and fetal hemoglobin and hematocrit values.

Methods: Clinical study evaluated 172 pregnancies, gestational age 28 to 32 weeks, in which cordocenthesis was performed due to maternal Rh- alloimmunisation. We registered blood flow velocities and Pi in MCA and hematological parameters–hemoglobin and hematocrit. Based on the hemoglobin levels all fetuses were divided in four groups: nonanemic (³ 140 g/l); mild anemia (120–139.9 g/l); moderate anemia (100–119.9 g/l); and severe anemia requiring transfusion, (£99.9 g/l). We compared mean systoloc velocities and Pi between the groups and studied the correlation between mean systoloc velocities and the values of hemoglobin and haematocrit.

Results: 34.09% fetuses were nonanemic, 31.82% showed mild anemia, 31.82% moderate anemia and 13.64% had severe anemia. Anemic fetuses had significantly higher MCA flow velocities compared with nonanemic fetuses. Values of Pi decreased in severe forms of anemia, but the difference wasn't significant. Levels of hemoglobin and hematocrit showed inverse correlation with the values of MCA mean systoloc velocities, while correlation with the values of Pi wasn't observed.

Conclusions: We suggest that measurements of MCA mean systolic velocities should be used in fetuses with risk of anemia and in selection of fetuses requiring invasive procedures.

426 VERY POOR PREGNANCY OUTCOME POST IVF AT A PCOS WOMEN

L. Ples¹, A.D. Stanescu¹, N. Ples²

¹Universitatea de Medicina Carol Davila, Bucuresti, Romania;²St John Hospital, Bucur Maternity, Bucuresti, Romania

We present a 37 years women case with many insuccesful pregnancy attempts. She was married for 11 years and never used a contraceptive method. The clinical examination revealed an overweigth lady with BMI of 31, oligospaniomenorheea, light pilar virilism. Laboratory tests confirmed the lack of ovulation an a normal testosteron level. The husband's spermogram was normal and the tubal patency was prooved for both uterine tubes. For six months the patient received Metformin 6 tb daily with no improvment in menstrual periodicity or ovulation. For 3 cicles she undergone ovarian stimulation with Clomifen 2 tb daily 5 days and 3 cicles with 3 tb daily. The absence of the ovarian response and the patient's age determined us to reffer her to a Human Assisted Reproduction Clinic. After two unsuccesful embrio transfer finally she got pregnant and she returned in our service for pregnancy monitoring.

The pregnancy went well until 18 weeks when at the ultrasound scan we observed a decrese of the amniotic fluid and insufficient fetal growth. The adverse evolution of the fetus was confirmed at 20 weeks the immages below illustrate severe oligoamnios (AFI 0.5 cm), high resistence in umbilical circulation with reverted dyastolic flow, low impedance in the mid cerebral artery flow. Two days after those findings the fetous died and the mother undergone an abortion in other unit.

We consider that the poor pregnancy outcome was related to the modifications induced at the uterine level by the insulionresitance characteristic to the PCOS.

427 PULSE OXIMETRY COMPARED WITH FETAL ELECTROCARDIOGRAM TO CONTROL INTRAPARTUM FETAL WELLBEING

A. Puertas Prieto, M. Valverde Pareja, I. Vico Zuñiga, T. Aguilar Romero, M.D. Ruiz León, F. Montoya Ventoso

University Hospital ‘Virgen De Las Nieves’, Obstetrics, Granada, Spain

Objective: Recently, there have appeared methods of fetal intrapartum monitoring such as fetal pulse oximetry and fetal electrocardiogram analysis (STAN21®). Our main objective was to compare their influence to reduce the total rate of cesarean sections, the indications of non reassuring fetal status (NRFS) and the neonatal result.

Materials and Methods: A randomized pilot study was used in which pregnant women with a single fetus, who showed a NRFS in the active stage of labor were selected. There were two groups: fetal pulse oximetry and STAN21®. The rate of caesarean sections, the operation signs for NRFS, the arterial and venous cord pH and the Apgar test were analysed in each group.

Results: We did not find significant differences in the caesarean rate, which was 47.5% in the pulse oximetry group and 40% in the STAN21® group, nor in the operation signs for NRFS which was 32.5% and 37.5% respectively. The neonatal results were similar to the pH arterial value (7.286 ± 0.072 vs. 7.239 ± 0.069) and venous value (7.286 ± 0.071 vs. 7.301 ± 0.069). We found higher scores in the Apgar index at the first and the fifth minute in the STAN21® group (8.55 ± 0.846 vs. 8.025 ± 1.271 and 8.975 ± 0.158 vs 8.25 ± 0.385). There were no differences in neonatal reanimation.

Conclusions: Both fetal monitoring procedures are equally useful for the control of fetus who have a NRFS, although the influence on the neonatal result is less conclusive.

428 EVALUATION OF 24 CASES OF PRENATALLY DIAGNOSED DIAPHRAGMATIC HERNIA

V. Sal, R. Madazli

Istanbul University Cerrahpasa Medical Faculty, Department of Perinatalogy, Istanbul, Turkey

Aims: Clinical characteristics and perinatal outcomes of prenatally diagnosed diaphragmatic hernia cases are evaluated.

Material and Methods: We present a retrospective study of the 24 consecutive cases of congenital diaphragmatic hernia diagnosed in utero during the period from 1998 to 2006 in our clinic. Gestational age at diagnosis and delivery, associated malformations and chromosomal anomalies, perinatal mortality and success rate of surgery are evaluated.

Results: Gestational age at diagnosis was 28.8 ± 6.1 (19–37 wk) weeks. Of the cases 14 (58.3%) were isolated and 10 (41.7%) were complex congenital diaphragmatic hernia. The defect was right-sided in 21% and liver herniation was present in 25% of the fetuses. The incidence of chromosomal abnormality was 8.3%. The perinatal mortality rate of the overall, complex and isolated groups was 91.6%, 100% and% 85.7 respectively. Surgery could be performed in 4 fetuses with an isolated left-sided diaphragmatic hernia and a survival rate was 50%.

Conclusion: Perinatal mortality is high in prenatally diagnosed cases of congenital diaphragmatic hernia. Prenatal diagnosis allows detecting associated malformations, prognostic factors and delivery of the fetuses at suitable centers.

429 ASSOCIATION OF FIRST TRIMESTER BLEEDING WITH ADVERSE MATERNAL AND PERINATAL OUTCOME

L. Saraswat¹, S. Bhattacharya², A. Maheshwari¹, S. Bhattacharya¹

¹University of Aberdeen, Obstetrics and Gynaecology, Aberdeen, United Kingdom;²Dugald Baird Centre for Research on Women's Health, Public Health, Aberdeen, United Kingdom

First trimester bleeding is a common complication occurring in 16% to 25% of all pregnancies. There is compelling evidence in the literature suggesting the association of poor feto-maternal outcome with first trimester bleeding. The aim of our study was to perform a systematic review of the available evidence to assess the effects of first trimester bleeding on maternal and perinatal outcomes. Standard systematic review methodology was used. 14 observational studies were identified that met the inclusion criteria. The interpretation of the results was compromised by variations in the definition of first trimester as well as inconsistencies in the choice and definition of outcome.

Women with first trimester bleeding had a significantly higher incidence of antepartum haemorrhage (APH) due to placenta praevia (pooled odds ratio (OR) 1.65, 95% CI 1.21, 2.24), placental abruption (pooled OR 1.92, 95% CI 1.23, 2.99) or APH of unknown origin (pooled OR 2.15, 95% CI 1.37.3.37) when compared to those without first trimester bleeding. They were more likely to have preterm prelabour rupture of membranes (pooled OR 1.63, 95% CI 1.16, 2.27), preterm delivery (pooled OR 2.02, 95% CI 1.72, 2.37) and babies with intrauterine growth restriction (pooled OR 1.69, 95% CI 1.32, 2.17). First trimester bleeding was associated with significantly higher rates of perinatal mortality (pooled OR 1.92, 95% CI 1.36, 2.73) and low birth weight babies (pooled OR 1.89, 95% CI 1.5, 2.37).

430 SUCCESSFUL TREATMENT OF ANTIPHOSPHOLIPID ANTIBODY SYNDROME DURING PREGNANCY WITH DALTEPARIN AND LOW DOSE ASPIRIN

E. Schleussner¹, T. Fischer², C. Thaler³, R. Bauersachs⁴, M. Bulgay-Moerschel¹

¹Friedrich-Schiller Universität Jena, Abt. Geburtshilfe, Jena, Germany;²Krankenhaus Landshut, Frauenklinik, Achern, Germany;³LMU München Großhardern, München, Germany;⁴Klinikum Darmstadt, Darmstadt, Germany

Objectives: To evaluate the efficacy of dalteparin in combination with low dose aspirin to prevent complications during pregnancy.

Methods: In a prospective trial (Efficacy of Thromboprophylaxis as an Intervention during.

Gravidity [EThIG]), 810 pregnant women received 50–100 IU dalteparin/ kg as prophylaxis for thrombembolic events. Of these women, 98 presented with antiphospholipid antibodies or positive lupus anticoagulant, so were treated additionally with 100 mg aspirin daily. 81 patients suffered from primary antiphospholipid antibody syndrome, 13 from lupus erythematosus.

Results: 46% of the women reported of past thrombembolic events. 66 of 98 women had miscarriages in their history, 20% of which at least 3 times or more. There were only eleven miscarriages during the study; three of which were late miscarriages and one was a stillbirth. Preterm delivery occurred in 19% of the cases. One pregnancy was complicated by severe preeclampsia and HELLP syndrome.

Conclusion: Low molecular heparin, such as dalteparin, is highly effective in preventing miscarriage and other pregnancy-related complications in women with antiphospholipid syndrome. A successful outcome of the pregnancy was achieved in 89% of the cases.

431 IRON AND ZINC DIETARY RESTRICTION OF PREGNANT RATS AND LITTERS

M. Shahbazi¹, S.H. Tahmasebi¹, N. Naghdi², M. Sheikh¹, N. Namvar Asl², A. Kazemnejad³, M. Taghi Khorand¹

¹University of Tehran, Tehran, Iran;²Pasteur Institute of Iran, Tehran, Iran;³Tarbiat Modarres University, Tehran, Iran

Evidence suggests that micronutrient deficiencies may be associated with problems in early growth. Iron (Fe) and Zinc (Zn) deficiency (D) are prevalent during gestation in low-income countries. For pregnant dams, adequate amount of these micronutrients are needed in the diet to ensure the capacity for increased physical growth. In this study the role of Fe and Zn dietary restriction of pregnant rats on physical growth of litters was investigated. Pregnant rats after to mating were divided to three groups. Control group fed a standard diet and a FeD group fed a diet deficient in Fe and a ZnD group fed a diet deficient in Zn. All the diets exposed during the last third of pregnancy.

The results showed serum Fe and Zn concentration after to exert dietary as compared before to exert dietary in FeD and ZnD groups was significant. There was significant difference in physical growth indexes (body weight, body length, tail length, and head length) between FeD and ZnD groups as compared to Control group, but was not seen significant difference in head width and brain weight between FeD and ZnD groups as compared Control group. The results of this study suggest that adequate Fe and Zn affect on physical growth of litters.

Keywords:Iron deficiency, zinc deficiency, micronutrient, physical growth, and rat

432 SECOND TRIMESTER FETAL LOSS IN TWIN PREGNANCIES

J.S. Shin, K.J. Lee, Y.K. Cho, J.H. Kang, C.N. Lee, C.J. Chung

Pochon CHA University, Department of Obstetrics and Gynecology, Seoul, Korea

Aims: The purpose of this study was to compare the rate and etiologies of second trimester pregnancy loss in natural or assisted reproductive technology (ART) twins, and monochorionic (MC) or dichorionic (DC) twins.

Methods: Between 1995 and 2006, there were 146 cases of second trimester twin pregnancy losses (between 12 and 24 weeks gestation) from 2467 twin pregnancies. They were divided into groups according to chorionicity and fertilization. Chorionicity was established by ultrasound at early gestation. The pregnancy loss rate and possible mechanisms were compared in each group.

Results: During the study period, there were 43 MC, 86 DC, and 17 unknown chorionicities. There were 45 natural, 78 ART, and 23 unknown fertilizations. Total pregnancy loss rate was 5.9% (146/2467), with 11.0% and 4.2% for MC and DC respectively. Likewise, it was 6.5% and 4.8% for natural and ART. The most common cause was intrauterine fetal death (IUFD) (51.2%) in MC and preterm premature rupture of membranes (PPROM) (46.5%) in DC, followed by preterm labor (PTL) (43%). In natural pregnancy, IUFD was the most common etiology (44.5%) and for ART, it was PTL (44.9%).

Conclusions: The most common etiology was IUFD in natural pregnancy and PTL in ART. Second trimester pregnancy loss rate was higher in MC compared with DC. MC had a higher incidence of IUFD as a cause of second trimester pregnancy loss. The etiologies in DC were PTL and PPROM.

433 BIRTH ORDER ON THE RISK OF PERINATAL MORBIDITY AND DEATH IN DICHORIONIC TWIN PREGNANCIES

M. Torgal¹, J. Metello², A. Relva², T. Semenova², E. Casal², M. Hermida²

¹Hospital Garcia d' Orta, Obstetrics, Linda-a-Velha, Portugal;²Hospital Garcia d' Orta, Obstetrics, Almada, Portugal

Introdution: Several studies have shown an increased morbity related to twin pregnancies, including prematurity, cesaereans and perinatal death. Studies of the effect of birth order on the risk of perinatal death have produced inconsistent results, with some of them concluding for an increased risk for the second twin. Several confounding factors are related to this question, not only gestational age, but also fetal weight, chorionicity and presentation part.

Objective: To determine the effect of birth order on the risk of perinatal morbidity and death in dichorionic twin pregnancies, according to fetal and labour variables.

Methods: Retrospective study of 250 consecutive sets of twin pregnancies which birth took place at our delievery suit between 2000 and 2007. Chorionicity was established during fisrt trimester or in doubt subsided after placental analyzes. All twin births were at or after 24 weeks´ gestation. Twin pairs in which either twin died before labour or with twin to twin transfusionsyndrome or with major anomalies were excluded. The outcomes studied were 5th minute apgar score less than 7, cord pH less than 7.10, number of days in an Neonatal Intensive Care Unit and death. Variables studies included: gestational age, chorionicity, fetal presentation, delivery mode, birth weight discordance, twin distocia and twin-to-twin delivery time interval.

434 THE CAUSES AND THE MANAGEMENT OF DYSTOCIA IN ANCIENT GREECE AND BYZANTIUM

G. Tsoukalas¹, M. Christodoulaki², S. Barbis², A. Kotta², E. Xydaki², E. Kourmoulis², A. Stamatakis², N. Nikolaidis³, I. Tsoukalas²

¹Center of Health, Skopelos Magnesia, Skopelos Magnesia, Greece;²General Hospital of Chania, Neonatal Intensive Care Unit, Chania, Greece;³Papageorgiou Hospital of Thessaloniki, Neonatal Intensive Care Unit, Thessaloniki, Greece

Introduction: Dystocia or difficult childbirth was one of the most serious problems the ancient doctors dealt with.

Aim: Recording the beliefs of the “old” doctors and philosophers.

Material and Method: Indexing the work of the writers.

Results: The problem may be caused by the mother, the fetus, the areas of the fetus passage. It is of great importance the psychic and the general health condition of the mother. They consider as causes the abnormal lie or presentation, the uterine inactivity (it is clinically described by Hippocrates), the non satisfying cervical dilatation, the multiple gestation, the oligohydramnio, the acute labor, the premature rupture of the membranes, the bad breathing of the mother that causes cessation of contractions, the fetal nerves necrosis, the nulliparity, the congenital fetal anomalies, etc.

They suggest immediate conservative therapy, physiotherapy (regulation of breathing in relation with the contractions), pharmaceutical medication and handling the mother with care. There was psychoprophylactic treatment. They tried to inhibit the acute labor and its consequences. If the conservative and pharmaceutical treatment fail, the doctor should proceed to abortion. The doctor should do several maneuvers: lubrication of the genital tract, external push of the fetus over the epigastrium, hot baths, trying to reinsert a prolapsing hand, maneuvers for breech or other malpresentations, surgical extraction of cervical polyps. The doctor should also use different tools (forceps), in case of failure he should proceed to visceral removal (gastroschisis) and craniotomy (hydrocephalus) and even to embryotomy.

Conclusion: Most of the Ancient Doctors' beliefs are still used nowadays.

435 THE OPINIONS OF THE ANCIENT DOCTORS ABOUT THE FETAL NUTRITION IN ANCIENT GREECE AND BYZANTIUM

G. Tsoukalas¹, M. Christodoulaki², S. Barbis², A. Kotta², E. Xydaki², E. Kourmoulis², A. Stamatakis², N. Nikolaidis³, I. Tsoukalas²

¹Center of Health, Skopelos Magnesia, Skopelos Magnesia, Greece;²General Hospital of Chania, Neonatal Intensive Care Unit, Chania, Greece;³Papageorgiou Hospital of Thessaloniki, Neonatal Intensive Care Unit, Thessaloniki, Greece

Introduction: The fetal nutrition occupied the mind of the ancient writers.

Aim: Recording the beliefs of the Ancient and Byzantine writers about this topic.

Material and Method: Indexing the work of the writers referred to the topic.

Results: Anaxagoras Klazomenios was the first to teach that the embryo is fed via the umbilical cord. Alkmaion believes that is fed from the “spongy” maternal abdomen. Empedoklis first mentioned that the blood (nutritional components) and the spirit (meaning the oxygen) are transferred through the umbilical cord.

Democritus Abdiritis and Epicouros believe that the fetus is fed from its mouth by some papillaries, because the neonate right after birth brings its mouth to its mother's breast. Hippocrates accepts this opinion and believes that “the umbilical cord is the only way to communicate with the fetus.” According to Hippocrates, the fetal development is mediated by the maternal circulation. He knows well that the placenta is not only a feeding organ, but also a breathing and purificating the fetal blood, organ.

He compared the fetal growth with the plants' growth, as both depend on the good or bad health condition during gestation.

Aristotle supports that the fetal growth is mediated via the “umbilicus”. Stoikoi believe that the embryo is fed by the placenta and the umbilical cord, that is why the midwives quickly cut the umbilical cord and open the neonate's mouth, so as a new way of nutrition will be established.

Conclusion: The references of our ancestors are surprising. Most of their thoughts are still accepted.

436 THE PREVALENCE OF ANTI-beta2MICROGLOBULIN I VS ACL ANTIBODIES IN APLS

D. Tutunaru, D.F. Lebit, I.L. Condulescu, B. Alexandru

Elias Emergency Hospital, Bucharest, Romania

Objective: To assess the prevalence of antiβ2GPI and ACL antibodies in the pathogenesis of APLS-related spontaneous abortions.

Material and Method: study design: prospective, open label, case-control study. Two study groups were formed. Group I included 73 women who experienced one miscarriage. Group II included 57 women who have experienced two or more miscarriages. A control group of 84 pregnant women was formed. We investigated the prevalence of antiβ2GPI antibodies in all three groups. Serum levels of both anticardiolipin (ACL) and antiβ2GPI antibodies were measured on antenatal visit and on first postconception visit. All patients were screened for anatomic, infectious, hormonal and genetic causes of miscarriage.

Results: From the first group 23 of them were positive for antiβ2GPI antibodies (IgG, IgM) and 15 for ACL antibodies (also IgG, IgM). The second group had 27 cases positive for antiβ2GPI antibodies and 22 for ACL antibodies. In the control group only 6 patients were positive for antiβ2G I antibodies and 7 for ACL antibodies. From the first group there were 19 spontaneous abortions (all positive for antiβ2GPI antibodies, but only 9 positive for ACL antibodies). From the second group there were 21 miscarriages (16 positive for antiβ2GPI antibody and 13 for ACL). Control group had 8 spontaneous abortions (3 positive for antiβ2GPI antibodies and 2 for ACL antibodies).

Conclusions: The study showed a higher prevalence of antiβ2GPI and ACL antibodies in the study groups over control group. Antiβ2GPI antibody titer has a better sensitivity over ACL antibodies in predicting recurrent miscarriage.

437 SUCCESSFULL MANAGEMENT AND OUTCOME OF QUADRUPLET GESTATION AFTER INTRAUTERINE INSEMINATION WITH DONOR SPERM

D. Tutunaru¹, M. Matei², I.L. Condulescu¹, D.F. Lebit¹, A. Petca¹

¹Elias Emergency Hospital, Bucharest, Romania;²CF Hospital, Bucharest, Romania

Objective: to present a case of successfully managed quadruplet gestation obtained after IUI using donor sperm.

Materials and Method: 28 old year woman with a history of 7 years of infertility. Previous investigations (ovulation monitoring, laparoscopy and hysteroscopy) revealed no abnormalities. Husband sperm analysis showed severe oligoastenoteratospermia. Several IUI attempted with husband sperm failed. Stimulation with Gonal F 75IU from Day2 was started. Day13 TVUS showed 5 follicles of over 23mm on both ovaries. After 5000IU hCG for triggering ovulation, 36h later IUI using donor sperm was performed. Positive pregnancy test after 2 weeks. TVUS made in Day35 showed four gestational sacs in uterine cavity. Supporting treatment with hCG 5000IU every 4 days and intravaginally progesterone 200mg tid was started. At 7th week of gestation all 4 embryos had cardiac activity and similar CRL. At 10^th week of gestation we performed selective embryoreduction on one embryo. At 12th week NT screening and bitest were performed. At 14th week the first anomaly scan and Doppler measurements were performed which were repeated by the 21st week. At 22^nd week a cervical double cerclage was performed for safety reasons. Careful measurement of fetal growth, FHR, AFI, Doppler waveforms on uterine arteries and on all umbilical arteries were performed at each visit.

Results: at 38 weeks CS was performed: a 2650g boy and two girls of 2750g and 2600g were delivered with high apgar scores. Postnatal adaptation was good.

Conclusion: carefully monitored multiple pregnancies can be successfully conducted to term without adverse events.

438 COMPARISON OF INTRAVAGINAL MISOPROSTOL, OXYTOSIN INFUSION AND INTRACERVICAL DINOPROSTON, OXYTOSIN INFUSION IN POSTTERM PREGNANCIES FOR LABOR INDUCTION

Ö. Dundar, L. Tütüncü, B. Atasever, A.R. Ergür, V. Atay, E. Müngen

GATA Haydarpasa Training Hospital, Department of Obstetric and Gynecology, Istanbul, Turkey

Objective: Comparison of intravaginal misoprostol, oxytosin infusion and intracervical dinoproston, oxytosin infusion in postterm pregnancies for labor induction.

Material and Method: 225 pregnant women who had delivery by induction between the dates January 2006-December 2007 were included to this study. According to early term ultrasonography results pregnancies which had a single vital fetus with a vertex presentation and intact membranes were included. Pregnants with a bishop score < 5 and who did not have spontane uterin contractures and who had a reactive nonstress test were included. 105 cases which had misoprostol and oxytosin induction (Group 2) and 120 cases which had dinoprostol and oxytosin induction (Group 1) were included. In comparison of these two groups APGAR scores and birth weights of the newborn babies, birth with cesarean, postpartum bleeding over 500 cc and the time between the first vaginal examination signs and birth were recorded.

Results: Statistically there were no difference between two groups according to demographic properties, delivery manner, bleeding during delivery and other complications. But caesarean rate was higher in Group 1 due to fetal distress and failure of induction. (respectively p = 0.032 and 0.048) Labor time was longer in Group 1 patients than group 2 (p = 0.023).

Conclusion: Because of less fetal distress and less induction failure, lower caesarean birth rates and shorter labor periods it was concluded that misoprostol is better than dinoproston for induction.

439 EFFECT OF MATERNAL SMOKING ON CORD BLOOD HORMONE CONCENTRATIONS

A. Varvarigou¹, S. Liatsis¹, V. Tsapanos², G. Decavalas², N. Beratis¹

¹University of Patras, Medical School, Pediatrics, Patras, Greece;²University of Patras, Medical School, Obstetrics & Gynecology, Patras, Greece

Background: Smoking during pregnancy affects the endocrine status of the fetus.

Objective: To measure cord blood (CB) concentrations of (E3), (hPL), (beta-HCG), FSH, LH and cortisol in offspring of smoking and nonsmoking women during pregnancy.

Methods: CB was collected from 100 term neonates of smoking mothers and 100 of nonsmoking. E3, hPL, beta-HCG, FSH and LH were determined by a radioimmunoassay and cortisol by a fluoroimmunometric assay.

Results: The E3, hPL, beta-HCG, and FSH CB concentrations were significantly lower in the neonates of smoking than in nonsmoking mothers. The LH concentrations were lower in the offspring of smoking mothers but the difference was not significant. Conversely, the cortisol concentrations were significantly greater in the smoking mothers' newborns. There was a significant negative correlation between number of cigarettes smoked/day and E3 (r = − 0.163, p = 0.021), hPL (r = −0.205, p = 0.013), beta-HCG (r = −0.143, p = 0.044), FSH (r = −0.289, p = 0.029). Cortisol showed a strong positive correlation to the number of cigarettes smoked/day (r = 0.259, p < 0.0001). Multiple linear regression analysis showed that maternal smoking during pregnancy is a determinant of CB E3, hPL, beta-HCG, and cortisol.

Conclusion: The E3, hPL, beta-HCG, and FSH concentrations were significantly reduced in CB of smoking mothers' newborns, whereas the cortisol levels were significantly increased. The disturbed endocrine status of the fetus induced by the tobacco smoke could cause several adverse effects on the offspring since there are data indicating that hormones participate in fetal growth and development, including the fetal brain that is a target organ for hormonal actions.

440 LISTERIA INFECTION IN PREGNANCY

L. Wong, U. Fahy

Limerick Maternity Hospital, Obstetrics and Gynaecology, Limerick, Ireland

This 28 year old Latvian para1 woman, presented at 36 weeks gestation feeling unwell with pyrexia, malaise, lethargy, headaches and joint pains. There were no gastrointestinal symptoms or history of recent travel abroad. She was treated symptomatically and discharged home a few days later as there was no obvious abnormality. She presented again 3 days later with similar symptoms. Blood cultures, performed because of pyrexia of > 38 degrees C, isolated Listeria Monocyogenes. She was treated with intravenous gentamicin and high dose amoxycillin for 2 weeks and had close maternal and fetal surveillance. Labour was induced at 39 + weeks, with vaginal delivery of a healthy baby girl. Grade 1 meconium was noted on membrane rupture. The baby was observed on NICU and treated with prophylactic antibiotics but had no problems. The mother had no postpartum problems.

The reported local incidence, diagnosis and management of the condition are discussed.

441 GIANT SACROCOCCYGEAL TERATOMA: REPORT OF A CASE

A. Yalinkaya, K. Kangal, Z. Savas, Z. Kaya

Dicle University Faculty of Medicine, Department of Obstetrics and Gynecology, Diyarbakir, Turkey

Objective: To present a pregnancy complicated with giant sacrococcygeal teratoma (SCT).

Case: The patient was 29 year old (G2P1) and reffered to our clinic for fetal abnormalities at 15 gestational weeks. On ultrasound sacrococcygeal teratoma were detected, and amniocentesis was performed. The karyotype was found normal, and the parents decided to continue the pregnancy. The patient was followed up with ultrasound examination periodically. At 35^th gestational week the tumor size was reached 150×200 mm, therefore, we performed cesarean section and delivered 4400 g, female fetus, first and fifth minutes APGAR scores were 6–7. The infant was operated by pediatric surgeon postpartum day 1, and died postoperative day 7 due to sepsis. The woman was discharged at day 6 without problems.

Conclusion: SCT is uncommon congenital tumour, and diagnosed by experienced obstetricians. SCT can cause complications of fetal hydrops, stillbirth during pregnancy, and dystocia, tumor rupture during labor. Despite this giant SCT, mother and fetus were not complicated before delivery.

442 WILL FIRST TRIMESTER MIDDLE CEREBRAL ARTER DOPPLER HELP TO INTRAUTERIN DIAGNOSE OF BETA-THALASSEMIA?

B. Yildirim, B. Kaleli, O. Oztekin

Pamukkale University, Obstetrics and Gynecology, Denizli, Turkey

Beta-thalassemia is an life threaning anemia. Chorionic villous sampling (CVS) is the only way to diagnose beta-globin gene mutations in fetal DNA in the late first trimester (11–13th weeks' gestation) for the prediction of thalassemia. Several aspects of first-trimester chorionic villus sampling remain controversial, especially fetal loss rate, feto-maternal complications. We investigated ´middle cerebral artery Doppler velocimetry´ as a non invasive method to diagnosis fetal anemi in late first trimester. Methods: Women referred for the prenatal diagnosis of homozygous beta-thalassaemia before 14 weeks of gestation were recruited. All fetuses underwent pulsed Doppler examinations following colour flow mapping at 12 or 13 weeks of gestation. Homozygous beta-thalassaemia was diagnosed by DNA or haemoglobin study. The middle cerebral artery Doppler indices were compared between the affected fetuses and fetuses unaffected by homozygous beta-thalassaemi.

Results: Between 2007 and 2008, 67 eligible women were recruited. Of these, 15 fetuses were affected by homozygous alpha-thalassaemia-1. The affected fetuses had significantly higher middle cerebral artery peak systolic velocity (V(max)) (36% increase) and time-averaged maximum velocity (V(tamx)) (33% increase).

Conclusion: The increase of cerebral blood flow in affected fetuses is consistent with our previous finding of an increased forward flow in the ductus venosus, cardiac dilatation and an increase of cardiac output to preferentially shunt more oxygenated blood to the brain as a compensatory mechanism. However, extensive overlap of the middle cerebral artery flow velocity values between affected and unaffected fetuses precludes its use in predicting anaemia at 12–13 weeks´ gestation.

443 ENVIRONMENTAL FACTORS IN FETAL OR EARLY NEONATAL LIFE CONFER GENETICALLY SUSCEPTIBLE INDIVIDUALS WITH PREDISPOSITION TO DISEASE

T. Zaharov¹, B. Kamenov², C. Vrang¹, H. Stanchev¹, V. Braendhold¹

¹Central Hospital Naestved, Pediatrics, Naestved, Denmark;²Faculty of Medicine, Immunology, Clinic of Paediatrics, Nis, Serbia

The uterine and placental tissue, fetus and newborn have a unique anatomical distribution and funktional expression of innate immune molecules: TLR, APPAs and chemocines. Uterine epithelial cells express TLR1 and 9, trophoblast TLR 2 and 4. TLR2 activation contribute to IUGR, infection-induced productionof Th1-cytokines is associated with preterm delivery. Activation of TLR2 or 4, such is chorioamnionitis, in the developing lung inhibits produktion of fibroblast growth factor (FGF) 10, thereby disrupting normal myofibroblast positioning in lung development. The innate immune mechanisms of the neonatal respiratory tract provide protection against microbial infection and prevent over exuberant inflammation. TLRs participate in the recognition of microbial pathogens in neonates, eg. including pathogens recognized by TLR2 (such Streptococcus, CMV), TLR4 (RSV).

Aim: to determine the prevalence of, and risk factors for, asthma, allergy and BHR in children with early-life RSV infektion on the basis of the pre-, peri- and postnatal RF. This study incorporating prenatal influences (uterine environment: reduction or loss of amniotic fluid, fetal well being-small for date, prematurity, maternal health: prenatal smoking, viral infection chronic disease) which are potentially important for differential diagnosis and monitoring of pediatric airways diseases.

Results: Premature and children born after pregnancies with RF show higher risk of wheezing lung disease, showed increased daily peak flow variability, suggesting an abnormality of airway dynamics unrelated to atopy, respond poorly to bronchodilator or ICS. There is the possibility of a genetic basis for this dysfunction of airway tone, it was related to reduce lung function and increased BHR.

444 WAVELET ANALYSIS OF FETAL HEART RATE (FHR)

E.N. Zelianko¹, S.L. Voskresensky¹, O.V. Doubrovina², M.V. Dubatovska³, S.V. Rogosin³

¹Belarusian Medical Academy of Post Graduate Education, Obstetric and Gynecology Department, Minsk, Belarus;²Belarusian National Technical University, Minsk, Belarus;³Belarusian State University, Minsk, Belarus

The aim is to investigate the diagnostic significant of FHR gain-frequency characteristics for antepartum asphyxia prediction.

The data set consists of 121 cardiotocograms (CTGs) with mean duration 18 (CI95% 17–19) minutes. There were two groups of CTGs: the first–in 9 cases of intrauterine deaths (37 CTG) and the second–in 31 cases of normal perinatal outcome (84 CTG). The data are decomposed by Haar wavelets to get maximum range, standard deviation and mean absolute deviation of fluctuation amplitude in 8 frequency bands.

Logistic regression is used. Diagnostic model is created by analyzing data of 40 CTGs (training sample) without accelerations, decelerations, with mean oscillation amplitude from 3 to 5 beat/minute. 20 CTGs are obtained before intrauterine deaths and other 20 CTGs are recoded in cases of normal perinatal outcome. Effectiveness of model is checked by analyzing data of the rest 81 CTGs (examination sample).

The mean absolute deviation in fluctuation amplitude within the range of 0.15–0.3 Hz and standard deviation in fluctuation amplitude in the range >0.3 Hz are included into the model (p < 0.05). Diagnostic efficacy for CTGs training sample was 90% (CI95% = 76–97%), sensitivity and specificity were 90% (90%, CI95% = 68–99%).

The application of the model gives the correct result in 17 from 17 CTGs obtained before intrauterine deaths and in 58 from 64 CTGs (91%, CI95% = 81–96%) in cases of normal perinatal outcome. The antenatal hypoxia is accompanied by increased variability in amplitude fluctuation characteristics of FHR within high-frequency ranges and its reduction between them.

445 EFFECTS OF CARBON MONOXIDE OF AIR POLLUTION ON ABSOLUTE NUCLEATED RED BLOOD CELL OF THE UMBILICAL CORD

S. Ziaei

Tarbiat Modares University, Tehran, Iran

In an analytical cross sectional study, The effects of carbon monoxide of air pollution on carboxyhemoglobin and absolute nucleated red blood cell of the cord venous blood,and umbilical cord abnormality were evaluated in 41 cords of the term cesarean delivered newborns of the mothers who live in an air polluted area in the center of Tehran during their pregnancies(study group). The mentioned parameters were compared with 32 cords of the term cesarean delivered newborns of the mothers who live in a healthy air area during their pregnancies(control study).A significant difference was observed between the two groups in the cord carboxyhemoglohin levels (p = 0.0001), cord nucleated red blood cells (p = 0.0001), and cord abnormality (p = 0.04). A significant correlation was found between ambient carbon monoxide and cord carboxyhemoglobin (p = 0.0001), and cord nucleated red blood cells (p = 0.02) in the study group.

Ziaei. Saeideh*, professor in Obstet & Gynaecol, Nouri. Kobra, M.Sc. in Midwifery, Tarbiat Modarres University, IR, Iran P.O.Box: 14115-111, Fax: 8013030, E-mail: [email protected]

446 STRUCTURAL CHANGES IN PLACENTAS OF PREGNANT SMOKERS: QUANTITATIVE STUDY

Z. Žigić¹, G. Bogdanović², Z. Fatušić², M. Alečković³

¹Medical Faculty, University of Tuzla, Department of Hystology and Embriology, Medical Faculty, Tuzla, Bosnia and Herzegovina;²University Clinical Center Tuzla, Clinic of Ginecology and Obstetrics, Tuzla, Bosnia and Herzegovina;³University Clinical Center Tuzla, Clinic for Internal Diseases, Tuzla, Bosnia and Herzegovina

Objectives: Tobbaco smoke cause fetal hypoxia and fetoplacental respiratory insuffitiency that causes retardation of fetal wight and lenght. We numericaly estimated the values of feto-maternal exchange.

Material and Methods: This was performed on 90 placentas of normally carried and delivered newborns, divided into three groups (placentas of heavy, moderate smokers and of non-smokers). The stereologic analysis of resorptive villi was performed on multipurpose testing sistem M42 with objective magnification of 40X.

Results: The average value of blood vessels' length density in placentas of heavy smokers was x = 2178.519 ± 1000.046, in control group x = 3839.489 ± 790.863. Smokers had significantly lower length density compared to the control group (t1 = −2.55, t2 = 8.44; p < 0.05). By comparison of heavy and moderate smokers, we have found statisticly significant difference (t = 5.66; p < 0.05). Statisticaly significant higher surface density of the blood vessels was found in heavy smokers compared to the control group (t = 4.971; p < 0.05) and moderate smokers (t = 3.181; p < 0.05). Significant difference existed among moderate smokers and control group (t = 1.674; p < 0.05). The least absolute length density of the resorptive villi´s blood vessels was in heavy and significantly lower compared to moderate smokers (t = 4.062; p < 0.05) and control group (t = −7.042; p < 0.05). Moderate smokers had significantly lower values of absolute length of the resorpive villi's blood vessels compared to the control group (t = −2.545; p < 0.05). Heavy smokers had statisticaly higher average absolute surface of blood vessels compared to modrate smokers (t = −4.405; p < 0.05) and the control group (t = 5.345; p < 0.05).

Conclusion: The intensity of smoking effects the structural changes of the placenta. Intensity of smoking during prenancy had a great impact on the proportion of the morfologic changes of the placentas.

447 PERINATAL ARTERIAL STROKE–10 YEARS' CASE-STUDY

T. Aguiar¹, J.P. Vieira², R. Barroso¹, A. Cadete², H. Carreiro¹

¹Hospital Fernando Fonseca, NICU, Amadora, Portugal;²Hospital Fernando Fonseca, Amadora, Portugal

Perinatal stroke, despite uncommon, is a recognised cause of long term neurological morbidity in children. Acute ischemic stroke has been estimated in aproximately1/3000-1/4000 newborns.

Objectives: Characterization of acute ischemic stroke in newborns and their neuro-development follow up.

Material and Methods: Retrospective study of the newborn charts admitted in the Neonatal Intensive Care Unit (NICU) of the Hospital Fernando Fonseca between January 1998 and December 2007, with diagnosis of acute ischemic stroke. Socio-demographic, clinical and imaging data were evaluated. For the evaluation of neuro-development Schedule of Growing Skills and/or test of Ruth Griffiths were used. Results: There were 8 acute ischemic stroke corresponding to 1/5445 newborns.

Birth weight varied between 2075g and 3740g and there was no difference between gender.

Most of the newborns presented clonic episodes; other clinical pictures were hypotonia, atonia with cyanosis. Convulsions occurred during the first 72 hours of life. One baby was asymptomatic.

The most frequently affected artery was the left medium cerebral. In 7 cases, neurological examination was normal at discharge.

Follow-up was made in all patients between 3 months and 5 years old. Six children were normal. One had unilateral brachial paresia and another presented a language delay.

Conclusion: Our study, though with a small number of cases, showed an inferior incidence and a favourable developmental follow-up compared to literature.

Although it is a rare disease, it should be considered in the event of neurological abnormalities.

448 COMPARISONS OF TWO BLOOD GAS ANALYZERS: ITS IMPORTANCE IN OBSTETRICS

J. Aixalà Gelonch¹, A. Marzal Escrivá², B. Varo Gomez-Marco², A. Perez Calvo², V. Diago Almela², A. Perales Marin²

¹Hospital Universitario La Fe, Obstetrice, Valencia, Spain;²Hospital Universitario La Fe, Valencia, Spain

The accuracy blood gas measurements in obstetrics is critical, pH and BE are in the core of the decision process of performing a cesarean section.

Objective: To ascertain model-specific differences between two blood gas models: Radiometrer ABL 77 and Bayer Rapidpoint 405.

Material and Methods: Samples were drown from umbilical vessels and transported to the blood gas analyzers in heparinized capillary tubes and syringes, analysis were performed in parallel. Variables measured are pH, PCO₂, PO₂, hematocrit (Ht), concentration of total hemoglobin (tHb), also base excess (BE) was calculated.

Results: When exposing blood from capillary tubes (n = 92) to the analyzers, we observed significant differences between the two analyzers on pH, PCO₂, PO₂, BE and Ht. The mean difference is ABL 77 overestimation of pH = 0.021 ± 0.03 and underestimation of BE = 3.31 ± 2.44. Similar but lower differences were obtained when analyzing from syringes (n = 50).

For each analyzer, capillary and syringe values correlated (ph, ABL 77 r² = 0.95 and Rapidpoint 405 r² = 0.90, both p < 0.001).

Rapidpoint 450 showed great dispersion in the The Bland -Altman plot.

The intraclass coefficient correlation were excellent for the two analyzers, for pH (ABL 0.99 and Rapidpoint 0.97), and BE (ABL 0.95 and Rapidpoint 0.91, p < 0.001), no differences was observed (95% CI).

Conclusion: There are significant differences between the two models of blood gas analyzers.

The observed differences may have implications in clinical practice as well as in court trials.

449 RESPIRATORY DISTRESS IN NEAR TERM INFANTS

A. Aktas, T. Gursoy, E. Kaya, F. Ovali

Zeynep Kamil Maternity and Children's Hospital, Neonatal Intensive Care Unit, Istanbul, Turkey

Aim: To evaluate the clinical progress of near term infants presenting with symptoms of respiratory distress in the Neonatal Intensive Care Unit.

Material and Methods: The records of 117 neonates hospitalised in Neonatal Intensive Care Unit of Zeynep Kamil Maternity and Children's hospital during the year 2007 and whose gestational ages ranged between 34 and 37 weeks were analysed retrospectively.

Results: Mean gestational age and birth weight of the infants were 35.04 ± 0.84 weeks and 2551.4 ± 480.6 gr respectively. Eighty one (71.7%) of these infants had the diagnosis of wet lung, 8 (7.1%) had multiple congenital anomaly, 6 (5.3%) had respiratory distress syndrome, 6 (5.3%) had sepsis, 3 (2.7%) had meconium aspiration syndrome, 3 (2.7%) had congenital heart disease, 2 (1.8%) had pneumonia, 2 (1.8%) had pulmonary maladaptation, 1 (0.9%) had hernia of the diaphragm and 1 (0.9%) had non-immune hydrops. Twenty eight (24.8%) of the infants were intubated and 55 (48.7%) infants received nasal continuous positive airway pressure (nCPAP). Antibiotics were administered to 32 (28.3%) infants with mean duration of 9.32 ± 5.61 days. Respiratory distress lasted 3.05 ± 3.5 days (ranging between 1 hour and 30 days). Thirteen (11.5%) of infants died (8 with multiple congenital anomaly, 2 with sepsis, 1 with congenital heart disease, 1 with hydrops and 1 with congenital diaphragmatic hernia).

Conclusion: Wet lung was the most frequent diagnosis in this population of infants with excellent prognosis. Death was usually due to congenital malformations.

450 CEREBRAL VENOUS SINUS THROMBOSIS IN NEONATES. REPORT OF TWO CASES

L. Albert de la Torre¹, L. Sanchez de Leon¹, N. Gutierrez Cruz², J. Arnaez Solis¹, M. Arriaga¹, P. Pujol Buil³

¹Hospital de Mostoles, Neonatology, Mostoles, Spain;²Hospital de Mostoles, Neurology, Mostoles, Spain;³Hospital de Mostoles, Pediatric, Mostoles, Spain

Introduction: Neonatal cerebrovenous sinus thrombosis (CVST) is rare. Tipical of term infants. It has several causes; the most important seems to be prothrombotic disorders. We report two cases of different CVST.

Case 1:Ten days old neonate, term with normal weight at birth. Deliver assisted with vacuum extractor. No resuscitation at birth. Healthy parents. Breast feeding with adequate ponderal gain. On the ninth day of life he developed vomiting, acute neurologic symptoms and seizures. Hemograme and coagulation were normal. Cerebrospinal fluid was haemorraghic. CT showed intraventricular hemorraghe and MRI confirmed the presence of intraventricular and thalamic hemorraghe associated to thrombosis of straight sinus and Galen Vein. In etiologic studies we found the presence of heterozygous G20210A mutation prothrombin gene, with no other alterations. No anticoagulant treatment. He developed progressive hydrocephaly and needed ventricle to peritoneal derivation.

Case 2: Term newborn with normal weigth at birth. Normal spontaneous vaginal deliver. He needed resuscitation with positive intermittent pressure to the birth. Healthy parents. Since birth he was extremely hypotonic and laboratory studies showed high CPK. Coagulation studies were normal. CT showed thrombosis of superior longitudinal sinus which was confirmed by MRI. There was neither hemorraghe nor ischemia signs. Biopsy confirmed congenital muscular dystrophy.

Discussion: Clinical manifestations and sequelae of sinovenous thrombosis in neonatal period are different and are dependent on the location, as showed in our two cases. The affectation of the straight sinus is unusual but its prognosis is poor.

451 POST-PHOTOTHERAPY REBOUND BILIRUBIN LEVELS: IT IS NECESSARY OR NOT?

E. Altuncu¹, Z. Yurdakul¹, H. Bilgen¹, A. Topuzoglu², P. Ürenden¹, I. Akman¹, E. Ozek¹

¹Marmara University, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey;²Marmara University, Department of Public Health, Istanbul, Turkey

Objective: The aim of this study was to determine whether a significant rebound increase in serum total bilirubin (STB) levels occurs after the termination of phototherapy.

Methods: STB levels were obtained from neonates with hyperbilirubinemia at the 8th and 24th hours after terminating phototherapy. Data including the demographic features of the babies, onset of jaundice and the aetiological factors were recorded.

Results: Data were available for 166 infants: 42% was female, 25% was preterm and 12% weighed less than 2500g. The rebound rate was 27.1% and a second course of phototherapy was started for 84% of rebounding infants. Among rebound cases, 42% of the infants developed post-phototherapy rebound in the first 8 hours, while 58% of the cases rebound at or later than 24 hours (24–48 hours). There was no statistically significant difference between infants who did rebound or not, regarding the demographic characteristics. Rebound occurred significantly higher in babies with hemolysis, and an earlier onset of jaundice. Almost half (45%) of the cases had no defined aetiology including prematurity, small or large for gestational age and excessive weight loss.

Conclusion: According to our results, it seems reasonable to obtain rebound bilirubin levels from all infants in our population at 8 and 24 hours after cessation of phototherapy without taking the risk factors into consideration, as most of the cases who rebounded did not have a significant risk factor.

452 INCIDENCE, COURSE AND PREDICTION OF SEVERITY OF HYPERBILIRUBINEMIA SECONDARY TO ABO INCOMPATIBILITY IN A GREEK DISTRICT GENERAL HOSPITAL

G. Amountza¹, P. Korovessi¹, P. Anastasopoulos², K. Avgeri¹, I. Kalaitzidis¹, C. Zeliou¹, E. Papadakis¹

¹Thriassio General Hospital, Paediatric Department, Athens, Greece;²Harris Birthright Research Centre, Fetal Medicine, Kings College Hospital, London, United Kingdom

Objective: We present the demographic and laboratory data of all infants born (510) with ABO incompatibility in a Greek District General Hospital during a period of six months. Our aim is to identify factors predicting the severity of hyperbilirubinemia and to examine the correlation between the Coombs test as well as the gestational age and the degree of hyperbilirubinemia.

Results: Out of 103 babies with ABO incompatibility, 92 had serial bilirubin assessment. 7 of them (7.6%) had significant hyperbilirubinemia requiring phototherapy. 5 had elevated levels (>5 mg/dl) at 6 hours of age whilst 2 had >13 mg/dl on Day 2.

The mean gestational age at delivery was 38.89 (±1.37) weeks, the birthweights ranged from 2240 to 4570 gr (mean 3284 gr, SD 442 gr), with sex ratio (M:F) 1.28:1.

66 (64%) babies had O/A incompatibility and 37 (36%) had O/B incompatibility.

17 (1.3%) babies were classified as preterm or near term (gestational age 35–38 weeks).

21 (22.8%) babies had positive direct Coomb's test, out of which 4 (19%) developed significant hyperbilirubinemia as opposed to only 3 (4%) with negative Coomb's test, indicating the correlation between positive Coomb's and increased bilirubin (X² = 5.065, p 0.024).

In the near-term group only 2 babies (11%) developed significant hyperbilirubinemia, while 5 (5.8%) presented from the term group (X² = 0.835, n.s.).

Conclusions: Direct Coomb's test remains a valuable marker in assessing the severity of hyperbilirubinemia in ABO incompatibility. In the subgroup of near term newborns, the impact of the gestational age remains to be established.

453 EARLY DISCHARGED NEWBORNS' READMISSION TO TALLINN CHILDREN'S HOSPITAL IN 2005–2006

P. Andresson¹, K. Margus¹, H. Mets¹, L. Veeber², L. Toome²

¹East Tallinn Central Hospital, Women's Clinic, Tallinn, Estonia;²Talinn Childres's Hospital, Tallinn, Estonia

Objective: The stay of newborns in the maternity hospital after normal vaginal delivery has diminished in Estonia and is now on average 2.5 days. This study was undertaken to evaluate the reasons of rehospitalisation of early discharged newborns.

Method: We retrospectively reviewed hospital records of newborns who had been readmitted during their neonatal period to Tallinn Children's Hospital between 2005 and 2006.

Results: During this period the total of 7232 live births were recorded at Tallinn Central Hospital.6941 newborns went home from the maternity ward. 137 (2.0%) of those were rehospitalised during their first month of life. 63 (0.9%) of the latter had been sent home early (<48 hours after vaginal delivery and <96 hours after SC).49 (78%) out of the rehospitalised newborns had been born by vaginal delivery and 14(21%) by SC. 27 (43%) mothers had been primiparous, and 36(57%) multiparous.42 (67%) of the newborns had had a weight loss of <7%, and 21 (23%) a weight loss of >7% when going home. The main reasons for rehospitalisation were neonatal jaundice (30%), feeding difficulties (22%), viral infection (13.5%), bacterial infection (9.5%), other reasons (25%).

Conclusion: Newborns discharged home early are not at increased risk for rehospitalization during their first month of life if the guidelines for early discharge are followed.

454 SIGNIFICANT REBOUND BILIRUBIN LEVEL FOLLOWING PHOTOTHERAPY IN TERM AND NEAR-TERM NEWBORNS

I. Anquela¹, S. Corral¹, A. Zuasnabar¹, F. Martinez²

¹Granollers General Hospital, Neonatal Unit (Pediatrics Department), Granollers, Spain;²Ajuntament de Granollers, Area Benestar Social, Granollers, Spain

Objective: To know the characteristics of healthy term and near-term newborns with significant rebound bilirubin level (TSB) who received repeated phototherapy (RPTT) after its discontinuation.

Methods: Retrospective study on a cohort of 248 healthy 35–41 wk babies,born between January 2006 and December 2007, treated with PTT according to AAP management parameters. Newborns who required PTT after 6h discontinuation were considered as suffering significant rebounds and received RPTT.

Differences in characteristics between RPTT receivers vs. No RPTT receivers were assessed, by using T-tests. Group means and (±) Standard Deviations, and p-values for the differences, were calculated.

Results: Nineteen (7.7%) of the 248 babies received RPTT, and 229 did not. Significant group differences were found in: birth weight (2820 ± 666.6 vs. 3167 ± 486.2gr; p = 0.038); TSB at start (17.1 ± 4.3 vs. 20.2 ± 3.2mg/dL; p = 0.006), TSB rebound (16.9 ± 2.0 vs. 13.7 ± 2.4mg/dL; p < 0.001), PTTstop age (4.0 ± 2.0 vs. 5.5 ± 2.1 days; p = 0.004), TSBrebound age (5.2 ± 2.3 vs 6.5 ± 2.2days; p < 0.01). No significant differences (p > 0.05) were found in: TSB at PTTstop (13.2vs13.2mg/dL), PTTstart age (2.9 vs. 3.5 days), PTT duration (52.9 vs. 47.4 hours), PTTstart weight (2702 vs. 2993 gr), PTTrebound weight (2765 vs. 3062g, p = 0.053), GA (37.7 vs. 38.3 weeks), and 1min. Apgar score (8.5 vs. 9.4).

Conclusions: RPTT in case of significant rebound TSB in healthy term and.

near-term babies is related to less birth weight (and TSB rebound weight) and less postnatal age when PTT is stopped. This is even with the same TSB at discontinuation of PTT.

455 REFERENCE VALUES OF PLASMA CYSTATIN C AND COMPARING WITH CREATININE IN PREMATURE INFANTS

D. Armangil, M. Yurdakök, F.E. Canpolat, A. Korkmaz, S. Yigit

Hacettepe University Faculty of Medicine Department of Pediatrics, Ankara, Turkey

Cystatin C (CysC) is a low molecular mass protein (13.343 Da, 120 amino acids) belonging to the cystatin superfamily of reversible inhibitors of cysteine proteases. CysC appears to be eliminated from the circulation almost exclusively by glomerular filtration, which makes it a promising endogenous marker of renal function. CysC has been demonstrated to reflect glomerular filtration rate better than other low molecular weight proteins, including creatinine (Cr).

We established reference values for serum cysC and compare with Cr in 108 preterm infants by particle-enhanced nephelometric immunoassay. At the first day, serum cysC values ranged from 1.25 to 2.84 mg/L and significantly decreasing after 3 days of life. Creatinine levels determined simultaneously at the first day ranged from 0.05 to 1.12 mg/dl and were also significantly different from day 3 levels. Both cysC and Cr levels were independent of sex, birth weight, hemoglobin levels and hydration state. Creatinine correlated negatively with gestational age (r = −0.25, p = 0.009), not similarly to cysC. Significant correlation was found between cysC and Cr in day one (r = 0.21, P = 0.031) but no correlation was found in day 3 blood samples (r = 0.19, P = 0.053).

Cystatin C is regarded as an alternative to for assessing renal function in preterm neonates, although its advantages over creatinine are not yet proven.

456 CASE PRESENTATION: EPIDURAL ANESTHESIA, METHEMOGLOBINEMIA, METHYLENE BLUE AND HEMOLYTIC JAUNDICE

S. Arsan, G. Atay, Ö. Erdeve, E. Okulu, Y.E. Bıkmaz

Mesa Hospital, Ankara, Turkey

Risk of methemoglobinemia (metHb) is high due to transient deficiency of NADH- dependent methemoglobin reductase in the newborn period. Although metylene blue (MB) is the most widely used treatment agent for metHb, it can also increase the oxidative stress in the erythrocytes and cause hemolysis. A newborn with hemolytic jaundice due to MB, administered for metHb resulting from local anesthetics is presented.

The baby was born to a 26 year old primigravid mother by elective cesarean section. Mother was given epidural anesthesia with bupivacain followed by infiltration anesthesia with 2% prilocain. He was born with a birth weight of 3500 g and good Apgar scores. He was admitted to the NICU at the 6^th hour of life for profound cyanosis. His vital findings were normal and he had neither respiratory distress nor a cardiac murmur. His satO₂ was 91% at room air and cyanosis did not respond to additional O₂. His echocardiography was normal. His methemoglobin level was found to be 30.9% and was administered MB at 2 mg/kg by oral route. He was discharged on his 2^nd day in full health. During the follow-up visit two days later, he was found profoundly jaundiced. His total bilirubin was 37.6 mg/dl and CBC yielded “Heinz body” positive hemolytic anemia. He was treated with exchange transfusion and phototherapy. Other hemolytic jaundices were ruled out by detailed evaluation and his jaundice was related to MB.

Maternal anesthesia may cause metHb in the newborn. Treatment modalities other than MB should also be considered.

457 OUTCOME OF DIABETIC PREGNANCIES

V. Astover¹, A. Kirss², A. Ormisson³

¹Children's Clinic, Tartu University Hospital, Tartu, Estonia;²Women's Clinic, Tartu University Hospital, Tartu, Estonia;³Department of Pediatrics, University of Tartu, Tartu, Estonia

Aim: To evaluate pregnancy outcomes of women with type 1 diabetes (T1D) before and after the implementation of glucometric monitoring.

Methods: All T1D pregnant women who delivered in Tartu University Hospital from 1988 to 2007 and their newborns were analysed retrospectively in three periods: period I (1988–1993)–before glucometric monitoring (n = 38), period II (1994–1999)–implemetation of monitoring (n = 20); period III (2000–2007)–stabile monitoring of all T1D pregnancies (n = 44).

Results: Compensation degree of diabetes by HbA1c was markably better in period III. The cases of diabetic nephropathy has increased up to 27% in period III. There was markable decrease of prematurity from 82% in period I to 39% in period III (p = 0.0001) and somewhat increase of macrosomia from 35% in period II to 43.2% in period III (p = 0.592). There was the increase of cesarean section rate up to 73% in period III. The incidence of asphyxia, congenital malformation, intrauterine growth retardation, respiratory and metabolic disorders has slightly but permanently decreased by the period III. Perinatal Mortality rate was 193.5%o in period I and there were no perinatal deaths in periods II and III.

Conclusion: The pregnancy outcome in the cases of complicated diabetes has been markably improved. The reduction of prematurity and neonatal diseases are due to monitoring during pregnancy. The risk of perinatal death for infants of diabetic mothers is minimal.

458 PRENATAL ACUTE STRESS POTENTIATED EPILEPTIFORM ACTIVITY IN NEONATE MICE

S. Attar Parsaie, E. Saboory

Urmia University of Medical Sciences, Physiology, Urmia, Iran

The development of the CNS is dependent on interactions between genetic and epigenetic factors, some of which could affect the susceptibility of the developing brain to subsequent damaging insults. Gestational stress has been shown to be a potential factor associated with a higher risk to develop some neurological and psychiatric disorders. The present study tested the hypothesis that exposure to prenatal acute stress would sensitize the offspring to neonatal epilepsy. Pregnant mice were exposed to restraint stress 3 times per day for 3 days in the beginning of last week of gestation. Ten days after birth animals decapitated and hippocampus extracted. The hippocampi were resected intact and bathed in low magnesium artificial cerebrospinal fluid to induce spontaneous seizure-like events recorded from CA1 neurons. Both number of recurrent seizures and seizure time increased in stressed group. Also, stress induced a significant rise of circulating corticosterone levels both in pregnant mothers and in newborn pups. These findings suggest that prenatal acute stress which may mimic acute stress in human pregnancy could be a novel risk factor for susceptibility to temporal lobe epilepsy in children.

Keywords:Epilepsy, stress, prenatal, neonatal, hippocampus, mice

459 NEONATAL THROMBOEMBOLISM: RISK FACTORS, CLINICAL FEATURES, AND OUTCOME

N. Demirel¹, M. Aydin¹, A. Zenciroglu¹, N. Okumus¹, M.S. Ipek¹, N. Yarali², G. Cinar³

¹Dr. Sami Ulus Children's Hospital, Neonatology, Ankara, Turkey;²Dr. Sami Ulus Children's Hospital, Pediatric Hematology, Ankara, Turkey;³Dr. Sami Ulus Children's Hospital, Radiology, Ankara, Turkey

Purpose: The neonatal period carries a relatively high risk for thrombosis. The objective of this study was to determine the risk factors, clinical features, and outcome of infants diagnosed with thromboembolism (TE).

Method: This study consisted of 19 patients (15 term, 4 preterm) diagnosed as neonatal TE between January 2005 and April 2008 in one NICU. Clinical data, laboratory testing for thrombophilic conditions, radiological studies, medications and outcomes were recorded.

Results: Overall, 12 venous (63.2%), 7 arterial (36.8%) TEs were noted. The sites of thrombosis were portal vein (10), renal vein (1), bilateral iliac and renal arteries (1), left renal artery (1), right femoral artery (3), right iliac artery (2), and multiple veins(1). Hereditary thrombotic mutations [anticardiolipin antibody positivity (1), coexisted heterozygous MTHFR + heterozygous factor V Leiden gene mutation (1), coexisted homozygous MTHFR gene mutation + homozygous protein C deficiency (1), and coexisted heterozygous MTHFR + heterozygous protrombin 20210A gene mutation (1)] were determined in four patients. Catheter placement detected in 13 patients (68.4%). Additional risk factors were available in 13 patients (68.4%) [congenital heart disease (5), septicemia (3), dehydration (3), meconium aspiration syndrome (1), respiratory distress syndrome (1), pneumonia (1), polycythemia (1), gestational diabetes (1), perinatal asphyxia (1)]. While most of the patients (84.2%) had recovered after anticoagulant (94.7%) or fibrinolytic therapy (27.8%); three patients died.

Conclusion: The most significant etiologic risk factors for thromboembolic events in sick neonates are placement of a central catheter and some genetic thrombophilic conditions.

460 NEPHROCALCINOSIS IN VERY LOW BIRTH WEIGHT INFANTS

A. Azhir¹, F. Nasseri¹, S. Rahmanian¹, R. Iranpour¹, A. Adibi²

¹Isfahan University of Medical Sciences, Pediatrics, Isfahan, Iran;²Isfahan University of Medical Sciences, Radiology, Isfahan, Iran

Objective: To determine the incidence and risk factors of nephrocalcinosis in preterm infants.

Methods: From Feb 2006 to Nov 2007 a total of 49 preterm infants of birth weight ≤ 1500 g were eligible to be entered into a prospective observational study. Data were collected on gestation, birth weight, sex and family history of renal calculi, respiratory support and use of nephrotoxic drugs. The parameters of mineral metabolism were assessed in blood and spot urine samples at the end of 2^nd and 4^th weeks of age.

Results: Nephrocalcinosis was seen in 13(26.5%) babies. The nephrocalcinosis was bilateral in 7 infants. Gestational age, birth weight and sex were not significantly associated with an increase risk of nephrocalcinosis. The length of stay in the NICU, duration of TPN and cumulative doses of nephrotoxic drug were similar between two groups. There were significant differences in the medium levels of urine calcium and phosphate at 4 weeks of age between two groups(P = 0.013, P = 0.048). There were also significant differences in urine calcium/creatinine ratio (p = 0.001), mean plasma levels of calcium at 2 weeks of age (P = 0.047) and plasma levels of phosphate at 4 weeks of age (p = 0.016) between two groups. Using logistic regression analysis, family history of renal stone (p = 0.002) and urine calcium/creatinine ratio (p = 0.011) were significant predictors of nephrocalcinosis.

Conclusion: The incidence of nephrocalcinosis was similar in our population to the previous studies. Family history of renal stone and urine calcium/creatinine ratio are the major risk factors of nephrocalcinosis.

461 NEONATAL RESPIRATORY PROBLEMS WITH INCREASING CAESAREAN DELIVERY RATES

F. Bakar, M. Berber, H. Özgün Karatepe, P. Ergenekon

Yeditepe University Hospital, Istanbul, Turkey

Objective: Caesarean delivery rates are increasing worldwide especially in high socioeconomic populations owing to maternal request and changing obstetric practice patterns. Although caesarean delivery has been shown to be protective against neonatal trauma it is associated with increased respiratory morbidity.

Patients and Methods: Deliveries occurring in a private university hospital between 1 May 2007 and 30 April 2008, which resulted in a live born singleton at term (≥36 weeks) without any known major congenital anomalies, were included in the study.

Results: From a total of 316 deliveries, there were 277 (87.7%) caesarean deliveries. Of these 277, 30 (10.8%) babies were admitted to neonatal intensive care unit mostly (25 babies) because of respiratory problems. Among the vaginal deliveries one minor (cephalohaematoma) and one major birth trauma (brachial plexus palsy) were detected.

Conclusion: Rates of caesarean delivery in our study population is very high, which resulted in high rates of neonatal respiratory morbidity. The risk and benefits of delivery mode must be discussed thoroughly with the parents before planning caesarean delivery.

462 NORMAL VALUES OF PULSE OXIMETRY IN NEONATES AT HIGH ALTITUDES

A. Bakr¹, H.S. Habib²

¹Al-Ahli Hospital, Doha, Qatar;²King Abdul-Aziz University, Jeddah, Saudi Arabia

The aim of the study was to establish normal values of pulse oximetry saturation, respiratory rate, heart rate, and blood pressure in healthy newborns at high altitude. Vital signs and oximetry saturation readings were collected from healthy term newborns at birth, at 1 h, and at 24 h of life. These were analyzed and compared with reference ranges at sea level. This study was carried out at altitudes of 1640m above sea level in Taif city, Saudi Arabia. A total of 6011 term newborns were examined at birth and 1 h and 4274 were examined at 24 h of life. At birth, the mean SpO₂ was 68.6 per cent and 60.3 per cent from the right upper and lower limbs, respectively. Mean SpO₂ was 94.3 per cent and 95.4 per cent at the age of 1 and 24 h, respectively. These values were significantly lower than those reported at sea level. The mean respiratory rate, heart rate, and mean blood pressure at 24 h were 45.7/min, 149.7/min, and 46.9 mmHg, respectively. It is concluded that pulse oximetry saturation for newborn babies is lower at higher altitudes than at sea level. This effect is observable at altitudes of 1600m above sea level. Cut-off levels lower than those used at sea level should be adopted when dealing with newborns living at high altitudes.

463 EFFICACY AND SAFETY OF IBUPROFENE VERSUS INDOMETHACIN IN PRETERM INFANTS TREATED FOR PATENT DUCTUS ARTERIOSUS: A RETROSPECTIVVE SINGLE CENTER EXPERIENCE

S. Belhadj, A. Hamdi, L. Dkhil, A. Khaldi, A. Bouziri, K. Kazdaghli, K. Menif, N. Ben Jaballah

Children's Hospital, Tunis, Tunisia

Aim: assess the efficacy and safety of early treatment with intravenous Ibuprofen and Indomethacin of haemodnamically significant patent ductus arteriosus (PDA) in preterm infants.

Methods: Medical records of all preterm infants less than 33 gestational weeks and with birth weight less or equal to 1500 grs, who had an echocardiographicaly confirmed PDA and admitted from January 2003 to Mars 2008, were retrospectively reviewed. Tow groups were identified: the Indomethacin group (IND) and the Ibuprofen group (IBU). Rate of ductal closure, need for surgical ligation, side effects and complications were recorded.

Results: Fourty one preterm (mean gestational age: 29 ± 2 weeks, mean birth weight: 1200 ± 230 grs)) were included in the study: 13 patients in the Group IND and 28 patients in the Group IBU. Rate of ductal closure was similar in two groups (IND: 15% vs IBU: 14%). Need for second course treatment was slightly more frequent in the group IBU (IND:7% vs IBU:13%; p = 0.58). Oliguria and renal dysfunction was the most frequent complication, observed in 39% of patients. Patients of the IND group had a near-significant tendency for higher serum creatinine (IND: 90 ± 25 mmol/l vs IBU: 82 ± 30 mmol/l, p = 0.6). There were no significant differences with respect to other side effects or complications.

Conclusion: By comparison with Indomethacin, Ibuprofen has the same efficacy in closing haemodnamically significant patent ductus arteriosus in preterm infants. Oliguria and transient renal failure were the most observed complications of treatment treatments and seem to be more frequent with indomethacin.

464 NEURODEVELOPMENTAL OUTCOME IN VLBW NEONATES

A. Bivoleanu¹, M. Stamatin²

¹Cuza Voda Maternity, NICU, IasI, Romania;²University of Medecine and Pharmacy, Neonatology, Iasi, Romania

Objective: The study was design to evaluate whether early neurofunctional assessment may be useful in predicting neurodevelopment outcome in children of very low birth weight (VLBW) in correlation with major risk factors.

Material and Method: Observational longitudinal study. A total of 311 VLBW born between 01.01.06- 31.03.08.These were selected from 752 newborn admitted in NICU, in the same period.16, 7% died before discharge. We performed Amiel Tison exam at discharge and BINS II at 3, 6, 9 12, 18 month corrected age. The risk factors quantified for this study lot include: perintal asphyxia, intraventricular hemorrhage, mechanical ventilation and hydrocephaly.

Results: The risk of perinatal asphyxia in VLBW is 4, 7 times higher compare with neonates > 1500g BW.(odds ratio–OR = 4.7, χ² = 65.2, p < 0.01, 95%CI). Amiel Tison before discharge revealed normal findings in 9% in asphyxiated neonates meanwhile the percent of normal exam reach 16% in those with HIV and 30% in ventilated babies.BINS II exams reveal a 17.3 times risk for minor and major dysfunctions in cases with perinatal asphyxia, compared with the other mentionated risk factors (χ² = 105.46, p < 0.01, 95%CI). Major neurologic dysfunction in ventilated babies was found in 12.5% 6 month (corrected age) CA, 9% at 1 year CA and also 9% at 18 month CA., in neonates with HIV the percents were:24%, 16% and respectiv 10%.All babies with hydrocephalus had cerebral palsy.

Conclusion: Monitorig the attainement of developmental milestones are essential to early diagnosis of developmental dissabilities. There is a significant correlation between perinatal asphyxia and neurologic dysfunction in VLBW neonates. (r = 0.7119, p = 0.000254, 95%CI).

465 THE NEURODEVELOPMENTAL PROGNOSIS OF PRETERMS WHO HAD INTRACRANIAL HEMORRHAGE

F. Bolu¹, S. Kavuncuoğlu¹, E. Yildiz Aldemir¹, S. Özbek¹, Ö. Önal², C. Gül Gök², G. Arslan³, E. Aksüyek³

¹The Ministry of Health, Bakirköy Gynecology, Obstetrics and Pediatrics Hospital, Department of Perinatology-Neonatology, Istanbul, Turkey;²Ankara University Developmental and Behavioral Pediatry, Ankara, Turkey;³The Ministry of Health, Bakirköy Gynecology, Obstetrics and Pediatrics Hospital, Department of Neonatology, Istanbul, Turkey

The prematures which makes the essential portion of the high risked neonatal group should be followed up for a long period due to cerebral palsy, mental retardation, posthemorrhagic hydrocephaly, sensoryneural deafness, visual problems, behavioral problems, inability to learn,language defects.

There are several perinatal and postnatal risk factors effecting neurodevelopmental prognosis. The leading causes are intraventricular hemorrhage and periventriculer leukomalasia.

In our study, we evaluated neuromotor development of prematures during their 24 th and 42.5 th months of life.

We reached to the 80 premature patients who were detected as having intracranial hemorrhage during their hospitalization period of 2004–2005 in premature service. These patients were evaluated by neurological examination and Bayley III developmental evaluation scale. When the groups are discriminated according to stages of intracranial hemorrhages, the results were as the following: stage I : 36 (% 44.4), stage II: 23 (%28.3), stage III : 7 (%8.64) stage IV: 3 (%3.7) patients. Periventriculer leukomalasia were detected in 11 (%13.5) patients.

Intracranial hemorrhage is bad prognostic factor effecting mortality and morbidity of premature babies. The neurological sequele frequency depends on the stage of the hemorrhage of germinal matrix specific to prematures.

In our study, according to Bayley developmental evaluation, we showed that as stage of intracarnial hemorrhage increases, neurodevelopmental delay increases. Especially patients with stage III-IV intracranial hemorrhage and PVL had increased delay in cognitive- language- motor function in %18–50 proportion when compared with stage I-II patients.

466 PROGESTERONE FOR MAINTENANCE TOCOLYTIC THERAPY AFTER THREATENED PRETERM LABOR. RANDOMIZED CONTROLLED TRIAL

S. Borna, S. Shakoie, H. Borna

Tehran University of Medical Sciences, Department of Perinatology, Tehran, Iran

Background: Women with preterm labor that is arrested with tocolytic therapy are at increased risk of recurrent preterm labor. The efficacy of maintenance tocolytic therapy after successful arrest of preterm labor remains controversial. It is unknown whether progesterone reduces this risk in such women.

Objective: The purpose of this study was to determine whether supplementation of vaginal progesterone after inhibition of Preterm labor is associated with an increased Latency Period and a decreased recurrent of preterm labor.

Methods: This trial was conducted in 70 women who presented with symptoms of threatened preterm labor, who after arrest of uterine activity were then randomized to progesterone therapy or no treatment. Treatment group received progesterone suppository (400 mg) daily until delivery and control group received no treatment.

Results: Longer mean latency until delivery (36/11 17/9 versus 24/52 27/2) (mean + SD) days, respiratory distress syndrome4 (10.8%) versus 12 (36.4%) P = 0.021, Low birth weight10 (27%) versus, 17(51.5%) P = 0.04, birth weight (3101.54 ± 587.9 gr versus r 2609.39 ± 662.9gr, P = 0.002) were significantly different between the two groups.

No significant differences were found with recurrent preterm labor 13(35.1%) versus 19 (57.6%), P = 0.092, Admission in intensive care unit 9 (24.3%) versus 13 (39.4%), P 0.205) and neonatal sepsis 2 (5.4%) versus 6(18.2%) P = 0.136 for the progesterone and control groups, respectively.

Conclusion: The use of vaginal progesterone suppository after successful parenteral tocolysis associated with a longer latency preceding delivery but failed to reduce the incidence of readmission for preterm labor.

467 BIRTH INJURIES: INCIDENCE AND MATERNAL AND FETAL PREDISPOSING FACTORS

H. Borna, S. Borna, S. Moaid Mohsenie

Tehran University of Medical Sciences, Department of Perinatology, Tehran, Iran

Objective: To study maternal and fetal parameters as potential risk factors for fetal injury.

Material and Method: From a series of 3596 vaginal deliveries between January 2002 and December 2005, 148 cases complicated by fetal injury were prospectively identified and compared with a control group of 280 uncomplicated deliveries. Maternal and infant characteristics, induction and length of labor, operative vaginal delivery and outcome were evaluated as possible risk factors for fetal injury.

Results: 3596 vaginal deliveries were included in the registry.

Fetal injury found in 148 infants (41.15/1000) deliveries, was born vaginally, nine infants had multiple injures. The most common injury was cephalohematoma (77 of 3596).

Other injuries included clavicles fracture 56(15.57/1000), brachial plexus 13(3.61/1000), asphyxia 7(1.94 /1000), and facial laceration (n = 4), brain hemorrhage 1(0.27/1000)), skin hematoma 2 (0.54/1000), Facial nerve palsy1 (0.27/1000).

In multiple regression analysis, Birth weight adjusted odds ratio 0.001, 95% confidence interval (0.00028–1.001))and Instrumental delivery adjusted odds ratio 2.145.95% confidence interval (0.559–8.55)) and Induction of labor adjusted odds ratio1.114, 95% confidence interval (0.355-3.13}, PROM adjusted odds ratio 0.952, 95% confidence interval (0.247–2.59) and academic degree of attendant physician at delivery adjusted odds ratio 0.875, 95% confidence interval (0.236–2.35) were the most significant fetal risk factors for infant injury.

Conclusion: Fetal injuries complicate (41.15/1000) of deliveries. Induction of labor, PROM and academic degree of attendant physician at delivery, Increasing Birth weight, and gestational age were associated with fetal injury.

468 MORTALITY AND MORBIDITY OF PRETERM INFANTS WHO BORNED ≤ 1500 G: SHORT-TERM OUTCOMES

A. Bülbül, F. Okan, S. Şahin, A. Nuhoglu

Şişli Etfal Children Hospital, Department of Neonatology, Istanbul, Turkey

Aim: The aim of this study was to evaluate clinical problems and early outcome of preterm infants.

Method: The data of preterm infants ≤ 36 weeks gestational age and with birth weight between 500–1500 g; and admitted to the NICU between January 2002–December 2006 were analysed retrospectively.

Results: During this time period 224 preterm infants admitted to the NICU. The gender, mean gestational age and mean birth weight of the infants were 43.8% male; 29.8 ± 3.0 weeks(range 23–36) and 1122 ± 294 g (range 530–1500) retrospectively. The rate of multiple pregnancy was 17% and the administration of antenatal steroid was 12.1%. The respiratory distress syndrome(RDS) was diagnosed in 72% of the infants and mild, moderate and severe forms of RDS were found 27.7%, 16.5% 28.1% respectively. Intraventricular hemorrhage grade I, II, III were seen in 6.7%, 10.3%, 7.1% respectively, and intraparenchymal hemorrhage developed in 3.1%. Retinopathy of prematurity stage I, II, III, IV was found in 11.8%, 12.5%, 3.4%, 0.7%; and necrotizing enterocolitis stage I, II, III was found in 6.7%, 3.1%, 1.3% respectively. Culture positive sepsis was diagnosed in 12.5% of the study group and in 44.2% clinical sepsis was noted. The total mortality rate was found to be 35.7% and 73.1% of these babies was under 1000g at birth.

Conclusions: In very low birth weight babies the mortality rate of infants who were under 1000 g at birth is still very high, To be aware of early and late outcomes of preterm infants is necessary to achieve further improvements in the outcome of these babies.

469 FECAL CALPROTECTIN AS A NON INVASIVE MARKER OF DIGESTIVE DISTRESS IN PRETERM NEONATES: CUT-OFF LEVELS

F. Campeotto

Hôpital St Vincent de Paul, Neonatologie, Paris, France

Objective: In preterm infants, enteropathy or necrotizing enterocolitis are prominent features of digestive distress, impacting differently enteral feeding. Their diagnosis, currently based on clinical and radiological data, would benefit from a non invasive biological marker.

Patients and Methods: This retrospective multicentric study enrolled 126 preterm infants (75 boys, 51 girls) born at a median gestational age of 33 weeks (range: 25.7–35 weeks) with a birthweight of 1760g (730–2750g). For each neonate, fecal samples were collected weekly from the end of the first week of life until the end of the first month and if any gastrointestinal event occurred. Samples were immediately stored at −80°C before ELISA measurement (CalprestÒ, Eurospital, Italy).

Results: Three hundred and twelve samples were analyzed. Median calprotectin value was 206 μg/g (16–1240), 393 μg/g (52–996) and 832 μg/g (168–4775) in samples from healthy neonates (252 samples), from neonates with mild digestive symptoms (42 samples) and from those with NEC (18 samples), respectively. ROC curves analysis gave a cut-off value of 363 μg/g (sensitivity 0.65, specificity 0.82) for the development of digestive symptoms and a cut-off of 636 μg/g (sensitivity 0.72, specificity 0.95) for the development of severe symptoms.

Conclusion: Calprotectin might be a promising non invasive clinical screening marker for intestinal distress in neonates. A prospective multicentric study is in progress to confirm its clinical utility.

470 EVALUATION OF MATERNAL AND NEONATAL OUTCOMES AFTER DELIVERIES ASSISTED BY VACUUM EXTRACTION

T. Carraca¹, S. Monteiro¹, M. Moucho¹, M. Mateus², N. Montenegro¹

¹Hospital de S. João, Serviço de Ginecologia e Obstetrícia, Porto, Portugal;²Hospital de S. João, Serviço de Neonatologia, Porto, Portugal

Objective: To evaluate maternal and neonatal complications of deliveries assisted by vacuum extractors.

Methods: The authors made a retrospective observational study to evaluate maternal and neonatal complications of vacuum-assisted deliveries. We reviewed a cohort of 527 vacuum extractions of singletons during the year of 2006 at Gynaecology/Obstetrics Department of Hospital de S. João, Porto. The authors evaluated maternal age, parity, gestational age at delivery, type and time of vaccum extractor, variety of presentation and position, weight and Apgar score of newborns, and maternal neonatal complications.

Results: A total of 527 deliveries were included. The main cause of vacuum-assisted deliveries was prolonged second stage (64.3%) and the vacuum extractor cup used in the majority was Mityvac (94.5%). Left anterior and right posterior fetal positions were the most frequent (40.4% and 16.1%, respectively). The skin injury occurred in 30.5%. Subgaleal subaponeurotic hemorrhage occurred in 5 cases (0.9%). Brachial plexus injury occurred in 3 (0.6%) cases, and clavicular fracture in 17 cases (3.2%). The most frequent maternal complications were vaginal tears, with 0.7% of third degree perineal tears.

Conclusion: In our study severe maternal and neonatal complications associated with vacuum extraction were uncommon as it is described in literature.

471 NEONATAL SUBGALEAL HEMORRHAGE

T. Carrión¹, J.L. Antich², G. Mir¹, J. Ferrer¹

¹Clinica Rotger, Neonatology, Palma de Mallorca, Spain;²Clinica Rotger, Hematology, Palma de Mallorca, Spain

A male full-term newborn of 18 hours of age was admitted to the neonatal intense care unit with skin pallor, respiratory distress, and hypoactivity.

He was born by cesarean section to a primiparous 39 year old woman.

The family history was unremarkable on both the maternal and the paternal sides.

The baby appeared normal at birth and Apgar scores were 9/10.

His weight was 3.400g, the length 51 cm and the head circumference 35 cm.

Heart rate was 180 bpm, respiratory rate 80 breath/min, the blood pressure was 44/23 mmHg.

On physical examination revealed a soft, nonpitting, and impressively fluctuant swelling underlying the entire scalp associated tenderness, edema and ecchymosis of left eye.

A clinical diagnosis of subgaleal hemorrhage was made.

Laboratory studies revealed : Hemoglobin 6 g/dl Hematocrit 17.1%. Platelet count 216.000. Prothrombin time 38% Partial- thromboplastin time 223. Factor VIII 1%, factor IX 20%.

The patient was treated with large volumes of fluids, inotropic support, and blood products to treat hypovolemic shock.

Radiograph of the skull showed rule out fracture.

Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures.

Coagulation studies confirmed factor VIII deficiency, or hemophilia A.

Soft- tissue bleeding is one of the most common manifestations of hemophilia in children.

Asking again his mother revealed that there was in her family deaths in males in early chilhood.

472 PRELIMINARY EXPERIENCE WITH INO VENTILATION IN VLBW PRETERM INFANTS

C. Cavalli¹, G. Bussolati¹, S. Moretti¹, L. Gambini¹, E. Volante¹, G. Bevilacqua²

¹Neonatology and NICU, Maternal and Child Care, Parma, Italy;²Chair of Neonatology, Maternal and Child Care, Parma, Italy

Background: Cardiovascular stabilization in VLBW infants is often associated to elevated arterial pulmonary pressure but concern still afflicts iNO utilization in preterm infants.

Series:

Case #1. ♀, 30 GA, BW 1380g (50–75 centile). Cesarean delivery for spontaneous labor and breech presentation. Apgar scores 7 and 6. Intubation and surfactant in the DR. Dopamine (5–7mg/kg/min) was started in the NICU (mean systemic pressure 32–34mmHg). At 11 hours of life: VI = 74, OI = 6. Echocardiography showed an RV pressure of 60–62mmHg (mean systemic pressure: 34mmHg) and right shunting PDA. A trial with iNO (5ppm) was effective thus 3ppm were given for 24 hours. The iNO ventilation was tolerated and echocardiographic follow-up was performed. The newborn was extubated on day 2 and she was oxygen-free at 2 weeks.

Case #2. ♀, 30 GA, BW 1180g (25–50 centile). Cesarean delivery for amnionitis with subsequent perinatal infection. Apgar scores 2 and 5. Intubation and surfactant in the DR. Dopamine (7mg/kg/min) was started in the NICU to achieve mean systemic pressure 32–37mmHg. At 10 hours: bidirectional PDA, myocardial dyskinesia, and quasi-systemic RV pressure (50mmHg), OI = 16, VI = 76, while acidosis persisted. iNO ventilation was started (3ppm) after an effective trial (5ppm). Cardiocirculatory stabilization was progressively achieved and iNO was stopped after 35 hours.

DISCUSSION. Rationale for iNO ventilation could be similar in VLBW as for larger infants. Our preliminary experience seems positive provided echocardiographic follow-up is available for minimizing exposure to iNO and checking results.

473 THE NECROTIZING ENTEROCOLITIS IN VERY LOW BIRTHWEIGHT INFANTS IN YEARS 2002–2006

V. Cunat¹, I. Berka¹, M. Rygl², J. Melichar¹, Z. Stranak¹

¹Institute for the Care of Mother and Child, NICU, Prague, Czech Republic;²University Hospital Motol, Department of Pediatric Surgery, Prague, Czech Republic

Retrospective study based on clinical and pathological findings in a group of 31 VLBW infants treated for necrotizing enterocolitis (NEC) by the authors team in years 2002–2006. Only newborns with NEC grade from I.B to III. according to Bell were included in the trial group. The aim of this study was evaluation of incidence and mortality of NEC, as well as evaluation of chosen risk factors, such as time of initiation of enteral feeding or a whole feeding protocol used, to determine more effective therapeutic approach in treatment of NEC.

474 THE ASSOCIATION BETWEEN SECOND-TRIMESTER MATERNAL SERUM ALPHA-FETOPROTEIN IN 14–22 WEEKS AND ADVERSE PREGNANCY OUTCOME

R. Dehghani Firouzabadi

Shahid Sedughi University of Medical Sciences and Health Services, Research and Clinical Center for Infertility, Department of Obstetrics & Gynecology, Yazd, Iran

Objective: To determine the risk of adverse pregnancy outcome by maternal serum alpha-fetoprotein (MSAFP) level.

Methods: We followed 295 pregnant women from MSAFP screening in the 14th to 22th week of gestation until the end of pregnancy and information on pregnancy outcome have been recorded in questionnaires.

Results: Of 295 pregnant women, 270 had term labor and 25 had preterm labor. The frequencies of pregnancy outcomes were as following: 3 (1.01%) stillbirths, 25(8.47%) preterm labor, and 10 (3.4%) preterm rupture of membranous (PROM), 15 (5.1%) pre-eclampsia, 23 (7.8%) oligohydramnious, and 1 (0.33%) miscarriage. The mean of preterm labor was significantly associated with the higher level of MSAFP (P-value∼0.021). The mean was 55.1 ng/cc in preterm labor and 41.1 ng/cc in term labor. Also, second trimester MSAFP levels were higher in women with pre-eclampsia (P-value∼0.001). The significant association was found between higher level of MSAFP with oligohydramnious (P-value∼0.000) and low birth weight (P-value∼0.000).

Conclusion: Pregnancies with an elevated MSAFP level are associated with adverse obstetric outcomes and need more prenatal care.

Keywords:Maternal serum Alpha-fetoprotein, Adverse pregnancy outcomes

475 MANAGEMENT OF NEONATAL HYPERBILIRUBINEMIA: PRACTICES OF PEDIATRICIANS WORKING IN ISTANBUL

B. Demirel¹, H. Bilgen², A. Topuzoğlu³, U. Demirel¹, M. Karavuş³, I. Akman², E. Özek²

¹Marmara University Hospital, Department of Pediatrics, Istanbul, Turkey;²Marmara University Hospital, Department of Neonatology, Istanbul, Turkey;³Marmara University Hospital, Department of Public Health, Istanbul, Turkey

Aim: The aim of our study is to evaluate knowledge and practices of pediatricians in Istanbul, about hyperbilirubinemia.

Method: The survey questionnaire included 29 questions addressing demographic characteristics of physicians and features of diagnosis, treatment and follow up. The questionnaries were answered by pediatricians providing services for neonates in training (University and State Hospitals) and Community Hospitals, Mother and Child Health Care Centers and Private Hospitals of Istanbul. It was aimed to reach 500 respondents.

Results: 77.2% of questionnaires (n = 647) were elligible for analysis. 47.6% of respondents were fellows and 52.4% were residents of pediatrics. According to the results, 82.6% of respondents informed families about neonatal hyperbilirubinemia verbally, while 4.5% presented both written and verbal information. Only 28.3% of respondents performed routine predischarge total serum bilirubin (TSB) measurements and 25.8% of these used bilirubin nomograms. 94.1% reported to have an institutional management policy of jaundice management, practices of 33.4% were in harmony with the recomendations of American Academy of Pediatrics. For the diagnosis of jaundice all of the physicians used TSB measurement, while 2.8% were also using transcutaneous bilirubinometers. Most of the pediatricians (98.8%) recommended initiation of phototherapy and frequent breast-feeding for the initial treatment, while 3.8% stopped breast feeding.

Conclusion: Predischarge TSB measurement rate was low and few used bilirubin nomograms for follow-up. TSB levels at which treatment initiated were generally consistent. Up-to-date and evidence-based protocols and continuous education are needed for the management of neonatal hyperbilirubinemia, which is a serious problem in our country.

476 HOW DOES TRANSIENT HYPOTHYROXINEMIA AFFECT THE RISK OF OSTEOPENIA OF PREMATURITY?

U. Demirel¹, T. Gürsoy², E. Özek³, A. Topuzoğlu⁴, B. Demirel¹, A. Bereket⁵, F. Ovalı², H. Bilgen³, I. Akman³

¹Marmara University Hospital, Department of Pediatrics, Istanbul, Turkey;²Zeynep Kamil Hospital, Department of Pediatrics, Istanbul, Turkey;³Marmara University Hospital, Department of Neonatology, Istanbul, Turkey;⁴Marmara University Hospital, Department of Public Health, Istanbul, Turkey;⁵Marmara University Hospital, Department of Pediatric Endocrinology, Istanbul, Turkey

Objective: The aim of the study is to determine the effect of transient hypothyroxinemia on osteopenia of prematurity.

Methods: 101 infants, born at a gestational age of less than 34 weeks, were enrolled. Demographic characteristics and clinical features were recorded. Thyroid function tests and Calcium, Phosphorus, Total Alkalene Phosphatase levels were determined in the first and third weeks of life. SPSS 13.0 program was used for statistical analysis.

Results: The mean gestational age and birth weight of the study group was 30.5 ± 4.4 weeks and 1460 ± 680 gr, respectively. Most of the preterms were fed by breast milk (n = 52, 51.4%) and 39 infants (38.6%) were fed by both breast milk and preterm formula. Fifty-four patients (53.4%) had TPN infusions for 7 or more days. Sixty (59.4%) patients had ventilator treatments, 16 of whom were diagnosed as having BPD. 38 (37.6%) babies had ALP values > 900 IU/L at three weeks of age. Fifteen (14.8%) babies had low free T₄ at 1^st week. Free T₄ level and ALP levels at the 3^rd week had statistically significant correlation (Spearman_rho = %22.1 p < 0.017).

Conclusions: Both transient hypothyroxinemia and osteopenia are common problems of prematurity. Free T4 levels had statistically significant correlation with ALP levels at the 3rd week. Low T4 levels can have a protective effect from osteopenia by slowing the remodelling process. This relationship should be investigated by the evaluation of a larger sample group.

477 EVALUATION OF DIFFERENT CULTURE CONDITIONS FOR HUMAN MESENCHYMAL STEM CELLS DERIVED FROM SECOND TRIMESTER AMNIOTIC FLUID

J. Deprest¹, Y. Ozog¹, G. Verbist¹, L. Vercruysse¹, V. Van Duppen², K. Theunissen², J.-P. Fryns², R. Lories³, L. Gucciardo¹, N. Ochsenbein-Kolble¹

¹Universitary Hospitals Leuven, Obstetrics and Gynecology, Leuven, Belgium;²Universitary Hospitals Leuven, Center for Human Genetics, Leuven, Belgium;³Universitary Hospitals Leuven, Rheumatology, Leuven, Belgium

Objective: To examine growth, phenotypic characteristics and differentiation potential of isolated mesenchymal stem cells (MSC) from second trimester amniotic fluid (AF) under different culture conditions.

Study design: MSC were co-cultured on fibronectin, gelatin and polystyrene using three different culture media. Medium 1, 2 and 3 were earlier proposed growing human AF-derived MSC (in't Anker 2004), amnion mesenchymal cell (Ochsenbein-Kölble 2003) and bone marrow-derived mesodermal progenitor cell (Reyes 2001). MSC were characterized after at least 15 cell doublings by morphology and FACS-analysis and differentiation potential by immuno- and cytochemical staining. Karyotyping was performed prior and after >15 cell doublings in order to show cytogenetic stability.

Results: Human MSC were isolated from second-trimester AF. Cell doubling time ranged between 49–104 h depending on culture conditions. Cytogenetic analysis showed normal karyotype. Medium 2 containing fetal bovine serum, epithelial growth factor, insulin, transferrin and tri-iodothyronine, stimulated cell growth better than the other two media and resulted in over 36 cell doublings. Flow cytometry of cells showed typical MSC phenotype, positive for CD166, CD105, CD73, CD44, CD29 & HLA-ABC, but negative for CD45, CD34, CD14 & HLA-DR. The cells showed potential of differentiation into osteoblasts.

Conclusion: We were able to identify the most potent medium and culture conditions for AF-derived MSC. This protocol is further being used to explore the potential of AF-MSC in perinatal tissue engineering. Work supported by a grant of the European Commission (6th Framework Programme www.eurostec.eu, LSHC-CT-2006-037409).

478 CLINICAL CONDITIONS ASSOCIATED WITH POST NATALGROWTH FAILURE IN PRETERM INFANTS

N.A. Dinerstein, C.L. Solana, R.M. Nieto, G.P. Perez

Maternidad Sarda, Neonatologia, Buenos Aires, Argentina

Objective: to evaluate the influence ofeach perinatal clinical condition on the frequency of post natal growthretardation (PNGR), low head circumference (HC) and short body length at 40PMA.

Design and Methods: cohort study. Inclusion criteria: in-born infants, <32 weeksGA, birth weight <1500 gand surviving up to 40 weeks of PMA. Three explicative logistical regressionmodels were constructed estimating in each case the 95% confidence intervalsfor the odds ratio of the significant factors.

Results: From 08/2001 to 11/2005, 339 infants were born, 238 met the inclusioncriteria and were studied. Clinical characteristics and outcomes were notstatistically diferents between grupos. Multivariate analysis showed that thefollowing variables were predictive for PNGF: gestacional age (OR:2.01, 95%CI1.52–2.66), combined morbidity (OR:2.85, 95%CI 1.43–5.69), birth weight(OR:0.53, 95%CI 0.43–0.66) and caloric deficit (OR:1.13, 95%CI 1.04–1.23).Predictive variables for short length were: gestacional age (OR:1.58, 95%CI1.22–2.03), combined morbidity (OR:3.09, 95%CI 1.6–5.96), birth weight (OR:0.54 95%CI 0.44 0.66) and male gender (OR:2.39, 95%CI 1.26–4.54). Predictivevariables for low HC were: birth weight (OR:0.62, 95%CI 0.54–0.83) and malegender (OR:6.39, 95%CI 1.76–23.23).

Conclusions: We found that combined morbidities such us RDS, PDA, late onsetsepsis and BPD, associated with lower birth weight, gestacional age, malegender and caloric deficit explain PNGR, shorter body length and lower headcircumference at 40 PMA weeks in our population. Postnatal growth failureprevention will only be possible improving nutritional interventions andreducing neonatal co-morbidities.

479 FEATURES OF POSTNATAL ADAPTATION OF PRETERM INFANTS BORN TO MOTHERS WITH PRETERM PRELABOUR RUPTURE OF MEMBRANES

D. Dobryanskyy¹, E. Golodnykh²

¹Lviv National Medical University, Paediatrics, Lviv, Ukraine;²Ivano-Frankivsk State Medical University, Paediatrics, Ivano-Frankivsk, Ukraine

Preterm premature rupture of membranes (PPROM) remains an important cause of preterm birth and can negatively affect perinatal outcomes.

The purpose of this study was to evaluate the influence of PPROM, current obstetric and neonatal care on perinatal outcomes.

Methods: The analysis of features of obstetric history, course of pregnancy and labour in 623 women who delivered preterm was done. PPROM was the cause of preterm birth in 266 (42.7%) women. Perinatal outcomes were compared in 304 infants born to mothers with PPROM (main group) and in 407 neonates who were born preterm due to the other causes (control group).

Results: The women with PPROM were significantly more often treated with antenatal steroids (62.41% vs 40.06%; p < 0.05) and antibiotics (62.41% vs. 40.06%; p < 0.05). The 2 groups of infants do not differ by gestational age (33.36 ± 2.83 wks in the main group vs. 33.21 ± 2.60 wks in the control group; p > 0.05) and birth weight (2066.15 ± 380.51 gm vs. 1982.65 ± 478.45 gm accordingly; p > 0.05). The babies from women with PPROM were born in better condition, less often required resuscitation at birth, hospitalisation to neonatal intensive care unit, and mechanical ventilation. Their mortality rate was significantly lower (10.43% vs. 16.46%; p < 0.05). Neither expectant nor active management of women with PPROM at 34–37 wks of pregnancy had any advantages in terms of perinatal outcome improvement.

Conclusions: The obtained results suggest the lack of negative influence of PPROM on newborns' postnatal transition if medical care of mothers and neonates is adequate.

480 GROWTH OF PREMATURE INFANTS RECEIVING A SUPPLEMENTARY FORMULA WITH EXTRA ENERGY, PROTEINS, ZINC AND COPPER AFTER HOSPITAL DISCHARGE

N. Díaz-Gómez¹, E. Domenech², F. Barroso³, C. Cortabarria⁴, C. Gonzalez-Campo⁵, A. Jimenez⁶, S. Castells¹

¹Nursing School, La Laguna, Spain;²Faculty of Medicine. University of La Laguna, Paediatrics, La Laguna, Spain;³Faculty of Medicine, La Laguna, Spain;⁴University of La Laguna, La Laguna, Spain;⁵University Hospital of the Canaries, La Laguna, Spain;⁶Research Unit. University Hospital of the Canaries, La Laguna, Spain

Our objective was to evaluate the effect on growth of preterm newborns (PT) until 4 months of corrected age (CA) fed a PT formula supplemented with zinc and copper.

We randomly assigned 49 PT, gestational age (GA) 36 weeks, to control group (n = 24, birthweight 1.6 ± 0.2kg; GA 31.8 ± 1.9weeks), fed with a PT formula (81kcal/100ml, proteins: 2.8g/100ml, zinc: 6mg/L, copper: 0.6mg/L), or to a supplement group (SG: n = 25, birthweight 1.7 ± 0.3kg; GA 31.2 ± 1.6weeks), receiving the same formula plus zinc (12 mg/L) and copper (0.95mg/L), until 4 months CA. All participants were evaluated at 36 and 40 weeks GA and 3 and 6 months CA. We also studied 65 term, breast-fed newborns at 2 days. At each evaluation we recorded anthropometrics, dietary intake, total serum and bone levels of zinc, copper, alkaline phosphatase (ALP), IGF-I, IGFBP-1 and IGFBP-3.

We found no significant differences between the two groups at 36 weeks. Calculated intake of zinc and copper was higher at 40 weeks GA in SG (zinc: 2.5 ± 0.6 vs 1.1 ± 0.2mg/kg/d; copper: 0.18 ± 0.05 vs 0.14 ± 0.02mg/kg/d) and at 3 months CA (zinc: 1.7 ± 0.3 vs 0.7 ± 0.1mg/kg/d; copper: 0.12 ± 0.02 vs 0.09 ± 0.02mg/kg/d).

On comparing the data from both groups at 40 weeks GA with those obtained from the group of term infants, we found that PT presented significantly higher values of head circumference, bone ALP, IGF-I and IGFBP-3. The results of this study indicate that a PT formula supplemented with zinc and copper administered until 4 months CA has no significant effect on growth.

481 SPEED EVOLUTION IN FETUS MATURATION THERAPY

M. Dugalic¹, A. Fazlagic², B. Vasiljevic³, R. Sparic¹, I. Babovic¹, K. Jeremic¹, S. Arsenijevic¹

¹Clinical Centre of Serbia, Belgrade, Serbia;²Hospital Narodni Front, Belgrade, Serbia;³Neonatal Ward, Insitute for Gyn and Obs, Belgrade, Serbia

Acceleration of fetal maturation was achieved by endogenous release of fetal TRH brought about by periodic fluctuations in fetal P02, resulting from oxytocin produced uterine contractions. Prevention of the permanent sequelae of fetal hyperinsulinemia, namely hypertension and obesity, in patients with GDM have remained unresolved. In virtually all larger studies fetal macrosomia has not been reduced by trying to maintain blood sugar in a certain range. This study reports elimination of fetal macrosomia by accelerating fetal maturation, and delivery before the 36th week. Thirty patients with gestational diabetes 33 to 35 weeks, twelve of whom had macrosomic children, agreed to participate in the study. Oxytocin was given for 6 hours each day to produce regular contractions. In 26 patients it was given for 5 days, and in 4 patients for 7 days to reach L-S ratio indicative of fetal maturity. Eighteen patients delivered vaginally after induction of labor, and four by cesarean section. The mean Apgar score at 5 minutes was 9.1, and the mean birth weight was, 2.917, range 2.100g to 3.400g. No newborn had respiratory difficulties, although four had short episodes of tachypnea. All were cared for in regular nursery, and all were discharged home with their mothers. Acceleration of fetal maturation, and delivery between 34 to 36 weeks appears to be promising to reduce or even to eliminate the permanent sequelae of fetal hyperinsulinemia in gestational diabetes, namely hypertension and obesity.

482 WEIGHING NEWBORNS WITHOUT USING SCALES

E. Elshibly¹, G. Schmalisch²

¹University of Khartoum, Paediatrics and Child Health, Khartoum, Sudan;²Charite Mitte University Hospital, Neonatology, Berlin, Germany

In Africa, most deliveries occur at home where scales are not always available. Low birthweight (LBW), which is responsible for the great majority of infant morbidity and mortality is therefore difficult to determine. We therefore designed this study with the goal of finding a formula to determine actual birth weight using anthropometric measurements Anthropometric measurements were taken within 24 hours of birth from a 1000 mothers and their singleton infants. Multiple regression analysis with backward selection was used to analyze data. The mean (standard deviation) of BW was 3131.7 (538.9) g and that of gestational age was 39.1 (1.8) weeks. All anthropometric measurements were strongly correlated with BW (p < 0.001).Those with highest correlations were obtained with chest (CC), mid thigh (MT), and head circumferences (HC). Utilizing these three measurements, a simple formula was obtained to measure BW as follows: BW(g) = 97*CC + 74*MT + 85*HC–4000 with a standard error of 285 g. For birthweights < 2000 g, specificity is near 100% and the sensitivity is > 80%. Applying a cutoff point of 2500 g, all infants (100%) with a birthweight < 2000 g are correctly identified. This formula by allowing for actual measurement of BW will enable the health worker in developing countries to select appropriate LBW infants for referral and the researcher to study birth weight in remote areas.

483 EFFECT OF ERYTHROCYTE TRANSFUSIONS ON SERUM IGF-1,IGFBP-3,VEGF AND NO LEVELS AND DEVELOPMENT OF ROP IN PRETERM NEWBORNS

D. Bozkaya¹, E. Ergenekon², D. Erbaş³, A. Yucel⁴, O. Turan², I. Hirfanoglu², E. Koc², E. Onal², C. Turkyilmaz², Y. Atalay²

¹Gazi University, Pediatrics, Ankara, Turkey;²Gazi University, Pediatrics/Newborn Medicine, Ankara, Turkey;³Gazi University, Physiology, Ankara, Turkey;⁴Gazi University, Immunology, Ankara, Turkey

Objectives of this study:

– To investigate the change in IGF-1,IGFBP-3,VEGF and NO levels with erythrocyte transfusion.

– To assess the role of erythrocyte transfusions and the mediator levels on development of ROP in preterm newborns.

Method: Newborns ≤ 34 weeks of gestation and at risk for development of ROP were included and blood samples before and after erythrocyte transfusions were obtained for mediator level measurements. The infants were examined for ROP according to AAP guidelines.

Results: Thirty newborns were included in the study. Mean BW:1236 g (613–2400), GA: 29.8 w (26–34), mean number of erythrocyte transfusions were 3 (1–13). Seventeen of the newborns had ROP (Stage 1: 11, Stage 2: 5, Stage 3: 1). Serum mediator levels did not change with transfusion and were similar in babies with and without ROP. They did not change according to the degree of ROP either (table).

ROC curve analysis showed that after 3–4 erythrocyte transfusions each new transfusion increased the risk of ROP by 1.66 (p = 0.02).

Conclusion: Erythrocyte transfusions pose risk for development of ROP independently from the known mediators known to play role in ROP.

484 PROTECTIVE EFFECTS OF CLARITHROMYCIN IN RATS WITH HYPOXIA/REOXYGENATION-INDUCED INTESTINAL INJURY

Ö.M.A. Özdemir¹, H. Ergin¹, Ç. Yenisey², N.S. Türk³, N.G. Şimşek²

¹Neonatology, Denizli, Turkey;²Biochemistry, Aydin, Turkey;³Pathology, Denizli, Turkey

There are many published reports on the ant-inflammatory and anti-microbial effects of macrolides. The aim of this study was to determine the effects of clarithromycin on the biochemical and histopathological alterations in rats with hypoxia/reoxygenation (H/R) induced intestinal injury. Wistar-albino rat pups (n = 21) were divided into three groups on first day: group I (control), group II (H/R), and group III (H/R + clarithromycin). Clarithromycin was administered (40 mg/kg) subcutaneously to group III for 3 days. For H/R, 3-days-old rat pups were placed into a chamber of 100% CO2 for 5 min, then they were reoxygenized with 100% O2 for the next 5 min. At 6th hours after H/R, all animals were killed on day four. Histopathologic injury scores, malonyldialdehyde (MDA), glutathione (GSH), catalase (CAT), nitric-oxide (NO), and glutathione-peroxidase (GSH-Px) activities were measured on intestinal samples. There were no histopathological changes in group I. The histopathological examination showed villous necrosis in H/R group. Intestinal damage was mild in group III, and these histological changes were significantly better than group II (p < 0.05). The median of histopathologic grade of group I was 1.0 (1 = normal, range 1), it was 3.0 in group II (3 = villous necrosis, range 3), and it was 1.8 in group III (2 = hydropic degeneration, range 1–3). While the only GSH-Px activities were found to be significantly increased in group III compared with group II (p < 0.05), the other biochemical parameters were not different between the groups.

We conclude that use of clarithromycin significantly reduced the severity of NEC in this study.

485 ELECTROPHYSIOLOGICAL ASSESSMENT OF THE BRAINFUNCTION IN THE TERM SGA INFANTS

Ö.M.A. Özdemir¹, H. Ergin², T. Şahiner³

¹Neonatology, Pediatrics, Denizli, Turkey;²Neonatology, Denizli, Turkey;³Neurology, Denizli, Turkey

The electroencephalography (EEG) is an excellent method for measuring brain maturation in newborns. We investigated the influence of fetal malnutrition to cerebrocortical electrographic activity on term small for gestational age (SGA) infants by EEG. Serial EEGs were performed in 40 term SGA, and 20 term appropriate for gestational age (AGA) infants in first week, first month and third month. Power spectral analysis was performed quantitatively in five channels (Fp1-C3, C3-O1, Fp2-C4, C4-O2, and Cz-C4 channels). In all records, amplitude levels of SGA group were significantly lower than AGA group (p < 0.000). Delta frequency was the major frequency component into two groups. However, while delta frequency activities in the Cz-C4 channel of SGA group were increased, these activities were decreased in AGA group with increasing postconceptual age (p < 0.05). Contrarily, while beta frequency activities in the Cz-C4 channel of SGA group were decreased, these activities were increased in AGA group with increasing postconceptual age (p = 0.000). Moreover, theta frequency activities in the Fp1-C3 and Fp2-C4 channels of two groups were significantly different by repeated-measures ANOVA analysis during the 3 months period (p < 0.05). In terms of the vertex, k complex, and sleep spindle, there were no differences between both groups in the third month (p > 0.05).

We conclude that cerebrocortical electrophysiological maturation of term SGA babies during the 3 months of postnatal life is delayed according to term AGA babies because of fetal malnutrition.

486 PROTECTIVE EFFECTS OF GINKGO BILOBA EXTRACT IN RATS WITH HYPOXIA/REOXYGENATION-INDUCED INTESTINAL INJURY

Ö.M.A. Özdemir¹, H. Ergin¹, N.S. Türk², Ç. Yenisey³, N.G. Şimşek³

¹Neonatology, Denizli, Turkey;²Pathology, Denizli, Turkey;³Biochemistry, Aydin, Turkey

Ginkgo biloba extract has anti-oxidative properties. The aim of this study was to determine the effects of ginkgo biloba extract on the biochemical and histopathological alterations in rats with hypoxia/reoxygenation (H/R) induced intestinal injury. Wistar-albino rat pups (n = 21) were divided into three groups on first day: group I (control), group II (H/R), and group III (H/R + ginkgo biloba extract). Ginkgo biloba extract (EGb 761) was given (100 mg/kg) orally to the group III for the next 3 days. For H/R, 3-days-old rat pups were placed into a chamber of 100% CO₂ for 5 min, then they were reoxygenized with 100% O₂ for the next 5 min. At 6th hours after H/R, all animals were killed on day four. Histopathologic injury scores, malonyldialdehyde (MDA), glutathione (GSH), catalase (CAT), nitric oxide (NO), and glutathione peroxidase (GSH-Px) activities were measured on intestinal samples. There were no histopathological changes in group I. The histopathological examination showed villous necrosis in H/R group. Significantly biochemical and histopathological alterations were not determined in group III (p > 0.05). The median of histopathologic grade of group I was 1.0 (1 = normal, range 1), it was 3.0 in the group II (3 = villous necrosis, range 3), and it was 3.0 in the group III (range 3). We concluded that ginkgo biloba extract (EGb 761) given orally did not any effect to the NEC in this study.

487 ABDOMINAL PSEUDOCYST IN A NEWBORN WITH NECROTIZING ENTEROCOLITIS PERFORMED PERITONEAL DIALYSIS

H. Ergin¹, Ö.M.A. Özdemir¹, N. Çördük², H. Halis³, N.Ç. Demirkan⁴

¹Neonatology, Denizli, Turkey;²Pediatric Surgery, Denizli, Turkey;³Pediatrics, Denizli, Turkey;⁴Pathology, Denizli, Turkey

Abdominal pseudocyst (APC) is rare complication of ventriculoperitoneal shunt. A newborn with APC who was performed peritoneal dialysis due to acute renal failure was presented. A female infant of 27 weeks' gestational age was born by normal vaginal delivery from a 31-year-old mother in her second pregnancy. The infant was admitted to our hospital because of respiratory distress syndrome (RDS) at 40th postnatal hour. At birth, her body weight (880g), height (37cm) and head circumference (25cm) were normal. She was applied surfactant and mechanical ventilation due to RDS. She was diagnosed with stage I necrotizing enterocolitis (NEC) on the 5th day, acute renal failure on the 8th day and applied peritoneal dialysis for two days. At follow-up, patient's condition got worse and stage II NEC developed. While dilatation and edema of the bowel were demonstrated on the left quadrants, abdominal X-ray did not show gas in the bowel of the right abdominal quadrant. There was no pneumatosis intestinalis and free air in peritoneal cavity. Abdominal ultrasound was normal. Abdominal laparotomy showed dilated and ischemic bowels, three perforation areas on the distal ileum and a cyst of 5.5 × 3.5 cm in diameter near the diaphragmatic surface of the liver. Cystectomy, distal ileum resection and double barrel ileostomy were performed to the patient. Histopathological examination demonstrated perforated NEC and pseudocyst. She died of cardiopulmonary arrest on postoperative 24th day.

Pseudocyst formation should be considered as a complication in newborns with peritoneal dialysis if physical examination or radiological signs show an abdominal mass.

488 BILINEAL CONGENITAL LEUKEMIA WITH SKIN INVOLVEMENT AFTER IN VITRO FERTILIZATION

H. Ergin¹, Ö.M.A. Özdemir¹, A. Karaca², N.S. Türk³, F. Düzcan⁴, S. Ergin⁵, E. Kazanci⁶, C. Vergin⁶, A. Erbay⁶

¹Neonatology, Denizli, Turkey;²Pediatrics, Denizli, Turkey;³Pathology, Denizli, Turkey;⁴Medical Biology, Denizli, Turkey;⁵Dermatology, Denizli, Turkey;⁶Pediatric Hematology-Oncology, Izmir, Turkey

Congenital leukemia is a rare condition diagnosed at birth to 6 weeks of life. Twenty-five percent of newborns with leukemia have leukemia cutis. We present a bilineal congenital leukemia cases with skin involvement. Ten days old female newborn was referred to our hospital owing to blue-grey dermal nodüles on her body presenting at birth. She was product of an uneventful pregnancy induced by in vitro fertilization(IVF) because of primer infertility. She was born by C/S following 35 weeks pregnancy as twins, to a 24-year old healthy mother. Birth weight(2350g), length(45cm), and head circumference(32cm) were normal. Her brother was healthy. There was no family history of malignancy, maternal illness, smoking, drug/alcohol use, exposure to X-ray or teratogens. Physical examination showed hepatosplenomegaly, multiple blue-grey dermal nodules on her body except oral mucosa, palms, and soles. On 6th day of hospitalization were determined peripheral facial nerve palsy. Complet blood count showed a white blood cell count of 10200/mm³, hemoglobin 12.2g/dL, and platelet count of 51000/mm³. Peripheral blood smear demonstrated circulating blasts(19%), bone marrow aspiration showed 40% blast of T lymphoid lineage. Skin biopsy and immunohistochemistry diagnosed myeloblastic infiltration with myeloperoxidase positivity. Transaminases, cerebrospinal fluid, cranial MRI, cytogenetic analysis were normal. Blood cultures and serum antibody titers against TORCH were negative. The patient treated with interfant leukemia protocol for ALL died a few days later due to unresponsivenes to chemotherapy. A possible association between IVF and congenital leukemia may be suggested in this patient who did not have any environmental, prenatal, or familial factors.

489 A NEWBORN WITH EEC SYNDROME DIAGNOSED A NEW HETEROZYGOUS MUTATION OF 934G > A (D312N) IN EXON 8 OF THE P63 GENE

H. Ergin¹, C.N. Semerci², Y.T. Karakuş³, H. van Bokhoven⁴, S. Ergin⁵, U. Koltuksuz⁶, H. Scheffer⁴, N.L. Şatıroğlu-Tufan²

¹Neonatology, Denizli, Turkey;²Medical Biology, Denizli, Turkey;³Pediatrics, Denizli, Turkey;⁴Human Genetics, Nijmegen, Netherlands;⁵Dermatology, Denizli, Turkey;⁶Pediatric Surgery, Denizli, Turkey

EEC syndrome consists of ectrodactyly(E), ectodermal dysplasia(E) and cleft lip(C) with or without cleft palate. There may also be some further anomalies such as deafness, mental retardation, choanal atresia, rectal atresia, urogenital and nipple anomalies. Its inheritance is autosomal dominant, although sporadic and autosomal recessive traits have been reported. This study reports a newborn with EEC syndrome diagnosed with type 2 urogenital sinus and a new heterozygous mutation of 934G > A (D312N) on exon 8 of the p63 gene.

A female newborn was referred to our hospital owing to hand-feet and face anomalies. She was born at full-term following a normal pregnancy and delivery with a birth weight of 2000g. Her non-consanguineous parents and the elder sister were healthy. There was no maternal diabetes, oligohydramnios or other conditions that could be associated with malformation. Physical examination showed complete cleft palate, bilateral cleft lip, typical lobster-claw hands and feet abnormality, and anteriorly placed anus. The scalp hair was sparse. The skin of scalp, face and body was dry, thin, and scaly. The eyebrows, the eyelashes and mammary glands were absent bilaterally. Routine laboratory tests showed no additional abnormalities. Ultrasonography and voiding cystourethrogram revealed left pelvicalixial dilatation and type 2 urogenital sinus, respectively. Cytogenetic and molecular genetic analysis revealed normal female karyotype (46 XX) and heterozygous mutation of 934G > A (D312N) in exon 8 of the p63 gene, respectively. To our knowledge, this heterozygous mutation of 934G > A (D312N) in exon 8 of the p63 gene was determined for the first time in EEC syndrome.

490 FOLLOW-UP OF OFFSPRING OF GESTATIONAL DIABETES MELLITUS (GDM): A RISK POPULATION

M.C. Espinheira, M. Grilo, S. Ferreira, C. Araújo, T. Caldeira, S. Tavares, M. Carrapato

Hospital São Sebastião, Santa Maria da Feira, Portugal

Introduction: With improving results in perineonatal period, the long term outcome of GDM-offspring is a potential worry, namely the late metabolic syndrome: can early signs be identified in childhood? Will postnatal strategies make a difference?.

Objectives: Compare anthropometry at ages 2 and 4 between GDM-offspring and a control group of large for gestational age (LGA) infants of non-GDM-mothers; Evaluate breastfeeding vs formula in relation to outcome.

Methodology: Out of 335 GDM-offspring 242(72.2%) were available for evaluation, and a group of 179/257(69.6%) LGA children were used as controls. Weight, height, body mass index (BMI) and blood pressure (BP) were explored. Breastfeeding vs formula was evaluated with outcome.

Results: The GDM-offspring with PI > 90^th centile at birth, by the age of 4, decreased their BMI to 75^th centile. Those with PI = 50^thcentile increased their BMI to 75–85^th centile. The most striking changes are for those born with PI < 10thcentile, which steadily increased their BMI to 50–75^th centile. Both, systolic and diastolic BP at 4, show higher values, although not significant, for those born with the lower PI. Breastfeeding vs formula wasn't relevant regarding outcome.

Discussion: Both control population of LGA and GDM-offspring, show a tendency to remain heavy, with significant BMI increase at age 2 for those with PI < 10^th centile (p < 0.05). However, by the age of 4, although all groups show BMI > 50^th centile, differences cease to be significant, implying accelerated weight gain for those born with PI < 10^th centile. An absent relationshipbetween feeding regimes and outcome suggests intrauterine events to be an increased risk for the late metabolic syndrome in GDM-offspring.

491 EVALUATION OF THE CAUSES OF NEONATAL MORTALITY IN SHOHADA - HOSPITAL/TEHRAN/IRAN BETWEEN 2004 AND 2007

M. Fallahee¹, H. Mohseny², N. Judaky²

¹Shahid Beheshty Univercity, Tehran, Iran;²Shahid Beheshty Univercity, Pediatric, Tehran, Iran

Background: Neonatal mortality rate is one of the main indicator in health care systems and 60%of death in this age group belongs to premature neonates. we search the causes of neonatal deaths in 3 years in shohada hospital.

Material and Methods: This study is a descriptive study based on the data in files of neonatal, who had died.

Results: We found 60 neonate died in the mentioned period in, among them, (44%)were females,(55%)were males and (1%)had undetermined sex. (59%)infants were born by C/S and (41%)were born by NVD. The Apgar score of (63%) were less than7.The birth weight of (27%) were less than 1000gr, (50%) 1000- 1499gr, (8%) 1500–1999gr and 8% 2000–2499gm and (5%) were over 2500gr. Gestational ages of most of these infants were 28 – 31 week, 65% most frequent mortality cause was RDS and then sepsis, congenital anomalies, asphyxia, metabolic disorders, pulmonary hemorrhage and NEC.

Conclusion: The most frequent causes of death in neonates, were RDS and sepsis then prophylaxis and appropriate treatment of these diseases are very important for decreasing of neonatal mortality.,because C/Swas the main way of delivery of died neonates then avoid from unnecessary C/S is very important and because most of died neonates reffered from another hospitals provide NICU facilities in delivery centers is neccessary.

Keywords:Neonates, mortality, RDS, sepsis

492 TRANSCUTANEOUS BILIRUBIN PERCENTILLES FOR HEALTHY NEWBORNS

S. Fouzas, D. Bougioukou, L. Mantagou, A. Varvarigou, S. Mantagos

University of Patras, Medical School, Pediatrics, Patras, Greece

Background and Aims: Determination of transcutaneous bilirubin (TcB) represents a reliable, non-invasive method for assessing neonatal bilirubinemia. The aim of our study was to develop an hour specific TcB nomogram for term and near term neonates.

Methods: Serial TcB measurements (Bilicheck bilirubinometer) were performed in designated times during the first 96 hours of life, in healthy neonates (gestational age > 35 weeks and birth weight > 2000 g) in the well-baby nursery of the University Hospital of Patras from September 2005 to August 2007. The 5^th, 25^th, 50^th, 75^th and 95^th percentiles of TcB measurements were calculated and plotted on an hour specific nomogram.

Results: Totally 8.195 TcB measurements were performed in 1685 newborns. Ninety (5.4%) neonates developed serious hyperbilirubinemia and underwent phototherapy. The hour specific TcB nomogram is presented below.

[TcB]

Display full size

Conclusions: TcB levels in healthy newborns, increased according to a particular pattern during the first 96 hours of life. We present an hour specific TcB nomogram for healthy term and near term neonates.

493 NEONATAL NETWORK PARTICIPATION AND QUALITY IMPROVEMENT: REDUCTION IN SEVERE INTRAVENTRICULAR HAEMORRHAGE AND MORTALITY

F. García-Muñoz, G. González Luis, C. Santana Reyes, R. Díaz Pulido, I. Reyes Azpeitia, N. Rodriguez Calcines, R. García Luzardo, B. Santana Salguero

Hospital Universitario Materno-Infantil de Canarias, Neonatology, Las Palmas de Gran Canaria, Spain

Background: Over the past two decades, there has been a dramatic increase in the survival rate of very-low-birth-weight infants due to advances in knowledge and application of emergent technology. Nevertheless, performance among units varies widely. Participation in neonatal networks offers the possibility to check for differences and identify potential areas of improvement.

Objective: To identify areas susceptible to improve and implement the appropriate practices to achieve better results.

Patients and Methods: Since 2004 our unit participates in the Vermont Oxford Neonatal Network (VON), and infants with birth weights 401–1500 grams and/or GA age 22–29 completed weeks were included. In the first year of participation we detected a significant higher rate of severe intraventricular haemorrhage (17% v 10%). During the next year a policy to reduce IVH was implemented according to the recommendation of Carteaux et al.¹ (Pediatrics 2003).

The main result are shown in the table:

Conclusions:

1. Neonatal Networks are useful to detect areas of potential quality improvement.

2. The implementation of the Potentially Better Practices for the Prevention of Brain Haemorrhage allowed us to significantly reduce the rate of IVH in our VLBW infants.

494 PROCALCITONIN VS C-REACTIVE PROTEIN IN EARLY DETECTION OF INTRAUTERINE INFECTION IN PREMATURE RUPTURE OF MEMBRANES

V. Gasparovic, G. Zlopaša, S. Mihaljevic, I. Maurac

University of Zagreb, Ob/Gyn, Zagreb, Croatia

The aim of this study was to consider the patterns of PCT response in normal pregnancy and in pregnancies complicated with premature rupture of the membranes and to compare the results of PCT with those of CRP and to asses their diagnostic accuracy both to mothers and the neonates.

A total of 120 mothers with singleton pregnancies were enrolled in this study. 60 pregnancies were complicated with the premature rupture of membranes, and 60 were control ones.

Clinical chorioamnionitis was diagnosed when maternal temperature was ≥38C, leukocytosis, maternal and fetal tachycardia.

Early neonatal onset bacterial infection was recognized during the first 48 hours of life based on maternal findings and the presence of clinical signs in the neonate: respiratory, cardiovascular, neurological, skin color and positive blood culture.

Clinical chorioamnionitis and antibiotics administration were significantly higher in study group (p < 0.001). We did not find the importance of the mode of delivery to the neonatal outcome. Apgar scores and birth weight were lower in the study group. We found statisticaly difference in PCT levels in study group compare to control one (p < 0.001).

Serum PCT levels seemd to be a better diagnostic marker superior to serum CRP levels in terms of early diagnosis of chorioamnionitis and neonatal infection.

495 SERUM C-REACTIVE PROTEIN LEVEL IN PRETERM INFANTS WITH SEPSIS AND CHOLESTASIS

S. Abbasi, T. Mancini, E. Sivieri, J. Gerdes

CHOP Newborn Care, Pennsylvania Hospital, University of Pennsylvania, Pediatrics, Philadelphia, United States

Introduction: Although many C-reactive Protein (CRP) elevations in neonates are non-specific, the single most common cause is neonatal sepsis. CRP is often used as an adjunctive diagnostic or screening test for the diagnosis of neonatal infection. Cholestasis (chol) in the neonate may be caused by infectious, metabolic, or anatomic factors, or prolonged TPN.

Objective: The purpose of this study was to determine the relationship between elevations of direct bilirubin (Dbili) and elevation of CRP.

Methods: Infants with <1500g BW who were on TPN beyond one week had plasma levels of CRP and Dbili measured weekly until the resolution of chol or discharge. Chol was defined as Dbili > 1 mg/dl.

Results: Of 104 babies, 78 had chol (dbili range 1.0–14.4); 26 patients had normal Dbili values. CRP was elevated in 48/62 (77%) patients with chol as compared to 8/21 (38%) of no chol (p < .05). None were septic at the study time. 12 epsisodes of sepsis in the chol group had increased CRP from 1.7 ± 1.1 to 7.5 ± 5.6 mg/dl; 24 episodes of sepsis in the normal dbili group had increased CRP from 0.34 ± 0.29 to 3.9 ± 4.1 mg/dl.

Conclusions: Neonatal cholestasis is associated with elevated CRP with or without Sepsis. Neonates with cholestasis and baseline elevated CRP can further increase CRP in the face of sepsis. Clinicians should be aware that neonatal cholestasis is associated with elevated CRP, which should be considered when using CRP as an adjunctive test in R/O sepsis.

496 NEONATAL MORBIDITY AND MORTALITY RESULTS IN PRETERM PREMATURE RUPTURE OF MEMBRANES

E. Parafit Yalçiner, A. Gezer, O. Güralp, F. Öçer, V. Yedigöz, S. Uludağ

Istanbul University Cerrahpaşa Medical Faculty, Obstetrics and Gynecology, Istanbul, Turkey

Background: To investigate neonatal morbidity and mortality in PPROM cases.

Material and Methods: A review of medical records of Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gynecology was performed on 228 singleton pregnancy PPROM cases between 1996–2005.

Results: Neonatal morbidities were detected as RDS in 70 (%30.7) IVH in 26 (%11.4), sepsis in 31(%13.6), NEC in 1(%0.4), congenital pneumonia in 16 (%7.0), cardiac problems in 3(%1.3), hyperbilirubinemia in 54 (%23.7), hemolytic anemia in 2(%0.9), pneumothorax in 4 (%1.8), hydrops in 2(%0.9), leukomalasia in 1 (%0.4), PDA in 10 (%4.4).

Inweeks of gestation and at risk for development of ROPweeks of gestation and at risk for development of ROP ≤28 weeks, low Apgar scores (<5) in the 1^st and 5th minutes were seen in %78.8 (44 of 56) and %41.1 (23 of 56) respectively while in ≥ 33 weeks these rates were %19.1 (17 of 89) and %4.5 (4 of 89) (p = 0.000). NICU requirement, PPV support, RDS, sepsis and IVH was significantly higher in newborns with Apgar scores < 5 (p = 0.000). Average duration of NICU stay was 15.8 ± 20.6 (0–108) days inweeks of gestation and at risk for development of ROP ≤ 28 weeks, 9.6 ± 11.5 (0–60) days in 29–32 weeks, 2.3 ± 4.1 (0–19) days in ≥ 33 (p = 0.000). Neonatal mortality rate was found as%17.5 (40 cases) in PPROM cases. Furthermore, neonatal mortality rate was %53.6 in ≤ 28 weeks, %8.4 in 29–32 weeks and %3.4 in ≥ 33 weeks (p = 0.000).

Conclusion: The most common neonatal morbidities in PPROM cases are RDS, sepsis and IVH. NICU and PPV requirement, RDS, sepsis and IVH rates increase if Apgar score is < 5.

497 PERINATAL MORTALITY AND MORBIDITY RATES OF TWIN PREGNANCIES

M. Rashidova, A. Gezer, F. Öçer, S. Uludağ

Istanbul University Cerrahpaşa Medical Faculty, Obstetrics and Gynecology, Istanbul, Turkey

Background: To investigate the perinatal mortality and morbidity rates of multiple pregnancies and determine the underlying factors responsible for the increase in these rates.

Materials and Method: A retrospective study has been performed on the records of twin pregnancies in İstanbul University Cerrahpasa Medical Faculty Gynecology and Obstetrics Department between January 1996 and December 2005.

Results: There had been 16549 deliveries during this period and 2.9% were twin deliveries. Our study material consisted of 300 twin pregnancies with eligible records.

Perinatal mortality rate of the twin pregnancies was 7.5%, adjusted perinatal mortality rate 6.9%, fetal loss rate 3%, neonatal mortality rate 5.8% and perinatal morbidity 15.4%.

The principal cause of perinatal mortality was prematurity,followed by antepartum fetal deaths and congenital abnormalities. The most frequent cause of morbidity was RDS due to prematurity and encountered in 9% of neonates. In the neonatal period 28% of the cases required NICU and 12.1% received PPV.

Major obstetrical complications contributing to perinatal mortality and morbidity were spontaneous preterm delivery,twin-to-twin transfusion syndrome,premature ruptures of membranes,in utero loss of one of the twins and severe preeclampsia. It has been detected that perinatal mortality and morbidity are not effected by IUGR,discordance between twins, RDS prophlaxis.

Conclusion: Twin pregnancies have increased perinatal mortality and morbidity rates and potential obstetrical complications compared to singleton pregnancies. Twin pregnancies should be intensively monitored and appropriate precautions should be taken against obstetrical complications. Twin deliveries should be performed in referral centers with competent NICU.

498 COMPARATIVE STUDY BETWEEN GLUCOSE-6-PHOSPHATE DEHYDROGONASE (G-6PD) INSUFFICIENCY AND HYPERCHOLERITHRINEMIA IN HEALTHY NEWBORNS

S. Patiakas¹, K. Giagloglou², A. Triantafilopoulou², K. Akritopoulou³, P. Akritopoulos³, G. Liapas², E. Sourla³, E. Tsoukis³, K. Pantelidou², E. Fotiadis³

¹General Hospital of Kastoria, Thessaloniki, Greece;²General Hospital of Kastoria, Kastoria, Greece;³General Hospital-Health Center of Goumenissa, Kilkis, Greece

Aim: To estimate the correlation between G-6PD insufficiency and Hypercholerithrinemia in newborns.

Material-Methods: We studied 1612 samples of total blood collected from the umbilical cord of full term healthy newborns. We run a quantity test of the G-6PD enzymic activity with the kinetic method. To the newborns that presented Hypercholerithrinemia, we run full laboratory tests (General blood analysis, Reticulocytes determination).

Results: G-6PD insufficiency (<7U/grHb) was encountered in 51 newborns (3, 16%). In 38 newborns (37 boys and 1 girl), out of these 51, the G-6PD levels were found < 1 U/grHb (74, 5%), while 13(all girls) of them presented G-6PD values > 1 U/grHb (25, 5%). Hypercholerithrinemia (IBIL > 14.5 mg/dl) was encountered in 7 newborns with G-6PD insufficiency (13.7%), while 93 newborns (54 boys and 39 girls) did not show G-6PD insufficiency (5.96%).

Conclusions: All girls with G-6PD insufficiency and Hypercholerithrinemia, the value of G-6PD was found >1 U/grHb, while in all boys with G-6PD insufficiency and Hypercholerithrinemia, the value of G-6PD was found <1 U/grHb and none of them suffered from Hemolytic Anemia. The Reticulocytes determination and the Hemoglobuline levels did not present any significant statistical difference between newborns, with or without G-6PD insufficiency.

There is a clear correlation between G-6PD insufficiency and Hypercholerithrinemia in newborns and suggests that the determination of the enzyme activity, immediately after delivery, while we should watch closely the newborns with G-6PD insufficiency for Hypercholerithrinemia.

499 OUTCOME OF GREAT PREMATURITY- IMPACT ON DEVELOPMENTAL CAPABILITIES

D. Gonzaga¹, M. Pinto², M. Azevedo², Z. Malta², M. Carrapato²

¹Hospital são Sebastião, Paediatrics, Santa Maria da Feira, Portugal;²Hospital são Sebastião, Santa Maria da Feira, Portugal

Prematurity < 32weeks gestation carries high mortality/morbidity in the neonatal period. What happens to survivors? To assess outcome in a cohort of children born at gestational age > 23 < 32weeks in level III NICU. Data was collected from files of all inborn children admitted to the NICU between January1999 -December2003; those transferred elsewhere were excluded. Follow-up was done according to standardized procedures and statistic analysis by SPSS15.0 and Fisher's exact test. Out of 97 life births admitted to the NICU, 21.4% died before discharge. All 66 surviving children, gestational age(GA) 29 ± 2 weeks birth weight(BW) 1250 ± 376g, were assessed at mean age 63 ± 20 months. Four children (6.1%) presented with moderate to severe cerebral palsy(CP), whilst minor neurologic abnormalities were found in 50%. Visual impairments in 24% (13% with CP). No blindness or deafness were registered. Normal mental and psychomotor developmental was found in 90% of children; in the remaining 10%, four had moderate/severe and one had mild cognitive disabilities. Learning disabilities, behavioural problems and ADHD were found in 58%, 36% and 15% respectively. Of the neonatal morbidities, nosocomial infections and the need for supplementary O2 at 36weeks GA appeared to negatively influence developmental outcome (p < 0.05). Neonatal mortality and morbidity was similar to other series. At follow-up only four children presented with major disabilities (one of them with 23weeks GA). None had blindness or deafness and those with minor handicaps, all live independent lives. Learning disabilities and socialbehavioural problems, demand that provision must be made for their educational needs and social support.

500 AMPLITUDE INTEGRATED ELECTROENCEPHALOGRAPY (A-EEG) AND NEAR-INFRARED SPECTROSCOPY (NIRS) FINDINGS DURING THE EARLY FOLLOW UP OF 3 PREMATURES WITH INTRAVENTRICULAR BLEEDING-POST-HEMORRHAGIC HYDROCEPHALUS(IVH-PHH)

K. Gücüyener¹, E. Ergenekon², I. Hirfanoglu², Ö. Turan², A. Özcelik¹, E. Koc², E. Önal², C. Türkyilmaz², Y. Atalay²

¹Gazi University Medical Faculty, Pediatric Neurology, Ankara, Turkey;²Gazi University Medical Faculty, Neonatology, Ankara, Turkey

Aim: The objective of this study is to evaluate the relation between the electrical activity of The brain and the cerebral oxygenation during the early follow up of the 3 prematures < 30weeks gestational age with IVH-PHH.

Methods: The patient group was made up of 3 babies one twin brother and sister with the GA of 28 weeks 3 days both had IVHPHH and another boy with the GA of 28 weeks who had ventriculoperitoneal shunt due to IVH-PHH. Cerebral oxygen measurements were made by using the NIRO-200 oximeter. a EEG traces were recorded by CFM-6000-OLYMPIC device and background activity patterns, epileptic activity were assessed.

Results:

Conclusion: In all cases, aEEG abnormalities and the low tissue oxygenation were parallel on the sides of the sunt and where the ventricular dilation and the bleeding were more prominent. By using NIRS and aEEG simultaneously in patients with posthemorrhagic hydrocephalus will give better information on cerebral activity and oxygenation and may possibly givesome help both in defining the best ime for intervention beforehand and for the monitoring in early follow up.

501 LONG TERM FOLLOW-UP OF EXTREMELY LOW BIRTH WEIGHT PREMATURE INFANTS; A SINGLE CENTER'S EXPERIENCE

B. Güneş, F. Uysal, S. Kavuncuoğlu, S. Özbek, E. Aldemir, H. Yildiz

Istanbul Bakirkoy Maternity and Children's Research and Education Hospital, Istanbul, Turkey

Premature infants are the most important group of patients among the high risk newborn infants. The survival rates of premature infants increases by the technological equipment of the intensive care units, experienced staff, mechanical ventilation and surfactant therapy. The increased survival rates effect the morbidity rates of these infants which are major and minor developmental disorders in a negative way. The long term follow-up of the premature infants is very important for this reason. To realize the problems initially lets us to take measures in order to increase the life quality of premature infants.

We studied acute problems during hospitalization, major and minor neurological disorders and somatic growths of premature infants who are born between 2002–2006 years with birth weight less than 1000 grams in a long term follow-up.

We evaluated 90 infants aged between 2–6 years and with birth weight less than 1000 grams. We investigated major neurological disorders (cerebral palsy, hearing impairment, visual impairment, seizures, posthemorrhagic hydrocephalus), minor neurological disorders(developmental-intellectual-academic achievement assessment, language-speech assessment, fine motor development, gross motor development) and somatic growth. We used Denver II developmental screening test.

In our study we emphasize quite low cerebral palsy ratio as a consequence of low intraventricular hemorrhage ratios.

502 TOTAL COLONIC AGANGLIONOSIS: A REVIEW OF THE LITERATURE 1998–2008

T. Hall, M. Samuel, J. Brain

Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Department of Paediatric Surgery, Cambridge, United Kingdom

Aims: To establish the likely outcomes for neonates born with this rare form of Hirschsprung's Disease based on the available evidence.

Methods: Comparative evaluation of six retrospective case-series of children born with total colonic aganglionosis (TCA) published in the last decade.

Results: Total TCA cases across six studies (n = 180); a median of 1.1 (range 0.9–3.0) TCA case per year of study was seen. Mortality varied (median 10%, range 3–30%) attributed mainly to associated anomalies, sepsis and significant small bowel involvement (median 22%; range 7–28%). Complications were: Enterocolitis (med 34.5%, range 20–54%); peri-anal excoriation (>20% overall incidence); bowel obstruction; anal stenosis; wound infection (all 5–10% incidence). Bowel function outcome measures were inconsistent across these series but most patients were free from long-term incontinence and function also improved with follow-up. No one definitive procedure could be shown as most effective in terms of bowel function.

Conclusions: Outcomes are poor in severe cases or in association with other anomalies, but most children with this rare condition can be expected to have a good outcome with improvement over time.

503 IS VAGINAL DELIVERY A SAFE OPTION IN TWIN PREGNANCIES?

T. Hassan

Our Lady of Lourdes Hospital, Obstetrics and Gynaecology, Drogheda, Ireland

Aims: The aim of this study is to identify the trends in the mode of delivery of twin pregnancy in our unit over a 3 year period and to determine the neonatal outcomes during this period.

Methods: Mode of delivery and neonatal outcome was retrospectively analysed for 3 years, 2005–2007 in OLLH (Our Lady of Lourdes) Drogheda. Neonatal outcome measures were assessed using Apgar scores <7 @ 5 min, Cord ph < 7.14 and admission to NICU.

Results: 156 sets of twins were identified in a 3 year period. Vaginal delivery rate was 42%, 48% & 29% while elective CS rates for these years were 28.5%, 38.8% and 45% respectively. Intrapartum CS rates were fairly consistent over the 3 year period from 15%, 7.5% and 6.7% in 2005, 2006 & 2007 respectively. NICU admissions regardless of the mode of delivery were 4.7%, 5.5% and 4.2% respectively.

Conclusions: There is no evidence to suggest from our study that rise in elective CS rate for the year 2007 is associated with a decline in the number of babies admitted to NICU with low apgars. We need to audit our elective CS rate for twins to account for this rise in 2007.

504 EFFECTS OF ANTENATAL CORTICOSTEROIDS ON SEVERITY AND FREQUENCY OF RDS

S. Heljic, H. Maksic, F. Catibusic, I. Kalkan, S. Uzicanin, E. Hadzipasic

Clinical University Center, Neonatology, Sarajevo, Bosnia and Herzegovina

Aim of this study is the evaluation of antenatal corticosteroid effects on severity and frequency of RDS.

This study included 163 premature babies between 26 and 34 gestational weeks. Babies with IUGR, babies of diabetic mothers and babies with congenital abnormalities were excluded. Babies were divided in two groups: 1) babies antenataly treated by corticosteroids (80/163) and 2) babies without antenatal corticosteroid treatment (92/163). RDS was classified in three categories; 1) mild RDS, including babies requiring FiO₂ < 0.4 and NCPAP, 2) moderate RDS with FiO₂ requirement 0.4–0.8 and necessity of IPPV, and 3) severe RDS, with FiO₂ requirement >0.8 and necessity of IPPV and surfactant replacement.

There was no statistical difference between groups according gender (x² test 0.614). Average birth weight and gestational age were significantly higher in corticosteroid group (1.828 g vs. 1.616 g, t = 2.822 p < 0.01; 31GW vs. 31.02 GW t = 2.924 p < 0.01). The explanation for this difference could be in better pregnancy control in corticosteroid group, on contrary to the control group, where babies came unexpectedly and suddenly.

Frequency of RDS was significantly lower in corticosteroid group (22/80) in relation to control group (53/92) (x² test p < 0.001). Severe RDS was significantly more frequent in control group 34/53 (64.15%) then in corticosteroid group 6/22 (27.27%) and significantly more frequent in male babies in both groups (for corticosteroid group t = 5.021 p < 0.01 and control group t = 2.841 p < 0.01).

Antenataly coricosteroid treatment significantly reduce incidence of RDS of premature babies, especially severe form that require artificial ventilation and surfactant replacement.

505 PROPYLTHIOURACIL-INDUCED TOXIC HEPATOPATHY DURING PREGNANCY

M. Braun¹, T. Reihs¹, T. Hoehn²

¹University Hospital Duesseldorf, Obstetrics & Gynecology, Duesseldorf, Germany;²University Hospital Duesseldorf, Neonatology, Duesseldorf, Germany

A 36 year-old woman, gravida 2, para 1, with Grave's disease and a history of low grade mitral insufficiency was admitted at 17 weeks of gestation due to reduced general condition, deranged coagulation, elevated liver enzymes, icterus, and systemic itch. She was treated with propylthiouracil due to hyperthyroidism. There were no clinical signs of obstetric complications like preeclampsia, HELLP, bleeding, premature contractions, or vaginal infection. Sonographic examination of the fetus revealed an intact pregnancy with appropriate growth for 17 weeks of gestation. Serologic tests for viral hepatitis were negative, other laboratory parameters included high liverenzymes (GOT 1738 U/l, GPT 1112 U/l, gamma-GT 43 U/l), bilirubin 12.9 mg/dl, Quick 65%. The patient had generalized seizures which might be attributed to toxic liver failure. Sonography of the liver demonstrated cirrhotic conversion of the liver. Liver biopsy showed drug-induced hepatotoxicity with propylthiouracil medication being the most likely cause of the condition. After discontinuing propylthiouracil, high-dose cortisone was started and continued for nearly 15weeks. Liver enzymes and Quick normalized quickly thereafter. During steroid therapy the patient developed acne, no further problems like Cushing-syndrome or gestational diabetes occurred. L-Thyroxin was substituted from 32 weeks of pregnancy onward. Further examinations during pregnancy showed no signs of fetal complications. A 3385 g newborn infant was spontaneously delivered at 41weeks gestation with normal APGAR score and normal umbilical cord-pH. Neither mother nor infant had any further complications postpartum or postnatally,respectively.

506 THE INITIAL CRY OF THE NEW-BORN, A POSSIBLE MARKER THE NEONATAL NEUROLOGICAL STATUS

C. Ilie¹, E. Bernad², I. Enatescu¹, V.R. Enatescu³, R. Ilie⁴

¹University of Medicine and Pharmacology ‘V.Babes’, Neonatology, Timisoara, Romania;²University of Medicine and Pharmacology ‘V.Babes’, Obstetrics and Gynecology, Timisoara, Romania;³University of Medicine and Pharmacology ‘V.Babes’, Psychiatry & Behavioral Sciences, Timisoara, Romania;⁴Children Hospital Louis Turcanu, Pathology, Timisoara, Romania

Objectives: This study approaches a domain of scientifically actuality: the development of non-invasive methods of neonatal quick diagnostic and of perinatal neurological sufferance. From this point of view, the scream and cry of the new-born presents normal and pathological variables that can be demonstrated in a screening test.

Design and Method: It has been studied a group of 122, normal, clinically, and neurologically healthy, new-born babies. For being included in the group of study they had to fulfill a lot of criteria; on the ground of them, the cases, have been validated with normal neurosensorial and metrical development for the age.

Results: By using some last generation technical utilities, we registered in basically conditions the initial cry on a range of 24 hours. After this period we registere din every case the cry caused by a heel-prick (vaccination).For a future multifactoriale complexes analyses in all cases we proceded the video-registrations of the new-born behavior, in the same time with audio-registratione. All the audio informations have been introduced in a data base using graphical diagrams as initial normal cry of the healthy new-born.

Conclusions:

• 1. The study method is efficient, cheap and totally non-invasive, if we refer to the standard registration.

• 2. Through the standard diagrams, the study results allowed to put the method between the large group of the screening test.

• 3. For validation is necessary the comparison of the results with the initial cry registration of the new-born suffering of perinatal neurological diseases.

507 INFLUENCE OF HYPOGLYCEMIA DURING THE 100-G ORAL GLUCOSE TOLERANCE TEST ON OBSTETRICS OUTCOMES

I. Inegol Gumus¹, H. Kafali¹, N. Ozturk Turhan¹, N. Seckin¹, F. Karakurt², A. Kargili²

¹Fatih University School of Medicine, Obstetrics and Gynecology, Ankara, Turkey;²Fatih University School of Medicine, Department of Endocrinology, Ankara, Turkey

Objectives: We aimed to investigate the impact of hypoglycemia during 100-g oral glucose tolerance test on perinatal outcomes.

Methods: Obstetrics records of 411 pregnants who delivered singletons at our institution were reviewed. 31/411 (7.5%) of patients who were diagnosed as Gestational Diabetes Mellitus were excluded from the study. The study group was consisted of pregnant women who experienced hypoglycemia defined as a plasma glucose level of 60 mg/dL or less during the 100-g oral glucose tolerance test. This group were compared with women who had normal glucose levels during 50-g oral glucose loading test (glucose challenge test) and who had normal values and had no hypoglycemia during 100-g OGTT.

Results: We identified 62 hypoglycemic patients (15%) on 100-g oral glucose tolerance test and 318 non-hypoglycemic patients (77.3%) as control group. Gestational weight gain was statistically higher in hypoglycemic group. The mean birth weight was 3419 ± 421.9 g in the study group and 3275 ± 491.7 g in the control group (p = 0.042). Rates of babies admitted to NICU were similar in both groups.

Conclusions: Women who experience hypoglycemia during the OGTT have a significantly higher incidence of gestational weight gain and higher neonatal birth weights as well. As a result if a pregnant has hypoglycemia during OGTT we should monitorize her and the fetus as well carefully.

508 CONJUGATED HYPERBILIRUBINEMIA IN NEONATAL INTENSIVE CARE UNIT (NICU)

M.S. Ipek¹, A. Zenciroglu¹, N. Demirel¹, N. Okumus¹, M. Aydın¹, F. Demirceken²

¹Dr. Sami Ulus Children Hospital, Neonatology, Ankara, Turkey;²Dr. Sami Ulus Children Hospital, Pediatric Gastroenterology, Ankara, Turkey

Objectives: To determine the causes and related outcomes of conjugated hyperbilirubinemia (CHB) in NICU.

Methods: All the patients with CHB who were admitted to the NICU of Ankara Dr. Sami Ulus Children Hospital, Turkey between January 2005 and December 2008 were retrospectively reviewed.

Results: Sixty five patients [42 (64.6%) term, 23 (35.4%) preterm] had CHB with a %1.79 frequency and with a slightly male (55.4%) predominance. Ten of preterms had VLBW. The mean postnatal age at presentation was 13.5 days (1 to 65 days). Intrahepatic disease was detected in 44 (67.7%) patients while 21 (32.3%) patients had extrahepatic disease as cause of CHB. The frequencies of final diagnosis in the patients are shown in table. Twenty one (32.3%) patients died due to predominantly multi organ failure. Liver damage was not found to be a primary factor to death, except three patients (two with metabolic liver disease, one with undiagnosed). Bilirubin levels in the most survivors (75%) had returned to normal within three month.

Conclusions: The findings suggest that CHB in NICU patients is more commonly caused by non-hepatic disorders and transient and, may be required prompt medical or surgical interventions. However, infective and metabolic causes must be excluded urgently.

509 THE ROLE OF PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) ON EARLY NEONATAL MORTALITY AND MORBIDITY: A CASE CONTROL STUDY

M. Jafari Shobeiri

Alzahra Hospital/Tabriz University of Medical Scienses, Tabriz, Iran

Introduction: PPROM complicates approximately 3% of pregnancies. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications. The aim of this study was to assess neonatal mortality and morbidity in 34 to 37 weeks of pregnancy with PPROM.

Aim & methods: A case control study including 350 singleton deliveries at 34 to 37 weeks of pregnancy between 2004 and 2006 was made in the teaching hospital (Alzahra). Of these, 150 women had ruptured membranes (case group) and 200 had intact membranes (control group) at admission. Early neonatal mortality and morbidity in two groups were compared. The chi-square test and T-test were used and p < 0.05 considered significant.

Results: The early neonatal morbidity rate including, hyaline membrane disease, pneumothorax, necrotizing enterocolitis, assisted ventilation, sepsis hospitalization period in the Intensive Care Unit, asphyxia and death, were not significantly different in two groups.

Conclusion: Our findings suggest that preterm premature rupture of membranes at 34 to 37 weeks have not significant effect on neonatal morbidity and mortality.

510 FOCAL CEREBRAL CORTICAL DYSGENESIS (DYSPLASIA). RARELY BEGIN CLINICALLY IN THE NEONATAL PERIOD

F. Jimenez Parrilla, A. Perez Sanchez, J.M. Nuñez Solís, V. Ruiz Dassy, A. Losada Martínez

Virgen del Rocío, Neonatal, Seville, Spain

The clinical syndromes associated with cerebral cortical dysgenesis (dysplasia) are dominated by seizures, the most common early clinical presentation is epilepsy, which is frequently intractable to pharmacologic agents and life threatening. Relate in considerable part to the topography of these lesions, and rarely present in the neonatal period. To our knowledge, stimulus induced seizures have not been reported as a presenting feature of cerebral dysgenesis in neonates. The spasms were predominantly generalized or at times focal-involving the extremities without any specific pattern. They occurred initially during attempts at breastfeeding. Magnetic resonance imaging showed right hemispheric megalencephaly with areas of hypointense signal on T1-weighted images and hyperintense signal on T2-weighted images; in addition, small left frontal lobe heterotopias, a smaller-than-normal submental plate, and focal calcifications were observed. The disorders rarely begin clinically in the neonatal period, we will consider a neonatal with complex o simple partial seizures, hemiparesis (frontal lesions) of epileptic seizure that are medication resistant.

[RNM CEREBRAL CORTICAL]

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Conclusions: Neuroimaging studies must be repeated in patients that have already been examined because in this way it may be possible to save a group of patients (who would otherwise have to resign to poor control over their seizures as well as the side effects of many AEDs) from becoming medication resistant. Cortical developmental malformations is uncommon etiologies of neonatal seizures, however they may represent treatable cause of refractory epilepsy and for this reason must be considered as possible etiological factors.

511 CONGENITAL CERVICAL TERATOMA. A MULTIDISCIPLINARY TEAM APPROACH FOR MANAGEMENT

F. Jimenez Parrilla, A. Perez Sanchez, J.M. Nuñez Solís, M. Solo de Zaldivar Tristancho, A. Losada Martínez

Virgen del Rocio, Neonatal, Seville, Spain

Congenital cervical teratomas are rare, representing 3% of teratomas in childhood. Although mostly benign, they are associated with a high mortality rate due to respiratory distress and require immediate surgical excision. The diagnosis is usually suggested on the physical examination. The imaging investigation is essential for the proper diagnosis and preoperative planning. Congenital cervical teratomas are associated with a high rate of perinatal mortality due to airway obstruction. We describe a multidisciplinary management of a neonate with prenatal diagnosis of giant cervical teratoma. We report the course and outcome of a pregnancy involving a giant fetal neck teratoma which was diagnosed at 23 weeks of gestation. Sonographic surveillance of the fetal neck revealed continuing growth of the tumor with development of polyhydramnios An ‘operation on placenta support’ (OOPS) technique was carried out during delivery, and intubation was successfully performed with no perinatal anoxic damage. Postnatal computed tomography and angiography showed a huge teratoma covering both sides of the neck with agenesis of the big blood vessels on the left side. A rapidly developing third space phenomenon and deterioration in the general status of the neonate, required early surgical intervention. Pathologic examination confirmed the diagnosis indicating immature teratoma with no signs of malignancy. This report confirms the efficacy of a multidisciplinary team-approach and the usefulness of the OOPS technique in prenatally diagnosed cervical masses. It emphasizes the extraordinary characteristics of this case, mainly the development of a third space phenomenon and the unusual surgical findings.

[Congenital cervical teratoma 1]

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[Congenital cervical teratoma 2]

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[Congenital cervical teratoma 3]

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512 NON-SPECIFIC MARKERS OF BACTERIAL SEPSIS IN NEWBORNS

N. Jincharadze

Childrens Central Hospital, Neonatology, Tbilisi, Georgia

Background: Sepsis is a great problem in neonatology with its high mortality (13–25%). The early diagnose represents good results.

Material: Were studied 110 newborns with sepsis. We divided 2 groups. 1^st group – 60 full term newborns. 2^nd group – 50 preterm newborns.

Methods: Was open prospective research, agreed with clinical bioethics commission. We studied C reactive protein (CRP) by Latex-agglutination method, Procalcitonini (PCT)-by immunoluminometric method; Detection of bacteria in blood was made with Polymerase Chain Reaction (PCR) and by traditional culture methods.

Results: During sepsis the level of CRP in full term newborns increased (96–192 mg/l; norm < 6 mg/l) but level was high in 36 hours (measured every 12 hour). During sepsis, In preterm newborns, the level of CRP was normal in 93% and increased in 7%. After 3 hours from developing sepsis, the level of PCT – increased in both groups (PCT > 2 ng/ml; norm < 0.05 ng/ml), but to determine Procalcitonini is limited. Research was statistically reliable (P < 0.05).

Conclusion:

• 1. PCT may be indicated as a useful surveillance marker in newborns at risk for sever nosocomial infections and in those presenting with clinical signs of sepsis.

• 2. CRP and PCT are reliable diagnostic markers in neonatal sepsis, among full term newborns, from 2 days live, but PCT was more informative, quick and right than CRP.

• 3. CRP isn't reliable diagnostic marker for preterm newborns in neonatal sepsis.

513 BRONCHOPULMONARY DYSPLASIA PREDICTS ADVERSE NEUROLOGICAL OUTCOME IN PRETERM INFANTS AT 12–18 MONTHS CHRONOLOGICAL AGE

P. Karagianni¹, M. Kyriakidou², G. Mitsiakos¹, E. Chatziionnidis¹, M. Porpodi¹, N. Nikolaidis¹

¹B' NICU Aristotle University of Thessaloniki, GPN Papageorgiou Hospital, Thessaloniki, Greece;²Department of Physiotherapy, GPN Papageorgiou Hospital, Thessaloniki, Greece

Introduction: Despite the advances in the prevention and management of neonatal acute respiratory illness, bronchopulmonary dysplasia (BPD) persists as one of the major complications in surviving very low birthweight infants. Children with a history of BPD are more likely to display developmental disorders, lower pulmonary function and academic difficulties at school. The aim of this study was to examine the neurological outcome in infants with and without BPD at 12–18 months chronological age.

Methods: One hundred twenty eight infants prospectively recruited in the study. The selection criteria included: gestational age of <32 weeks, absence of congenital or genetic anomalies, born to the study hospital and alive at discharge. Group A (without BPD) consisted of 75 preterm infants (mean gestational age 28.4 [SD 2.1], birthweight 1151.2 [SD 479]). Group B (with BPD) consisted of 53 preterm infants (mean gestational age 27.6 [SD 2.1], birthweight 1000 [SD 389.9]). Neurological outcome was assessed using the Hammersmith Infant Neurological Examination. Data were analyzed using the SPSS 11.5 and the chi-square test.

Results: Compared with infants without BPD, infants with BDP scored lower in 9 of the 20 items assessed. There were significant differences in ‘Head in sitting’ (p = 0.001), ‘Trunk in sitting’ (p = 0.033), ‘Arms at rest’ (p = 0.001), ‘Hands’ (p = 0.005), ‘Legs in sitting’ (p = 0.001), ‘Pulled to sit’ (p = 0.019), ‘Arm Protection’ (p = 0.003), ‘Vertical suspension’ (p = 0.001), and ‘Lateral tilting’ (p = 0.001).

Conclusions: BPD predicts poor neurological outcome at 18 months chronological age.

514 HOSPITALIZATION REASONS OF HIGH RISK GROUP OF NEWBORN INFANTS IN OUR INTENSIVE CARE UNIT: A SIX YEAR EXPERIENCE

S. Kavuncuoğlu, S. Özbek, F. Uysal, B. Güneş, D. Bezen, S. Oral, E. Yildiz, H. Yildiz

Istanbul Bakirkoy Maternity and Children's Research and Education Hospital, Istanbul, Turkey

The aim was identifying of internation indications and mortality at high risk newborn who were followed in newborn intensive care unit. Patients that were followed in our hospital's newborn intensive care unit between January 2002 – December 2007 were evaluated. Diagnosis, internation and ventilation periods, ventilation reasons, and mortality and morbidity of term and preterm infants were studied.

2523 patients were followed at our hospital's newborn intensive care unit for six years. The ratio of preterm patients was stated as %64, and the ratio of term patients was %36. Preterm infants were often followed with Respiratory Distress Syndrome (RDS), Transient Tachypnea of the Newborn (TTN), septicemia, intracranial hemorrhage (ICH) diagnosis. Term infants were often followed with Transient Tachypnea of the Newborn (TTN), pneumonia, pneumothorax, sepsis, perinatal asphyxia (PNA), Meconium Aspiration Syndrome (MAS) diagnosis. Total survival rates was %84.2. Average internation duration in our unit was 8.7 days. %59 of patients who were followed in our service needed ventilation. 504 patients that were followed in newborn intensive care unit were given surfactant. Second surfactant therapy was given to 50 patients. Conjenital anomalies were seen in 428 (%17) patients. %48 of these conjenital anomalies were heart disease. 252 patients (%10) had intraventricular hemorrhage. PROM ratio was %6 and septicemia was seen in our 403 patients (%16). 126 patients (%5) had perinatal asphyxia.

In this study we emphasized the importance of determining the risk factors prenatally so that we can increase the survival rates by following them in the intensive care units.

515 FACTORS RELATED TO SEVERE OUTCOME OF INITIALLY PRESUMED TRANSIENT TACHYPNOE OF THE TERM OR NEAR-TERM NEWBORN

A. Khaldi, A. Bouziri, K. Kazdaghli, A. Hamdi, S. Belhadj, K. Menif, N. Ben Jaballah

Children's Hospital, Tunis, Tunisia

Objective: To determine the best factorsrelated to a severe course of initially presumed transient tachypnoe (TTN) ofterm or near-term newborn.

Methods: Retrospective analysis of perinatal data, initial evaluation, and outcome of newborns ≥34 weeks gestation admitted for final diagnosis of TTN between 2003 and 2007. patients were classified into two groups: Group A: moderate or mild respiratory distress (no mechanical ventilation (MV) or MV with O₂ requirement not exceeding 50% and group B: severe respiratory distress (hypoxemic respiratory failure, use of inhaled NO or HFOV).

Results: 89 newborns, all out born, were finally included: 53 in the Group A and 36 in the Group B. Duration of MV, use of HFOV and iNO and length of stay were significantly higher in the Group B (p < 0.03). There was no difference between the two groups in respect to gestational age, birth weight, median APGAR score (5 mn) and sexe. Unvaried analysis showed that postnatal age, initial ventilation and oxygenation requirements (Inspiratory peak pressure, PEEP and FiO₂), Oxygenation index (OI) and Alveolar to arterial O₂ gradient (DAaO₂) were higher in the Group B (p < 0.04). Multivariate analysis concluded that factors independently related to poor outcome were: delay to PICU transfer >12 hours (p = 0.03), Initial FiO₂ > 45% (p = 0.02) and especially OI > 15 (p < 0.01).

Conclusion: Delay in transfer to intensive care and initial severity of TTN are good indicators for high respiratory morbidity. Such factors can be useful for early identification of patients with potentially pejorative course.

516 OLIGOHYDRAMNIOS: DIFFERENT CONCEPTS OF AMNIOTIC FLUID VOLUME MEASUREMENT AS A PROGNOSTIC FACTOR IN PRETERM SMALL FOR GESTATIONAL AGE INFANTS

H.-Y. Kim, H.-S. Kim, J.-I. Yang, S.-J. Chang

Ajou University School of Medicine, Obstetrics and Gynecology, Suwon, Korea

Objective: To predict perinatal outcome of preterm small for gestational age (SGA) infants according to severity of oligohydramnios.

Method: This was a retrospective review of 310 pregnancies with SGA infants who had antenatal care and were delivered at 26–37 weeks of gestation. We excluded pregnancies with no sonographic records, twin and chromosome or structural abnormalities. Comparisons of maternal demographics and neonatal outcome were made between those with and without oligohydramnios. SGA was defined as neonatal weight <or = 10^th percentile and oligohydramnios, as amniotic fluid index (AFI) < or = 5 cm or < or = 5^th percentile of each corresponding gestational weeks. Chi-square test and independent t-test were used as statistical analyses.

Results: For oligohydramnios < or = 5 cm of AFI, there were no statistical differences in maternal characteristics, gestational age at delivery, and neonatal morbidity and mortality between oligohydramnios (n = 49) and normal (n = 261). For oligohydramnios < or = 5^th percentile, significant differences in neonatal birth weight (1628.9 ± 480.3 vs. 1787.7 ± 476.1 g, p = 0.005), duration of stay in NICU (22.7 ± 21.8 vs. 17.1 ± 21.2 days, p = 0.027) and adverse perinatal outcome (26.2 vs. 16.5%, P = 0.037) were observed between abnormal (n = 122) and normal (n = 188) group.

Conclusion: Oligohydramnios based on AFI below 5^th percentile is more useful than AFI below 5 cm to predict perinatal outcome in preterm SGA infants. To improve neonatal outcome in preterm SGA infants with oligohydramnios below 5^th percentile, intensive fetal surveillance is crucial.

517 MATERNAL PRE-PREGNANCY BODY MASS INDEX AND WEIGHT GAIN DURING PREGNANCY: EFFECTS ON NEONATAL BIRTH WEIGHT AND DELIVERY OUTCOMES

J.-H. Kim, S.-E. Song, E.-S. Seo, S.-J. Choi, S.-Y. Oh, C.-R. Roh

Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Obstetrics and Gynecology, Seoul, Korea

Objective: To investigate the effects of maternal pre-pregnancy body mass index (BMI) and weight gain during pregnancy on neonatal birth weight and delivery outcomes.

Materials and Methods: We retrospectively reviewed the medical records of 590 singleton pregnant women who delivered in Samsung Medical Center, from Jan 2005 to Dec 2006. The subjects were categorized into four groups according to pre-pregnancy BMI: under-weight (BMI < 18.5), normal-weight (BMI 18.5–24.9), over-weight (BMI 25.0–29.9) and obese (BMI > 30.0). They were categorized into subgroups according to maternal weight gain: <10 kg, 10–15 kg, 15–20 kg, and >20 kg. Pregnancy outcomes including neonatal birth weight, large-for-gestational age (LGA), small-for-gestational age (SGA), shoulder dystocia and cesarean section were analyzed.

Results: Among the 590 women, normal-weight women were 451 (76.4%) and under-weight, over-weight and obese women were 91 (15.4%), 44 (7.5%), 4 (0.7%), respectively. Pre-pregnancy BMI, maternal weight gain during the first 6 months and total weight gain at delivery were significantly associated with increased neonatal birth weight. However, maternal weight gain during the first 3 months was not associated with neonatal birth weight. Maternal weight gain over 15 kg was significantly associated with a higher risk of LGA and cesarean section after trial of labor, particularly in the normal-weight women. Shoulder dystocia occurred significantly higher in over-weight or obese women, but maternal weight gain was not associated with the risk of shoulder dystocia.

Conclusion: Maternal pre-pregnancy BMI and weight gain during pregnancy is closely associated with neonatal birth weight and risk of LGA and cesarean section.

518 INCIDENCE AND CLINICAL OUTCOME OF NEONATAL MENINGITIS: A SINGLE-CENTER CASE-CONTROL RETROSPECTIVE ANALYSIS

M. Koropouli, V. Valari, M. Polychronaki, M. Theodoraki, M. Fillippidis

Venizeleion, NICU, Heraclion, Greece

Background: Neonatal meningitis demonstrates a decreasing frequency during these last years. This is valid also for mortality although neurodevelopmental disorders remain stable.

Methods: Retrospective analysis of frequency, causes and clinical outcome of neonatal meningitis cases in a well-determined single-center cohort of neonates.

Results: 1934 neonates that were hospitalized in our department from January 2004 until December 2007, were extensively reviewed. 606/1934 (31.3%) neonates needed a lumbar puncture mainly for ruling out central nervous system infection. Meningitis was clinically detected in 39/1934 (2%). In 10/39 (25.6%) cerebrospinal fluid (CSF) cultivation turned out positive for various species (Staphylococcus: 3 aureus; 1 haemolyticus; 1 hominis, 1 Streptococcus group B, 1 Enterobacteroides, 1 Pseudomonas aeruginosa, 1 Serratia liquefaciens and 1 Candida albicans). In the blood samples of 12/39 (30.8%) neonates infectious agents were cultured, mainly Gram ( + ) cocci. All neonates underwent a brain ultrasound which in 7 of them (17.9%) demonstrated abnormal findings. All subjects survived except from 1 (28 weeks gestation, CSF and blood cultures positive for Pseudomonas aeruginosa). Severe motormental retardation developed in 3/39 (7.7%) infected neonates during follow-up.

Conclusions: Mortality due to neonatal meningitis in our cohort of hospitalized neonates was low (1/39, 2.5%) following the low overall incidence of this infectious disease (2%). We continue to follow-up the few cases with severe motormental retardation for future learning or other disorders.

519 INCIDENCE AND CLINICAL OUTCOME OF NEONATAL SEPTICEMIA: A SINGLE-CENTER CASE-CONTROL RETROSPECTIVE ANALYSIS

M. Koropouli, M. Polychronaki, V. Valari, M. Papadimas, M. Giannakaki

Venizeleion, NICU, Heraclion, Greece

Background: Neonatal sepsis remains the primal cause of mortality and morbidity of neonates and especially the pre-terms.

Methods: Review of infected cases with positive blood cultures and registration of incidence and cause of sepsis at the time (precocious or belated) and place (nosocomial or not) of appearance.

Results: 863 neonates were hospitalized in our neonatal intensive care unit between January 2003 and February 2004 (14 months). 35/654 (5.3%) blood cultures were found positive in 32 neonates. Of these, 15 experienced a < 35 weeks gestation. 12/32 were infected while hospitalized. All of them were pre-term and in 8/12 gram ( − ) bacteria were detected. 15/32 neonates were infected during the first 72 hours of life and in all but one gram ( + ) bacteria were found. 12/15 were full-term neonates. The most common microbe was Staphylococcus. 19/32 neonates were affected by Klebsiella pneumoniae. All gram ( + ) bacteria were sensitive to vancomycin and all gram ( − ) to imipenem, amikacin and ciprofloxacin. The frequency of sepsis was 6.21%. The mortality rate was 6.25% (2/32). Premature rupture of membranes was seen in 2 neonates. No relationship was found between sepsis and maternal diabetes mellitus, multiple pregnancies, meconium aspiration, gender and the way of delivery.

Conclusions: The resistant to oxacyclin Staphylococci aureus and epidermidis as well as the multi-resistant gram ( − ) bacteria are the most frequent factors of sepsis in our unit. Nosocomial infections are usually caused by Klebsiella (ESBL). The early onset sepsis is almost exclusively due to gram ( + ) bacteria.

520 BULLOUS PEMPHIGOID IN A NEONATE – CASE REPORT

P. Korovessi¹, G. Amountza¹, C. Zeliou¹, P. Anastasopoulos², N. Stavrianeas³, E. Papadakis¹

¹Thriassio General Hospital, Paediatric Department, Athens, Greece;²Harris Birthright Research Centre, Fetal Medicine, Kings College Hospital, London, United Kingdom;³University of Athens, Attikon Hospital, Department of Dermatology, Athens, Greece

Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease in adulthood. It is, however, very rare in the pediatric and even rarer in the neonatal population. It is an immune-mediated disease associated with a humoral and cellular response directed against two well-characterized self-antigens: BP 180 and BP 230. Only few neonatal cases have been reported, probably related to passive transfer of maternal IgG autoantibodies. As maternal IgGs are cleared from such neonates, lesions resolve. There are no long-term adverse effects on the fetus or the newborn.

We present a female neonate with multiple bullae located on palms and soles and necrotic lesions on hand nails. The neonate was otherwise well without systemic signs, including fever. Complete blood count revealed no eosinophilia. Bacteriological exam of the blister fluid, the serological markers for HSV 1 and 2, and syphilis serology were negative. The mother had bullous pemphigoid 10 years prior to this pregnancy.

Biopsy revealed a subepidermal blister present along with a dermal mononuclear infiltrate rich in eosinophils. In focal areas collagen flame figures were also observed. Direct immunofluorescence showed linear reactivity for C3c and IgG at the dermal-epidermal junction. IgA was not found. After topical glucocorticoid therapy, complete resolution without scarring was achieved.

This report illustrates the importance of considering a diagnosis of BP in any neonate or infant who presents with blisters of the hands and feet, and performing the necessary immunofluorescence studies to make a definitive diagnosis.

521 NEONATAL MORBIDITY OF PRETERM BABIES AND CAUSES OF THEIR DEATHS

B. Kowalska¹, T. Maciejewski¹, M. Rutkowska², K. Szamotulska³

¹Institute of Mother and Child, Obstetric and Gynaecology, Warsaw, Poland;²Institute of Mother and Child, Neonatal Department, Warsaw, Poland;³Institute of Mother and Child, Warsaw, Poland

Preterm labor is the main reason of fetal and neonatal morbidity and mortality.

Aim: The aim of the study was to evaluate neonatal mortality of preterm babies.

Material and Methods: There were 207 preterm born babies analyzed, all between 24^th and 32^nd week of gestation during the period: 01.10.1998–30.09.1999 in the region of Warsaw. They were divided according to gestational age into two groups: 1: 24–28 and 2: 29–32 weeks of gestation.

Results: 127 (61.4%) preterm babies were NVD* and 80 (38.6%) LSCS**. 78 preterm babies were born in group [1], 129 in group [2]. 46.2% (36 of 78) survived in group [1] and caesarian section have no influence for neonatal morbidity. 87% (112 of 129) survived in group [2]. Caesarean section decreased neonatal morbidity from 33.3% to 18.2% in newborns with fetal breech presentation in group [2]. We noted 59 neonatal deaths in our study −28.5% but 71.2% of them died in group before 29 week of gestation (42 of 59). 19 (32.2%) neonates died due to respiratory distress and 18 (30.5%) died because of secondary infections. Respiratory causes were more frequent in group 1–40.5% (17 of 42). Secondary infections were more frequent in group 2–52.9% (9 of 17).

Conclusions: Caesarian section decrease neonatal morbidity in newborns with fetal breech presentation. Secondary infections are still main cause of preterm babies deaths.

*NVD- normal vaginal delivery.

**LSCS- low segment cesarean section.

522 GASTRIC PERFORATION IN THE NEWBORN

I. Krichene

CHU Fatouma Bourguiba Monastir, Pediatric Surgery, Monastir, Tunisia

Introduction: Gastric perforationis a rare abdominal catastrophe with high mortality, usually occurring in neonatal intensive care unit setting. The authors sought to analyze the clinical presentation, etiology, treatment and outcome of this pathology.

Materials and Methods: A retrospective review was conducted of 8 cases of gastric perforation seen over a 22-year period on the pediatric surgical service of CHU-Fattouma-Bourguiba- Monastir Tunisia.

Results: The diagnosis was made at an average age of 2.4 days. The average weight was 2130 g. There were 5 girls and 3 boys. Four babies were premature. Three premature had asphyxia and required mechanical ventilation. The initial clinical finding was abdominal distention in all cases. X-ray examination showed massive pneumoperitoneum in all cases. Surgery was performed urgently after a brief resuscitation. Necrosis was localized to the lesser gastric curvature in 4 cases, to the greater curvature in 3 cases and, in one case to the huge rent anterior antrum surface. The perforation site was large more than 1 cm in diameter in 7 cases. Associated malformations were showed in six cases. The edges of the perforation were closed. Four neonates had a gastrostomy and the associated malformations were managed at the same time. There were six deaths in the early post-operative period. No complication was seen between the survivors during 4 years of follow up.

Conclusion: Gastric perforation of the newborn is a rare and life threatening problem. The etiology should be sought. Success in treatment depends on early diagnosis, prompt resuscitation and immediate surgical intervention.

523 CLINICAL CONSIDERATION OF PREMATURE TWINS CONCEIVED BY IN VITRO FERTILIZATION AND THOSE OF NATURALLY CONCEIVED

K.H. Lee, J.W. Kim, J.H. Shin

College of Medicine, Pochon CHA University Hospital, Pediatrics, Sungnam-si, Korea

Objectives: Diffusion of assisted reproduction techniques (ovarian stimulation, IVF, GIFT, ICSI) has led to an increased incidence of multiple pregnancies and preterm delivery and related obstetric-neonatal problems. Our attention has been focused on neonatal outcome, comparing premature twins born from spontaneous and assisted pregnancies.

Methods: We retrospectively analyzed neonatal outcome of 60 pairs of premature twins conceived by IVF(IVF twin group) and 34 pairs that naturally conceived(natural twin group). Maternal and obstetric characteristics were also compared. All were born before 35 weeks of gestation between January 2000 and December 2004. Student t-test and χ² test were used for statistical analysis.

Results: For obstetrical characteristics, maternal age and rates of nulliparous were significant higher in IVF twin group. But, other parameters(preterm labor, premature rupture of membranes, pregnancy-induced hypertension, gestational diabetes mellitus) were similar between two groups. For neonatal outcome, gestational age, duration of hospital stay, APGAR score, neonatal mortality and morbidity were reviewed. All parameters were no significant differences in IVF twin group compare to natural twin group.

Conclusion: We found that IVF twin group had no significant differences in obstetric characteristics(except for maternal age and parity and neonatal outcome compare to natural twin group in our study.

524 IMMEDIATE POSTNATAL SERUM TUMOR NECROSIS FACTOR-ALPHA CONCENTRATION AND THE DEVELOPMENT OF BRONCHOPULMONARY DYSPLASIA

J.A. Lee¹, B.I. Kim², T.J. Sung³, H.-S. Kim², J.-H. Choi²

¹Seoul National University Boramae Hospital, Pediatrics, Seoul, Korea;²Seoul National University College of Medicine, Pediatrics, Seoul, Korea;³Hallym University College of Medicine, Seoul, Korea

Purpose: We tested the hypothesis that preterm infants who develop bronchopulmonary dysplasia (BPD) have higher concentrations of serum tumor necrosis factor-alpha (TNF-α) within 8 hours after birth than those who do not.

Methods: Serum and tracheal aspirate (TA) TNF-α concentrations were measured by enzyme-linked immunosorbent assay in the thirty-four preterm infants born before 32 weeks of gestation. Multiple logistic regression analysis was done.

Results: Median concentrations of both serum and TA TNF-α were higher in BPD group than in non BPD group [serum TNF-α, 214.52 pg/mL (84.20–244.20) versus 100.07 pg/mL (78.43–225.52), P = 0.037],[TA TNF-α, 13.12 pg/mL (10.43–64.67) versus 11.58 pg/mL (9.76–58.53), P = 0.038]. After making adjustments for the effects of gestational age at birth, 5 minute Apgar score less than 7 and histologic chorioamnionitis, only serum TNF-α concentration was independently significant [P = 0.047 Odds ratio, 1.033 95% confidence interval, 1.001–1.006]. The diagnostic indices of TNF-α (cutoff, 97.1 pg/mL) as a predictor of development of BPD were: sensitivity of 85.7%, specificity of 38.5%, positive predictive value of 69.2%, negative predictive value of 62.5% (P = 0.037).

Conclusion: Increased serum TNF-α concentration within 8 hours after birth may be a significant predictor of later development of BPD.

525 FIRST EXPERIENCE WITH ECG-ST WAVEFORM ANALYSIS

R. Lermann, L. Aboim, G. Gomes, C. Soares, F. Serrano

Maternity Dr. Alfredo da Costa, Lisbon, Portugal

Background: The STAN methodology has been shown to reduce both operative delivery for fetal distress and the cord artery metabolic acidosis rate.

Objective: The objective of this study was to monitor delivery modes and perinatal outcomes following the introduction of the STAN methodology in selectionated cases.

Methodology: 29 term pregnancies were monitored using the STAN fetal heart monitor (Neoventa Medical) and the associated clinical guidelines in 9 month period (August/07 to April/08). All women were in first stage of labour, over 36 weeks of gestation and with nonreassuring FHR tracings. Cord metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were recorded.

Results: Mean maternal age was 30.8 years, 77.8% were nulliparous and mean gestational age at birth was 39 weeks. STAN was introduced at 4.6 cm of mean dilatation and the mean period until delivery was 3.2 hours. Cesarean section rate was 29.5% but only 18.5% was for fetal distress. There were 44.4% instrumental deliveries, 37% for fetal distress. No neonatal asphyxia was recorded (5'Apgar score >7 in all cases). Arterial cord pH was superior to 7 in all cases. Mean pH in the caesarean section for fetal distress group was 7.17 and 7.26 in the reminiscent deliveries.

Conclusions: Our results demonstrate that a safe implementation of the STAN methodology is possible. Attending that all cases had nonreassuring tracings we can consider a positive reduction in cesarean section rate for fetal distress.

526 ENDOTHELIAL FUNCTION IN CHILDREN WITH A HISTORY OF PREMATURE PROLONGED RUPTURE OF MEMBRANES AND BRONCHOPULMONARY DYSPLASIA – A PILOT STUDY

M. Liljedahl¹, H. Martin², A. Magnuson³, S. Montgomery³, J. Schollin¹

¹Örebro University Hospital, Department of Pediatrics, Örebro, Sweden;²Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden;³Statistics and Epidemiology Unit, Örebro University Hospital, Örebro, Sweden

Aim: To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD).

Methods: Children born at < 31 weeks 1994–2000 was investigated at a present age of 6–12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n = 15/13) and PPROM/no PPROM (n = 10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation.

Results: Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p = 0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p = 0.404), after adjustment for confounders.

Conclusion: A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.

527 CONGENITAL CHYLOTHORAX AND LYMPHEDEMA IN A NEONATE WITH SUPERIOR VENA CAVA SYNDROME

V. Makri, A. Konstantinidi, M. Papadopoulou, O. Dedousi, S. Tantros, I. Lambadaridis, A. Gounaris

General Hospital of Nikea-Piraeus, NICU, Athens, Greece

Chylothorax and venous congestion leading to lymphedema of the body's upper half are clinical characteristics of superiorvena cava syndrome, which usually presents either as a complication after cardiopulmonary surgery or due to local compression by underlying neoplasms of the mediastinum. In extremely rare cases superior vena cava syndrome can occur due to congenital vascular thrombosis. This is a case report of a 33-week gestation infant, which was delivered vaginally and needed cardiorespiratory resuscitation immediately after birth. The neonate was in severe respiratory distress and arterial blood samples revealed both respiratory and metabolic acidosis, which was treated with High Frequency Oscillatory Ventilation. The neonate's physical examination revealed lymphedema of the body's upper half and the chest radiograph demonstrated pleural effusion of the right hemithorax consistent with chylothorax. Despite the temporary improvement the neonate showed after the chest tube drainage of the chylothorax, about 12 hours after birth the patient's condition worsened dramatically by developing tension pneumothorax, which did not respond to any resuscitation effort we made. The neonate's body was examined at the Department of Pathology, where superior vena cava thrombosis was confirmed. The review of the literature revealed very rare cases of congenital vascular thrombosis concerning either the inferior vena cava or the renal veins. To the best of our knowledge, this is the first report of congenital superior vena cava thrombosis. Among the possible causes, inherited thrombotic disorders of either the mother or the fetus, as well as prothrombotic intrauterine conditions (i.e.chorioamnionitis) should be evaluated.

528 INTRACRANEAL HEMORRHAGE IN FULL-TERM NEONATES

M. Markovic

Clinical Centre of Montenegro, Gynaecological Clinic, Podgorica, Montenegro

Intracraneal hemorrhage in the full-term neonates also may occur as a consequence of birth trauma or perinatal asphyxia. Affected infants usually exhibit neurologic symptoms shortly after birth.

Methods: We analyzed the records of all full term newborns diagnozed of ICH in period of five years (2001–2006). We studied the clinical findings, risk factors, treatment and prognosis of every infant with ICH.

Results: We found 12 full term neonates with ICH. Six infants born after VE, 4 infants after spontaneous non traumatic labor, and 2 were born by caesarean. Three hemorrhages were intraventricular, 6 were intraparenchymals, and 3 were intracerebellars. Clinical findings included: four cephalohematomas, three case with seizures, four with irritability, five infants very hypotonic, two infants with hypertonia and three cases were asymptomatic. Only one infant need surgical treatments. One infant suffered epileptic disorders.

Conclusions: In meny cases the ICH does not produce significant clinical signs or these are subtle.

529 HYPERBILIRUBINEMIA AND WEIGHT LOSS IN FULL-TERM INFANTS

L. Marseglia

University of Messina, Pediatric and Surgery Sciences, Messina, Italy

Objective: To verify in exclusively breast-fed, term neonates if a neonatal weight loss ≥ 10% of birth weight increases the frequency of hyperbilirubinemia.

Study design: The study prospectively included 92 health term neonates with a weight loss ≥ 10% (study group), compared to184 healthy term neonates with a weight loss < 10% (control group), matched on their birth dates. All neonates were exclusively breastfed. In neonates with jaundice serum total bilirubin (Bt) was measured by direct spectrophotometry. A Bt ≥ 12 mg/dl (205.2 μmol/l) was arbitrarily defined hyperbilirubinemia. Mann-Whitney U test, χ² test, Relative Risk (RR), and Attributable Risk (AR), were performed for statistical analysis of the data.

Results: Hyperbilirubinemia was found in 38% of study group and on 26% of control group (p < 0.003). RR (1.4) shows a positive association between weight loss and hyperbilirubinemia, and AR (0.12) shows that the prevention of weight loss ≥ 10% could reduce the frequency of hyperbilirubinemia by 12%.

Conclusion: Our study demonstrates that in healthy term neonates, exclusively breastfeeding, a weight loss ≥ 10% significantly increases the frequency of hyperbilirubinemia. Daily weight evaluation and careful assessment of breastfeeding can be effective methods to prevent breastfeeding jaundice.

530 MULTIPLE BIRTH FROM A PEADIATRIC POINT OF VIEW

J.L. Martínez, H. Villalon

Clinica Las Condes, Neonatologia, Santiago de Chile, Chile

Multiple birth is often a reproductive medicine consequence. Clinica Las Condes, is one of the most important in South America; assisted fertilization, has led to high rates of multiple birth. Our goal is to show our experience, focusing on biological and psychosocial features.

144 twins, 82 triplets, 16 quadruplets and 5 quintuplets' biological features (see below) were analyzed. 60 couples, who underwent triplets or more, were asked through a questionnaire about psychosocial features, after having their children, at least, one year old.

623 newborns were included. General mortality rate was 43.3‰, 31.2‰ in quadruplets and 200‰ in quintuplets, mainly due to ELBW. Main differences in gestational age were seen in quintuplets (29 weeks), as so were in birth weight: 1190 g (560–1430 g). Complications:

BIRTH IVH NEC PDA Retinop BPD MV Hosp. stay Malf.

Twins (288) 1.3% 3.9% 3.1% 1.3% 1.3% 7.9% 5 (3–111) d 4.8%.

Tripl. (246) 3.7% 8.4% 6.4% 2.6% 1.3% 8.3% 28(9–77) d 4.8%.

Quad. (64) 1.6% 10.9% 4.7% 6.3% 7.9% 40.6% 44(20–116) 4.7%.

Quint. (25) 20% 32% 24% 52% 24% 80% 67(45–119) 0%.

Questionnaire showed that 85% of families wished a singleton. 90% of mothers had mood disorders during the first year and 38.8% of them required medication. 63.3% of families were economical impaired after first years and 31.6% showed relationship damage.

Conclusion: Multiple birth more than triplets should be avoided, because of related risks. High morbimortality and long term psychosocial impairment must be considered when deciding reproductive medicine strategies.

531 PREDICTING NEONATAL OUTCOMES: THE GOOD, THE BAD AND THE INEVITABLY UNCERTAIN?

W. Meadow, B. Andrews, J. Lagatta

University of Chicago, Pediatrics, Chicago, United States

Background: Parents of NICU babieswant to know whether the baby going to be all right? Responses usually center on the predictive power of abnormal tests for undesired outcomes.

Objective: We ask here the reverse question; that is, in addition to asking how good our predictions of a bad outcome are, we asked how bad our predictions of a good outcome are?

Design and Methods: For 291 ventilated VLBW infants, on each day of ventilation, we asked MDs, RNs, NNPs whether they thought the baby would die in the NICU. We correlated these intuitions with MDI/PDI at 2 years.

Results: Median GA/BW was 26 wks/893 g. The positive predictive value of intuitions of “die before NICU discharge” was high – < 15% of infants with a prediction of “die before discharge” were alive with both MDI/PDI > 70 at 2 years. 2) However, the sensitivity of intuitions of “die before discharge” was low – at least half of infants who were either dead or survived with MDI or PDI < 70 were NEVER predicted to die before discharge.

Conclusions:

• 1. Predictions of diebefore discharge are highly correlated with morbid outcomes in ventilated premature infants.

• 2. However, infants not predicted to die are still at great risk – most infants with burdensome outcomes were not identified by clinical intuitions of “die before discharge”.

• 3. Unfortunately, we are aware of no other prognostic tool available WHILE THE CHILD IS ON THE VENTILATOR whose predictive power is superior to intuitions of “die before NICU discharge”.

532 COMPARISON OF TWO METHODS FOR REDUCING INSENSIBLE WATER LOSS (IWL) IN VERY LOW BIRTH WEIGHT INFANTS

J. Meritano¹, C.L. Solana¹, N. Rolando¹, E. Valenzuela¹, A. Miranda¹, J. Miragaya², A. Gaidimauskas², J.C. Guerra²

¹Maternidad Sarda, Neonatologia, Buenos Aires, Argentina;²Medix ICSA, Buenos Aires, Argentina

Objective: To determine if IWL is significantly reduced in an incubator with high relative humidity (HRH) versus low relative humidity (LRH).

Design/ methods: Randomized controlled clinical trial. Inclusion criteria: inborn VLBW infants (birth weight < 1500 g and gestational age < 32 weeks). Following NICU admission, infants were placed in an incubator (NATAL CARE, MEDIX, Argentina) with servo-controlled humidity capability. Patients were randomly assigned to HRH (80%) or LRH. IWL was indirectly estimated during the first 72 hours by means of a closed fluids and electrolyte balance. Weight was continuously monitored with an electronic scale. Central and peripheral temperatures, fluid intake and urinary output were recorded and serum sodium determined. Morbidities were recorded up to hospital discharge or dead.

Results: 20 patients in LRH and 21 in HRH were included. Groups were comparables in clinical characteristics and morbidity. Maximum body weight loss was 8.9% in HRH group and 14.5% in LRH group (p < 0.001); days to re-gain birth weight were 10.3 in HRH group and 16 for LRH (p < 0.001), mean fluid intake was 87 and 104.4 ml/kg/day respectively (p < 0.001). Mean serum sodium in HRH group was 134.1 mEq/l and 138.6 mEq/l in LRH group(p < 0.0001). 7 infants in the LRH and none in the HRH developed hypernatremia. There were no differences between groups in late onset sepsis, nor other complications during hospitalization.

Conclusions: The results of this study indirectly confirm that VLBW infants cared inan incubator with HRH have lower IWL without imposing additional risks in the first days after birth.

533 ROLE OF N-ACETYL CYSTEINE IN ENDOTRACHEAL TUBE PATENCY IN INTUBATED INFANTS

P. Mohagheghi

Iran Medical Sciences University, Tehran, Iran

Objectives: To evaluate feasibility and safety of N-acetyl cysteine (NAC) administration in terms of number of re-intubation and safety in neonates.

Methods: This pilot clinical study took place in Hazrate Rassoul Hospital as a tertiary level NICU between March 2006–September 2007. Sixty infants were included in this study. Their birth weight was more than 1500 gram and needed more than three days of mechanical ventilation for different reasons. They were randomly distributed in two groups. Group1 (n = 30) received 10 mg NAC every 4 hours through endotracheal tube (ETT) and group 2(n = 30) were treated with the same amount of normal saline. The frequency of ETT change and side effects of NAC including cyanosis, apnea, bradycardia and hemoptysis were recorded.

Results: The median number of reintubation was 1.4 ± 0.72 in group 1 in comparison to 2.6 ± 0.67 in group 2 (p value = 0.000). No more side effects were observed in the NAC group.

Conclusion: NAC is a safe and valuable adjunctive therapy which provided longer period of ETT patency with no proven side effects. We recommend to prophylactically using NAC in intubated infants with mechanical ventilation.

534 CONTINUOUS OXYGEN SATURATION MONITORING (COSM) IN PRETERMSWITH BORONCOPULMONARY DYSPLASIA AND RESPIRATORY OUTCOME

M. Morgues, P. Vernal, M. Palomino, I. Valdes, S. Montes

Chile University – San Jose Hospital, Neonatology, Santiago, Chile

We described 3 patterns of COSM that have been useful to predict respiratory outcome (p < 0.00). There are still many doubts respect the target saturation in healthy and BPD preterm.

Objective: Evaluate respiratory stability in healthy and BPD preterm, using COSM at 34–36 weeks gestation. Identify COSM and clinical factors associated with respiratory outcome.

Methods: Cohort of 116 preterm < 32 weeks born over 18 months period, with (n = 45) and without Broncopulmonary dysplasia (n = 71), weight = 1171 g, GE μ = 28 weeks, were studied with COSM for 12–24 hours done prior to discharge. Reports were revised for 5 experts made consensus in the 3 patterns, were blind for the clinical history. Readmissions and oxygen needs after discharge were recorded. STATA was used.

Results: COSM pattern type 1 identified babies with and without BPD with respiratory stability for discharge at follow up. Average saturation ≤94.8 ± 1% and > 20 seg episodes with sats < 80% plus bradicardya (3 episodes ± 4) or tachycardia (1.45 episodes ± 2.3) correlated with respiratory instability, > in BPD (χ²p < 0.01). GER and < age at examination was associate to type 2 (χ²p < 0.01). Oxygen needs and readmissions at 1 year outcome, correlates with type 2.

Conclusion: COSM was useful to discriminate respiratory instability and DBP follow up. Average saturation and N° episodes predicted better respiratory instability. GER frequently deteriorate the registry, correlated well with type 2. Suction immaturity was a problem at less age of COSM. Type 3 registries did not allow discharge.

535 EVALUATION OF THE APGAR SCORES AND UMBILICAL ARTERY BLOOD BASE VALUES IN CESAREAN SECTION UNDER GENERAL OR REGIONAL ANESTHESIA

F. Moslemi, S. Rasooli, M. Parish

Tabriz University of Medical Sciences, Anesthesiology, Tabriz, Iran

Background: There are several controversies regarding to the effect of spinal and general anesthesia on newborn's condition in cesarean section. Each type of anesthesia may have some risks and benefits on mother and her fetus. The aim of this study is to determine the effect of the technique of anesthesia on apgar scores and umbilical artery blood gas values in newborns delivered from cesarean section under general or spinal anesthesia.

Methods: We collected the data of 324 parturient who were candidate for elective cesarean section in Alzahra hospital from 2006/8/10 to 2007/8/10.

Demographic data, maternal blood pressure before and after anesthesia, 1^st and 5^th minutes apgar score and umbilical artery blood gas values (PH, Hco3, Be, Pco2) were recorded.

Results: 117patients received general and 207 patients received spinal anesthesia. Mean maternal systolic and diastolic pressures were lower in spinal group, but there were not significantly different (p > 0.05). Apgar score of the 1^st minute in general anesthesia was lower than in spinal anesthesia, But 5^th minute apgar score showed no difference. umbilical artery blood gas values had not any significant difference between two groups (p > 0.05).

Conclusion: Regarding to the lack of any adverse effect of spinal anesthesia on neonatal condition, it can be is a safe choice of anesthesia in cesarean section.

Keywords:General anesthesia, Spinal anesthesia, Apgar score, Umbilical arterial blood gas value

536 THE NEONATAL CEREBRAL LESIONS OF THE CHILDREN RESULTED FROM IATROGENIC PREGNANCIES

C. Musuroi¹, M. Motoc², A. Motoc², S. Bolintineanu², M. Vaida²

¹Tibiscus University, Timisoara, Romania;²Medicine and Pharmacy University, Timisoara, Romania

Aims: The analysis of the behaviour of the cerebral lesions (HIE and IVH) in the case of the children resulted from iatrogenic pregnancies.

Methods: The study was carried out on a group of 212 children resulted from assisted reproductive technology (ART) of which 183 children resulted simple gestation and 29 from twin pregnancies.

Results: In the case of the simple pregnancies, 4% of the children were diagnosed with cerebral lesions. The mild and moderate manifestations of the illness were registered for 15% of the group III B new-borns, while the severe ones were registered for the 11% of the group III B (TBW 1501–2500 g), 50% of the group III A (TBW 1001–1500 g), and for all the group IIa (500–800 g) new-borns. In the case of the second order pregnancies only mild and moderate cerebral lesions were registered. All the children obtained at birth an APGAR score higher than 7, with a certain concordance in the twin pair. The lesions affected especially the female babies from the F/F twin pair.

Conclusions: The twins from a ART pregnancy present the diagnoses of HIE/IHV, with a frequency which is significantly higher than for the single children from ART pregnancies (p = 0.0012), yet the lesions are of a moderate severity, with a favourable prognostic for the long term evolution. The severe lesions had a reduced frequency, affecting especially the babies from a single pregnancy, with a significant prematurity degree and a reserved short term prognostic.

537 COMPARISON OF RECOMBINANT HUMAN GRANULOCYTE COLONY-STIMULATING FACTOR IN NEONATAL SEPTICEMIA AS ONCE-DAILY AND THRICE-DAILY DOSES IN TEHRAN-IRAN

F. Nayeri¹, Z. Oloomi Yazdi², M. Kaveh³, M. Shariat⁴

¹Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences, NICU, Tehran, Iran;²Vali-asr Hospital, Tehran University of Medical Sciences, Pediatric Ward, Tehran, Iran;³Mirza Koochak Khan Hospital, Tehran University of Medical Sciences, Neonatal Ward, Tehran, Iran; ⁴Maternal-Fetal-Neonatal Health Research Center, Tehran University of Medical Sciences, Reserch Department, Tehran, Iran

Aim: The effectiveness of rG-CSF in the treatment of neutropenia in children motivated us to study and compare once-daily and thrice-daily doses of rG-CSF in the treatment of neutropenia in neonates with septicemia.

Method: This randomized clinical trial was performed in the form of a pilot study on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr And Mirza Koochak Khan hospitals in Tehran (Iran). The neonates were randomly divided into two equal groups of 20. rG-CSF was administered subcutaneously in the form of a single dose of 10 μg/kg to neonates in group A and in the form of a thrice daily dose of 10 μg/kg/day to neonates in group B. CBC and differential count was checked six and 24 hours after the initial dose and 48 hours after the final dose. Results were analyzed using appropriate statistical methods.

Results: Although there was no significant difference regarding mean birth weight, gender, age, and risk factors for neutropenia, but this condition improved 48 hours after the final dose of rG-CSF and there was no significant statistical difference between the two groups (p-value > 0.05). Final outcome including death or alive, duration of hospitalization and duration of antibiotic therapy required after rG-CSF administration, did not vary in neonates who received once-daily and those who received thrice-daily therapies (p-value > 0.05).

Conclusion: The results of this study show that the administration of a single subcutaneous dose of rG-CSF (10 μg/kg) is effective in treating neonates with septicemia.

538 CONGENITAL VASCULAR RING: AN UNUSUAL CAUSE OF RESPIRATORY DISTRESS IN NEONATES

A. Alexaki, A. Nika, G. Kourakis

A.&P Kyriakou Children's Hospital, NICU, Athens, Greece

Compression of the neonatal airway is a relatively common and often unrecognized complication of a variety of cardiovascular diseases. Double aortic arches result from persistence of the right fourth aortic arch and right dorsal aorta and account for 50–60% of vascular rings. It is a common form of complete vascular ring, encircling both the trachea and esophagus, resulting in noncardiac morbidity.

We report the case of a term neonate presenting shortly after birth with severe respiratory distress and audible non positional stridor and expiratory wheeze.

Chest radiography was normal while a posterior indentation of the oesophagus was noted on barium esophagography.

Echocardiography by subcostal views documented the presence of a double aortic arch and excluded associated cardiovascular anomalies. The patient underwent bronchoscopy for the evaluation of the tracheobronchial tree for coexisting or intrinsic abnormalities and a pulsatile compression of the posterior and lateral walls of the trachea was observed. As for technical reasons a non invasive investigation was not possible at the time he underwent cardiac catheterization which confirmed the isolated diagnosis of a double aortic arch and surgical correction was performed.

A high index of suspicion of mechanical airway compression should be maintained in neonates with respiratory symptoms unexplained by other causes since prompt diagnosis is required to avoid death and minimize airway damage.

539 COMBINATION THERAPY OF CYCLOPHOSPHAMIDE AND INTERFERON ALFA 2A FOR THE TREATMENT OF ORBITAL HEMANGIOMA IN A PREMATURE NEONATE

A. Nika¹, A. Alexaki¹, E. Dana¹, A. Koidou-Tsiligianni²

¹A&P Kyriakou Children's Hospital, NICU, Athens, Greece;²A&P Kyriakou Children's Hospital, Opthalmologist Department, Athens, Greece

Capillary hemangiomas are the commonest benign orbital tumors in infancy. Their ophthalmic morbidity is largely related to their space-occupying effects.

We report the case of a capillary, steroid resistant, orbital hemangioma in a premature neonate treated successfully with the combined treatment of INFa2a and cyclophosphamide.

A 32 week gestation female infant was transferred in our unit for management of an orbital capillary hemangioma. The lesion presented at 5 weeks of age as periorbital oedema with aggressive growth resulting in proptosis of the right eye. She was initially treated with steroids for 3 weeks but due to rapid and vision threatening deterioration she was commenced on a combination therapy with low dose cyclophosphamide (30/mg/kg/dose twice weekly) and daily INFa 2a (3 × 10⁶ U/m²).

Following 5 courses of the above treatment marked regression of the tumor was achieved. Rebound growth however occurred with discontinuation of treatment requiring 3 further additional course of cyclophosphamide.

Corticosteroids are the first choice treatment but cannot always control the growth of alarming hemangiomas. INFa2a has also been used effectively but serious side effects have been reported with prolonged treatment. In our case the combination therapy of low dose cyclophosphamide and IFNa2a resulted in tumor regression minimizing the potential adverse effects of a prolonged course of INFa 2a. Furthermore rebound growth was successfully controlled with cyclophosphamide alone. Anti-angiogenic drugs alone or in combination therapy are an alternative in steroid resistant or organ threatening hemangiomas however further studies are needed to evaluate their effectiveness and safety.

540 MORBIDITY AND MORTALITY OF NEONATES LESS THAN 32 WEEKS GESTATIONAL AGE

S. Nouri-Merchaoui¹, R. Zakhama¹, J. Methlouthi¹, M. Fekih², N. Mahdhaoui¹, N. Salem¹, H. Seboui¹

¹Farhat Hached Hospital, Neonatology, Sousse, Tunisia;²Farhat Hached Hospital, Gynecology Obstetrics, Sousse, Tunisia

Prematurity remains a public health problem in tunisia especially for neonates (NN) less than 32 weeks gestational age (GA).

Objective: study morbidity and mortality of NN < 32 weeks.

Patients and Methods: retrospective study of live-born NN between 28 and 32 weeks GA admitted at our departement during time period between January 2005 and december 2006. Were excluded NN born after pregnancy medical interruption.

Results: 184 eligible NN representing 1% of all live born NN, 25% of all admitted premature NN and 7.7% of all admissions. GA was determined by last menstrual period in 163 cases (88.6%), early ultrasound examination in 10 cases (5.4%) and by morphologic score in 11 cases (6%). Hypotrophy was found in 65 NN (35.3%).

22% were issued from mutiple pregnancies. Antenatal corticosteroids were given in 97 pregnancies (53%). Early morbidity was found in 161 NN (87.5%) represented mainly by respiratory distress in 89 (48%) NN in relation with respiratory distress syndrome (51/89), transient respiratory distress (24/89) and materno fetal infection (14/89). Late morbidity consisted of nosocomial infections (NI) in 61 NN(33.1%) and anemia in 76 NN (41.3%). Ventilatory support was indicated at any time of stay in 92 NN (50%). Surfactant was used in 30 NN. 46 NN died (25%). Causes were NI (40%) and intracranial hemorrhage (21%).

Conclusion: Despite developpement in neonatal care mortality of premature NN less than 32 weeks remains considerable. more efforts have to be employed in order to decrease nosocomial infections and to protect against intracranial hemorrhage.

541 FAMILIAL HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS: CASE REPORT

S. Nouri-Merchaoui¹, R. Zakhama¹, M. Fekih², J. Methlouthi¹, N. Mahdhaoui¹, N. Salem¹, H. Seboui¹

¹Farhat Hached Hospital, Neonatology, Sousse, Tunisia;²Farhat Hached Hospital, Gynecology-Obstetrics, Sousse, Tunisia

Familial hemophagocytic lymphohistiocytosis (FHL) is a rare disease characterized by non malignant but uncontrolled proliferation of T cells and macrophages. It consists of fever, hepatosplenomegaly, cytopenia, hypertriglyceridemia, hypofibrinogenemia and hemophagocytosis. Ascites is not a classical feature. We report a 25 day old boy issued from consanguinous parents, admitted for abdominal distension associated to diarrhea and hepatomegaly. Death of unknown etiology occured in two brothers. Diagnosis of familial pseudoobstruction syndrome was first considered but was eliminated on follow up. Clinical features consisted by the age of 4 months of intermittent fever, important hepatomegaly, splenomegaly and progressive ascites. Laboratory analysis showed pancytopenia, hepatic failure, cytolysis, hypertriglyceridemia and hypofibrogenemia.

Liver biopsy was not performed becauses of coagulation anomalies. Bone marrow biopsy showed histiocytosis with hemophagocytosis. Diagnosis of post infection lymphohistiocytosis activation syndrome was eliminated. Diagnosis of FHL was considered. The infant died rapidly by the age of 6 months in a multiorgan dysfunction syndrome before treatment was started.

Conclusion: The diagnosis of lymphohistiocytosis activation syndrome should be considered in case of association of intermittent or prolonged fever, hepatomegaly, splenomegaly in an infant. FHL is considered after other causes of this syndrome are ruled out. Untreated FHL is fatal in all cases. Medical treatment combining corticosteroids, cyclosporin A and etoposide should be started as earlier as possible. This has to be followed by stem cell transplantation as the only curtaive treatment.

542 THE ROLE OF JAK-STAT3 SIGNALING PATHWAY DURING FETAL LUNG DEVELOPMENT

C. Nogueira-Silva, S. Nunes, R.S. Moura, J. Correia-Pinto

Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal

Background and Aim: The process of lung development involves several effectors that exert its action via JAK/STAT signaling pathway. The elucidation of the signaling pathways involved in lung development may lead to strategies to rescue pulmonary hypoplasia associated with a broad spectrum of human diseases. Thus, our aim was clarify the role of STAT3 during fetal lung development.

Material and Methods: STAT3 expression pattern was assessed by immunohistochemistry. Rat lung explants were harvested at 13.5 days post-conception and cultured during 4 days with STAT3 antisense and scrambled oligodeoxynucleotides and also with increasing doses of piceatannol, an inhibitor of STAT3 phosphorylation (0, 0.01, 0.1, 1, 10, 20, 30 ng/mL). STAT3, MAPK (ERK1/2, JNK and p38) and PI3-AKT phosphorylation in explants was assessed by western-blot. Daily pictures were made and the number of peripheral airway buds and epithelial perimeter were determined in all lung explants, at day 0 and 4 of culture.

Results: STAT3 was expressed by pulmonary endothelium during lung development. Antisense oligodeoxynucleotides for STAT3 and higher doses of piceatannol inhibited JAK/STAT3 pathway (as supported by western blot results) and decreased lung growth. However, lower doses of piceatannol induced increase of STAT3 phosphorylation (accordingly previously described in literature) and also increased lung growth. Moreover, western blot demonstrated none difference on ERK1/2, JNK, p38 and PI3-AKT pathways, confirming the specificity of piceatannol for STAT3.

Conclusions: These findings suggest that JAK/STAT3 signaling pathway is a positive regulator of fetal lung development. Moreover, the STAT3 endothelial expression proposes an airway-vasculature interaction on branching regulation.

543 THE ROLE OF GLYCOPROTEIN 130 (GP130) FAMILY OF CYTOKINES ON FETAL LUNG DEVELOPMENT MECHANISMS

C. Nogueira-Silva, E. Dias, S. Nunes, R.S. Moura, J. Correia-Pinto

Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal

Background and Aim: Interleukin 6 (IL6), IL11, leukaemia inhibitory factor (LIF) and cardiotrophin-like cytokine (CLC) belong to the family of glycoprotein 130 (gp130)-type cytokines. These cytokines are aggregated in same family since all they use gp130 as signal transducer. Recently, it was demonstrated that IL6 is expressed in fetal pulmonary epithelium and enhances lung branching. Thus, our aim was clarify the role of IL11, LIF and CLC during fetal lung development.

Material and Methods: Fetal rat lungs were harvested at 13.5 days post-conception and cultured during 4 days with increasing doses of IL11 (0, 0.01, 0.1, 1, 10, 100 ng/mL), LIF (0, 0.4, 4, 20, 40 ng/mL) and CLC (0, 0.0003, 0.003, 0.03, 0.3, 3, 30 nM). LIF inhibition studies were also performed using neutralizing antibodies. Daily pictures were made and the total number of peripheral airway buds and epithelial perimeter were determined in lung explants. The results were expressed as Day 4/Day 0 ratio.

Results: A total of 226 fetal lungs were dissected. IL11 supplementation induced no significant effect on lung growth, whereas LIF and CLC supplementation significantly decreased, in a dose-dependent way, the branching and epithelial perimeter. Additionally, the inhibition of LIF action increased the measured parameters.

Conclusions: Although these cytokines share a common signal transducer, these findings suggest specific biological activities on lung development. This specificity can represent a regulatory mechanism of lung morphogenesis, intrinsic to this family, in order to achieve the correct lung growth.

544 OUTCOME OF PERINATAL/TYPICAL VERSUS POSTNATAL/ATYPICAL HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE)

K. Obaid

Neonatal Intensive Care Unit, Pediatrics, Doha, Qatar

Background: The objective of the study is to compare the outcome of perinatal hypoxic-ischemic encephalopathy with those who developed postnatal hypoxic ischemic encephalopathy within 7 days after birth for post-natal acquired pathology.

Methods and Materials: A Retrospective chart review study of newborn infants admitted to NICU/WH/HMC& PICU/HGH/HMC/DOHA/QATAR, with perinatal HIES or those postnatal HIE born at WH/HMC. The Follow-up of abnormalities on psychomotor development are based on the neurological status at discharge from the intensive care as well as out-patient clinic follow ups.

Results: Forty-four cases were identified. Group one had 22 cases of perinatal (HIE) compared to 22 cases of the postnatal HIE. All cases of perinatal HIE required resuscitation and assisted ventilation compared to 8 of postnatal HIE (P 0.000), 11 cases of perinatal HIE died while one case of postnatal HIE died (P 0.003), mean GA was 36.8 weeks for perinatal HIE cases while was 38.8 weeks for postnatal HIE (P 0.040). Mean Apgar score at 5 min was 2.8 for perinatal HIE while it was 9.18 for postnatal HIE cases (P 0.000), 8 cases of perinatal HIE had delayed mile stones while 1 case among postnatal HIE cases (P 0.000), 3 cases of perinatal HIE born normally compared to 12 cases of postnatal HIE (P 0.005).

Conclusions: The outcome of cases of postnatal hypoxic ischemic encephalopathy was much better than those with perinatal HIE, lower threshold for caesarian section might help to reduce the incidence of HIEthat preterm babies perinataly depressed they will present soon after birth while full term babies might presented later.

545 HEMATOLOGICAL PARAMETERS IN PREMATURE NEWBORNS WITH RESPECT TO THEIR GESTATIONAL AGES

A. Kara Uzun¹, S.S. Oguz², U. Dilmen²

¹Dr Zekai Tahir Burak Maternity Health Education and Research Hospital, Ankara, Turkey;²Dr Zekai Tahir Burak Maternity Health Education and Research Hospital, Neonatology, Ankara, Turkey

In this study, the hematological parameters of premature infants were investigated with respect to their gestational ages. Sixtyeight neonates with gestational ages between 24–36 weeks who were admitted to our neonatal intensive care unit (NICU) with a diagnosis of prematurity and low birth weight were enrolled in this study. During the first five days of their admission venous blood sampled from a peripheral vein was analysed for a complete blood count analysis (CBC) using an automated counter. The mean gestational age of the 68 premature infants was 29.9 ± 2.7 (mean ± SD) weeks. The infants were divided into four groups with respect to their gestational ages. The hematological parameters analysed in this study were white blood cell count (WBC), hemoglobin concentration (Hb), hematocrit value (Hct), platelet count (Plt), red blood cell distribution width (RDW), and platelet distribution width (PDW). No statistically significant differences were found among the four groups with respect to any of the six hematological parameters analysed (Table). Every NICU should determine their own hematological reference values, taking care into their patient profiles and laboratory technologies.

546 INTENSIVE TREATMENT OF GESTATIONAL DIABETES MELLITUS REDUCE PERINATAL COMPLICATIONS

M. Onofriescu¹, M. Stamatin², D. Nemescu¹, A. Luca¹

¹University Medicine Iasi, Obstetric Gynecology, Iasi, Romania;²University Medicine Iasi, Neonatal Intensive Care Department, Iasi, Romania

Objective: GDM is defined as glucose intolerance with onset or first detection during pregnancy and occurs in 2% to 5% of all pregnancies. We evaluated the effects of an intensive treatment of gestational diabetes mellitus (GDM) on the incidence of perinatal complications.

Material and Methods: We compared newborns of women delivered in our hospital (Jan. 2005–Dec. 2007) who had been diagnosis of GDM between 24 and 30 weeks and who had been intensively treated (study group, SG = 54) vs. neonates born in the same period whose mothers had not been treated in our clinic, had not reached the treatment targets or had been diagnosed very late (control group, CG = 23); The visits were planned every 2–3 weeks or more. Outcomes evaluated: admission to the NICU, TTN, RDS, gestational age (GA), pathological jaundice, hypoglycemia and hypocalcaemia.

Results: 1 infant in the IG was admitted in NICU for RDS (1.5%); 6 (11%) had TTN. 10 neonates in the CG were admitted in the NICU, 5 (21.7%) for RDS and 5 (21.7%) for TTN. Mean GA at delivery was 37.3 ± 1.5 vs. 35.5 ± 2.4 (p < 0.0001). In the SG 4 had hypoglycemia (7.4%) vs. 6 in the CG (26%); hypocalcaemia and pathological jaundice showed similar results confirming a rate of complications 10 times lower. The mean hospital staying was 6 in SG vs. 15.2 days in CG.

Conclusions: The intensive treatment of GDM with the support of a multidisciplinary team and frequent contacts, significantly improves neonatal outcomes, reduce complications and the costs of care.

547 ASSESSMENT OF MATERNAL, NEONATAL AND PERINATAL OUTCOMES OF BREECH DELIVERY

S. Ozdemir, A. Aydin, I. Gezen, Y. Aydin, M. Donmez, G. Ozdemir

Sisli Etfal Training &Research Hospital, 3rd Obstetrics &Gynecology Clinic, Istanbul, Turkey

Objective: We aimed to assess the perinatal outcomes of breech deliveries in recent 3 years.

Method: The breech deliveries occured between the years of 2005–2007 in our clinic were taken into this study.

Results: In a three year period, total of 3300 deliveries, out of which 145 (4.49%) were breech presentation. Mean gestational birth week at the time of application to hospital was 35.6 week (22–40) and mean birth weight was 2667.7 gr (400–4100). Mean patient age was 27.7. Out of 145 deliveries, 45.5% of the pregnants were nullipar, whereas 54.5% were multipar. 67.5% of the deliveries occurred with cesarean section, 32.5% of those occured with vaginal way, supported manually. There was a total of 4.1% fetal anomaly which accounted for hydrocephaly, ventriculomegalia, meningomyelocel. Out of these 145 deliveries, the rate of neonatal mortality was 6.2%. No maternal mortality was seen. Out of total 145 deliveries, the ratio of birth trauma was 3.4%. 40% of birth traumas was femur dislocation & fracture, which occured during cesarean section, 40% of those was Erb Duchenne paralysis occured during vaginal delivery and 20% was clavicle fracture occured during vaginal delivery.

Result: Breech presentation rate is % 3–4 of all pregnancies. There is a tend to cesarean delivery in term breech presentations though an increase in perinatal mortality and morbidity in vaginal breech delivery. In this re study, it has been introduced that birth traumas are more commonly seen in vaginal breech presentations.

548 LONG QT SYNDROME PRESENTING AS FETAL BRADYCARDIA

H. Ozdemir¹, F. Akalin², I. Akman¹, H. Bilgen¹, E. Ozek¹

¹Marmara University, Neonatology, Istanbul, Turkey;²Marmara University, Pediatric Cardiology, Istanbul, Turkey

Fetal bradycardia or other dysrhythymias should be evaluated by echocardiography. Untreated long QT syndrome (LQTS) can cause tachyarrhythmia, syncope and sudden death. In this case report we present a patient with fetal bradycardia who was diagnosed to have long QT syndrome.

A patient was referred to our hospital in her 38th weeks of gestation, for suspected AV block for fetal bradycardia since the 34th week. In the fetal echocardiography 1:1 AV conduction was noted and the heart rate was 65–80 beats per minute. Long QT Syndrome (LQTS) was considered and the baby was delivered by C/S. The ECG taken immedately after birth showed a sinus rhythm of 65 bpm with 1:1 AV conduction. The calculated corrected QT (QTc) interval was 530 ms which exceeds the limit of 440 ms. According to schwartz criterions, the patient had 3.5 points so the diagnosis was probable LQTS. The prenatal history was unremarkable for a maternal medications and infections. There were no sudden death in the family or deafness in any family members. The hearing screening (auditory brainstem response) was found normal. Propranolol was started immediately after birth. Twenty-four hour Holter monitoring was normal and no ventricular ectopic beats were found. During the follow-up, the QTc interval shortened and measured as normal after the 10^th postnatal day.

LQTS can be congenital or acquired. Transient LQT may be found in neonates. Atrioventricular block and LQTS must be considered in differential diagnosis of fetal bradicardia.

Keywords:Long QT, bradycardia, prenatal diagnosis, newborn

549 PROTECTIVE EFFECTS OF CARNOSINE IN RATS WITH HYPOXIA/REOXYGENATION-INDUCED INTESTINAL INJURY

Ö.M.A. Özdemir¹, H. Ergin², N. Türk³, Ç. Yenisey⁴, N.G. Şimşek⁴

¹Neonatology, Pediatrics, Denizli, Turkey;²Pamukkale University, Faculty of Medicine, Pediatrics, Denizli, Turkey;³Pathology, Denizli, Turkey;⁴Biochemistry, Aydin, Turkey

Carnosine is a non-enzymatic free-radical scavenger and a natural antioxidant. The aim of this study was to determine the effects of carnosine on the biochemical and histopathological alterations in rats with hypoxia/reoxygenation (H/R) induced intestinal injury. Wistar-albino rat pups (n = 21) were divided into three groups on first day: group I (control), group II (H/R), and group III (H/R + carnosine). Carnosine was administered (250 mg/kg) intraperitoneally to group III for 3 days. For H/R, 3-days-old rat pups were placed into a chamber of 100% CO₂ for 5 min, then they were reoxygenized with 100% O₂ for the next 5 min. At 6th hours after H/R, all animals were killed on day four. Histopathologic injury scores, malonyldialdehyde (MDA), glutathione (GSH), catalase (CAT), nitric oxide (NO), and glutathione peroxidase (GSH-Px) activities were measured on intestinal samples. There were no histopathological changes in group I. The histopathological examination showed villous necrosis in H/R group. Intestinal damage was mild in group III, and these histological changes were significantly better than group II (p < 0.05). The median of histopathologic grade of group I was 1.0 (1 = normal, range 1), it was 3.0 in the group II (3 = villous necrosis, range 3), and it was 2.4 in the group III (2 = hydropic degeneration, range 2–3). While the only tissue nitrate levels were found to be significantly increased in group III compared with group II (p < 0.05), the other biochemical parameters were not different between the groups. We conclude that use of carnosine significantly reduced the severity of NEC in this study.

550 STUDY OF THE RISK FACTORS OF NEONATAL CLAVICLE FRACTURE

M.J. Kim, D.M. Kim, M.S. Park, S.J. Kim

The Catholic University, Seoul, Korea

Objective: To know the clinical correlation of maternal or infantile factors with neonatal clavicle fracture.

Methods: Total 51 cases of newborn clavicle fracture were studied. Among studied cases, 3 infants were born in preterm, which possibly could give an effect on birth weight.

Results: Total 92.384 singleton were delivered. 3 infants with clavicle fracture were born by CS. Among them, 2 infants showed breech presentation, and were in preterm labor. Including these 2 infants, 5 affected infants were born in preterm. 38 cases of neonatal clavicle fracture represented 0.055% of all vaginal deliveries and 3 of them did 0.006% of all cesarean deliveries (total clavicle fracture: 41 cases). When compared to infants of the control group, those of study group were found to have a higher birth weight (3.80 ± 0.51 kg versus 3.37 ± 0.36 kg) (P < 0.05). The number of infants born with more than 4.0kg was also large in study group (P < 0.05). Infantile birth weight was identified as prevalence of risk factors of neonatal clavicle fracture. Evaluated and found not to be significant risk factors were maternal age, gestational diabetes, weight, height, parity, mode of delivery, presentation, and infantile gender (P > 0.05).

Conclusions: Through this study, only infantile birth weight was the risk factor of neonatal clavicle fracture. Other factors were found not to give effect on neonatal clavicle fracture.

551 HYPERTENSIVE DISORDERS IN PREGNANCY AND INFANT OUTCOME

E. Petkovska

University Clinic of Gynecology and Obstetrics, Department of Neonatal Intensive Care, Skopje, Macedonia

Objectives: To determine outcomes of preterm infants from pregnancies with hypertensive disorders.

Methods: A prospective study included all preterm infants who were born in University Clinic of Gynecology and Obstetrics, Skopje, Macedonia, between 1 January 2006 and 31 December 2006.

Main outcome measures: Rate of infant morbidity and mortality from pregnancies with hypertensive disorders.

Results: 454 preterm infants were includes in study. Overall, 88(19.4%) were from pregnancies with hypertensive disorders and 366 (80.6%) from pregnancies not complicated with hypertensive disorders. Infants exposed to hypertension during pregnancy were more likely to be delivered with caesarean section 67/88(76.1%), born small for gestational age 14/88(15.9%) and transferred to NICU 65/88(73.8%) compared with infants who did not expose to hypertension during pregnancy: 152/366(41.5%); 33/366(9.0%) and 203/366(55.4%). There was no significant difference in infant morbidity.

Conclusion: Hypertension disorders in pregnancy present a potential danger to infant which increased its adverse outcome. To avoid the risk of a poor outcome all hypertensive pregnant women should be transferred and managed in large district or tertiary hospitals where the most appropriate level of care can be provided. Close collaboration between obstetricians and neonatologist is essential for adequate care of infants from pregnancy.

552 END OF LIFE CARE: A FAMILY CENTERED APPROACH

C. Philips, S. Forte

Sunnybrook Health Sciences Centre, NICU, Toronto, Canada

Advancements in perinatology and supportive medical technologies have resulted in improved viability and improved healthcare delivery for critically ill neonates. These changes however, also present new challenges regarding end of life care in the Neonatal Intensive Care Unit (NICU). Important ethical considerations surrounding withdrawal of care have been the primary focus of discussion in this topic area. Development and implementation of a family centered approach to withdrawal of care is another relevant issue for consideration. The highly technical environment of the NICU can be dehumanizing, and the focus on technology and reassuring outcomes, may lead to medicalization of the dying process, and ultimately to a less than holistic approach. Healthcare practitioners in the NICU must become proficient at providing family centered care in all situations, including end of life care. Despite medical and technological advancements, neonatal emergencies such as fatal anomalies, extreme prematurity and severe ventricular hemorrhage can result in the need for withdrawal or non-initiation of care. The death of an infant is a tragic and painful experience that requires the same focused attention practitioners provide to families of infants facing more reassuring outcomes. A family centered approach to end of life care allows caregivers to offer medical “care” even in the face of a catastrophic outcome. In this model, the preferences of the family have a major impact on care delivery. Care is individualized to meet each family's unique needs and is sensitive to personal, spiritual, and cultural values and beliefs.

553 NEONATAL BRAIN SCANNING VERSUS LATE CLINICAL OUTCOME IN PRETERM BABIES

M. Pinto, D. Gonzaga, M. Azevedo, Z. Malta, M. Carrapato

Hospital São Sebastião, Paediatrics, Santa Maria da Feira, Portugal

What's the role of neonatal ultrasound scanning(US) in antecipating quality of survival in preterms? Correlate clinical outcome in childhood with neonatal brain US and MMR (when applicable) in preterm at GA > 23 < 32 weeks and whether US and MMR findings are concordant. Data was collected from files of all inborns admitted to NICU between January 1999–December 2003. Outcome was assessed according to standard procedures. All children had US performed and MMR when clinically indicated. Statistic analysis by SPSS15.0; Fisher's exact test. Of the 66 survivors, 15(23%) had abnormal ultrasounds including subependimary haemorrhage 53%, IVH 27%, PVL 13% and ventricular dilatation 7%. At follow-up, only 2 children had severe impairment, the remaining 87% were clinically normal or with minor PMD delay, whilst of the 51 children with normal US, one presented with CP. Of the 15 children with abnormal US, 8 were submitted to MMR which showed abnormalities, 3 referring to children with CP, whilst the others corresponded to either normal/mild psychomotor delay. Of the 51 children with normal US, 11 performed MMR. Two of those were considered normal, 9 abnormal (one child with diplegia and eight with either normal/mild psychomotor delay). Ultrasounds findings in the neonatal period, unless severe, bear a poor correlation to late neurological outcome. MMR for children with normal clinical evaluation and normal neonatal scanning add very little information. However, normal neonatal US do not reassure for the survival of a normal child and MMR might be a more sensitive tool in the clinical assessment of these children.

554 NEONATAL OUTCOME RELATED TO MATERNAL CRITICAL ILLNESS

W. Pollock¹, J. King², N. Harley³, S. Nelson⁴

¹The University of Melbourne, Carlton, Australia;²Royal Women's Hospital, Perinatal Medicine, Melbourne, Australia;³Royal Melbourne Hospital, Intensive Care Unit, Melbourne, Australia;⁴University of Toronto, Faculty of Nursing, Toronto, Canada

Introduction: This study examined the neonatal outcome in women who experienced critical illness during pregnancy and postpartum.

Method: A prospective study was conducted in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals. All pregnant and postnatal women admitted to ICU and HDU were eligible for the study, as were women who remained in DS for care related to maternal ill-health. Clinicians assisted with recruitment and data collection. Additional data were obtained from the medical records.

Results: Of the 145 enrolled women, 137 gave consent: ICU (n = 33), HDU (n = 46) & DS (n = 58). Analysis was conducted on 148 neonates from 134 women. Less than half the neonates were born at term; 19.4% < 32 weeks' gestation and 20.4% had a birthweight < 1500 g. Nearly 10% of neonates had a 5 minute Apgar score < 7. There were three stillbirths and five neonatal deaths. Neonates born during the episode of maternal critical illness fared the worst, with those born following maternal recovery more likely to be born at term. Birth gestation, birth weight and need for intubation did not differ for neonates born to women across the three levels of care. Neonates born to women admitted to ICU were more likely to have a 5 minute Apgar score < 7 and a perinatal death.

Conclusion: Critically ill pregnant and postnatal women across all levels of care were at risk of poor neonatal outcome, with women admitted to ICU more likely to experience a perinatal death.

555 RISK FACTORS FOR BRONCHOPULMONARY DYSPLASIA IN ELBW NEONATES

E. Chatziionidis, P. Karagianni, G. Mitsiakos, C. Tsakalidis, K. Kailidis, M. Porpodi, D. Karatasios, N. Nikolaidis

B' NICU Aristotle University of Thessaloniki, GPN Papageorgiou Hospital, Thessaloniki, Greece.

Background: Aetiology of bronchopulmonary dysplasia (BPD) is multifactorial. A combination of various factors results in acute lung injury, causing airway and vascular damage.

Objective: To determine the risk factors associated to bronchopulmonary dysplasia (BPD) in ELBW neonates.

Patients-methods: BPD met the 36-weeks definition. Data from 61 ELBW neonates who were hospitalized between April 2004 and December 2007 were studied retrospectively. Neonates were classified in group A (BPD) and B (non BPD). Both obstetrical and perinatal history factors as well as clinical variables were associated with BPD incidence.

Results: Of the 61 neonates 37 developed BPD (60.7%). Neonates in group A (BPD) compared with group B had statistically significant lower birth weight (p = 0.004), weight at discharge (p = 0.001), gestational age (p = 0.04), longer length of stay in NICU (p = 0.029), longer duration in all forms of ventilatory support (p < 0.05), longer overall oxygen supply (p = 0.004) and higher oxygen requirement (p = 0.001). Resuscitation, patent ductus arteriosus and sepsis where associated with increased incidence of BPD ([OR] 3.59; 95%CI: 1.2–10.9, [OR] 10.7; 95%CI: 2.8–40.3 and [OR] 11; 95%CI: 1.3–91.7 respectively).

Conclusions: Many factors play role in the development of BPD. Prevention of resuscitation, prophylactic treatment of patent ductus arteriosus and timely intervention on septic neonates, along with decrease on duration of mechanical ventilation and exposure to oxygen (especially high oxygen levels) are necessary to prevent BPD.

556 COMPARISON OF GBS COLONIZATION AND PERINATAL OUTCOME IN PRETERM AND TERM LABORS

B. Kowalska, P. Raczynski, E. Filipp, U. Tarnowska-Madra, K.T. Niemiec, T. Maciejewski

Institute of Mother and Child, Obstetric and Gynaecology, Warsaw, Poland

Relation between Group B streptococcus colonization and preterm delivery is unclear and data are inconsistent.

Aim: The aim of the study was comparison of GBS colonization and perinatal outcome.

Methods: Pregnant women and their newborns from our Obstetric and Gynecology Department were included to our study between June 2001–June 2003 year. Cervical, vaginal and perianal swab were obtained. Women with positive cultures were treated with antibiotic during labor. Earns and perianal swab of their neonate were obtained. Cultures of GBS were isolated using blood agar medium (Columbia). Plates were read for beta hemolysis and suspect colonies were subcultured and tested with biochemical test (Api 20 Strep) and verified with group-specific antisera (Slidex Strepto – Kit).

Results: 202 pregnant women and their neonates took part in our study. In this study the prevalence of preterm deliveries (<37 hbd) was 30%. We analyzed perinatal outcome in groups: < 1499 g, 1500–2499 g, > 2500 g. We found that newborns < 1499 g Apgars score was lower than in other groups (p < 0.01). In < 1499 g group amond GBS + newborns Apgars score was 5.2 in comparision to GBS- and other groups (p < 0.05). The results in 1500–2499 and > 2500 were similar but Apgars score of 1499–2500 g GBS + were statistically different than in > 2500 g group (p < 0.05).

Conclusions: GBS colonization among preterm born babies with very low birth weight is connected with worse perinatal outcome.

557 SMALL DOSE BUPIVACAINE-SUFENTANYL SPINAL ANESTHESIA FOR CESAREAN DELIVERY IN PREECLAMPTIC PATIENTS AND NEONATAL OUTCOME

S. Rasouli, F. Moslemi, M. Parish, A. Baybordi

Tabriz University of Medical Sciences, Tabriz, Iran

Background: We studied both markers of neonatal condition and maternal hemodynamic, and we evaluated their wellbeing at NICU in preeclamptic patients receiving spinal anesthesia for cesarean section.

Methods: Sixty parturient patients were randomized to two groups of 30 in this double-blind clinical trial. Group A (n = 30) were severely preeclamptic patients, and group B were healthy parturient (n = 30). Spinal anesthesia was performed with 6mg hyperbaric 0.5% bupivacaine and3.3mg sufentanyl. Hypotension was treated with intravenous ephedrine. After delivery, neonatal 1 St and 5 th Apgar scores were evaluated and umbilical arterial blood gas samples after delivery and in NICU were taken and analyzed. Also the neonatal outcome was followed.

Results: All patients had satisfactory anesthesia. 1^st and5 th Apgar scores (P = 0.760, P = 0.349) and umbilical arterial blood gas markers (PH, PCO2, HCO3, BE), after delivery and in NICU showed no deference between two groups (p > 0.05). All neonates discharged, only one case in group A died.

Conclusion: A “small-dose” of bupivacaine in combination with 3.3 μg sufentanyl provides satisfactory spinal anesthesia for cesarean section in all patients, and caused dramatically less hypotension in preeclamptic than healthy patients. Also neonatal Apgar score and umbilical artery blood markers are not influenced with it.

558 MATERNAL IRON DEFICIENCY: EFFECTS ON FATTY ACID AND EICOSANOID METABOLISM, MOTRICITY AND SPATIAL MEMORY IN THE GUINEA PIG OFFSPRING

F.M. Rioux¹, C.P. LeBlanc², M. Surette³, S. Fiset⁴

¹Université de Moncton, School of Nutrition and Nutritional Sciences, Moncton, Canada;²Université Laval, Department of Nutritional Sciences and Nutrition, Québec, Canada;³Université de Moncton, Department of Chemistry and Biochemistry, Moncton, Canada;⁴Université de Moncton, Human Sciences, Psychology, Edmundston, Canada

Iron deficiency is the most prevalent nutritional deficiency. The groups particularly at high risk of developing anemia are infants and pregnant women even in industrialized countries. To date, the biochemical and physiological effects of maternal iron deficiency on the infants are not well characterized. The goal of this study was to evaluate the impact of maternal iron deficiency on the offspring's fatty acid and eicosanoid metabolism, motricity and spatial memory in Guinea pigs. Iron sufficient (IS) and iron deficient (ID) diets were fed 14 days before mating and throughout pregnancy and lactation. Dietary restriction of iron resulted in iron deficiency in both females and offspring. The pups were tested for motricity and spatial memory on post-natal days 4–7. On post-natal day 9, the biochemical analyses included liver, RBC and brain fatty acid composition. The brain prostaglandin (PGE₂ and PGF_2α) concentrations and brain cyclooxygenase II (COX II) protein levels were measured as indices of eicosanoid metabolism. Motricity and spatial memory measures as well as indices of eicosanoid metabolism were comparable in both dietary groups. However, total omega–3 fatty acids, DPA (22:5ω–3) and DHA (22:6ω–3) expressed as a percent of total fatty acids, were higher in the liver and brain lipids of ID than in IS pups. This study demonstrates that moderate iron deficiency during gestation and lactation results in a modification of the fatty acid profile of the offspring's liver and brain that was not associated to any mobility or spatial memory deficits during early development.

559 GENERAL ANAESTHESIA FOR CAESAREANSECTION AND ITS EFFECT ON APGAR SCORE AT 5 MINUTES

C. Roberts¹, C. Algert¹, W. Giles², S. Lain¹, J. Bowen³

¹University of Sydney, Clinical and Population Perinatal Research, St Leonards, Australia;²Royal North Shore Hospital, Obstetrics and Gynaecology, St Leonards, Australia;³Royal North Shore Hospital, Neonatology, St Leonards, Australia

Background: Anaesthetic guidelines recommend spinal orepidural over general anaesthesia (GA) for caesarean sections (CS), exceptwhere contraindicated. Recommendations are based on maternal health, but thereis little evidence about the effect on neonates past the first minute of life. Randomised trials have been too small to provide evidence, and observationalstudies have not controlled for indication for delivery.

Methods: The study used two statewide, linked,population databases (birth records and hospital discharge records) from Australia. Changes in anaesthesia for caesareans were examined. Deliveries werecategorised by risk and indication for delivery, and the risk of a 5 minuteApgar score < 7 calculated.

Results: From 1998 to 2005 there were > 690.000 livebirths. In 1998, 28% of caesareans were performed under GA. This fell to 13% in2005, due to an overall increase in CS, a small absolute drop in GA and adramatic rise in spinals. Use of GA fell at all hospitals, but fell most rapidlyat non-tertiary public hospitals. For low-risk elective repeat caesareans, use of GA had a relative risk for 5 minute Apgar < 7 of 13.3 (9.3–19.0). Moderate risk and high risk deliveries hadsignificant but smaller RR's of 8.0 (6.0–10.6) and 4.6 (3.7–5.9) respectively.

Conclusions: This study provides evidence that GA may havelonger term consequences for some infants. Recommendations that regional blockshould be used for caesarean sections where not contra-indicated are prudent,and efforts to reduce the use of GA should continue. Observational studies canprovide useful data in situations where randomised trials are inadequate.

560 AXIAL MESODERMAL DYSPLASIA: REPORT OF AN ATYPICAL CASE

I. Loureiro¹, C. Moura², M. Rodrigues¹, G. Rocha¹, A. Martins¹, H. Guimarães¹

¹Hospital S. João, Neonatologia, Porto, Portugal;²Hospital S. João, Otorrinolaringologia, Porto, Portugal.

Axial mesodermal dysplasia comprises several syndromes, characterized by anomalies in the embryogenesis of mesodermal derivatives, such as the Goldenhar syndrome, VATER association and the caudal regression syndrome. There are same reports of patients who cannot be placed in any category, but whose features fit loosely in this spectrum. We report on a male neonate, with unrelated healthy parents, admited at our NICU for surgical correction of an imperfurate anus. He also presented with facial asymmetry, left external auditory canal atresia, facial paralisis and right preauricular tags. A left renal agenesis and aortic coarctation were also diagnosed. The CT showed cranial asymmetry with temporal and zigomatic hypoplasia, affecting mainly the left side, right deviation of the sagital suture, interparietal suture, external auditory canal atresia and left hemivertebrae at C3 and T1. He was submitted to colostomy and surgical correction of the aortic coarctation. Despite the several major anomalies he was discharged to ambulatory follow-up. These malformations suggested a Goldenhar syndrome, however ocular anomalies were not present. We emphasized the caudal involvement that is rare in this syndrome although commonly present in the axial mesodermal dysplasia.

561 EARLY NEURODEVELOPMENTAL ASSESMENT VALUE IN PREDICTION OF ABNORMAL NEUROLOGICAL OUTCOME IN TERM NEWBORNS AFTER NEONATAL ASPHYXIA

I. Rodrigues Machado Rosa¹, S. Tadeu Martins Marba¹, M.V. Leme de Moura Ribeiro²

¹Neonatal Intensive Care Unit at Womens's Hospital at the State University of Campinas, Pediatrics, Campinas, Brazil;²State University of Campinas, Neurology, Campinas, Brazil

Objective: To investigate whether a detailed neurological and neurodevelopmental examination at three months could predict outcome among asphyxiated term newborns.

Methods: The study had an observational analitic cohort design, of neurological examination and Denver Developmental Screening Test (DDST) of these neonates at 3 and 12 months. Perinatal variables were studied. The statistical analysis employed was bivariate, and multiple, with significance level of 5%.

Results: 81 newborns were enrolled. At one year, 54 (66.7%) were normal and 27(33.3%) had neurological abnormalities. The DDST was normal in 66 (81.5%) and delayed in 15 (18.5%). 34 infants exhibited transient abnormalities. In bivariate analysis, the variables associated with abnormal examination at year were ultrasonografy with brain edema, abnormal neurological examination at week, a lenght of stay in hospital > 12 days and abnormal neurological examination at three months. After multiple analysis, ultrasonografy with brain edema, and abnormal neurological examination at three months, remained associated with abnormalities at one year. In DDST, bivariate analysis showed associated with delay: hipoxic-ischemic encephalopathy grade 2 or 3, more than three sistemic abnormalities, neonatal seizures, need of mechanical ventilation, time of first feeding > 4 days, renal failure, abnormal neurological examinaton at week, a lenght of stay in hospital > 12 days and abnormal neurological examination at three months. After multiple analysis, abnormal neurological examinaton at three months remained associated with delay.

Conclusions: The results of this study, suggests that, in term asphyxiated newborns the outcome can be predict at three months of age, using a neurological and neurodevelomental examination.

562 IMMEDIATE TREATMENT OF CONGENITAL KNEE DISLOCATION IN NEONATES: PERSONAL EXPERIENCE IN 36 CASES

N. Rumyantsev, A. Baindurashvili, G. Omarov

Turner's Pediatric Orthopedic Institute, Neonatal Orthopedic Department, St. Petersburg, Russian Federation

Purpose: The purpose of the study is to show a different types of treatment programs for neonates with congenital knee dislocation.

Methods: Prenatal sonographic video-evaluation and X-rays at the birth were used. Treatment methods included permanent gentle manual manipulations (traction & flexion), von Rosen splinting and cast correction.

Results: The mean follow-up is 7 years (range from 1 to 18 years) We use five clinical and radiological criteria to evaluate the results. All results were good or excellent, and no surgical procedures were necessary.

Conclusions: The treatment of congenital knee dislocation should be started in the first hours of life. We believe that this condition could be a primarily reversible, but the possibility of correction diminishes drastically every day of patient's life.

Significance: The analysis of prenatal sonographic data shows, that this condition is formed between 12^th and 24^th weeks of gestation.

563 DEXTROMETHORPHAN (DM) IS PROTECTIVE AGAINST INFLAMMATION-SENSITIZED N-METHYL-D-ASPARTAT RECEPTOR (NMDAR) MEDIATED EXCITOTOXIC BRAIN-DAMAGE IN THE DEVELOPING MOUSE BRAIN

G. Sarközy¹, E. Griesmaier², M. Auer², G. Schlager², M. Urbanek², G. Simbruner², M. Keller²

¹Medical University Innsbruck, 4^th Department of Pediatrics, Innsbruck, Austria; Semmelweis University, 1^st Department of Pediatrics, Budapest, Hungary;²Medical University Innsbruck, 4^th Department of Pediatrics, Innsbruck, Austria

Introduction: Enhanced glutamate-release and inflammation play important role in the pathogenesis of developmental brain-injury. As previously shown, DM, a low-affinity NMDAR-antagonist, reduces excitotoxic brain-injury in newborn mice without stimulation of apoptosis. Additional anti-inflammatory properties of DM are of particular importance, since presence of inflammation is associated with higher risk of neurological injury in neonates.

Hypothesis: We hypothesized that DM may be particulary effective in a model of inflammation-sensitized perinatal brain-injury since NMDAR-antagonist and anti-inflammatory properties of DM are added.

Methods: We used an established rodent model of excitotoxic brain-damage that mimics key characteristics of human periventricular leukomalacia. On postnatal day (P)5 animals were randomized into three pre-injury groups: i) vehicle intraperitoneal (i.p.), ii) IL-1β (10 ng) i.p. from P1 to P4 and iii) single injection of LPS (1 μg) i.p. 6h before injury (single intracranial injection of ibotenate into one hemisphere). After the insult, animals were further randomized into two groups: i) vehicle i.p. and ii) DM (5 μg/bwg) i.p. Treatment regimen of DM was based on our previous results. Brains were analyzed 24 hours after setting the lesion.

Results: Pre-treatment with IL-1β or LPS significantly enlarged NMDAR-mediated excitotoxic brain-damage and increased the amount of activated microglial cells in white matter and cortical plate. This sensitizing effect was completely abolished by DM in terms of both lesion size and microglial cell activation.

Conclusion: Although functional parameters were not measured, our data corroborate reports that DM is neuroprotective, also via its anti-inflammatory effect. Our study supports a putative beneficial role of DM in neonatology.

564 SUCCESSFUL PERCUTANEOUS REMOVAL OF A BROKEN UMBILICAL VEIN CATHETER FROM LEFT ATRIUM WITH VENA CAVA INFERIOR THROMBOSIS IN A PREMATURE NEWBORN

A. Saygili¹, F. Okan², S. Dağdelen³, A. Yağcı⁴

¹Acibadem Hospital, Pediatric Cardiology, Istanbul, Turkey;²Acibadem Hospital, Neonatology Unit, Istanbul, Turkey;³Acibadem Hospital, Istanbul, Turkey;⁴Acibadem Hospital, Anestesiology, Istanbul, Turkey

A 28-week preterm infant weighing 1.250 gr born with cesarian section had a broken umbilical vein catheter lodged in the left atrium. The catheter was later found to have fractured, and a 7 cm piece of catheter was lodged in the patient's vena inferior to right atrium. We successfully retrieved percutaneously by fluoroscopically guided cardiac catheterization using a cobra catheter and a snare wire without complications. Fracture and embolization of a umbilical vein catheter is a rare but serious complication, and we report our experience of catheter umbilical vein catheter fracture and embolization in a premature infant, in which the catheter fragment was retrieved via a percutaneous endovascular approach.

565 IMMEDIATE AND DELAYED CORD CLAMPING IN INFANTS BORN BETWEEN 26 AND 34 WEEKS

L. Sekhavat, A. Tabatabaii

Shahid Sedughi University of Medical Sciences and Health Services, Ob&Gy, Yazd, Iran

Objective: The purpose of this study was to test whether delayed versus immediate cord clamping would result in higher blood pressure (BP), hematocrit (Hct) and blood glucose (BS), and other outcome on the neonatal course in premature neonates.

Material and Method: In a prospective, randomized, controlled study, prior to delivery, 24 neonates were randomly assigned to immediate cord clamping (ICC) at 10 to 15 seconds, and a comparable group of 28 neonates were randomly assigned to delay cord clamping (DCC) at 30 to 60 seconds.

Result: Intention-to-treat analyses revealed that the DCC group tended to have higher initial mean BP and higher mean Hct (ICC = 34% mg/dl, DCC = 41% mg/dl; p = 0.00), and needed less mechanical ventilation and surfactant compared with ICC neonates. Infants with DCC did not experience more polycythemia (Hct > 60%), but had a trend toward higher bilirubin levels with no differences in the phototherapy needs. DCC group infants had higher initial glucose levels (ICC = 49.1 mg/dl, DCC = 75.6 mg/dl; p = 0.00).

Conclusion: DCC seems to be safe and may be beneficial when compared with ICC in premature neonates. DCC improved blood pressure and blood glucose in premature neonates. However, other findings deserve consideration for further study.

566 IMMEDIATE AND DELAYED CORD CLAMPING IN INFANTS BORN BETWEEN 26 AND 34 WEEKS

L. Sekhavat, A. Tabatabaii

Shahid Sedughi Hospital, Shahid Sedughi University of Medical Sciences and Health Services, Department of Obstetrics & Gynecology, Yazd, Iran

Objective: The purpose of this study was to test whether delayed versus immediate cord clamping would result in higher blood pressure (BP), hematocrit (Hct) and blood glucose (BS), and other outcome on the neonatal course in premature neonates.

Material and Method: In a prospective, randomized, controlled study, prior to delivery, 24 neonates were randomly assigned to immediate cord clamping (ICC) at 10 to 15 seconds, and a comparable group of 28 neonates were randomly assigned to delay cord clamping (DCC) at 30 to 60 seconds.

Result: Intention-to-treat analyses revealed that the DCC group tended to have higher initial mean BP and higher mean Hct (ICC = 34% mg/dl, DCC = 41% mg/dl; p = 0.00), and needed less mechanical ventilation and surfactant compared with ICC neonates. Infants with DCC did not experience more polycythemia (Hct > 60%), but had a trend toward higher bilirubin levels with no differences in the phototherapy needs. DCC group infants had higher initial glucose levels (ICC = 49.1 mg/dl, DCC = 75.6 mg/dl; p = 0.00).

Conclusion: DCC seems to be safe and may be beneficial when compared with ICC in premature neonates. DCC improved blood pressure and blood glucose in premature neonates. However, other findings deserve consideration for further study.

567 MATERNAL RISK FACTORS AND EARLY-ONSET NEONATAL SEPSIS

A. Selimovic¹, F. Skokic¹, Z. Selimovic²

¹University Clinical Center, Tuzla, Bosnia and Herzegovina, Department of Neonatology, Clinic for Gynecology and Obstetrics, Tuzla, Bosnia and Herzegovina;²Clinic for Surgery, University Clinical Center, Tuzla, Bosnia and Herzegovina, Department of Urology, Tuzla, Bosnia and Herzegovina

Objective: To analyse various maternal risk factors to determine their effects on early-onset neonatal sepsis (EONS) in a tertiary care neonatal unit of Clinic for Gynecology and Obstetrics, Tuzla.

Methods: Relevant data of analysed neonates born from January, 2004 to December, 2006 were obtained from their case records. A diagnosis of EONS was made if neonate had positive culture (blood, CSF or urine), clinical, radiographic or laboratory findings consistent with sepsis within 72 hours of life.

Statistical analysis: MedCalc statistical software (version 8.1) was used for analysis.

Results: Of the 341 neonates with maternal risk factors, 199 (58.4%) had EONS. The rate of EONS among neonates with the prolonged rupture of membranes was 93/199 (46.7%) with low OR:0.178 (95%CI:0.101–0.307). Intrapartum fever was related to EONS among 40/199 (20.1%) neonates, with high OR:3.717 (95%CI:1.691–9.008). Chorioamnionitis and excessive vaginal discharge were related to EONS in the same per cent 15.6%, whereas Odds ratio was high for chorioamnionitis (4.182;95%CI:1.648–12.580), and low for excessive vaginal discharge (1.271;95%CI:0.654–2.529). EONS occurred among 35/199 (17.6%) neonates whose mothers had urinary tract infection, with high OR:4.115 (95%CI: 1.723–11.729).

Conclusion: The rate of EONS is high among neonates with maternal risk factors. EONS is more likely to develop among neonates whose mothers has chorioamnionitis, urinary tract infection and intrapartum fever.

Keywords:Neonate, Early-onset, Maternal risk factors, Sepsis

568 NEONATAL OUTCOME OF TWINS DEPENDING ON PRESENTATION AND DELIVERY MODE

M. Skender, M. Raicevic-Pavlovic, L. Avramovic, V. Corac-Stojakov, R. Mijailovic-Borlja, V. Ljubic

Clinical Hospital Centre Zemun-Belgrade, Gynecology and Obstetrics, Belgrade, Serbia

To examine the neonatal outcome of twins, depending on presentation and delivery mode (MOD).

A retrospective study of live born, nonanomalous twins, delivered at Clinical Hospital Centre Zemun-Belgrade (1998–2007) was performed. The study subjects (150 twin sets) were divided, according to presentation, into 4 groups: vertex-vertex (Vx-Vx), vertex-nonvertex (Vx-NVx), nonvertex-vertex (NVx-Vx) and nonvertex-nonvertex (NVx-NVx). The mean 5-minute Apgar score (AS-5), incidence of respiratory distress syndrome (iRDS), cerebral pathology and neonatal mortality of each group were analised according to MOD: vaginal-vaginal (VV), cesarean-cesarean (CC) or vaginal-cesarean (VC). Statistical analysis was performed using chi-square and Student's T test.

From 300 neonates, VV/CC ratio was: in Vx-Vx: 90/50, in Vx-NVx: 52/24, in NVx-Vx:12/30 and in NVx-NVx: 9/21. VC group included 6 twin sets. We found a significantly: higher iRDS at VV versus CC twins in NVx-NVx group (χ² = 4.46, p < 0.05), lower AS-5 at VV versus CC in NVx-Vx group (t = 2.12, p < 0.05), both without significant difference after excluding the babies weighing < 1500 g (VLBW); lower AS-5 of second twin from VC group, versus his co-twin (t = 4.6, p < 0.01), and versus the second twin from CC group (t = 4.37, p < 0.01). No significant difference in mortality between the groups was registered, regardless of presentation or MOD.

The risk of perinatal asphyxia is increased for cesarean second twins whose co-twins delivered vaginally, whatever the gestational age. Neonatal outcome of VLBW twins relate to gestational age more than to presentation and MOD. Delivery could be safely achived vaginally regardless of fetal presentation in appropriate selected twin pregnancies.

569 IL-6 VALUES FROM THE BLOOD OF UMBILICAL CORD IN PREDICTION OF EARLY BRAIN DAMAGE

F. Skokić¹, A. Babović¹, A. Ćosićkić², A. Selimović¹

¹Clinic for Gynecology and Obstetrics, University Clinical Center, Department of Neonatology, Tuzla, Bosnia and Herzegovina;²Clinic for Children's Diseases, University Clinical Center, Department of Imunology, Tuzla, Bosnia and Herzegovina

Objective: To examine predictive value of interleukin 6 (IL-6) in the blood of umbilical cord in detection of early brain damage.

Examinees and methods: This prospective study was made at the Clinic of Gynecology and Obstetrics in Tuzla in the period from 1.1. to 31.12. 2007. It included 315 newborns with the birth weight of < 2.500 grams. IL-6 values were analysed from the blood of umbilical cord of newborns with peri and intraventricular bleeding (PV and IVH) and hypoxic-ischemic encephalopathy (HIE) and compared to ultrasonic results.

Results: 113/315 (35.8%) newborns had early brain damage. 37/117 newborns had PV and IVH, with median IL-6 = 21.1 pg/ml, HIE 33/117 (IL-6 = 16 pg/ml) and 43/117 newborns had both bleeding and HIE with median IL-6 = 19.5 pg/ml. The difference in median IL-6 between groups is not significant (p > 0.05). IL-6 values in all three groups were increased. The sensitivity of IL-6 for early brain damage compared to ultrasound is 100%.

Conclusion: IL-6 from the blood of umbilical cord is reliable in prediction of early brain damage in newborns, but IL-6 is still an expensive test which requires a long period of waiting and cannot be used as a routine test.

Keywords:IL-6, early brain damage, low birth weight, newborn

570 WHAT ARE THE RISK FACTORS FOR NEUROLOGIC IMPAIRMENT OF CHILDREN BORN PRETERM

S. Škrablin, I. Maurac, V. Banović

School of Medicine University of Zagreb, Dept. of Perinatal Medicine, Zagreb, Croatia

Objective: To investigate perinatal risk factors for long term neurologic impairment in preterm infants.

Study design: Perinatal factors of 60 neurologically impaired and 60 healthy infants matched by birth weight and gestational age were compared. Multiple logistic regression was done entering variables shown to be significant at univariate level.

Results: Unlike mothers of children suffering cerebral palsy (CP), mothers of children suffering minimal cerebral disfunction (MCD) were more frequently primiparas. Neurological impairment was unrelated to maternal pregnancy complications, steroid administration, bacteriological analysis of cervical smears, presentation, mode of delivery, pathologic fetal heart rate (FHR) or doppler analyses. In CP children membrane rupture to delivery interval of 5 or more days and pathohystological signs of multiple placental lesions were significantly more frequent, Apgar scores were significantly lower. CP children suffered more often perinatal asphyxia, early neurological dysfunction, septicemia and had pathologic neonatal brain ultrasound (US). The correlation of clinical chorioamnionitis and neurologic impairment was borderline. Antibiotic prophylactic, but not therapeutic use, was followed by significantly less frequent neurologic impairment. Umbilical artery pH values, but not base excess (BE), were significantly lower in both CP and MCD infants. Multiple placental lesions, former term deliveries, neonatal septicemia, severe brain US abnormality and perinatal asphyxia showed independent correlation to long term neurologic handicap.

Conclusions: Perinatal infection, clinical signs of perinatal asphyxia and brain ultrasound (US) abnormality, seem to be the most important risk factors in the development of CP. Primiparity and fetal blood acidosis seem to be correlated to the occurrence of MCD.

571 RESPIRATORY DISTRESSAT TERM AND NEAR TERM NEONATES IN A LEVEL III NICU

M. Stamatin¹, L. Paduraru¹, S. Ghironte², M. Alboi²

¹University of Medicine and Pharmacy “Gr. T. Popa”, Neonatology, Iasi, Romania;²“Cuza-Voda” Clinical Hospital of Obstetrics and Gynecology, Regional Center of Neonatal Intensive Care, Iasi, Romania

Background: Neonatalrespiratory distress is specific for prematures, but there are still many termor near term cases presenting with this clinical syndrome of various etiology.

Objective: Was to evaluate incidence, morbidity, respiratory therapy and outcomefor babies more than 34 weeks gestation.

Material and Methods: We evaluated 228 neonates admitted into level III NICU for clinical signs of respiratory distress, considered into group I (35–36 wg – 122 cases) and group II (>36 wg – 106 cases).

Results: Significantly statistic higher incidence of TTN (35.2% vs. 24.5%), BMH (9.8% vs. 7.5%) was noticed in group I, but SAM was higher in group II. No significant difference was found for bronchopneumonia or infection in the two groups. Also HIE, pulmonary hypertension were higher in term babies but pulmonary hemorrhage, pneumothorax were higher in near term babies. Group I presented better rate of survival (93.5%) than group II (82.1%) due of higher incidence in this group of cardiac malformations and severe asphyxia. Treatment with free flow oxygen was efficient and sufficient more in group I (41.8% vs. 34%), and also CPAP (33.6% vs. 22.6%), but not for mechanical ventilation, that was more necessary in term babies with respiratory distress (43.4% vs. 24.6%), related with the specific pathology.

Conclusions: Respiratory distress still affects term or near term babies. Cesarian section,asphyxia and mild hypoxia are main risk factors. CPAP can be a useful management especial for near term babies with mild respiratory distress of various etiology.

572 NEUROLOGICAL DISFUNCTION IN MACROSOMIC NEWBORNS OF NONDIABETIC MOTHERS

I. Stojkovic-Eferica, S. Sljivic, M. Stojanovic

Gynecology and Obstetric Clinic, Neonatology, Nis, Serbia

Aim: ofthisstudy was to point out prental activation of the immune system in macrosomicnewborn with neurological dysfunction.

Methods: This studyinclude 30 term macrosomic newborns (PTM > 4000 g) from nondiabetic mothers. Mother's case history, neurological assessment, laboratory examination (blood cellcount, NBT test, serum immunoglobulin levels, lactate dehydrogenase and creatinphosphokinase activities, glycemia, ultrasound examination of CNS, have been analyzed.

Results: All mothershad pregnancies complicated with multiple and diverse acute and chronicdisorders. The most frequent problem were recurrent urogenital infections, no onehad gestational diabetes. Neurological dysfunction was present in 86.6% newborns, hypotonia in 66.6%, hypertonia in 20%, altered reflex activity in 76.6%, convulsions in 10%. Ultrasound examination of CNS showed intracranial hemorrhagein 43.3% and cysts in plexuses chorioidei in 26.6%. Moderate parental asphyxiawas present in only 16.6%. Laboratory findings showed: elevated level of totalserum IgM, increased absolute number of neutrophyls, monocytes and NBT positivecells, increased activity of CPK and LDH, transient hypoglycemia in 83.3% of newborns.

Conclusions: Increased serum IgM, increased absolute number of neutrophyls, monocytesand NBT positive peripheral blood phagocytes, indicate prenatal activation ofimmune system and inflammatory cascade. Inflammatory cytokines may cause neuronal andwhite matter damages during development of CNS. IL-1 beta, the main mediatorof early inflammatory response in CNS, can induce increased production of IGF-1in all fetal tissues, resulting in fetal macrosomia, even in absence ofmaternal hyperglycemia and fetal hyperinsulinism. These disturbances can becommon etiopathogenetic factor of fetal overgrowth and neurological dysfunction.

573 PAIN SYNDROM IN NEWBORN: CURRENT MANAGEMENT AND FUTURE PROSPECTS

P. Stratulat, A. Curteanu, T. Caraus

Mother&Child Health Care Research Institute, Perinatology, Chisinau, Moldova

The aim of the newborn's pain syndrome study was to test in practice the scales of pain evaluation.

Materials and Methods: 36 newborns with severe and mildly severe pathology from NICU have been examined: in 18 of them the acute pain has been evaluated with the Neonatal Infant Pain Scale (NIPS), whereas in other 18 children the chronic pain has been examined with the Pain and Discomfort Scale.

Results: The usage of NIPS has shown that 8 (44.4%) of children have suffered major pain appreciated with 7–8 points, 8 (44.4%) – mildly severe pain appreciated with 6–4 points and 2 (11.1%) of children reduced pain, estimated with 3 points. The most frequent signs of acute pain were: face grimaces and changes in breathing (88.8%), weeping and tachycardia (27.7%); stiffness of the inferior limbs, rigidity or their rapid flexion/extension (44.4%) and rarely – intense cry, agitation, the increase of the O₂ (33.2%). The manifestations of the chronic pain have varied according to the intensity and duration: the most intensive pain had its onset in the first day, being measured with 14–8 points, in the 2^nd and 3^rd day the pain was less severe, estimate with 6 or less points. For the reduction of pain, the following have been used: sol. Analgin, supp. Paracetamol, the combination of Analgin, Dimedrol and Diazepam, sol. Novocain, and Traumel locally.

Conclusion: For the improvement of the treatment of pain, the use of pain recognition and evaluation protocols is needed, while the therapy requires more efficient remedies.

574 EFFECT OF TOCOLYTIC MAGNESIUM SULFATE ON NEONATAL ADVERSE OUTCOMES IN LESS THAN 32 WEEKS OF AGE

T.-J. Sung¹, T.-Y. Kim¹, H.-H. Lee¹, J.-A. Lee²

¹Department of Pediatrics, College of Medicine, Hallym University Medical Center, Seoul, Korea;²Department of Pediatrics, College of Medicine, Seoul National University Hospital, Seoul, Korea

Objective: The study was performed to access the effect of tocolytic magnesium sulfate (MgSO₄) on neonatal outcomes in preterm babies less than 32 weeks of age.

Methods: A prospective study was performed with inborn infants less than 32 weeks of age. They were divided into two groups; born from mother treated with or without MgSO₄ from July 2006 to December 2007. Total magnesium (tMg), ionized Mg (iMg), and pH were collected immediately after delivery or within 3 hours of birth. Adverse outcomes such as respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and mortality rate were compared between two groups.

Results: Among 80 neonates eligible for this study, 56 were born from MgSO₄-treated mother (study) and 24 were not (control). Mean level of tMg and iMg were significantly higher in study group (3.56 ± 1.47 vs 2.30 ± 0.77 mmol/L, p < 0.001, 0.75 ± 0.28 vs 0.58 ± 0.17 mmol/L, p < 0.05). Mean gestational age and mean birth weight were indifferent in two groups. Incidences of RDS, BPD, ROP, ROP with laser treatment, and mortality were not significantly different. However, incidence of IVH was higher in study group (55.4% vs 25%, p = 0.015) and this was still significant with logistic regression adjusted for gestational age and birth weight (OR 3.44, 95% CI 1.15–10.26).

Conclusions: Our study showed that administration of antenatal tocolytic MgSO4 may increase the risk of IVH for preterm baby and hence obstetrician should consider its adverse effects.

575 ASSOCIATION OF IONIZED MAGNESIUM, TOTAL MAGNESIUM, AND GESTATIONAL AGE IN PRETERM BABIES

T.-J. Sung¹, T.-Y. Kim¹, H.-H. Lee¹, J.-A. Lee²

¹Department of Pediatrics, College of Medicine, Hallym University Medical Center, Seoul, Korea;²Department of Pediatrics, College of Medicine, Seoul National University Hospital, Seoul, Korea

Objective: Although magnesium is the second highest electrolyte in the body, its pathophysiology is still under investigation especially in preterm babies. Our first goal was to access the association between magnesium (Mg), ionized Mg (iMg) and gestational age in preterm babies and second goal was to access the association between preterm babies' hypermagnesemia and adverse outcomes.

Methods: A prospective study was performed in inborn preterm infants who were admitted to our institution from July 2006 to December 2007. Exclusion criteria were those whose mothers were administered with antenatal magnesium at any time before pregnancy and babies with congenital anomaly. Mg, iMg, calcium (Ca), and ionized Ca (iCa) were collected immediately after delivery or within 3 hours of birth. Incidence of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and intraventricular hemorrhage (IVH) were compared between hypermagnesemia group, defined as more than 2.9 mg/dL, and normal group.

Results: One hundred twenty nine neonates were eligible for this study. IMg was significantly correlated with Mg (r = 0.367, p < 0.001). However, there were no correlation between iMg and gestational age, Ca, iCa, and Apgar score at 1 min and 5 min. Among adverse outcomes, only the incidence of IVH was higher in hypermagnesemia than normal group (23.8% vs 7.5%, p = 0.04).

Conclusions: In preterm babies less than 37 weeks of age, the level of iMg was similar regardless of gestational age. Additionally, preterm babies with high magnesium without exogenous magnesium supply should be screened for IVH.

576 CONCENTRATION OF ADIPONECTIN IN THE UMBILICAL BLOOD OF HEALTHY, FULL-TERM NEWBORNS: NO CORRELATION WITH BIRTH WEIGHT AND PONDERAL INDEX

M. Szczepanski¹, B. Chrostowski¹, S. Wolczynski²

¹Medical University of Bialystok, Department of Neonatology, Bialystok, Poland;²Medical University of Bialystok, Department of Gynecological Endocrinology, Bialystok, Poland

The aim of this study was to estimate the possible correlation between adiponectin concentration in the umbilical blood of healthy newborns and their anthropometric parameters, as birth weight and ponderal index.

Materials and Methods: The study investigations covered 100 healthy, full-term newborns in good general conditions. Only newborns with the result of 8 or more in Apgar scale were included. The women were strictly selected due to possible factors influencing adiponectin concentration in the blood. The umbilical blood was taken immediately after delivery. The concentration of adiponectin was measured using radioimmunoassay.

Results: Adiponectin concentration in the umbilical blood range from 8.7 to 54.8 μg/ml (30.5 ± 9.63 μg/ml). There were no correlation between adiponectin concentration in the umbilical blood and birth weight (mean: 3385 ± 441 g: range: 2490–4400 g). Either no correlation between adiponectin concentration and ponderal index has been shown.

Conclusions: The study result indicated that in the physiological pregnancy fetal growth is mainly genetically determined. The healthy newborn, in spite of different anthropometric features (birth weight, ponderal index) indicate similar glucose tolerance, estimated as a serum adiponectin concentration. Low adiponectin concentration in the blood of SGA newborns, described by others, need to be explained in the separate study.

577 NEONATAL OUTCOME OF PRETERM PREMATURE RUPTURE OF MEMBRANES: INPATIENT VERSUS OUTPATIENT MANAGEMENT

S. Taghavi, F. Abam, S.H. Abbasalizadeh, F. Abbasalizadeh

Alzahra Hospital, Obstetrics & Gynecology Department, Tabriz Medical Science University, Tabriz, Iran

Objective: The best caring of the pregnant woman whose pregnancy has been complicated with PPROM plays an important role to minimize risks and maximize the probability of the desired outcome. The aim of this study was to assess and compare neonatal outcome of inpatient and outpatient management of PPROM in singleton pregnancies.

Materials and Methods: Sixty women presenting with PPROM between 26 + 0 and 32 + 0 weeks' gestation referred to the Al-Zahra Hospital in Tabriz, Iran were eligible for participation. All patients were observed for one week in hospital and then were divided randomly into two inpatient or outpatient groups with 30 pregnant women.

Results: Latency period to delivery (P < 0.0001) and 1^st minute Apgar (P = 0.006) were higher in outpatient group, whereas 5th minute Apgar (P < 0.0001), necessity for ventilation (P = 0.037), and necessity for NICU admission (P = 0.020) were more in inpatient group. Also, neonates in inpatient group had lower FHR than other neonates (P = 0.005). Neonatal mortality in inpatients was 10% and no mortality was occurred in outpatient group. Among maternal criteria, no significant differences in all studied criteria between the two groups were found.

Conclusions: According to the similar maternal complications and low neonatal complications of outpatient management, this management can be suitable for women with PPROM and accompanied with low patient and family stress and economic burden.

578 EFFECT OF ZINC DIETARY LEVELS ON ANTHROPOMETRICAL OF OFFSPRINGS

S. Tahmasebi, M. Shahbazi, N. Naghdi, A. Seghatoleslami

University of Tehran, Tehran, Iran

The purpose of this study was to evaluate effect of Dietary Zinc Levels during gestation on Anthropometrical Parameters of rat's offspring. Zinc deficiency (ZD) and Zinc supplement (ZSu) during gestation affects on physical growth and development. Adult male and female rats (Albino-Wistar) were obtained from the Pasteur Institute, Iran. After mating, 9 pregnant female rats divided into 3 groups: 1) ZD (< 1 ppm); 2) Control ( = 40 ppm) 3) ZSu ( = 50 ppm). All pregnant rats fed in last semester. Maternal blood was obtained before and after dietary to measurement serum zinc concentration. After delivery selected 12 offspring in every group. Brain Weight and Body Weight was measured by Electronic balance: (0.0001 g) and Crown-Rump length, tail length, Head width, Head length was measured by Caliper (0.01 mm). The statistical analysis was One-Way ANOVA (p < 0.05). Post-hoc analysis was made by Tukey's Test. The results showed serum zinc concentration after to exert dietary (in contrast before to exert dietary) in all groups was significant. There was significant difference in some anthropometric parameters (Body Weight, Crown-Rump length, Tail length, Head length) between ZD and control groups but wasn't seen significant difference in Head width and Brain Weight between ZD and control. There was significant difference in some anthropometric parameters (Body Weight, Tail length, Head length) between ZD and ZSu. The results of this study suggest that equate zinc affect on anthropometric parameters.

Keywords:Zinc deficiency diet, Zinc supplement diet, Anthropometrical parameters

579 OBSTETRIC RISK FACTORS ASSOCIATED WITH THE DEVELOPMENT OF PERIVENTRICULAR LEUKOMALACIA IN PRETERM INFANTS BORN TO MOTHERS COMPLICATED BY PLACENTA PREVIA

K. Takeuchi, K. Kitao

Hyogo Prefectura Tsukaguchi Hospital, Department of Obstetrics and Gynecology, Amagasaki, Japan

Objectives: This study was designed to evaluate the effect of risk factors on the occurrence of periventricular leukomalacia (PVL) in preterm infants from pregnancies complicated by placenta previa.

Study design: The association between obstetric risk factors and PVL was assessed in 30 singleton live births complicated with placenta previa delivered between 24 and 33 weeks gestation. Each infant underwent at least two cranial ultrasounds: the first before 72 hours and the second around 14 days of life. Analysis of variance was used to compare continuous variables across groups.

Results: The obstetric factors in infants with PVL were compared to those in infants with negative cranial ultrasonographic findings. The main risk factors for PVL in preterm placenta previa were initial antepartum hemorrhage < 28 weeks gestation (OR 13.7; 95% CI 1.38–136.2), although the differences of gestational age of delivery between two groups were not statistically significant. Low Apgar score (< 7) at 1 minute increased the risk of PVL (OR 8.89; 95% CI 12.9–61.1), while no associations with PVL were observed in low Apgar score at 5 minutes, neonatal acidosis (pH < 7.2), and neonatal anemia (Hb < 14 g/dl).

Conclusions: This study demonstrates that initial antepartum hemorrhage during the second trimester and low Apgar score at birth increase the risk of PVL in preterm infants born to mothers with placenta previa. We speculate that the pathophysiologic mechanisms for this finding may be due to decreased placental perfusion in the second trimester of pregnancy, which is the developmental window of vulnerability for PVL.

580 DETERMINATION OF VITAMIN D AND CALCIUM METABOLISMS OF TERM NEWBORNS AND MOTHERS AND ASSESSMENT OF BONE STRENGTH BY QUANTITATIVE ULTRASOUND

E. Canda¹, N. Tansuğ², B. Ersoy³, C. Ulman⁴, Y. Bülbül Baytar⁵

¹Celal Bayar University, Pediatrics, Manisa, Turkey;²Celal Bayar University, Neonatology, Izmir, Turkey;³Celal Bayar University, Pediatric Endocrinology and Metabolism, Manisa, Turkey;⁴Celal Bayar University, Biochemistry, Manisa, Turkey;⁵Celal Bayar University, Obstetrics and Gynecology, Manisa, Turkey

Aim: Changes in mothers' bone turnover during pregnancy effect bone mineral composition of the fetus. The aim of this study was to evaluate the factors determining fetal bone mineralization including biochemical markers, the factors effecting vitamin D metabolism, and to assess bone structure by quantitative ultrasonography.

Methods: Ninety term newborns and mothers were enrolled in this study. Serum levels of Ca, P, ALP, bone ALP, 1.25(OH)2D, 25(OH)D, parathyroid hormone (PTH), and osteocalcin were analyzed from the serums of mothers and newborns. Quantitative ultrasound was performed for all infants. SOS and Z scores were recorded.

Results: Mean values for 25(OH)D and 1.25(OH)2D were within normal ranges in mothers. Significant correlations were observed between 25(OH)D levels of the mothers and PTH and 25(OH)D levels of newborns. Serum 25(OH)D values were higher in mothers who used vitamin D supplementation, PTH values were higher and osteocalcin values were lower in mothers who did not use vitamin D supplementation. PTH values were lower in newborns whose mothers did not receive vitamin D supplementation. Mean SOS value was 3127 ± 107, and mean Z score was 0.3 ± 0.7. Significant correlation was observed between the SOS scores and Ca, ALP values of the newborns. SOS scores of newborns whose mothers consumed caffeine products during pregnancy were lower than the newborns whose mothers did not consume caffeine products.

Conclusion: Vitamin D values of the mothers and biochemical bone markers, vitamin D values and SOS values, which were assessed by quantitative ultrasound, of the newborns were within normal range in our region.

581 USE OF RECOMBINANT-HUMAN ALPHA-ERYTHROPOIETIN FOR EXTREMELY PREMATURE BABIES IN A 3RD LEVEL NON-ACADEMIC NICU

A. Tempera, E. Stival, D. De Luca, C. Ottaviano, N. Rossi, C. Cafforio, E. Buffone, M. Assumma

Neonatal Intensive Care Unit, Neonatology – S.Camillo General Hospital, Roma, Italy

Background: Erythropoietin (r-hu-EPOa) has been supposed to be useful for sparing blood transfusion in extremely preterm infant admitted to NICUs. Very few data are available about the usefulness and safety of r-hu-EPOa administration and its use is still on debate. We were aimed to embark in a pilot study to verify possible efficacy of r-hu-EPOa during the clinical routine assistance of preterm babies in a 3rd level non-academic NICU.

Methods: All babies with BW < 1250 gr and GA < 30 were eligible. We enrolled the first ten babies meeting these characteristics who were born in 2007 and we choose as controls babies born immediately before and after every study neonate. R-hu-EPOa was administered as 300 IU/kg/dose 3 times/week subcutaneously. Primary endpoint was the blood transfusion requirement. Clinical data were real-time recorded.

Results: Ten babies were enrolled in the study group and 20 as controls. Treated babies received significantly less transfusions compared to controls (4 vs 23; p < 0.001). Mean number of transfusions/neonate was significantly higher in control babies (1.15 vs 0.4; p = 0.02). A non significant reduction in BPD incidence and mechanical ventilation time was observed. No differences in ROP incidence were noted, as for neurological events.

Discussions: R-hu-EPOal is potentially useful in extremely preterm babies admitted to a non-academic NICU. Its use also appears safe and without raising of any side effects. Larger randomised studies are warranted to clarify the protective role of this drug in critically ill preterm babies.

582 THORAOSCOPIC CORRECTION OF ESOPHAGEAL ATRESIA

W. Treef, F. Schier, S. Turial, A. Weltzien, V. Engl

University Medical Center Mainz, Pediatric Surgery, Mainz, Germany

To report the experiences with minimally invasive repair of esophageal atresia.

13 children, 5-mm optic and two 2-mm trocars for the two hands of the surgeon. In three children, the distance was found to be too long to be joined immediately. In two, the fistula was ligated and the thoracoscopy terminated. In the third, Foker threads were placed thoracoscopically and a gastrostomy laparoscopically. In the remaining 10 children, the esophagus was anastomosed thoracoscopically. The mean operating time was 90 minutes.

Among the 11 children with primary anastomosis, three had a completely uneventful postoperative course. Three further children required 2–4 dilatations. Three other children seem to have permanent swallowing difficulties. In one child, an anastomotic leak occurred. One child developed a recurrent fistula. An open thoracocotmy was performed and the fistula closed. The Foker procedure resulted in an intrathoracal abscess, a drainage procedure (thoracotomy), a recurrent fistula and a further thoracotomy.

The second child with long gap atresia child was successfully operated on thoracoscopically 4 months later. The third child the distance was still too long 4 months later. An open thoracotomy was performed and the stomach pulled up. 14 months later, a third of the stomach is above the diaphragm but the child is doing perfect. A hiatoplasty is scheduled.

Thoracoscopic correction of esophageal atresia is feasible. It requires more operating time. It had more complications than we had seen with the open approach. It avoids, however, all the the long-term complications of thoracotomy.

583 EARLY SCREEN AND TREAT STRATEGY FOR LOWER GENITAL TRACT INFECTIONS IN WOMEN SCREENED FOR GESTATIONAL DIABETES MELLITUS TO IMPROVE MATERNAL AND PERINATAL OUTCOME

A.R. Tristão¹, M.G. Silva², J. Polettini², I. Maestá¹, F. Gondo¹, M.V.C. Rudge¹

¹São Paulo State University, Gynecology &Obstetrics, Botucatu, Brazil;²São Paulo State University, Pathology, Botucatu, Brazil

Objectives: To evaluate the prevalence of lower GTI in positive GDM screening and whether an early screen and treat strategy for lower GTI improves maternal and perinatal outcome.

Patients and Methods: Case control study with 400 pregnant women split into four groups according to GDM screening and a screen and treat strategy for lower GTI which included vaginal sample collection, prescription and follow-up.

Results: The prevalence of lower GTI in 200 GDM screened was 68.5%. The screen and treat strategy for lower GTI in GDM screened patients improved gestational, perinatal and puerperal outcome. It increased the risk for gestational age ≥ 37 weeks (OR = 3.01, CI 95% 1.26–7.18) and newborn weight (NBW) > 2500 g (OR = 6.36, CI 95% 2.87–14.06), and decreased the risk for adverse gestational outcome (OR = 0.25, CI 95% 0.13–0.48) and for adverse perinatal outcome (OR = 0.31, CI 95% 0.16–0.59). Positive GDM screening increased the risk of cesarean section (OR = 2.02, CI 95% 1.06–3.85). There was no interaction between screen and treat strategy for lower GTI and screening for GDM.

Conclusions: The early screen and treat strategy for lower GTI improved gestational, perinatal and puerperal outcome in positive and negative GDM screening. This strategy needs to be incorporated into the first prenatal care visit, regardless of positive or negative GDM screening.

584 THE EVALUATION OF PERINATAL AND MATERNAL COMPLICATIONS, TYPE OF DELIVERIES AND NEONATAL OUTCOMES IN MACROSOMIC AND NORMAL WEIGHED NEWBORNS

L. Ünlü Civak, S. Etiz Sayharman, N. Aka, G. Köse, C. Tüfekçi

Haydarpasa Numune Education and Research Hospital, Obstetrics and Gynecology, Istanbul, Turkey

Objective: The aim of this study was to evaluate the perinatal and maternal complications, the type of the deliveries and neonatal outcomes in the patients whose newborns were weighing 4000 gr and over (macrosomic) and between 2500–3999 gr (normal).

Material and Methods: This retrospective study was done based upon the records of the patients who were given birth between 01.01.2000 and 31.12.2007 in Department of Obstetrics in Haydarpasa Numune Education and Research Hospital. There were totally 6777 patients. We included 1025 patients to our study. In the study group (n = 515) the newborns were weighing 4000 gr and above(macrosomic) and in the control group (n = 510), who were selected randomly, the newborns were weighing 2500–3999 gr (normal). The patients who were given birth before 37 weeks, the multiple gestations and intrauterin growth restricted babies were excluded from the control group.

Results: Of the 515 macrosomic newborns, 444 of them (86.21%) were 4000–4499 gr, 60 of them (11.05%) were 4500–4999 gr and 11 of them (2.13%) were 5000 gr and above. Maternal complications were seen 22.04% in the study group, whereas 7.25% in the control group. There were 4 perinatal deaths;2 of them were intrauterine and 2 of them were neonatal deaths.

Conclusion: The risk of perinatal morbidity, maternal complications, birth trauma and neonatal complications were higher in the study group than in the control group. And this was statistically significant (p = 0.0001). But according to the perinatal deaths, there was no statistically significant difference between the two groups.(p = 0.267).

585 COORDINATION OF SUCKING, SWALLOWING, AND BREATHING IN HEALTHY FULL-TERM AND NEAR-TERM INFANTS

A.L.H. van der Meer

Developmental Neuroscience Laboratory, Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway

Successful feeding requires precise coordination of sucking, swallowing, and breathing. We aimed to describe the normal organization of bottle feeding in healthy newborn infants (10 full-term and 3 near-term). Sucking pressure and breathing movements were recorded by specialized pressure transducers. Swallowing sounds were recorded on a professional DAT sound recorder with a miniature microphone attached to the infant's throat. A well-coordinated feeding pattern showed flexibility and good control, and was characterized by a 1:1:1 coordination of sucking, swallowing, and breathing, where maximum sucking pressure was coordinated with breathing out, and swallowing took place just before the onset of the next suck and between breathing out and breathing in. An efficient sucking pattern was characterised by a relatively lower sucking pressure and longer duration of each suck. When the coordination broke down, breathing was typically the bottleneck, with infants being unable to maintain adequate ventilation while sucking and swallowing during nutritive feeding. In order to be able to positively identify abnormal feeding patterns that may be indicative of brain damage in infants who are neurologically at risk, detailed knowledge about what characterizes a normal feeding pattern is first required. The results of this study are promising as they provide us with norm data on the temporal organization between sucking, swallowing, and breathing. However, in order to be able to use feeding successfully to identify neurological problems in infants early on in life, more data on premature infants are warranted.

586 NEONATAL INTENSIVE CARE UNIT: ADMISSION AND OUTCOME

C. Veríssimo¹, C. Santos², V. Anacleto², E. Paulino², T. Matos¹, R. Barroso², F. Nogueira¹

¹Hospital Fernando Fonseca, Women's Department, Amadora, Portugal;²Hospital Fernando Fonseca, Neonatal Intensive Care Unit, Amadora, Portugal

Introduction: Neonatal Intensive Care Unit (NICU) admission relates to prenatal care, maternal and fetal pathologies, labor management and adaptation to extrauterine life.

Objectives: To identify risk factors for NICU admission; to scrutinize procedures, complications and outcomes.

Methods:

Design: retrospective systematic controlled study.

Group A – all newborns admitted to NICU between 01-01-2007 and 31-06-2007;

Group B (control) – newborns delivered immediately after.

Setting: Level III referral NICU and Maternal/Fetal Medicine Unit.

Analysis: SPSS 15.0.

Results: 2014 deliveries; 120 NICU admissions (6.0%).

Mother:

Age: A-29.0y; B-27.2y; p = 0.03;

Weight: A-88.8Kg; B-84.2Kg; p < 0.0001;

Height: A-162cm; B-164cm; p = 0.02;

Chronic hypertension: A-15.8%; B-2.5%; p = 0.001.

Pregnancy:

Visits: A-5.1; B-7.6; p < 0.0001;

Gestational age (GA) at 1^st visit: A-16.8w; B-13.1; p = 0.0001;

US exams: A-2.7; B-3.7; p < 0.0001;

GA at 1^st US exam: A-18.0w; B-14.2w; p = 0.0001;

IUGR: A-12.0%; B-0.0%; p = 0.0002;

Preeclampsia: A-7.5%; B-0.0%; p = 0.004.

Labor: Ruptured membranes: A-6.3h; B-5.0h; p = 0.03;

Meconium: A-25%; B-10%; p = 0.008;

Active phase: A-6.9h; B-5.9h; p = 0.008;

Nonreassuring CTG: A-16.7%; B-5.8%; p = 0.01;

Intrapartum CRP: A-3.4mg/dL; B-0.8mg/dL; p = 0.02.

Delivery:

GA: A-35.3w; B-38.0w; p < 0.0001;

Spontaneous: A-35.8%; B-56.7%; p = 0.001;

Cesarean-section: A-58.3; B-35.8%; p = 0.001.

Newborn:

Apgar score 1‘: A-7.3; B-8.6; p < 0.0001; 5': A-8.8; B-9.6; p < 0.0001;

Weight: A-2690 g (LBW-25%; VLBW-7.5%; ELBW-5%; SGA-15%); B-3511 g; p < 0.0001; Admission at 2.8h of life. CRIB-1.86; SNAP II-11.0; SNAPPE II-12.7.

Diagnoses: respiratory distress-50%; jaundice-30%; hypoglycemia-18.3%; anemia-17.5%; sepsis- 14.2%.

Procedures: IPPV-15.8%; high-frequency ventilation – 6.7%; inotropic support -6.7%.

Length of stay: 13.6d;

Dietary autonomy: 8.1d;

Mortality: 2.5%.

Conclusions: Early recognition, thorough evaluation and prompt treatment are crucial to achieve favorable neonatal outcome.

587 EFECT OF CUROSURF AND NASAL CPAP THERAPEUTIC USE AT RESPIRATORY DISTRESS SYNDROME AT PRETERM BABIES ENGLISH TITLE

V. Videnovic¹, N. Videnovic²

¹General Hospital Leskovac, Neonatology, leskovac, Serbia;²Medical Faculty Kosovska Mitrovica, Anesthesia et Intensive Care, Kosovska Mitrovica, Serbia

Introduction: Surfactant therapy with the use of nasal CPAP is as effective as it is early used during the RDS at preterm babies.

Aim of the work: Represent the therapeutic effects of Curosurf and nasal CPAP, on acid-base status, PaO2, PaCO2, SaO2 and the lenhgt of oxigenotherapy use.

Material and Methods: Two groups of 20 preterm babies with a high degree of RDS were examined by prospective study. At the examined group the “INSURE” technique was used (intubation-surfactant-extubation to nasal CPAP). Curosurf was used as a single dose of 100 mg/kg/bw and 5 minutes after the use, the infant was extubated and put on nasal CPAP. At the other, controlled group only nasal CPAP was used. Monitoring parameters were controlled 15 minutes before the used of Curosurf and during the first two hours after the medicine use.

Research results: The average ege of the children in the examined group at the time of the Curosurf application is 6.9 hours, average gestation age is 31.33 gw, body weight 1690 g, Apgar score 5.66/7.68. Silverman scor 5, RDS degree 3.91. Examined group, for the shoter period of time, got improvement in acidbase status, SaO2, need for less FiO₂ and shorter duration of oxigenotherapy (p < 0.00l) and less morbidity.

Conclusion: Surfactant substitution therapy is the curtail one in the RDS therapy with the support of nasal CPAP. As soon as CPAP is used, the chances for avoiding mechanical ventilation are bigger. Middle hard forms of RDS are very often overcome by putting the infants on CPAP without surfactnt treatment.

588 RISK FACTORS OF EARLY NEONATAL MORTALITY OF LOW BIRTHWEIGHT NEWBORNS BORN BY CESAREAN SECTION

S. Vrzic-Petronijevic, M. Petronijevic, J. Opalic, I. Babovic, D. Bratic, Z. Maricic, M. Pervulov, Z. Bogdanovic, R. Argirovic

Institute of Obstetrics and Gynecology, Clinical Centre of Serbia, Belgrade, Serbia

Aims: Analisys of early neonatal mortality of low birthweight newborns born by cesarean section.

Material and Methods: Low birthweight neonates (1000–2500 g) born by cesarean section during 5 year period were studied. Analysed group consisted of newborns who died in early neonatal period (22.9%), while the rest of these newborns were used as control group. Analyzed parameters were: maternal age, parity, gestational age, presentation, Apgar score, gender, birthweight, complications during pregnancy, and neonatal morbidity.

Results: No statistically significant differences were found regarding maternal age, parity and gender of newborns. Average gestational age was lower in analyzed group (32.25 weeks of gestation) comparing to control group (35.60 weeks of gestation) without statistical significance. Average Apgar score was significantly lower in analized group comparing to control (4.91 and 5.37; p < 0.01). In weight interval 1000–1499 g there were significantly more newborns in I group than in control group (46.26% and 7.96%); in weight interval 1500–1999 g no significant difference was found, while there were significantly more newborns in control group in weight interval 2000–2500 g (66.37% and 22.38%). Asphyxiation and pulmonary complications were leading causes of death. Most frequent indications for cesarean delivery were abruption of placenta, placenta praevia, prior cesarean section, PIH and PROM.

Conclusion: Most cesarean sections with low birthweight newborns were performed due to severe maternal hemorrhage and early neonatal mortality of these children is high, almost 1/3 dies. Improvement of antenatal and neonatal care is essential for better perinatal outcome of these newborns.

589 CONGENITAL OVARIAN CYST IN NEWBORNS – TWO CASE REPORTS

M. Vusurovic¹, L. Avramovic¹, Z. Stankovic²

¹Clinic for Obstetrics and Gynecology “Narodni Front”, Neonatology, Belgrade, Serbia;²Health Care Institute of Mother and Child “Dr Vukan Cupic”, Gynecology, Belgrade, Serbia

Introduction: Fetal abdominal tumors are discovered much easier than before using modern prenatal echosonography. Ovarian cysts are most frequently diagnosed. Spontaneous involution is a possible natural course of disease. However, complications arise. Prenatal and postnatal ultrasound examination, size, form, appearance of the abnormality is crucial to deciding upon a choice of treatment.

Methods: We present two cases of newborns born in April of 2008. with prenataly diagnosed congenital ovarian cyst.

Case 1: Newborn K.Z., (congenital abdominal cyst). Vaginal delivery in 39 g.w. Birthweight 3250 g. Abdomen is tense, sensitive, slightly painful. Postnatal ultrasound: large anechogen cystic formation is visible in the abdomen, echogen capsule clearly visible, size 62.5 × 65 × 70 mm. Around 180 ml of yellowish-colored liquid was evacuated using percutaneous aspiration. Laboratory analysis estradiol over 15000 nmol/l. After the punction, cyst is rapidly shrinking; size is 38 × 30 × 25 mm, ovarian tissue is visible.

Case 2: Newborn N.D. (large unilocular cyst, size 80x50 mm, filled with dense content with thin septums). Vaginal delivery in 40 g.w. Birthweight 4000 g. Postnatal ultrasound examination: ovarian size 45 × 40 × 28 mm, ovarian tissue 2mm, without stroma hemorrhage. Signs of torsion negative. Given that spontaneous resolution of cyst occurred, a decision is made to undertake ultrasound monitoring.

Conclusion: Early ultrasound monitoring should be undertaken in newborns with prenatal diagnosis of ovarian cyst. Special attention is required with cysts over 40 mm According to most authors, aspiration is a method of choice for treatment of large simple ovarian cyst. Surgical treatment remains an option for complex ovarian cysts and complications.

590 OXYGEN SATURATION TARGETING: A SECOND LOOK

B. Walsh, S. Tabassum, P. Gallagher, J. Heslin, D. Corcoran, A. Foran, T. Clarke

Rotunda Hospital, Dublin, Ireland

Aim: A recent internal audit of compliance with our unit's protocol for oxygen saturation alarms showed results in keeping with the literature(1, 2). Teaching was initiated for all staff regarding the audit results and importance of the alarms in lowering BPD(3). Subsequently compliance with the alarms and the time within the target range was re-audited.

Method: The study was conducted over a month. Twice daily recordings were taken on infants of gestational age 32 weeks or less, with a birth weight less than 1500 gm, on supplemental oxygen. Measurements included were spot oxygen saturations, oxygen saturation alarm settings, and FiO₂ administered.

Results: 17 infants were studied and 123 recordings were taken. The mean gestational age was 26.8 weeks (SD 2.4), and the average CGA was 30.7 weeks (SD 4.48). The upper alarms were correct in 55%, and the lower in 90%. The saturations were within the unit's target range 38% of the time. There were 74 recordings in the subgroup with a CGA less than 34 weeks. The upper limit was correct in 53%, and high in 47%, the lower was correct in 89%. The saturations were within the protocol's range in 37%.

Conclusion: The audit showed a significant improvement in our compliance with the upper alarm settings from 27% to 55%. The compliance with the lower settings also improved from 83.6% to 90%. The improvement shown demonstrates the effectiveness of audit and subsequent teaching, and should have a true impact on reducing BPD in our unit.

591 SPONTANEOUS APOPTOSIS OF T LYMPHOCYTES IN CORD BLOOD OF HEALTHY TERM NEWBORNS

A. Wasiluk¹, K. Wnuczko¹, K. Ratomski², J. Zak², M. Szczepanski¹, J. Wysocka², E. Baran¹

¹Medical University of Bialystok, Department of Neonatology, Bialystok, Poland;²Medical University of Bialystok, Department of Pediatric Laboratory Diagnostics, Bialystok, Poland

Aim: The best-defined regulators of apoptosis in T cells are members of the Fas and Bcl families. We have compared spontaneous apoptosis of T lymphocytes from cord blood and tested there is or not relation to gender.

Patients: 23 full term newborns. Blood from umbilical artery. We determined parameters: CD4 + and CD8 + , Fas, FasL, Bcl-2 using flow cytometer.

Results: CD4 + in females 55.57%, in males 39.66%. CD8 + : 18.16% females, 18.53% males. Fas in females: on CD4 + 13.37%, CD8 + 8.02%, in males: CD4 + 10.54%, CD8 + 6.15%. FasL in females: on CD4 + 7.05%, CD8 + 5.90%, in males: CD4 + 9.75%, CD8 + 6.08%. Bcl-2 in females on CD4 + 96.7% and on CD8 + 80.86%. In males we noted on CD4 + 97.81% and on CD8 + 92.11%.

T lymphocytes in females are more activated. Bcl-2 is less expressed in females, in comparison to males lymphocytes.

Conclusion: Spontaneous apoptosis of T lymphocytes is more expressed in female newborns.

592 PRENATAL EXPOSURE TO NICOTINE AFFECTS SUBSTANCE P AND PREPROTACHYKININ-A MRNA LEVELS IN NEWBORN RAT

J. Berner, T. Ringstedt, E. Brodin, H. Lagercrantz, T. Hökfelt, R. Wickström

Karolinska Institutet, Stockholm, Sweden

Prenatal nicotine exposure profoundly influences neuronal development including effects on several neurotransmitter systems. It also attenuates the ventilatory response to hypoxia, processes known to require a functional substance P-ergic system. Previous studies have shown that nicotine increases the risk for sudden infant death syndrome (SIDS) by four-fold and infants who succumbed to SIDS have elevated brainstem levels of substance P. We therefore studied the effect of prenatal nicotine exposure on the levels of substance P-like immunoreactivity by radioimmunoassay in the brain and the adrenals in newborn rat pups. The expression of the substance P precursor preprotachykinin A mRNA was also determined by real-time RT-PCR in carotid body, in petrosal/jugular and trigeminal ganglia, in cervical and lumbar dorsal root ganglia as well as in the brainstem.

We found that prenatal nicotine exposure increased levels of substance P- like immunoreactivity in the brainstem without changing levels in other parts of the brain or in the adrenals. Furthermore, mRNA levels were increased in the carotid bodies and in the petrosal ganglia, contrasting to the cervical dorsal root ganglia, where mRNA levels were decreased.

We conclude that nicotine causes alterations in the substance P-ergic system at the lower brain stem level, possibly linked to increased risks for SIDS in the newborn after prenatal nicotine exposure.

593 THE RELATIONSHIP BETWEEN HISTOLOGICAL CHORIOAMNIONITIS AND THE OCCURRENCE OF THE NEONATAL RESPIRATORY DISTRESS SYNDROME

S.A. Choe, S.M. Lee, J.H. Lee, J.S. Hong, J.K. Jun, H.C. Syn, B.H. Yoon

Seoul National University Hospital, Department of Obstetrics and Gynecology, Seoul, Korea

Objectives: To examine if the presence of histologic chorioamnionitis is associated with the decrease in the occurrence of neonatal respiratory distress syndrome (RDS) in preterm gestation.

Study designs: The relationship between the development of RDS and histologic chorioamnionitis was examined in 191 consecutive singleton pregnant women and their preterm (24–32 weeks of gestation) babies born in Seoul National University Hospital. The perinatal factors including the histologic examination of the placentae and neonatal morbidities including RDS were reviewed.

Result: Neonatal RDS was developed in 91 (47.6%) cases. The incidence of histological chorioamnionitis was significantly lower in cases with RDS than in those without RDS (27.1% vs 47.4%, p = .005). Cases with RDS had lower gestational age at birth and higher rates of cesarean delivery, 1-min Apgar score of < 7, 5-min Apgar score of < 7, cord blood pH of < 7.15, and hypertensive disorders. The incidence of RDS was significantly lower in cases with spontaneous preterm labor or preterm PROM than in those with medically indicated preterm delivery. There were no differences in sex of the newborns and antenatal steroid use between groups with and without RDS. Logistic regression analysis indicated that the presence of histological chorioamnionitis significantly decreased the odds of the occurrence of RDS (adjusted OR = 0.38, 95% CI 0.16–0.90, p = .027; adjusted for gestational age at delivery, etiology of preterm delivery, hypertensive disorder, cesarean delivery, sex of newborns and antenatal steroid use).

Conclusion: The occurrence of RDS was significantly decreased in the presence of the histological chorioamnionitis in preterm gestation.

594 INFLUENCE OF MATERNAL AGE AND PARITY IN PREGNANCY AND NEONATAL OUTCOME. ANALYSIS OF 25.755 DELIVERIES

I. Zapardiel¹, J. DelaFuente-Valero¹, E. Pérez-Carbajo¹, T. Pérez-Medina¹, J. Molero², A. Aguarón², J. Bajo-Arenas¹

¹Santa Cristina University Hospital, Obstetrics and Gynecology, Madrid, Spain;²Gregorio Marañón University Hospital, Obstetrics and Gynecology, Madrid, Spain

Objective: To determinate the influence of maternal age and parity in the neonatal outcome and type of delivery.

Material and Methods: A retrospective cohort study was carried out with the data of all deliveries between 2005 and 2007 at Gregorio Marañón Hospital in Madrid. We reviewed the perinatal data of 25755 deliveries comparing the group of women who delivered at age of 40 or older to the group of women aged less than 40 years old. We also grouped the results by parity, in primiparous and multiparous women. The analyzed variables were: gestational age, 1 and 5-minute Apgar score, neonatal weight and height, cephalic perimeter and umbilical artery Ph at birth. Type of delivery was analyzed as well.

Results: Women aged 40 or more had significantly lower neonatal weight and gestational age at delivery than the group of younger women. We observed also a lower 5 minute Apgar score in primiparous older women compared to primiparous under 40 years old (p = 0.018). Among primiparous women, in the group of advanced maternal age, the rates of non-assisted vaginal delivery, operative vaginal delivery and cesarean delivery were 27.9%, 31.4% and 40.7% respectively against 51%, 26.7% and 22.3% in the younger group (p < 0.0005).

Conclusions: Women who delivered at age of 40 or older have newborns with lower weigth and gestational age than the younger ones. Primiparous women also have lower 5-minute Apgar score. Maternal age over 40 years old is a risk factor for cesarean and operative vaginal delivery in primiparous women.

595 FETAL BIOMETRY IN ETHNIC BRAZILIAN FROM THE SOUTH REGION: BIPARIETAL DIAMETER, HEAD CIRCUMFERENCE, ABDOMINAL CIRCUMFERENCE AND FEMUR LENGTH

A.C.K. Ayub, P. El Beitune, C. Zagonel, C.R. Maia, R.C. Werthein, M. Pontremoli-Salcedo, C. Pereira-Lima

Federal University of Health Sciences of Porto Alegre (UFCSPA), Obstetrics and Gynecology, Porto Alegre, Brazil

Objective: To develop the curve of fetal growth, according to the data from the serial biometrics and their validation in the immediate postnatal period.

Methods: A prospective study with ultrasound evaluation of women with single pregnancy and accurate gestational age. The women were assessed only once between 20 and 38 weeks of gestation, including systematically 275 pregnant women. The parameters evaluated were biparietal diameter (BPD), cranial circumference (HC), abdominal circumference (AC), length of the femur (CF) and estimated fetal weight (EFW). They were excluded women who presented adverse neonatal parameters. The results were analyzed using the statistical package SPSS10.0 comparing 5 percentiles with those described by Hadlock in 1991, considering significant differences with p < 0.05.

Result: The results of the various parameters are shown in tables, and observed that the estimated fetal weight percentiles for 3, 10, 50, 90 and 97 were the following for weeks 20 (302 g, 310 g, 370 g, 432g, 448 g), 24 (542 g, 551 g, 671 g, 760 g, 775g), 28 (466 g, 515 g, 1196 g, 1438 g, 1499 g), 32 (1531 g, 1586 g, 1932 g, 2095 g, 2100 g) and 36 (1863 g, 1967 g, 2417 g, 3625 g, 4517 g). The partial results at the moment show no significant differentiation with respect to the results published by Hadlock (p > 0.40).

Conclusion: The use of inaccurate curves of weight according to the GA is an important cause of inappropriate interpretation of the normal profile of growth in fetuses of na specific region and is highly recommended studies based on the characteristics of its local population. This project is funded by CNPq.

596 UNDERSTANDING THE PERCEPTIONS OF PREGNANT WOMEN CONCERNING TO THE ULTRASOUND SCREENING FOR FETAL ABNORMALITIES: A QUALITATIVE INTERVIEW STUDY

R.A.O. Freitas-Jr¹, G.D. Azevedo², S.N.T. Moreira³, A.K.M.S.O. Freitas⁴

¹Instituto Internacional de Neurociências de Natal-Edmond e Lily Safra, Obstetrics and Gynecology, Federal University of Rio Grande do Norte, Natal, Brazil;²Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Morphology, Natal, Brazil;³Postgraduate Program of Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil;⁴Maternidade Escola Januário Cicco, Federal University of Rio Grande do Norte, Natal, Brazil

Objective: To analyze the psychological reactions and the content of social representations by pregnant women concerning to obstetric ultrasound for screening of fetal abnormalities.

Methods: A qualitative study involving a sample of healthy Brazilian pregnant women. Data were collected immediately before ultrasound scan at 11–13⁺⁶ weeks for assessment of nuchal translucency or anomaly scan at 18–23 weeks. For data collection, we used the following techniques: semi-structured interview, word association test and participative observation. Interviews were recorded on cassette tape and later transcribed in their entirety for categorical data analysis. According to the access strategy to Vergès' Central Nucleus, the evocation of three words was requested. Data analysis used the EVOC 2000 software.

Results: The fetal screening was able to elicit the following psychological responses: anxiety, fear, doubt, hope and insecurity. Furthermore, we observed manifestation of a number of psychological defenses, such as rationalization. The results showed two thematic blocks, namely positive and negative experiences. The positive experience representation discusses themes related to maternal love and care. The negative representation discusses the feelings of fear, uncertain and anxiety related to the ultrasound assessment.

Conclusion: The professionals who perform obstetric ultrasound must be aware of the feelings of these women and provide a receptive environment, where they can manifest the fears and anxieties they have about the examination, thus contributing to the strengthening of the mother-baby bond. Additionally, we believe that incorporating qualitative approaches can contribute to understanding the psychological reactions involved in the ultrasound screening for fetal abnormalities.

597 DOPPLER, PATHOLOGICAL EXAMINATION OF THE PLACENTA AND INTRAUTERINE FETAL DEATH

I. Babovic¹, J. Opalic¹, J. Tadic², S. Plesinac¹, M. Petronijevic¹, Z. Mladenovic-Bogdanovic¹, M. Pervulov¹

¹Clinical Center of Serbia, Institute of Gynecology and Obstetrics, Delivery Rooms, Belgrade, Serbia;²Clinical Center of Serbia, Institute of Gynecology and Obstetrics, Department of Pathology, Belgrade, Serbia

Objective: To estimate the accuracy of pathological antepartum Doppler velocity /absent end-diastolic velocity in the umbilical artery or AEDV and the middle cerebral artery centralization/ on prediction of fetal death.

Material and Methods: We conducted a retrospective study of antepartum Doppler velocity and its relation to pathological findings of the placenta in 55 pregnancies complicated with fetal death during 2005–2007 year in our Institute. Fetuses with congenital malformations and pregnancies complicated with maternal RH isoimmunisatio were excluded from the study. Statistical analysis: Spearman coefficient correlation and Chi squared likelyhood ratio test.

Results: Intrauterine fetal death occurred most frequently 30 to 34 weeks /40%/ and at term /38.2%/.The majority of women did not have adequate prenatal care in current pregnancy. The most common cord lesions associated with fetal death were: cord compression in 11 /20.0%/, short cord in 8/14.5%/, long cord in 6/11.0%/ and true knot in 4/5.4%/ cases. We found statisticaly significant difference between abnormal Doppler velocity and umbilical cord abnormalities /p = 0.032; p < 0.05/. The most common placental abnormalities were infarct in 20/36.4%/ and chorioamnionitis in 5/16.45%/ cases.

There is no statistically significant difference between abnormal Doppler findings and placental abnormalities/p = 0.273; p > 0.05/.

Conclusion: Absent end-diastolic velocity in the umbilical artery is worrisome sign and should prompt consideration of delivery. The association is strongest for stillbirths due to umbilical cord lesions and is strongest for stillbirths occurring at 30 to 34 weeks as well as at term. Umbilical artery Doppler is relatively poor predictor of stillbirths due to placental dysfunction.

598 EARLY DIAGNOSIS OF NEPHROBLASTOMA IN NEONATAL PERIOD (CASE PRESENTATION)

R. Bejiqi

Pediatric Clinic, UCC Kosova, Prishtina, Albania

Background: Nephroblastoma is most common solid tumor I children and often diagnosis is event during the rutinary examination, especially during ekosonographic examination of abdomen. Ekosonographic procedure have important role in diagnosis and follow up all abdominal tumors especially nephroblastoma.

Aim of presentation is presenting g neonate with nefroblastoma early after delivery.

Method: Eksonographics procedures.

Presentation: 2 days old male child, from the normal controlled pregnancy and normal delivery, with good Appgar-score and in good condition during the rutinary ekosonografphic examination was detected massive solid tumor on the left kidney. After eksonographic, computer tomography and laboratory examination child was surgically treated and tumor was extirpated ad mass. Diagnosis was confirmed pathohistologicaly in prosekture. After surgery child vas stabile and there isn't methastasis or tumor recidiv after three years follow up.

Keywords:Tumor, nephroblastoma, ekosonography

599 EFFECT OF ANTENATAL BETAMETHASONE USE ON ADRENAL GLAND SIZE AND ENDOGEN CORTISOL AND 17-HYDROXYPROGESTERONE IN PRETERM INFANTS

D. Buyukkayhan¹, A. Ozturk², S. Kurtoglu², E. Koklu²

¹Cumhuriyet University Medical Faculty, Dept of Neonatology, Sivas, Turkey;²Erciyes University Medical Faculty, Dept of Neonatology, Kayseri, Turkey

Aim: In the present study, our aim was to assess whether the effect of antenatal bethametasone use on adrenal gland size and adrenal hormones in preterm neonates who had gestational ages of 27–36 weeks.

Patients and Methods: One hundred-fourty-five neonates divided into two groups as betamethasone group, whose mothers received bethametasone 12 mg two times 24 hour apart, and no betamethasone group (group 1), whose mothers did not received any steroid agent during antenatal period (group 2). There were no significant differences between the groups in clinical characteristics and anthropometric variables. Preterm infants with congenital malformations, congenital adrenal hyperplasia, intrauterin growth retardation and intrauterin infection were excluded. Serum 17-hidroxyprogesteron levels, and cortisol levels were measured at first six hours of life. In addition adrenal glands lengths and widths were determined at first day of life. Hormones tests and ultrasonographic evaluation were repeated fifth days of life.

Results: Comparing the groups, we found statistically significant reduction in 17-hydroxyprogesterone levels at birth in corticosteroid-exposed neonates (p < 0.05). Cortisol levels of the betamethasone group were lower than those of the no betamethasone group but there was no significant difference (p > 0.05). There was no significant difference between the study groups with regards to adrenal glands lengths and widths (p > 0.05).

Conclusion: This study demonstrates that antenatal bethametasone use in preterm neonates reduces endogen 17-hydroxyprogesterone and cortisol levels, however it has no effect on adrenal gland size.

Keywords:17-hydroxyprogesterone, cortisol, adrenal gland size, prematüre infant

600 TWIN PREGNANCY AFTER IVF TREATMENT COMPLICATED WITH COMPLETE MOLE HYDATIDIFORM

R. Keskin Kurt, A.N. Cakir Gungor, A. Sucak, A. Basbug, C. Kunt, G. Ozaksit

Dr. Zekai Tahir Burak Kadin Sagligi ve Hastaliklari Egitim ve Arastirma Hastanesi, ve Arastirma Hastanesi, Turkey

33 years old pregnant woman at 20 weeks of gestation came to emergency room with abdominal pain and vaginal bleeding. This pregnancy was achieved after IVF because of unexplained infertility. It was a quadriplet pregnancy at the beginning, but two of them died by the 8th week of gestation. At ultrasonography; two fetuses were determined. Both of them were living and their mesures were concordant with pregnancy week. Placenta was on anterior wall and partly had a molar image. At vaginal examination it was understood that she was aborting the fetuses. After abortion we see the grape-like placental material discharging from cervix. Patological diagnosis of the material was complete mole hydatidiform.

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601 THE VALUES OF MESENTERIC AND CELIAC ARTERIAL BLOOD FLOW PARAMETERS IN HEALTHY PRETERM NEWBORNS

M. Czarnecka, J. Gadzinowski

Poznan University of Medical Sciences, Chair and Department of Neonatology, Poznan, Poland

Mesenteric and celiac arterial blood flow parameters may be useful in diagnosis of abdominal complaints. In differential diagnosis necrotizing enterocolitis (NEC) should always be considered, especially in preterms infants. Incidence of this disease comes to 2.5/1000 live births, but mortality reaches 20–50%. Early diagnosis is of great importance in early stages of NEC, to avoid surgical treatment and peritonitis. It may decrease mortality in this group of patients and improve further quality of life. Aim of the study was to evaluate values of mesenteric and celiac arterial blood flow assessment during abdominal ultrasonography in healthy preterms.

Method: Study group consists of 50 healthy preterms. Ultrasound of the abdomen was performed in all babies and blood flow in superior mesenteric artery (SMA) and celiac artery (CA) was assessed: peak systolic velocity (PSV), pulsation index (PI) and resistance index (RI).

Results: Mean SMA PSV was 58 cm/s (range 32.3–84.2 cm/s); CA PSV = 56 cm/s (range 14.3–126.0 cm/s), mean SMA PI = 2.0 (range 1.21–4.52); CA PI = 1.65 (range 0.66–3.13); mean SMA RI = 0.86 (range 0.71–1.11); CA RI = 0.79 (range 0.5–1.13).The study group is being extended. This measurements are physiological values for group of preterm infants and might become a reference values and useful in diagnosis of NEC.

602 WHAT EXPECTANT MOTHERS UNDERSTAND BY HAVING FIRST TRIMESTER AND MID PREGNANCY SCANS?

S. Daud¹, G. Raje¹, S. Scarlett², M. Lawler², M. Sule¹

¹Ipswich Hospital NHS Trust, O&G, Ipswich, United Kingdom;²Ipswich Hospital NHS Trust, Ultrasound Dept, Ipswich, United Kingdom

First trimester and mid-pregnancy ultrasound scan (uss), are two-dimensional scans in pregnancy, are part of antenatal screening programme and are offered to all pregnant women in the United Kingdom. They are clinical examinations and their main purpose is to look for fetal abnormalities. The first trimester scan is also done to date the pregnancy. The expectant mothers are informed of their purposes by the midwife at booking visits and reinforced by the information leaflet.

Method: Prospective observational study performed at Ipswich Hospital NHS Trust, UK in 2008, to investigate the expectant mothers perceptions of the purpose of having the first trimester and mid-pregnancy scan.

Result: The expectant mothers' perception and understanding of having their pregnancy scans may be different from what the purpose of the scan intended to be. “Bonding”, “to determine the sex of baby” and “no idea” are some of the answers given by the expectant mothers.

Conclusion: Ultrasound examination of developing fetus is a significant screening and diagnostic test. It could have a wide range of clinical and emotional consequences; and life and death decision about the future of their unborn baby has sometimes been made by expectant mother as direct consequence of the findings. UK antenatal screening committee and The College of Radiographers recommended that a consent should be obtained prior to each mid pregnancy scan, to ensure the expectant mothers has the correct understanding and may wish not to participate in the screening programme.

603 CONGENITAL HEART ANOMALIES IN PRAETERM TWINS

S. Dinarevic¹, H. Maksić¹, A. Redžić², R. Terzić¹, E. Hadžipašić¹, M. Halimić¹

¹Paediatric Clinic, CCU, Sarajevo, Bosnia and Herzegovina;²Medical Faculty, University Sarajevo, Sarajevo, Bosnia and Herzegovina

Introduction: In twin pregnancies congenital heart anomalies (CHA) are present in 6%. The risk for development of CHA in twin pregnancies is higher than in single pregnancies and as such requires foetal echocardiography.

Aim: to determine the frequency and type of CHA in twin newborns as well as to evaluate the percentage of performed foetal echocardiography.

Subjects and methods: preterm newborns from twin pregnancies were referred to Cardiology department of Paediatric clinic CUC Sarajevo for cardiac assessment, during 1.1.2004. up to 31.1.2007, using Colour Doppler echocardiography on Toshiba Nemio ultrasound machine in standard views.

Results: During 4 years period of investigation, there were 13537 deliveries in CUC Sarajevo with 224 twin pregnancies (1.65%); 22/224 (9%) preterm newborns were referred for cardiac assessment. A diagnosis of CHA was made in 12 (5.35%), the gestational age varied from 30 weeks of gestation (WG) up to 33, in 12/448 (2.67%) as follows: ASD in 4/12 (33.3%), FoA 7/12 (58.3%), VSD in 2/12 (16.6%), ASA in 4/12 (3.33%), DAP in 3/12 (25.0%), 6/12 (50%) twins had two CHA, and in 8/12 (66.6%) a single CHA was diagnosed. In none patients a foetal echocardiography was performed.

Conclusion: Diagnosed CHA in 12/448 (2.67%) were with L-R shunt, at gestational age ranging 30 WG up to 33. Although twin pregnancy is considered to be an indication for foetal echocardiography, in this study group none was performed, the fact which needs establishment in Bosnia and Herzegovina.

604 METHOTREXATE CONSERVATIVE TREATMENT OF AN INTRAMURAL ECTOPIC PREGNANCY

I. Dumitrascu¹, L. Docan², I. Paun¹, M.-J. Aldea¹

¹University of Medicine and Pharmacy Gr.T.Popa, Obstetrics Gynecology, Iasi, Romania;²County Women's Hospital, Obstetrics Gynecology, Galati, Romania

Background: Intramural localisation of ectopic pregnancies is extremely rare and happens usually in adenomiosis diverticles and uterine scars after caesarean sections or incomplete perforations after curettage. If misdiagnosed it can lead to uterine rupture, extensive hemmorhage and even hysterectomy. The incidence is <1% of all ectopic pregnancies, and less than 100 cases are reported. An early diagnosis is important in order to minimize the consequences on patient's fertility.

Case:A 23-year-old woman, gravida 2, para 0, was admitted for 86 days of amenorrhea and lower abdominal pain. Her serum beta-hCG level was 25000 U/L. Transvaginal sonography (TVS) revealed a normal empty uterine cavity with 16 mm endometrial thickness. A gestational sac with a 9 weeks living embryo was present in the left anterolateral isthmic uterine wall, quite close to the uterine artery. The only surgery the patient had was a D&C for an elective abortion, so we supposed that the pregnancy implanted into an old incomplete uterine perforation scar. The patient was treated first by systemic intramuscular methotrexate (MTX) which didn't succeed to stop the embryo heart activity, thus we continued by injecting MTX into the gestational sac under transvaginal echografic guidance. After the 6th injection of 50 mg MTX the embryo heart activity stopped. Beta-HCG levels normalised and patient's menstrual cycle returned after 8 weeks, but the ultrasonographic image of gestational sac with embryo and vascularization persisted for 5 months.

Conclusion: MTX treatment is a good therapeutic option for even advanced intramural pregnancies.

605 DOMPERIDONE AND GASTRIC EMPTYING IN VLBW INFANTS

A. Gounaris¹, C. Costalos², E. Varhalama³, F. Kokori³, M. Theodoraki³, O. Dedousi³, A. Konstandinidi³

¹General Hospital of Nikea, Piraeus, NICU, Athens, Greece;²NICU ‘Alexandra’ Regional Hospital of Athens, Athens, Greece;³General Hospital of Nikea, Piraeus, Athens, Greece

Objective: Gut motility in VLBW infants is immature and causes feeding intolerance with regurgitations, vomiting, abdominal distention and delay in stool passage. We evaluated the effect of domperidone, a prokinetic agent, in the gastric emptying of VLBW infants.

Study design: The crossover design was used for the study. Gastric emptying was assessed ultrasonographically by measuring the change in half time of antral cross sectional area (ACSA) of the stomach on two occasions:

• 1. when they had been receiving domperidone, (0.3 mg/kg/8hrs PO), for at least two days, and

• 2. when they were receiving an equal quantity of sterile water.

Results: 22 infants with a mean (SD) birth weight of 1377 (319) grams and a mean (SD) gestational age of 30.2 (2.1) weeks were studied. In infants treated with domperidone, mean (SD) half time of ACSA was 47.6 (23.9), whereas in controls 68.2 (25.5) minutes (p = 0.008). There was no significant difference between babies fed formula or own mother's milk in both groups.

Conclusions: Domperidone significantly reduces gastric emptying in preterm neonates, and this may be one of the actions of domperidone when we use it, in case of gut motility problems.

606 THE TURKISH NOMOGRAM OF THE HUMERUS LENGTH AT 16–24 GESTATIONAL WEEKS

G. Goynumer¹, R. Arisoy², L. Wetherilt¹, M. Yayla³

¹Goztepe Educational and Research Hospital, Obstetrics and Gynecology, Istanbul, Turkey;²Okmeydani Educational and Research Hospital, Obstetrics and Gynecology, Istanbul, Turkey;³International Hospital, Obstetrics and Gynecology, Istanbul, Turkey

Aim: To obtain the nomogram of the humerus length measured at 16–24 weeks of gestation in normal pregnancies and to campare it with other nomograms.

Method: A cross sectional prospective study was performed during routine prenatal screening of 1490 pregnant women between 2006 and 2007. The biparietal diameter (BPD), and the humerus and femur lengths (HL, FL) in accurately dated pregnancies with normal outcomes were recorded; the 5th, 50th and 95th percentiles according to gestational weeks were obtained, statistics were performed by linear and cubic regression analyses and the Pearson test was applied.

Results: In the whole study group 856 pregnant women matched the study criteria and the mean gestational week was found to be 20.89 ± 1.94. The mean HL at 16–24 weeks of gestation was measured to be 20–39 mm. The formula showing the correlation between the humerus length and gestational week was: HL = GW × 2.4–17.13 (CI: 95%; r² = 0.818; p < 0.001). A correlation was also found between the HL and the FL and BPD. No significant difference was noted between this nomogram and the nomograms of other nations; however, a small variation from previous nomograms of the Turkish population was noted.

Conclusion: The Turkish humerus length nomogram obtained in this study at 16–24 weeks of gestation is in conformance with the worldwide nomograms.

607 EFFECT OF PARITY ON UTERINE ARTERY DOPPLER FINDINGS AT MIDGESTATION IN THE LOW RISK POPULATION

G. Göynümer¹, L. Wetherilt¹, R. Arisoy², M. Yayla³

¹Göztepe Educational and Research Hospital, Obstetrics and Gynecology, Istanbul, Turkey;²Okmeydani Educational and Research Hospital, Obstetrics and Gynecology, Istanbul, Turkey;³International Hospital, Obstetrics and Gynecology, Istanbul, Turkey

Objective: To establish the effect of parity on uteroplacental Doppler findings during midgestation in low risk pregnancies.

Methods: Colour flow pulse Doppler imaging of both uterine arteries was performed on 760 singleton pregnancies fulfilling the study criteria at 18–23 weeks of gestation, determined to be in the low risk group according to routine antenatal examinations. An abnormal result was defined as a mean uterine artery PI value greater than 1.45 (>95^th percentile) and the presence of bilateral diastolic notches. The mean uterine artery PI values were compared in nulliparous women with primiparous and multiparous pregnant women at the same gestational weeks.

Results: No significant difference in the mean uterine artery PI values but we found the significant difference in the prevalence of bilateral diastolic notches was detected between nulliparous and parous women.

Conclusions: Although in many recent studies parity has been shown to affect uterine artery perfusion in the high risk population, parity does not seem to have a significant effect on the pulsatility index but parity has a significant effect on the prevalence of bilateral diastolic notches in the uterine artery waveforms when studied in the low risk population.

608 ULTRASOUND DIAGNOSIS OF MACROSOMIA IN NON DIABETIC MOTHERS AND BIRTHS EFFECTS

L. Guariglia, P. Rosati, L. Caforio, G. Scambia

Catholic University of the Sacred Heart, Obstetrics and Gynecology, Rome, Italy

Aims: To examine the correlation between correct prenatal ultrasound diagnosis of large for gestational age fetus, management of labor and delivery and maternal and perinatal outcomes.

Methods: In a series of 800 macrosomic term singleton newbons in non diabetic pregnant women a standard ultrasound scan within 7 days of delivery was performed in 136 fetuses. Estimated fetal weight was determined using the mathematical formula proposed by Hadlock. An estimated fetal weight at or above the 90^th percentile for gestational age defined a macrosomic fetus.

Results: A correct ultrasound diagnosis of macrosomia was obtained in 99 cases (72.8%). The incidence of caesarean section is higher in 99 fetuses with an ultrasound diagnosis of macrosomia (group 1) with a statistically significant difference comparing to other 701 fetuses (group 2) (p < 0.001). The duration of labor was shorter (188 ± 61 vs 359 ± 84 minutes) in patients with an ultrasound diagnosis of macrosomia, particularly when operative delivery was performed for suspected macrosomia (p < 0.001). Maternal and neonatal outcomes were similar in the groups considered.

Conclusions: The intrapartum management of macrosomia remain a challenge for the modern obstetrician. Nevertheless, a perfect method to identify macrosomia has not yet emerged. Our study demonstrate that antenatal ultrasound diagnosis of macrosomia is associated with a statistical increase of caesarean section without reducing the incidence of maternal or neonatal birth trauma. It appears that sonographic data should not be considered the sole basis for obstetrical management even if it remains an important piece of the clinical puzzle.

609 ULTRASOUND DIAGNOSIS OF MACROSOMIA: MODE OF DELIVERY

L. Guariglia, P. Rosati, L. Caforio, G. Scambia

Catholic University of the Sacred Heart, Obstetrics and Gynecology, Rome, Italy

Aims: To investigate the predictivity of macrosomia by ultrasound examination and its contribution in the mode of delivery.

Methods: A retrospective study was performed on 800 pregnant women who delivered large for gestational age newborns with and without correct prenatal ultrasound diagnosis of excessive birth weight. The incidence of operative delivery even according to the different indications were evaluated.

Results: A correct ultrasound diagnosis of macrosomia was achieved in 73% of cases. The incidence of caesarean section was similar in macrosomic and non macrosomic infants. However, the indications of caesarean delivery reported an hjgher percentage for failure to progress or for cephalopelvic disproportion and suspected macrosomia in the macrosomic group (p < 0.001). In case of macrosomia a correct sonographic diagnosis allowed a statistically significant increase in the incidence of caesarean section, particularly for suspected macrosomia (p < 0.001). Instead, in the same group, the incidence of caesarean section for failure to progress or for cephalopelvic disproportion was higher in cases without ultrasound diagnosis of macrosomia.

Conclusions: Our findings confirm the limitations in predicting macrosomia by ultrasound. An antenatal prediction of fetal macrosomia was associated with an increase in the caesarean section rate; nevertheless, an elective caesarean section in those cases is non justified. Ultrasound antenatal diagnosis of excessive birth weight can suggest an appropriate route of delivery.

610 MIDDLE CEREBRAL ARTERY DOPPLER MEASUREMENTS IN A POPULATION OF 182 MONOCHORIONIC DIAMNIOTIC TWIN PREGNANCIES WITH TWIN-TO-TWIN TRANSFUSION SYNDROME

L. Gucciardo, P. Klaritsch, T. Van Mieghem, E. Done', L. Lewi, J. Deprest

Universitary Hospitals Leuven, Obstetrics and Gynecology, Leuven, Belgium

Objective: Analysis of the evolution of middle cerebral artery (MCA) Doppler measurements in monochorionic diamniotic (MCDA) twin pregnancies with twin-to-twin transfusion syndrome (TTTS) and treated withfetoscopic laser coagulation.

Methods: In a prospective cross-sectionalobservational study we examined before and after laser coagulation, 182 MCDA twin pregnancies between 15 and 36 weeks of gestation. Cases were recruited between 2002 to 2007 from the Eurotwin2twin study, or referred by other centers for antenatal fetoscopic therapy. The diagnosis of TTTS was made by ultrasound observation of a twin oligohydramnios polyhydramnios sequence (TOPS) as defined by the Eurofoetus consortium. Fetal MCA pulsatility index (PI), resistance index (RI) and peak systolic velocity (PSV) were assessed according to the technique described by Mari et al. Regression analysis was used to determine age-specific curves and to make a comparison with MCA Doppler measurements in anormal MCDA population.

Result: PI, RI and PSV of the MCA Doppler measurement in TTTS are significantly different from our reference ranges for normal MCDA population.

Conclusion: The hemodynamic imbalance responsible for TTTS is correlated to significant differences in term of MCA Doppler measurements.

611 UMBILICAL ARTERY PULSATILITY INDEX IN PREGNANCIES COMPLICATED BY INSULIN DEPENDENT DIABETES MELLITUS WITHOUT HYPERTENSION

M. Hadzi Lega^1,2, K. Daneva Trajkova¹, V. Livrinova¹, T. Nikolova¹

¹University Clinic of Obstetrics and Gynecology, Skopje, Macedonia;²Private Hospital Remedika, Skopje, Macedonia

Objective: In a group of diabetic pregnant women, the umbilical artery pulsatilityindex (PI) was compared with both pregnancy complications and perinatal outcomes.

Method: We evaluated 67 women with pregnancies complicated by insulin-dependent diabetes mellitus (IDDM), without hypertension. Fort he study we took the last umbilical PI value before delivery into consideration. Doppler results were not used for patient management. Umbilical artery PI was correlated with the route of delivery and the following perinatal complications: intrauterine growth retardation; cesarean sections for acute fetal distress; respiratory distresssyndrome (RDS); neonatal hyperbilirubinemia; hypocalcemia; hypoglycemia; macrosomia, and neonatal intensive care unit (NICU).

Results: Among the 67 diabetic patients enrolled in this study, 44(66%) had umbilical PIs ranging from the 5th to the 95th percentile (PI mean ± SD = 1.2 ± 0.3), while 23 (34%) had PIs above the 95thpercentile (PI mean ± SD = 1.6 ± 0.3). Among the group with pathologic umbilical PIs, analysis of the data revealed a significantly higher incidence of both cesarean sections for acute fetal distress and perinatal complications: RDS; hyperbilirubinemia; hypoglycemia, and theneed for NICU, respectively.

Conclusion: In 34% of the diabetic pregnant women without hypertension, we found increased vascular resistances. Among these patients the incidence of perinatal complications was higher, and both closer maternal metabolic control and stricter care of fetal conditions are needed.

612 PRENATAL DIAGNOSIS OF CYSTIC DEGENERATION OF WHARTON'S JELLY IN CHORIOAMNIONITIS: A CASE REPORT

J.Y. Hwang¹, S.H. Na², H.A. Lee¹, J.S. Cho¹, D.H. Lee¹

¹Kangwon National University, Department of Obstetrics & Gynecology, Chuncheon, Korea;²College of Medicine Ulsan University, Department of Obstetrics & Gynecology, Chuncheon, Korea

Introduction: Umbilical cord cyst is the common disease of the umbilical cord. However, most of physicians often don't try to find out umbilical cord cyst in prenatal examination, because they think that umbilical cord cyst is a minimal disease in fetus and searching the umbilical cord abnormality is very difficult. So then umbilical cord diseases usually are detected in the postnatal examination than the prenatal examination. We experienced the prenatal diagnosis of cystic degeneration of Wharton's jelly in chorioamnionitis.

Case report: A 33-year-old multigravida women being with twin fetus visited to our center for the antenatal routine exam at 30 weeks of gestation. We found out that 1^st fetus was death and 2^nd fetus had cystic degeneration of Wharton's jelly. We planned her to admit the hospital for close observation. Preterm labor with elevation of the C reactive protein developed at 31 weeks. We took an amniocentesis for work up about the chorioamnionitis, and then we confirmed the chorioamnionitis because of the detection of leukocytosis in amniotic fluid. The women delivered a 2025 gm healthy male at 32 weeks. Fortunately, he was a healthy at birth and was discharged without intensive care on postnatal 14 days. At postnatal pathologic biopsy, the cause of fetal death was the stricture of umbilical cord and cystic degeneration was confirmed.

613 ASPECTS OF PRENATAL DIAGNOSIS AND OBSTETRICALMANAGEMENT IN URINARY TRACT MALFORMATIONS

G. Iliev¹, C.N. Trifan¹, D. Scripcaru¹, M. Stamatin¹, C. Rusu², C. Mihaila¹, C. Schaas¹

¹“Cuza Vodă” Maternity Hospital, Iasi, Romania;²“Gr. T. Popa” University of Medicine and Pharmacy, Medical Genetics Department, Iasi, Romania

Aims: To show the importance of routine fetal morphology at 21–23 weeks of gestation (w.g.) for the diagnosis of urinary tract defects and the obstetrical management.

Material and Methods: In the context of routine fetal morphology we have examined fetal urinary tract starting with 11–12 w.g. Pregnancies with severe malformations have been electively terminated. For those with therapeutic termination of pregnancy or neonatal death pathologic examination has been performed.

Results: Between 01.01.2001–31.03.2007 we have identified 72 cases of urinary tract malformations. In 57 of them (20–38 w.g.) urinary defects were not severe, allowing a favorable evolution after birth. The other 15 cases (17–34 w.g.) presented severe urinary tract malformations: 7 pragnancies have been terminated, 4children have been born preterm and 4 at term. Neonatal death has been recordedin 8 cases. Pathologic examination has been performed in 15 cases and confirmed prenatal diagnosis.

Conclusions: Fetal morphology at 21–23 w.g. represents a crucial point in the echographic follow-up of a pregnancy. Ultrasound scan offers the possibility of prenatal diagnosis of urinary malformations with echographic expression at this age of pregnancy and may contribute to a significant decrease of neonatal death associated with this kind of pathology.

614 ASPECTS OF PRENATAL DIAGNOSIS AND OBSTETRICAL MANAGEMENT IN CRANIO-CEREBRAL MALFORMATIONS

G. Iliev¹, D. Scripcaru¹, M. Stamatin¹, C. Rusu², A. Bivoleanu¹, E. Mihalceanu¹

¹“Cuza Vodă” Maternity Hospital, Iasi, Romania;²“Gr. T. Popa” University of Medicine and Pharmacy, Medical Genetics Department, Iasi, Romania

Objective: To evidentiate the importance of routine foetal morphology from 12–14 weeks and 20–24 weeks of gestation (w.g), in prenatal diagnosis of cranio-cerebral malformationin order to establish obstetrical attitude.

Material and Method: During routine foetal ultrasound were examined cranio-cerebral structures beginning with 12–14 w.g. In some cases prenatal genetic exams were performed or genetic exam in newborns. Cases with severe cranio-cerebral malformations or associated with severe extracerebral malformations benefits of therapeutic abortion. In those situations or in neonatal death necroptic exams were done.

Results: In period 01.01.1999–31.03.2008 were identified 51 cases with cranio-cerebral malformations: 12 caseswith anencephaly (14–31 w.g.), 20 cases with holoprosencephaly (14–41 w.g.), 8 cases with corpus callous agenesis (24–37 w.g.), 2 cases with acranie (14–15 w.g.), 3 cases with encephalocel (22–26 w.g.) and 6 cases with hydrocephaly (18–37 w.g.). 24 cases benefit of therapeutic abortion. 27pregnant women gave birth prematurely and at term. Neonatal death has been recorded in 19 cases.

Conclusion: Routine foetal morphology performed at 12–14 and at 21–24 w.g. could reveal the possibility of prenatal diagnosis of cranio-cerebral malformations and contribute to decrease of perinatal mortality and neonatal and infantmorbidity.

615 PRENATAL PERIVENTRICULAR – INTRAVENTRICULAR HEMORRHAGE IN TERM NEWBORN

M. Jonovic, B. Miljkovic, S. Stamenovic, G. Jovanovic, N. Stojanovic

The Clinic for Obstetrics and Gynecology, Clinical Center, Nis, Serbia

Periventricular – intraventricular hemorrhage (PVH – IVH) isone of the most common forms of intracranial hemorrhages in newborn age. Although it is more common in neonates, PVH – IVH is described in prenatalperiod.

The aim of this work is to present a case of a newborn whose birth took place in the Clinic for Obstetrics and Gynecology in Nis in which weprenatally diagnosed PVH – IVH.

Case report: First child from the first controlled pregnancy, from 4^th month having hypertension. From the 32nd week of gestation we have ultrasonographically registered periventricular hemorrhage (both – sided subependymal) with verification of starting ventriculomegalia. Laboratory analyses excluded presence of intrauterine infection (TORCH was negative). Delivery was done by cesarean section in the 39th week ofgestation. Mail newborn BW 3750/54/35, Apgar score was 8/9, vital, clinical andneurological tests were regular. In the first day of life we performed anultrasonography of the CNS: subependymally on both sides hemorrhage was inregression, with dilatation of lateral ventricles. We continued to monitor theneurological and neurosonographical test of child until 11th monthof life. Ultrasound scan has not registered a progression of ventricular dilatation. Developmental milestones have been accepted from the schedule for the age.

Discussion and Conclusion: Due to particularity in brain development, species of cerebral lesions depends on gestational maturity aboveall, and long – term prognosis on localization, spreading and time of arising. Etiology of PVH – IVH in prenatal period involves trauma, infection, hypoxia, immune thrombocytopenia. Proportion of hemorrhage and degree of ventricular dilatation are two of the most importantfactors, on which depends all further development.

616 THE STUDY OF BLOOD FLOW IN THE UTERINE-PLACENTAL-FETUS SYSTEM AT PREGNANT WOMEN WITH ANEMIA

A. Karimov, R. Daminov, M. Fattahova

Tashkent Medical Academy, Obstetrics and Gynecology, Tashkent, Uzbekistan

Objective: Echodopplerography and Dopplerometry of blood flow in the uterine-placental- fetus system at pregnant women withanemia.

Methods: Dopplerography and Dopplerometry of uterine-fetus-placental blood flow. 50 pregnant women with anemia and 30 pregnant women with physiological pregnancy were evaluated during 20–24, 28–32, 37–40 weeks. The blood flow velocity in uterine and spiral arteries, umbilicalartery and medium cerebral artery of fetus was measured.

Results: In uterine-placental system at pregnant womenwith anemia as was shown the blood flow in uterine artery was decreased (placental side) during 28–32 weeks (23.0%) and during 37–40 weeks it wasincreased on 22.3% in comparison with physiological pregnancy. In Umbilical artery at pregnant women with anemia theblood flow was increased during 20–24 weeks (32.3%) and during 28–32 weeks (25.0%). The blood flow in cerebral artery of fetus was increased to 37–40 weeks (7.5%) in comparison with physiological pregnancy.

Conclusion: Carrying out studies was shown thehemodynamic abnormalities inside mother-placenta-fetus at middle and severeform of anemia during 28–32 weeks. The examination of blood flow by Dopplerometry in these vessels gives objective information about of fetuscondition and as a result the possibility exists of prognosis of fetushypotrophy.

617 CHORIONICITY DETERMINATION IN TWIN PREGNANCY AFTER SECOND TRIMESTER OF GESTATION

S.Y. Kim, S.Y. Ahn, H.Y. Park, H.M. Oh, G.H. Lee, S.P. Lee

Gil Medical Center, Graduate School of Medicine, Gachon University of Medicine and Science, Obstetrics and Gynecology, Incheon, Korea

Purpose: This study evaluated the accuracy of ultrasonographic landmarks in twin pregnancy determining chorionicity during 2^nd and 3rd trimester.

Methods: We had 95 cases of twin pregnancy diagnosed 20cases in 1^st trimester, 34 cases in 2^nd trimester and 41 cases in 3rd trimester between January 2004 and December 2006. In 75 cases of twins, they were performed by ultrasonography after 2^nd trimester, and chorionicity was predicted by number of placenta, sex of fetus, thickness of membrane (more than 1.8 mm) and shape of membrane (T or lambda sign). We investigate the accuracy of chorionicity confirmed by postnatal placenta examination to the prediction of it performed by ultrasonography. And we evaluated more useful ultrasonographic markers in twin pregnancy determining chorionicity during 2^nd and 3rd trimester by statistical analysis.

Results: The accuracy where the result met between prenatal diagnosis and postnatal diagnosis in 32 cases of monochorionic twins diagnosed after second trimester was 81.3% and 43 cases of 88.4% was dichorionic twins. The sensitivity was 90% in fetal sex and 80% in number of placenta in monochorionic twin. But in dichorionic twin the sensitivity was of 80% in number of placenta and 78% in thickness of membrane. There was no difference in sensitivity between sonographic markers for diagnosis of mono or dichorionic twins.

Conclusion: Although the accuracy of sonographic diagnosis decreases in twin pregnancy performed after second trimester, it will be improved by findings multiple markers in ultrasonography.

618 3D TRANSPERINEAL ULTRASOUND COMPARED TO DIGITAL VAGINAL EXAMINATION PRIOR TO INSTRUMENTAL DELIVERY FOR FAILURE TO PROGRESS

F. Lovegrove¹, C. Macpherson¹, S. Harris¹, K. Kalache², G. Michailidis¹

¹Southampton University, School of Medicine, Southampton, United Kingdom;²Klinik fur Geburtsmedizen, Charite Campus Benjamin Franklin, Berlin, Germany

Objectives: Accurate assessment of fetal head position and station is imperative before an instrumental delivery. The aim of this study was to determine whether 3D transperineal ultrasound can make objective and reliable assessments of fetal head position and station prior to an instrumental delivery.

Methods: Women with term, singleton pregnancies were invited to participate in the study. Transperineal ultrasound (TPU) volumes were obtained just before an instrumental delivery. The volumes were examined at a later stage to obtain information about station, position, molding and caput succedaneum. Station was recorded by measuring the angle defined by two lines: one placed through the proximal end of the right pubic bone and the other running from the proximal right pubic bone tangentially to the fetal skull (‘Angle of Progression’ – AOP).

Results: To date 17 women have been scanned for the study. There was good agreement between head positions on digital examination and those on TPU (kappa 0.8). Caput and molding were visualised easily using ultrasound but there was poor agreement with the digital findings. There were no failed instrumentals. The average AOP was 170.12° (95% CI: 163.50 to 176.74°).

Conclusions: Preliminary results indicate that 3D transperineal ultrasound can help in determining fetal head position accurately. Documentation of variables like station, caput and molding was inconsistent with the scan results, probably demonstrating well known weaknesses of digital examination. Our results suggest that transperineal 3D ultrasound could potentially aid clinical management by providing an accurate assessment prior to an instrumental delivery.

619 POSTNATAL ULTRASOUND OF HIPS FOR BABIES WITH BREECH PRESENTATION AT TERM

S. Masood

Ulster Hospital, Obstetrics and Gynaecology, Belfast, United Kingdom

Background: Breech presentation in late pregnancy has been identified as a risk factor for developmental dysplasia of the hip (DDH), a spectrum of disorders including congenital dislocation. DDH is associated with significant impact on quality of life as well as implications for heatlhcare resources. The American Academy of Paediatrics published a guideline in 2000 which recommended that all babies who had presented as breech should have ultrasonic within the first 6 weeks of life.

Objectives: All babies delivered with a history of breech presentation at six weeks weeks should have a postnatal USS hips requested before discharge from hospital. These scans should occur within the first 6 weeks of life. Results should be filed in the baby chart. Abnormal results should be acted upon.

Methods: Babies born with breech presentation were identified via Northern Ireland Maternity Statistics Database (NIMATS). Maternal charts were requested for calendar months Feb to June 2007. 34 charts were reviewed. If the information contained within the charts was incomplete, enquiries were made to Radiology and to the infant's General Practitioner in order to exclude filing errors and lost reports as false negative results.

Results: Evidence of request for USS before discharge was found in 77% of cases. The report was in baby notes in 77% of cases. No abnormal results were noted. 26% of the ultrasound examinations were completed within 6 weeks.

620 EARLY POSTNATAL CHANGES IN SPLANCHNIC CIRCULATION IN HEALTHY TERM INFANTS

K. Matasova, L. Stillova, H. Kolarovszka, M. Zibolen

Faculty Hospital Martin, Neonatology, Martin, Slovakia

Background and Aims: After birth, the splanchnic circulation undergoes physiological changes. The aim was to characterize the changes in coeliac artery (CA) and superior mesenteric artery (SMA) blood flow during the first three days of life.

Methods: 50 healthy term infants were studied at the age of 2, 24 and 72 hours. Blood flow velocities in CA and SMA were measured by Doppler ultrasound, peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged mean velocity (TAV) were recorded. Resistance index (RI) and pulsatility index (PI) were calculated. A one-way ANOVA test and Bonferroni comparisons of means were used for statistical analyses. P < 0.05 was considered significant.

Results: SMA EDV showed negative values in 92% of infants at the age of 2 hours. In CA, there were not recorded negative values of EDV at any time point. By 72 hours there was a significant increase in EDV and TAV in SMA and CA. Basal vascular resistance, as measured by RI and PI decreased significantly in both vessels during the first 3 days of life.

Conclusion: The blood flow velocity in CA and SMA increases during the early neonatal period in healthy term infants. The increase in perfusion is due to a fall in vascular resistance. A reversed blood flow was observed in SMA in majority of infants at 2 hours of age. The SMA perfusion is generally lower compared with CA perfusion after birth. The most remarkable changes in splanchnic circulation occur within the first 24 hours of life.

621 CONGENITAL MALFORMACY OF THE BRAIN – CASE REPORT

B. Miljkovic, M. Jonovic, S. Stamenovic, G. Jovanovic, N. Stojanovic

The Clinic for Obstetrics and Gynecology, Clinical Center, Nis, Serbia

Introduction: This anomaly belongs to congenital defects ofprosencephalon. It is associated with trisomy of 13 and 18. In these disordersembryologic defect affects the development of both, the brain and the face. Incidence of holoprosencephaly is 1:250 during embryogenesis and 1:16000 oflive births.

The aim of this study is to present a newborn baby withmicrocephaly and semi lobar holoprosencephaly.

Case report: The male newborn from second pregnancy of a 25years-old woman. The birth weight was 1900 g, the head circumpherency was 26.5 cm (below 10^th percentile), Apgar scor was 7, gestation age was 35 weeks. The head was microcephalic and sinostotic. A baby developed a respiratorydistress syndrome and was treated in a intensive care unit. MRI was done – thediagnosis was semi lobar holoprosencephaly. Kariotypisation was done: 46XY. Theultrasound of heart and abdomen was regular. This baby with brain anomaly wasnot recognized prenatally, despite of microcephaly was suspected.

Conclusion: A newborn with suspected congenital anomaly needsexact diagnosis. It is very important to perform exact prenatal ultrasoundexamination. The risk for the further pregnancies with this anomaly is 2–30%. It is necessary to work as a team and use a wide diapason of diagnosticmethods.

622 PRENATAL DIAGNOSIS OF NEUROBLASTOMA BY ULTRASOUND: A CASE REPORT

A. Montoya-Saldarriaga, J.E. Sanin-Blair, A. Cuartas

Maternal-Fetal Medicine Unit, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, Antioquia, Medellin, Colombia

Neuroblastoma is the most common extracranial solid tumor in the neonatal period and represents the 30% of the childhood tumors. Nevertheless the prenatal diagnosis is unusual; most of them are made in the third trimester.

About 60–90% of them are located in the adrenal glands but they can be present in any place of the sympathetic nervous system. Prognosis depends on the affected area, age at diagnosis, stage of disease, metastasis, cytogenetic abnormalities, and associated malformations.

Differential diagnosis of adrenal masses could be difficult. The distinction between neuroblastoma and renal cyst, Wilm's tumor, mesoblastic nephroma and adrenal hemorrhage should be done.

We report a case of neuroblastoma identified at 31 weeks of gestation with metastasis in liver, lung, pancreas, bone marrow and placenta with poor fetal outcome. The diagnosis was histologically confirmed after delivery.

623 PERIVENTRICULAR LEUKOMALACIA – CORRELATIONS WITH LOW APGAR SCORE AND PERINATAL HYPOXIA

M.L. Ognean¹, N. Silaghy², M. Cucerea³, E. Olariu¹, S. Andreica⁴, A. Craciun⁵

¹Clinical County Emergency Hospital Sibiu, Neonatology, Sibiu, Romania;²Pediatric Clinical Hospital Sibiu, Emergency, Sibiu, Romania;³Clinical County Emergency Hospital, Neonatology, Tg. Mures, Romania;⁴Obstetrics and Gynecology Clinical Hospital I, Neonatology, Cluj Napoca, Romania;⁵Clinical Hospital Dr. C. Cantacuzino, Neonatology, Bucharest, Romania

Introduction: Periventricular leucomalacia (PVL) is a major ischemic brain lesion in preterm infants with serious impact on the neurodevelopmental long term outcome.

Objectives: to establish correlations between PVL and low Apgar score and perinatal hypoxia.

Material and Methods: The prospective study was developed in the Neonatology Depts. I and II of the Clinical County Emergency Hospital Sibiu, between 01.09.2000 and 31.08.2006. A number of 2116 preterm babies were scanned using head ultrasonography (HUS) using a serial scanning protocol designed to diagnose all important cerebral lesions. Clinical and sonographic data were collected using an electronic database and statistical analysis was done using SPSS 10.0 for Windows.

Results: A number of 112 cases of PVL were identified, the incidence of the disease being 5.29% in the study group, most of the cases occurring between 30 and 34 wks gestation. Prematures with PVL had significant lower gestational age and birth weight than a control group with normal scans matched for gestational age (GA). Apgar score less than 7 at 1, 5 and 10 minutes and the presence of respiratory distress syndrome (RDS) were significantly correlated with PVL (p < 0.05). When the analysis was done separately for babies less or more than 32 weeks GA, RDS was found to be a risk factor only for older prematures (>32 wks GA) but perinatal infection was significantly correlated with PVL, irrespective of gestational age.

Conclusions: HUS can be used to identify PVL and to establish correlations with perinatal hypoxia and low Apgar score.

624 THE PROGNOSTIC VALUE OF DOPPLER MEASUREMENTS IN THE UMBILICAL ARTERY AND BIOPHYSICAL PROFILE IN PREGNANCIES COMPLICATED WITH DIABETES MELLITUS

J. Opalic, I. Babovic, M. Petronijevic, S. Vukajlovic, S. Plesinac, Z. Mladenovic-Bogdanovic

Clinical Center of Serbia, Institute of Gynecology and Obstetrics, Delivery Rooms, Belgrade, Serbia

The Aim of the study was to evaluate the accurancy of the umbilical artery resistance index /RiAU/ and fetal biophysical profile /BPP/ on the Apgar score after 5th minute in pregnancies complicated with pregestational /IDDM/ and gestational insulin dependent diabetes mellitus /GDM A2/.

Material and Methods: We conducted a retrospective study of 12 monofetal pregnancies complicated with gestational DM A2 and 30 pregnancies complicated with pregestational insulin -dependent DM classes B-R delivered by cesarean section in our Institute from 1.10.2004. to 1.10.2007. Fetuses with congenital malformations and intrauterine infections were excluded from the study. Statistical analysis: Chi-squared likelyhood ratio, Student t-test, Spearman coefficient correlation and Mann Withney tests.

Results: The patients in GDM A2 group were older than in IDDM group /36 ± 5y vs. 28 ± 4y, p = 0.000; p < 0.05/. Primiparous women were more frequently delivered in IDDM group /76.7% vs. 25.05, p = 0.002; p < 0.05/. The average birth weight was 3217 ± 505 g in GDM A2 group and 3150 ± 854 g in IDDM group /p = 0.802; p > 0.05/. There was no statistical difference in mean gestational age at delivery /37.0 ± 2.0 gw vs. 37.0 ± 2.5 gw, p = 0.916; p > 0.05/ as well as between Apgar-5 /p = 0.0468; p > 0.05/ between groups. There was statistical significant correlation between RiAU and Apgar-5 /r = 0.508; p = 0.04/ and between BPP and Apgar-5 /r = −0.508; p = 0.005/ in IDDM group. We did not find statistical significant difference in RiAU /p = 0.778; p > 0.05/ and in BPP scores between 2 groups /p = 0.914; p > 0.05/.

Conclusion: Resistance index and biophysical profile are good predictors of low Apgar-5 in pregnancies complicated with pregestational insulin dependent diabetes mellitus. Insulin therapy started preconceptionaly or during the pregnancy is essential for good perinatal outcome in pregnancies complicated with diabetes mellitus.

625 UNUSUAL COURSE OF HYDROPS FETALIS DUE TO ANTI-C ISOIMMUNIZATION FOLLOWING MATERNAL BLOOD TRANSFUSION

Ö. Özyüncü, T. Özlü, L.S. Önderoğlu, Ö. Deren

Hacettepe University, Obstetrics and Gynecology, Ankara, Turkey

Introduction: Among anti-erythrocyte antibodies, anti-c is one of the most frequent and can cause significant hemolytic disease. Below, we describe a case with hydrops fetalis(HF) because of anti-c isoimmunization.

Case report: A Rh-positive, 30 week pregnant woman referred with a diagnosis of HF (Figure 1A) which began 10 days ago. In ultrasonography, beside massive HF, MCA PSV was above 1.5 MOM. Indirect coombs test was positive and pregnant was found to be anti-c antibody positive.

In detailed history, it is learnt that due to chronic maternal anemia, she was transfused several times with her husbands' blood. Thereafter, she developed a transfusion reaction, probably sensitized to c-antigen and after the 3rd transfusion, anti-c antibodies caused severe hemolytic anemia in the fetus. We performed intrahepatic and intraperitoneal transfusion with Rh and c-antigen negative blood (Figure 1B). Fetal ascites disappeared rapidly (Figure 1C).

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Unfortunately, 5 days after transfusion, she delivered and the fetus died from thrombocytopenia and prematurity.

Discussion: Disappearance of HF after single transfusion is an unexpected finding. However, aspiration of ascites and intraperitoneal transfusion may relieve the increased cardiac preload. As a conclusion, to prevent the development of anti-erithrocyte antibodies, selective blood-transfusion policy should be performed in the reproductive age women.

626 MANAGEMENT OF ISOIMMUNIZED PREGNANCIES WITH THE USE OF MIDDLE

N. Papantoniou, G. Daskalakis, E. Anastasakis, S. Mesogitis, M. Theodora, T. Ikonomou, A. Antsaklis

Athens University, 1^st Department of Obstetrics and Gynaecology, Athens, Greece

Objective: To determine the clinical outcome of isoimmunized pregnancies managed by middle cerebral artery peak systolic velocity in an intention to treat study.

Methods: Pregnancies complicated by rhesus isoimmunization were managed with serial ultrasound and Doppler studies during a four year period (2001–2004). Pregnancy monitoring with peak systolic velocity (PSV) of the middle cerebral artery (MCA) at 7 days interval, up to 34 gestational weeks. Invasive diagnostic and therapeutic procedures were carried out when PSV of MCA was indicative of moderate or severe anemia. Inclusion criteria were an obstetric history of isoimmunization, increased maternal titers (≥1:32) from 20 to 34 gestational weeks. The results of this study were compared to those of a previous study of our institution, involving a historic cohort (1986–1989) that was managed with maternal titers of indirect Coombs, serial ultrasound (US) and serial FBS.

Results: Overall sensitivity to detect moderate to severe anaemia below 34 weeks was 100% as there were neither false negative cases nor cases of intrauterine death related to undetected fetal anaemia. We identified 6 fetuses that at cordocentesis revealed haematocrit > 26% (false positive cases). 22 cases were managed with MCA – PSV only, while twelve cases needed additional FBS and six cases IUT. Perinatal mortality was 0%. In the cohort study there were 45 invasive procedures in 18 patients that today would be avoided. Perinatal survival was 100%.

Conclusions: Management by MCA – PSV Doppler using a seven day monitoring interval, is a highly sensitive detecting fetal anaemia.

627 THE ROLE OF SONOHYSTEROGRAPHY IN DIAGNOSTIC MANAGEMENT IN RECURRENT PREGNANCY LOSS PATIENT

C. Riviello, G. Mello, M.E. Coccia

University of Florence, Florence, Italy

Introduction: In the diagnosis of recurrent pregnancy loss (RPL), many studies claim the importance of the uterine factors. Several diagnostic techniques may be used to evaluate the uterine cavity and tubal patency such as transvaginal sonography (TVS), hysterosalpingographygraphy (HSG), sonohysterography (SHG), hysteroscopy (HSC), and laparoscopy with cromo perturbation.

Aim: The present study evaluated the accuracy of the SHG compared with HSC in the uterine and tubal patency evaluation and to verify if SHG can be suggested instead of the invasive technique in the first step of RPL management.

Materials and Methods: We recruited 25 consecutive RPL women with a mean age 35.8 ± 4.1 years, who underwent to TVS, SHG and HSC.

Results: TVS compared with SHG showed an accordance of 89% in detecting uterine abnormalities. Moreover using HSC as gold standard for uterine cavity evaluation, SHG showed a sensivity of 94% and a specificy of 90%.

Conclusion: The high sensitivity and specificity of SHG obtained in this study, can suggest the use of SHG as preliminary test in the evaluation of the uterine cavity in the RPL patients.

628 COMPARISON OF 17 MATHEMATICAL FORMULAS IN PREDICTING MACROSOMIA

P. Rosati¹, L. Guariglia¹, C. Giri¹, M. Arduini²

¹Catholic University of the Sacred Heart, Obstetrics and Gynecology, Rome, Italy;²University of Perugia, Obstetrics and Gynecology, Perugia, Italy

Aims: To evaluate the accuracy of 17 mathematical formulas in estimating fetal weight in macrosomic fetuses.

Methods: In 333 pregnant patients submitted to sonographic scan less than 7 days before delivery the estimation of fetal weight was evaluated by mean absolute percentage error, standard deviation (SD), accuracy in prediction within ±5%, ±10%, ±15% of error. A new variable labelled “hypotenuse”, expressed as a single value, evaluate jointly mean percentage error and SD. Statistical analysis was performed using the student t-test and chi square test; a p value < 0.05 was considered significant.

Results: Fourteen of 17 formulas provided an overall mean absolute percentage error < 10% with predictions within 10% of the actual birth weight in 82% of cases. The lowest mean percentage error (4.16), SD (±3.3%) and hypotenuse (5.34) resulted with Warsof's equation (p < 0.01) with overall prediction ± 5%, ±10%, ±15% of the actual birth weight in 68%, 94%, and 98% of cases, respectively.

Conclusions: The accuracy of sonographic fetal weight estimation in macrosomic fetuses is higher using Warsof's formula that considered only abdominal circumference measurement. A new parameter, the hypotenuse was proposed and a value < 7 can be considered as a good predictor of macrosomia.

629 ACCURACY OF SONOGRAPHIC ESTIMATION OF MACROSOMIA

P. Rosati¹, L. Guariglia¹, M. Arduini², C. Giri¹

¹Catholic University of the Sacred Heart, Obstetrics and Gynecology, Rome, Italy;²University of Perugia, Obstetrics and Gynecology, Perugia, Italy

Aims: To compare in two series of macrosomic fetuses of non-diabetic and diabetic mothers four mathematical formulas considering respectively one, two or more biometric parameters in predicting birthweight.

Methods: Birth weight were recorded and compared with the ultrasonographic evaluation in 232 macrosomic fetuses of non-diabetic and 101 of diabetic mothers. Accuracy of formulas in estimating birthweight was assessed by the mean absolute percentage error, the mean systematic error and its standard deviations. Paired t-test was used to compare the difference in the mean percentage error and standard deviation from the different formulae in diabetic and non-diabetic groups. A p value < 0.01 was considered statistically significant.

Results: Considering newborns weighing over 4200 g, all the formulas revealed an underestimation of birthweight. The Warsof's formula based only on abdominal circumference provided the best prediction of birthweight (p < 0.01). The smallest mean differences in absolute percentage error and standard deviation were obtained either in diabetic (3.65 ± 3.04%) and non-diabetic (4.39 ± 3.45%) group.

Conclusions: Warsof's formula proved to be the most effective in sonographic estimation of macrosomia, even if our results did not show a significant difference in the accuracy between the two groups. Biparietal diameter measurements are similar for the same gestational age; however, due to the subcutaneous fatty tissue accumulation mainly in the abdomen and thorax of fetuses of diabetic subjects, abdominal measurements show dissimilarity. Our results show that in macrosomic fetuses ultrasound prediction of birthweight became less accurate with formulas using two or more parameters, particularly in diabetic women.

630 3D-ULTRASOUND MEASUREMENT OF PLACENTAL VOLUME AND FETAL GROWTH DURING UNCOMPLICATED PREGNANCY

E. Schleussner¹, C. Wandsleb¹, J. Westphal¹, W. Hunger-Battefeld², M. Bulgay-Moerschel¹

¹Friedrich-Schiller Universität Jena, Abt. Geburtshilfe, Jena, Germany;²Friedrich-Schiller Universität Jena, Innere Medizin, Jena, Germany

Objectives: The correlation between birth weight and placental weight at term is well known. The aim of the study was to correlate placental and fetal growth in the course of uncomplicated pregnancy.

Methods: Using 3D-ultrasound, fetal estimated weight (EW), abdominal circumference (AC), and placental volume (PV) were assessed in 323 women with uncomplicated singleton pregnancy from week 10 to 38 of gestation. All recordings were accomplished with a GE Voluson 730 Expert using the formula of Hadlock for weight estimation and the method of Hafner for volume measurement (1). ANOVA and analysis of correlations according to Pearson were used for statistical analysis.

Results: PV grew during second and third trimester from a mean of 32 to 400 ml (regession coefficient R = 0.776; p < 0.001), while the PV/EW ratio decreased exponentially (R = 0.778; p < 00.1). In the same manner, a decline in the ratio of birth and placental weight in preterm birth from week 27 onwards (R = 0.708; p < 0.001) was observed. However, PV/AC ratio seems to be independent from gestational age. There is a high correlation between PV and AC (r = 0.787; p < 0.01) as well as PV and EW (r = 0.551; p < 0.01).

Conclusions: For the first time, placental growth dynamics are described over the course of pregnancy using 3D ultrasound measurement. The ratio of placental to fetal size decreased during pregnancy in spite of an increasing demand of functional placental capacity. The PV/AC ratio could be a predictor independent of gestational age.

631 THE INTER- AND INTRAOBSERVER RELIABILITY OF TOTAL UTERUS VOLUME CALCULATION AT THE GESTATIONAL AGE OF 11⁺⁰–13⁺⁶ WEEKS WITH THREE-DIMENSIONAL ULTRASOUND

J. van de Ven¹, S.G. Oei¹, N.A.C. Smeets²

¹Maxima Medical Centre, Gynaecology, Veldhoven, Netherlands;²Atrium Medical Centre, Gynaecology, Heerlen, Netherlands

Introduction: Volume measurements of the human fetus are possible with three-dimensional ultrasound systems. A three-dimensional volume scan is acquired in less time and is superior in relation to two-dimensional ultrasound in volume calculations of irregular objects^1,2,3,4,5,6. In-vivo studies confirm these conclusions^3,5,7.

Materials and Methods: Three-dimensional volume scans were acquired by an experienced investigator during nuchal translucency measurements in pregnant women with a gestational age between 11⁺⁰ and 13⁺⁶ weeks. Two observers measured randomly fifty fetuses, blinded for the results.

3D View© (Kretz Sonoview II) was used to receive, store and measure the uterine volumes from the 3D-datasets. The Virtual Organ Computer Aided Analysis (VOCAL) imaging program was used to calculate the uterine volumes using 9 degrees of rotation in C-plane (coronal plane). After collecting the data a statistical analysis was performed to calculate the Intraclass Correlation Coefficients (ICC).

Results: Intraclass Correlation Coefficient (ICC) between observers (interobserver reliability): 0.001. ICC of intraobserver reliability: 0.969.

Discussion: The intraobserver reliability of three-dimensional ultrasound uterine volume calculations is reliable. In contrary the inter-observer reliability is not reliable at all. A reason for this worse inter-observer reliability lies perhaps in the extent of magnification of the ultrasound scans.

As the real uterine volume is not known in this in vivo setting it is not possible to investigate the accuracy of these volume calculations.

Conclusions: Uterine three-dimensional ultrasound volume calculations with 3D View have a high intraobserver but a very low inter-observer reliability.

632 CEREBRAL COLOR DOPPLER IN NEAR TERM INFANTS WITH PERINATAL ASPHXYHIA

B. Vasiljevic¹, O. Antonovic¹, M. Gojnic²

¹Institute of Gynecology and Obstetrics-University Clinical Centre of Serbia, Neonatology, Belgrade, Serbia;²Institute of Gynecology and Obstetrics-University Clinical Centre of Serbia, Perinatolgy, Belgrade, Serbia

Aims: Several methods are usedto assess the extent of neuronal damage during the first daysof life. The use of color Doppler imaging (cDI) allow simultaneous examination of parenchymal and vascular cerebral structures. The aimof this study is to estimate values of cerebral blood flow velocities (CBFV) and Doppler indices (RI) in cerebral arteries (ACA) during the first 12 hours of life in near term infants with asphyxia and long-term prognosis.

Methods: Values of CBFV and RI were obtained in first 12h of life with cDI in near term infants with perinatal asphyxia and compared this values to the control group. We compared the values of PSV, EDV and RI with long-term prognosis.

Results: The mean BW was 3540 ± 950 g (range 2050–4600). In the 1^st control group (34–36 wk) of 10 infants values of RI-ACA was 0.88 ± 0.15; PSV-ACA 45 ± 15.80 cm/s and EDV-ACA 8.60 ± 2.80 cm/s. In the 2^nd control group (≥37 wk) of 20 infants values of RI-ACA was 0.90 ± 0.13; PSV-ACA 48 ± 14.50 cm/s and EDV-ACA 6.70 ± 2.40 cm/s. In the 1^st asphyxia group (34–36 wk) of 10 infants values of RI-ACA was 0.86 ± 0.15; PSV-ACA 25 ± 11.50 cm/s and EDV-ACA 3.40 ± 2.30 cm/s. In the 2^nd asphyxia group (≥37 wk) of 20 infants values of RI-ACA was 0.80 ± 0.13; PSV-ACA 28 ± 12.50 cm/s and EDV-ACA 4.50 ± 1.40 cm/s.

Conclusions: Values of PSV and EDV were significantly lower in asphyxia groups (particularly in infants with poor prognosis) and RI significantly higher in same groups. Measurements CBFV with cDI would be useful in predicting long-term prognosis in infants with perinatal asphyxia.

633 THE ROLE OF ULTRASOUND TO DIAGNOSE PERIVENTRICULAR LEUCOMALATY IN PRETERM DELIVERED BABIES

N. Zeka¹, M. Shala², R. Bejiqi¹, R. Ratkoceri¹, M. Azemi¹

¹Clinical University Center – Pediatric Clinic, Departament of Pediatric Neurology, Prishtina, Albania;²Clinical University Center – Pediatric Clinic, Departament of Neonatology, Prishtina, Albania

Introduction: Periventricular leucomalatio (PVL) is a serious damage of brain that occurs during antenatal, perinatal and postnatal period. In preterm babies under 32 gestational weeks, we have 4–9% of PVL.In term babies, this kind of damage is very rare 0.9–2‰. In 35–90% of cases, damage can cause severe changes, which clinically are express as spastic diplegy and cerebral palsy.

Objective: To look accordance between of positive hemoculture and scale of PVL.

Material and Methods: In our annual study (January 2004-january 2005) we examined 200 preterm babies hospitalised in our Clinic. Babies were 28–35 gestational weeks (mean 31 weeks) weight 900–2500 gr. (mean 1600 gr.), at all preterm babies we made brain ultrasound with 7.5 MHz frequency probe.

Results: PVL is developing at 22 cases (11%) and according to sex: 12 males and 10 females. From them 14 were PVL of I-st and II-nd type and eight cases with III-rd type. From this number 17 or 75% had positive hemoculture. We had a significant relation between positive hemoculture and third type of PVL, which results with 7 cases or 88%. In addition, the size of cyst play important role in prognosis, were cysts larger than 1 cm give permanent changes also depend on localisation.

Conclusion: PVL is very often at preterm babies and our results show relation between results of hemoculture and type of PVL.

Keywords:Periventricular leucomalatio, preterm delivery, ultrasound

634 IUGR AND NEONATAL OUTCOME

E. Bajalski¹, J. Ivanov¹, J. Guleva², B. Mihajlovic²

¹Gynecology Hospital Cair, Perinatology, Skopje, Macedonia;²Gynecology Hospital Cair, Neonatology, Skopje, Macedonia

The most widely approved definition of IUGR is a fetus whose estimated weight is below 10^th percentile fot its gestational age and whose abdominal circumference is below 2.5^th percentile. Aproximatly 70% of these fetuses are constitutionally small and the remaining 30% are patologic. The exact data about the last menstrual period and assessment the gestational age by ultrasound before 20^th gest. week are the key points of early diagnose of IUGR. Ultrasound biometry of the fetus in IUGR is gold standard for assessing fetal growth, specially BIP, ACL and FL.

In our hospital we had 12592 newborns between 2004–2007 out of which 1375 or 11% were IUGR. The caesaren section was performed in 321(23%) pregnancies and the rest were spontaneously delivered. The most frequent age group was 25–30 years in 492(35%) of the cases. The neonatal morbidity is presented by asphyxia,palida and livida in 56(26%) cases and the livida is prevalating over 70%, as well as 17 cases of meconial aspiration. We found 60(4.5%) cases of foetal dystress during delivery. In terms of the type of IUGR the asymetric predominate by 55% over the symetric one. Congenital malformations were found in 50(3.6%) cases.

The results of our analysis are similar to those of the literarture. At baseline children with IUGR have been found to demonstrate attention and performance deficiency. Minimization of hypoxic episodes during labor and delivery as well as optimization of neonatal care for these infants will likely produce the healthiest outcome.

635 GUIDELINE FOR MANAGEMENT OF FETAL GROWTH RESTRICTION AND PERINATAL IMPLICATIONS

M.D. Gómez-Roig, M. Reig, E. Mazarico, L. Allué, J. Sabrià, J.M. Laïlla

University Hospital San Joan de Déu, Obstetrics and Gynecology, Esplugues, Spain

Objective: To determine Doppler influence in the management of growth restricted fetuses and the decrease in their perinatal morbid-mortality.

Material and Methods: This is a longitudinal prospective study, carried out in Hospital Sant Joan de Déu, Barcelona, with an annual volume of 4500 deliveries and 11264 ultrasounds. The study lasted 16 months (from September 2006 until December 2007). A new guideline based on Doppler was applied and fetuses with EFW (estimated fetal weight) < 10 percentile (121 cases) were classified in two groups: 79 IUGR (intrauterine growth retardation) (EFW < 10 percentile with Doppler abnormalities, and EFW < 3 percentile without Doppler abnormalities), and 42 SGA (small gestational age) (EFW < 10 percentile, but > 3 percentile, without Doppler abnormalities).

Results: Significant differences were observed between SGA and IUGR in non-reassuring fetal heart rate status (14% SGA vs 29% IUGR) (p = 0.053), APGAR score at 1 and 5 minutes (p < 0.05) and neonatal admission (2.4% SGA vs 25% IUGR) (p = 0.01).

Conclusions: The application of a new guideline based on Doppler examination helped to avoid unnecessary prematurity and to decrease perinatal morbid-mortality, and, therefore, neonatal admission.

636 FETAL GROWTH RESTRICTION: MANAGEMENT AND OBSTETRICAL IMPLICATIONS

E. Mazarico, M. Reig, L. Almeida, L. Pallarés, A. Hernández, M.D. Gómez-Roig

University Hospital San Joan de Déu, Obstetrics and Gynecology, Esplugues, Spain

Objective: To determine Doppler influence in the management of growth restricted fetuses and its implications in the obstetrical results.

Material and Methods: This is a longitudinal prospective study, carried out in Hospital Sant Joan Déu, Barcelona, with an annual volume of 4500 deliveries and 11264 ultrasounds. The study lasted 16 months (from September 2006 until December 2007). A new guideline was applied and fetuses with EFW (estimated fetal weight) < 10 percentile (121 cases) were classified in two groups: 79 IUGR (intrauterine growth retardation) (EFW < 10 percentile with Doppler abnormalities, and EFW < 3 percentile without Doppler abnormalities), and 42 SGA (small gestational age) (EFW < 10 percentile, but > 3 percentile, without Doppler abnormalities).

Results: There were no significant differences between SGA and IUGR in obstetrical precedents, gestational age of diagnosis (EFW < 10 percentile), and amniotic fluid index less than 5 (p > 0.05). Significant differences were observed between SGA and IUGR in gestational age at delivery time (mean gestational age: 38 weeks in SGA, 35 weeks in IUGR) (p < 0.001), way of starting delivery (spontaneous: 60% SGA vs 18% IUGR/induced or programmed: 40% SGA vs 82% IUGR) (p < 0.001) and way of delivery (vaginal: 76% SGA vs 46% IUGR /caesarean: 24% SGA vs 54% IUGR) (p = 0.001).

Conclusions: Making a distinction between IUGR/SGA fetuses based on Doppler may help early detection of populations at risk, and decrease iatrogenic prematurity, induced deliveries, and caesarean rate.

637 MATERNAL FACTORS AND SMALL- FOR- GESTATIONAL- AGE INFANT

S. Milenkovic¹, S. Tasic¹, A. Dukic², M. Raicevic- Pavlovic¹, I. Madic², M. Milenkovic³

¹Clinical Hospital Center Zemun, Neonatology, Beograd, Serbia;²Clinical Hospital Center Zemun, Obstetrics and Gynecology, Beograd, Serbia;³Health Center Sveti Luka, Obstetrics and Gynecology, Smederevo, Serbia

Fetal growth is under multiple influences of genetic and environmental factors of maternal, placentaland fetal origin.

The aim of our study was to investigate association between different maternal factors and low birth weight.

Patients and Methods: The study was carried out in Clinical- hospital center Zemun, Belgrade from 2003–2007. Small for gestational age- SGA (birth weight less than 10^th percentile for gender, gestational age and parity) and age matched apropriate for gestational age-AGA infants from singleton pregnancies as controls were compared for various maternal factors. Data were obtained from computer database and questionaries for mothers.

Results: 544 SGA and 564 AGA infants were included in study. Mothers younger than 17 are at significantly greater risk of having SGA infant (OR 3.07, 95% CI: 1.42–6.84) as well as multiparous- greater or equal to 4 (OR 3.06, 95% CI: 1.92–4.81), mothers with uncontroled pregnancies (OR 4.34, 95% CI: 2.72–6.94), women with hypertensive disorders of pregnancy (OR 1.63, 95% CI: 1.12–2.32) and smokers (OR 1.72, 95% CI: 1.35–2.18). Previous preterm infant (OR 4.77, 95% CI: 2.20–10.40) or child deaths (OR 3.83, 95% CI: 1.07–13.83) also showed association with SGA. We did not found statisticaly significant differences among women aged 35 years or older (p > 0.05). Number of SGA infants were significantly lower among nulliparous (p < 0.05). Birth weight and birth length showed a significant correlation with maternal height (r = 0.52, r = 0.55), maternal weight gain (r = −0.33, r = 0.82) and maternal birth weight (r = 0.49, r = 0.40).

Conclusion: Fetal growth is under great influence of maternal health, nutrition and habits.

638 PERINATAL OUTCOME OF PREGNANCY AND PARTURITION IN IUGR

S. Petakovic, D. Malobabic, Z. Petrovic, B. Mitrovic

Health Care Center Sremska Mitrovica, Department of Gynecology, Obstetrics, and Neonatology, Sremska Mitrovica, Serbia

Introduction: Pregnancies with a potential to end in miscarriage, intrauterine growth retardation (IUGR), fetal damage or fetal death, are regarded as risk pregnancies. Frequency of IUGR is 3–10%.

GOAL: The goal of the paper is to analyze IUGR neonates for incidence and perinatal morbidity and mortality.

Methods: Retrospective analysis of data from medical documentation for the period from 1 January 2003 to 31 December 2007.

Results: There were a total of 7186 parturitions, with a total of 7262 neonates, of which 7230 were liveborn, and 32 stillborn. There were a total of 547 (7.53%) IUGR neonates, 538 (98.35%) liveborn, and 9 (1.65%) stillborn. Analysis of body weight and gestation weeks: 25 (4.57%) < 37 GW, 495 (90.49%) 37–42 GW, and 27 (4.94%) > 42 GW. The highest number of neonates, 409 (74.77%) had BW > 2500 gr, of which 379 (92.68%) were term neonates. Vaginal parturitions were 450 (82.27%) and 97(17.73%) were completed by Caesarian section. Most frequent pathological states were: perinatal asphixia (68 or 23.21%), conjuctivitis (57 or 19.45%), hyperbilirubinemia (54 or 18.43%), and hypoglycemia (23 or 7.85%). Congenital anomalies were present in 53 (9.69%) neonates, 9 (1.64%) were stillborn, with 1 (0.18%) early neonatal exitus due to a congenital cardiac disorder. Perinatal mortality in IUGR neonates was 18.28 promille.

Conclusion: Adequate supervision and control during pregnancy and parturition in IUGR patients will enable the concluding of the pregnancy at the optimal time, and reduce complications and deaths during the perinatal period.

639 UTERINE AND UMBILICAL ARTERY DOPPLER: PREDICTION OF IUGR/PREECLAMPSIA

S. Stamenovic¹, S. Milicevic², M. Jonovic³

¹Clinic of Obs and Gynecology, Clinical Center Nis, High Risk Pregnancies, Nis, Serbia;²Institut of Obs and Gynecology, Clinical Center Serbia, Endocrinology, Belgrade, Serbia;³Clinic of Obs and Gynecology, Clinical Center Nis, Neonatology, Nis, Serbia

Objective: Doppler measurement diagnostic efficiency in uterine and umbilical artery in fetus prenatal detection and respiratory menace with IUGR and preeclampsia was examined in this paper.

Methods: A prospective analysis was performed in 141 pregnancies. The control group included 65 normal pregnancies without complications and experimental group included 76 high-risk pregnancies which was divided into three sub-groups, namely, 31 with IUGR and preeclampsia, 24 with preeclampsia and 21 with IUGR. Ri-resistance index was measured in uterine artery was as well as presence of diastolic notch and Pi index in umbilical artery.

Results: Uterine artery Doppler analysis has shown statistically higher values of RI index as well as presence of unilateral diastolic notch in 80% and bilateral diastolic notch in 30%, with IUGR and preeclampsia pregnancies. Statistically higher Pi index in umbilical artery was recorded in IUGR pregnancies comparing to the others, and Pi index higher values were particularly noticed with IUGR and preeclampsia pregnancies. Uterine and umbilical artery Doppler has shown a significant negative correlation comparing to Apgar score in the 5^th minute of the newborn with IUGR and preeclampsia.

Conclusion: The best uterine and umbilical artery Doppler parameters diagnostic efficiency has been achieved with IUGR and preeclampsia pregnancies, and the efficiency is increased together with the biophysical profiles and CTG.

640 FETAL GROWTH INFLUENCED BY MOTHER HEALTH

M. Stojanovic, S. Sljivic, I. Stojkovic-Eferica

Gynecology and Obstetric Clinic, Neonatology, Nis, Serbia

Aim: The equilibrium of maternal immune, endocrine and nervous systems is asignificant condition for the normal growth and development of the fetus. Some data demonstrate that insulin-like growth factor-I andinsulin-like growth factor binding protein-1 are related to fetal growth. The aim of this study is topoint out the importance of comparative hematological, immunological andbiochemical laboratory analyses in newborns with in utero growth retardation and early neonatal diseases inthese babies, as indicator of prenatal activation of the immune system.

Methods: Twenty-five newborns with IUGR, and body mass belowp 10 (2500 g) have been monitored. Mother's case-history, examination afterbirth, laboratory examinations (red and white blood cellcount, hemoglobin and hematocrit level, nitro-blue-tetrasolium test-NBT, serumimmunoglobulin levels, lactate dehydrogenase, creatin phosphocinase, glicemia), ultrasound and radiological examination have been analyzed.

Results: All mothers suffered from acute and chronic disorders during or before theactual pregnancy. The most frequent early neonatal diseases that appeared in IUGR group of newborns are: altered tonus of muscules in 73%, respiratory distress in 36%, perinatal asphyxio in 36%. Ultrasound examination of central nervous system showed intracranial hemorrhagein 27%, periventricular leucomalation in 36%. Altered laboratory parametersshowed: hypoglicemia in 45%, increased absolute number of monocytes, neutrophylesand NBT positive cells, and increased serum level of immunoglobuline M.

Conclusions: Thealtered immune system parameters indicated potential pathophysiologicalbackground of in utero growth retardation. Good health condition of mother, before and during pregnancy, may be very important for fetal growth.

641 ARTERIAL WALL THICKNESS AND BLOOD PRESSURE IN CHILDREN WHO WERE BORN SMALL FOR GESTATIONAL AGE: CORRELATION WITH UMBILICAL CORD HIGH-SENSITIVITY C-REACTIVE PROTEIN

F. Avezz[ugrave]¹, F. Mario¹, N. Doglioni¹, M. Marzolo¹, F. Verlato¹, V. Zanardo¹, D. Trevisanuto²

¹University of Padova, Azienda Ospedaliera Padova, Padova, Italy;²University of Padova, Azienda Ospedaliera Padova, Pediatric Department, Padova, Italy

Background: Epidemiological studies show that small for gestational age (SGA) infants have an increased risk of later cardiovascular disease. At birth, high sensitivity-C reactive protein (hs-CRP), a prognostic marker of cardiovascular disease, is significantly higher in SGA infants in comparison with adequate for gestational age (AGA) infants.

Aim: To measure aortic and carotid intima media thickness (aIMT – cIMT) and blood pressure (BP) in children (aged 3–5 years) who were born SGA and AGA, and to assess the correlation between hs-CRP concentrations obtained at birth and these hemodynamic parameters.

Methods: aIMT and cIMT were measured by high-resolution ultrasound scan, in the dorsal arterial wall. Anthropometrical parameters and BPs were obtained for each child.

Results: MedianaIMT was similar between children who were born SGA (n. 17) and AGA (n. 21): 0.700 mm (range 0.460–0.870) vs 0.610 mm (0.400–0.780); p = 0.13. Right and left cIMTs were similar between the 2 study groups. Concentrations of hs-CRP were not correlated with IMTs, neither in SGA nor in AGA infants. In children who were born SGA, systolic BP was significantly correlated with the cordonal hs-CRP concentrations (r = 0.59; p = 0.01).

Conclusions: Children who were born SGA have a higher, although not significant, aIMT than those who were born AGA, not correlated with cordonal hs-CRP. Instead, cordonal hs-CRP wes significantly related to systolic BP values in children who were born SGA suggesting that the presence of an inflammatory status during the fetal life could play a role in the sympathetic system hyperactivity and in the stress-response during childhood.

642 OUTLOOK OF THE SLOVAK NEWBORNS ON THE BORDER OF VIABILITY

K. Demova, A. Bystricka, G. Magyarova, F. Bauer

FNsP Nove Zamky, Dpt. of Neonatology, Nove Zamky, Slovakia

A brief background and aim: The goal of our study is the evaluation of mortality, short and long term morbidity in ELBWI on the border of viability in Slovak republic.

Material and Methods: The evaluation of statistical data of mortality and morbidity collected from perinatological centers and NICU in Slovakia.

Results: Specific neonatal mortality according to GA decreases with each additional week of gestation, while in 23 wks' gestation reaches 923‰, in 29 wks' it is only 353‰. The most prevalent morbidity in survivals newborns in 24–26 wks' is CP (75%–31%) and PMR (100%–37%), high incidence has blindness and deafness. The survival is not the only goal of perinatal medicine when attempting to establish a “lower limit of viability”. Quality of life should be a major priority.

Conclusions: In Slovakia despite ongoing progress in perinatal care over the last decade mortality of newborns on the borderline of viability remains high and the majority from survivors have serious neurosensory sequels. The knowledge about the survivals and the following quality of life of newborns on the borderline of viability assists in decision making of method of treatment. Trying to push the limit of viability towards lower GA is not a priority in our country. Research efforts should focus on improving long-term sequel for survivors and on developing high quality palliative care of infants with infaust prognosis.

643 EVALUATION OF PARENT SATISFACTION IN A NICU SETTING

M. Dasopoulou, O. Dedousi, V. Makri, A. Salapata, G. Karavana, A. Gounaris

Pireus, Neonatal Department, Pireus, Greece

Objective: Evaluation of health care services by the consumers is vital to the assessment of quality of care. Very few questionnaires assess parent satisfaction. The aim of the study is to validate a project questionnaire as an instrument for measuring parental satisfaction in a NICU setting.

Methods: Twentyfive items selected with reduction to 20, 11 of which measuring satisfaction and 9 measuring dissatisfaction. The items fell into three domains: communication, personality, confidence. The questionnaire was of a 4 scale response in which 4 indicated the highest level and 1 the lowest. It was offered at the time of discharge and re administered within 7 days. Socioeconomic issues and the parental education status were recorded.

Results: We then conducted a pilot study, enrolling 61 parents and 10 NICU doctors and nurses. Thirty-five had male and 26 female infants, 41 in the ICU, 20 in the low dependency unit. The mean gestation age was 33.81 weeks (SD: 3.98), the mean birth weight was 2648 gr (SD: 890.63) and the mean duration of care was 26.1 days (SD: 7.4). 50.7% of parents had completed secondary education and 10% had a university degree. The ranges of satisfaction were of min: 51 to max: 80 (hope scores min: 45, max: 72, mean: 56.94, SD: 8.96). Ten parents re completed the questionnaire within 7 days after discharge. Single sample t-test p value was <0.05 (reliability). Cronbach a for reliability testing was high 0.79.

Conclusion: The project questionnaire could be proved a valuable tool to measure parent satisfaction in NICU.

644 FETAL RIGHTS-ETHICS AND REGULATIONS

A. Ismail

Al-Azhar University for Girls, Obstetrics&Gynaecology, Giza, Egypt

The existence, validity and the content of fetal rightscontinue to be the subject of debate in philosophy, political science andmedicine. My study includes a historical presentation of the subject of fetalrights and proposals for legalisations of the fetal rights for example insubjects as abortion, sex selective abortion in some countries especiallydeveloping countries, surrogacy, embryo cryo-preservation and termination of pregnancy in congenital anomalies.

645 EFFECTS OVERWEIGHT AND OBESITY OF PREGNANCY ON OBSTETRIC OUTCOMES IN IRAN

E. Jenabi

Department of Midwifery, Touyserkan, Iran

Objective: The purpose of this study was to investigate effect of increase in body mass index (BMI) group on obstetric outcomes.

Methods: Women with singleton pregnancies included in this study. Women were grouped in four groups of BMI. Wilcoxon was used to compare continues variables, and chi-square test for categorical variables.

Results: This study included 879 women. Increase in BMI groups was associated with higher rates gestational age and neonate weight, whereas nulliparity decreased with increasing BMI groups. Increase in BMI groups in overweight and obese women was in duration second stage (p < 0.001) and active phase of labor (p < 0.001) when compared with other BMI groups, respectively.

Conclusion: Increase in BMI groups is associated with increased risk of complications.

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646 COMPLICATIONS IN PIERRE ROBIN SYNDROME – DIFFICULT DECISION FOR ENDING A NEW LIFE

D. Mocuta¹, C. Aur¹, H. Brezovsky², C. Rusu³, M. Veres¹

¹Faculty of Medicine and Pharmacy, Obstetrics – Gynecology, Oradea, Romania;²Clinical Hospital of Obstetrics – Gynecology, Obstetrics – Gynecology, Oradea, Romania;³Clinical Hospital of Obstetrics – Gynecology, Neonatal Intensive Care Unit, Oradea, Romania

Pierre Robin Syndrome or Pierre Robin Malformation is a congenital condition of facial abnormalities in humans and is characterized by an unusually small jaw (micrognathia), posterior displacement or retraction of the tongue (glossoptosis), and upper airway obstruction. Incomplete closure of the roof of the mouth (cleft palate), is present in the majority of patients, and is commonly U-shaped. The syndrome is generally diagnosed shortly after birth and has an incidence ranging from 1 in 8500 to 1 in 30000. There are some theories for the etiology of this syndrome: the mechanical theory, the neurological maturation theory and the rhombencephalic dysneurulation theory. The first one is the most accepted and it's about the initial event, mandibular hypoplasia, which occurs between the 7th and 11th week of gestation. This keeps the tongue high in the oral cavity, causing a cleft in the palate by preventing the closure of the palatal shelves. Oligohydramnios could play a role in the etiology since the lack of amniotic fluid could cause deformation of the chin and subsequent impaction of the tongue between the palatal shelves. Children affected with PRS usually reach full development and size, very rare appears death because of the complications. We will present a case of pregnant woman with neurological pathology, under treatment, which had polihydramios, and the medical attitude after delivery regarding the new born with Pierre Robin Syndrome and an unfavorable evolution, about continuing resuscitate or decision for ending life of the baby.

Keywords:Pierre Robin Syndrome, hydramnios, resusitation, ending life

647 THE NEW-BORN'S ABANDON, A PROBLEM WHICH NEEDS RESOLUTION

F.-M. Veres¹, T. Pop¹, L. Antal¹, S. Lacziko¹, R. Herczegh²

¹University of Oradea, Oradea, Romania;²Spitalul Clinic de Obstetrica – Ginecologie Oradea, Oradea, Romania

Nowadays, in III-rd millennium's Romania, we still have to confront with the abandon of new-born children, a negative social phenomenon, due to some inadequate governmental strategies, which were not able to solve series of medical-social problems, like for example the pregnancies at under-age. A retrospective analysis, done for the last 5 years in the Obstetrics-Gynecology Hospital of Oradea, shows that there were 22813 births, followed by 908 abandonment. This study tries to highlight some pending particularities, related to geographic area, family history or the level of school, in order to elaborate some conclusions, meant to decrease the high percentage of abandonment, which entail in any of the European Community states.

648 ANAESTHETIC TECHNIQUE FOR CAESAREAN DELIVERY AND FETO-MATERNAL OUTCOME IN A DEVELOPING COUNTRY

U. Okafor¹, B. Ozumba², K. Ekwuazi², H. Ezegwui²

¹University of Nigeria Teaching Hospital, Anaesthesia and Intensive Care, Enugu, Nigeria;²University of Nigeria Teaching Hospital, Department of Obstetrics and Gynaecology, Enugu, Nigeria

Objective: General anaesthesia is recognized as a leading cause of maternal mortality in caesarean deliveries. And regional anaesthesia is believed to reduce anaesthesia – related maternal/fetal morbidity and mortality. We undertook this study in the University of Nigeria Teaching hospital, Enugu, Nigeria to determine feto-maternal outcome following caesarean delivery.

Method: We conducted a retrospective survey of hospital records of anaesthesia and caesarean deliveries in this unit over a 4 year span from January 2003 to December 2006.

Results: There were 2968 deliveries with 729 women (24%) delivered by caesarean section. There were sixty-one stillbirths giving a stillbirth rate of 83.6/1000 caesarean deliveries. The total number of stillbirths in the hospital during the study period was 181 giving a stillbirth rate of 61/1000 deliveries. Forty-four (72%) stillbirth deliveries were associated with general anesthesia and 17 (28%) associated with spinal anesthesia. Of the thirty-two neonates with Apgar score of 3–5 at five minutes after birth, 21 (66%) delivered under general anesthesia and 11 (34%) delivered under spinal anesthesia. There was one maternal death in a patient that delivered under general anesthesia.

Conclusion: The fetal loss in this study is high and may indicate that most data on stillbirths from parts of the developing world may be underestimates. Regional anesthesia may be associated with a reduction in anesthesia-related maternal/fetal morbidity and mortality. Its use should be encouraged in the developing world, especially resource poor environments.

649 THE CORRELATION OF PLACENTAL VASCULAR DAMAGE WITH CLINICAL SIGNS AND FETAL OUTCOME IN PATIENTS WITH PREECLAMPSIA

A.K. Syamsuri

Medical Faculty of Sriwijaya University/Moh. Hoesin General Hospital, Obstetric and Gynecology, Palembang, Indonesia

Objective: to assess placental vascular damage histologically and to assess the correlation of placental vascular damage with clinical signs and fetal outcome in patients with severe preeclampsia.

Methods: This study was a descriptive analytic study for 66 pregnant women with preeclampsia/eclampsia who delivered at Department of Obstetrics and Gynecology of dr. M. Hoesin General Hospital in Palembang, Indonesia.

Results: Vascular placental damage had positive correlations in systolic blood pressure (r = 0.255; p = 0.000), diastolic blood pressure (r = 0.253; p = 0.000), gestosis index (r = 0.277; p = 0.000), leucocyte (r = 0.386; p = 0.000), hematocryte (r = 0.386; p = 0.000). In addition, placental vascular damage had negative correlation in trombocyte (r = −0.153; p = 0.000), fetal body weight (r = −0.453; p = 0.000), fetal body length (r = −0.218; p = 0.000), and placental weight (r = −0.453; p = 0.000). There was a significant association of the score of placental vascular damage with proteinuria + 2 and proteinuria + 3 (p = 0.012). And the score of placental vascular damage with and without edema showed a significant association (p = 0.024). We also found significant association of placental vascular damage with mild asphyxia (p = 0.049) and severe asphyxia (p = 0.031) in the first minute of APGAR score.

Conclusion: Placental vascular damage in patients with severe preeclampsia could affect the development of the placenta and fetus. Blood pressure, gestosis index, and hemolytic profile were associated with placental vascular damage in severe preeclampsia.

Keywords:Preeclampsia/eclampsia, placental vascular damage

650 EVALUATION THE COMPARED DOPPLER ULTRASONOGRAPHY AND SERIAL FONDAL HEIGHT MEASUREMENT IN DETECTION OF IUGR

S. Alimohammadi, M. Zamani

Hamedan Medical Univ., Hamedan, Iran

Introduction and objective: There are different method for detection of fetal growth restriction. The important of this are serial fondal height (SFH), and ultrasonic measurement. Becouse of sensivity and specificity in different studies are variable. We evaluate the comparence between sensivity and specificity of SFH (a safe and simple method) with Doppler ultrasonography in F.G.R.

Materials and Methods:This study was cross-sectional and we selected 550 peregnant women with growth retardation in physical exam more than 4cm in SFH. so thay referred to Doppler ultrasonography. we matched demographic character, obstetrics history, B Mode sonography finding (AFI/ placental grading) and evaluated in last records of neonatal weight/and other records for IUGR.we analysis sensivity and specificity of SFH and Doppler ulterasonography in detection of IUGR.

Results: The average age was 22.5 ± 4.9(16–45), average of Parity was 1.3 ± 0.7(1–11). Prevalence of IUGR in population study was 9.4% and sensivity and specificity of SFH in detection of IUGR 44/7%, 93.8% respectively with positive predictive value 44.8% and negative predictive value 94.6%, Doppler ultrasonography sensivity and specificitywas 90.9% and 100% resppectivly.

Conclusion: Our study propose that SFH in detection of IUGR is valid measurement and draw growth curve is necessery.

Keywords:Fetal Growth Retardation/Fondal Height/Gestational Age Ultrasonogaphy, Doppler

651 A LOW CESAREAN DELIVERY RATE DOES NOT AFFECT PERINATAL OUTCOMES

J. García Adánez, N. Marín, M. Lure, J. Larraz Soravilla

Hospital Donostia, San Sebastian, Spain

Objective: To compare perinatal outcomes in two periods with different cesarean delivery rates, secondary to changes in our obstetric practice.

Methods: This study includes all the deliveries in our hospital in 2002–2007. We established two different periods: 2002–2004 and 2005–2007 considering that our obstetric practice changed in 2005. From that date, we applied evidence based medicine. SEGO definition for dystocia, and Xenakis' conclusions for failure induction were strictly applied. We used Zalar criteria for intrapartum fetal acidosis and ACOG requirements for vaginal birth after caesarean delivery (VBAC). We also introduced amnioinfusion, cephalic external version and selected breech vaginal delivery criteria from Dublin Maternity Hospital. We analysed the changes in overall cesarean rate and in the different indications: failure induction, dystocia, breech presentation, nonreassuring fetal status and previous cesarean, and evaluated perinatal mortality, apgar test, umbilical artery blood ph and neonatal intensive care admission.

Results: 13.105 births were attended in 2002–2004 and 13.341 in 2005–2007. In the 2005–2007 period there was a significant reduction in failure induction (24.3% vs 13.7%; p < 0.0001), dystocia (6.5% vs 2.8%; p < 0.0001), breech presentation (94.4 vs 86.3%; p = 0.04), nonreassuring fetal status (4.9% vs 2.9%; p < 0.0001) and overall cesarean rate (17.5 vs 12.2%; p < 0.0001). VBAC increased from 57% to 70% (p < 0.0001).

There were no statically differences in perinatal mortality (6.5‰ vs 6.6‰; p = 0.789), umbilical artery pH < 7 (0.4% vs 0.4%; p = 0.308), 5'apgar test < 4 (0.2% vs 0.2%; p = 0.763) and neonatal intensive care admission (0.0295% vs 0.030%; p = 0.87).

Conclusions: lowering cesarean rate using an evidence based medicine model does not affect perinatal outcome.

652 A CASE WITH OHTAHARA SYNDROME THAT WAS MISDIAGNOSED AS BECKWITH-WIEDEMANN SYNDROME IN THE INTRAUTERINE PERIOD

M. Polat¹, N. Tansug¹, G. Tekin¹, Y. Baytur², I. Sezgin³

¹Celal Bayar University Medical Faculty, Pediatrics, Manisa, Turkey;²Celal Bayar University Medical Faculty, Gynecology and Obstetrics, Manisa, Turkey;³Celal Bayar University Medical Faculty, Medical Biology and Genetics, Manisa, Turkey

Introduction: Ohtara Sydrome is the earliest form of age-dependant encephalopathies. It is characterized by early onset, tonic spasms and a suppression-burst pattern on electroencephalogram (EEG). Cerebral structural abnormalities and metabolic disorders have been reported as the etiologic factors. To date, no medical treatment has proved effectiveness and prognosis remains very poor with early death or severe handicap.

The present case has been diagnosed as Beckwith-Wiedemann Syndrome in the intrauterine period and EEG and radiological findings revealed Ohtahara Sydrome. Case: Length and weight of the female infant were in the 50–75 percentile; head circumference was in the 10–25 percentile. Pathologic findings were hemihypertrophy, macroglossia, hepatomegaly, and systolic murmur during cardiac oscultation. Hypoglisemia did not develop and fasting insulin level was normal. Abdominal ultrasonography showed bilateral nephromegalia. Echocardiography revealed a narrowing of the right pulmonary artery at the bifurcation. Burst-suppression pattern was present in EEG. Cranial magnetic resonance findings were thinning of the corpus callosum and bilateral frontal and left parietal polimikrogri.

Discussion: Ohtahara Sydrome is characterized by tonic seizures with early onset, burst-supression on EEG, poor prognosis and severe mental retardation or death. Majority of the cases are associated with cerebral structural abnormalities and a few cases had metabolic diseases.

Macroglossia and organomegalia during the intrauterine period resembled Beckwith-Wiedemann Syndrome; however, clinical signs of encephalopathy, seizures in the form of tonic spasm, EEG pattern and structural brain abnormalities changed the diagnosis as Ohtahara Syndrome. Clinical findings such as macroglossia and hemihypertrophy could not be related to these cortical developmental abnormalities.

653 NEONATAL MORTALITY RATE AND STILL BIRTH IN YAZD – IRAN

S. Akhavan Karbasi

Yazd, Pediatrics, Yazd, Iran

Objective: Neonatal mortality accounts two-thirds of all infant death and over one-third of deaths in under-five-year-olds. Neonatal mortality rates in different countries have to be identified. The main objective of the present study was to determine neonatal mortality rates and still birth in Yazd, central city of Iran.

Materials & methods: In a descriptive cross-sectional study, all births of the four maternity hospitals of Yazd- Iran in 2006, followed up for one month and neonatal deaths and still births was evaluated.

Results: NMR and stillbirth rate were 24 and 23 in 1000 live birth respectively. 62% of neonatal deaths occurred in the first 24 hours after birth and 93% in the first week. 8.4% of all newborns were low birth weight. NMR in LBW was 22 times more than that of normal weight newborns and in preterm was 19 times more than that of term, and in illiterate mothers was 9.4 times more than that of highly educate mothers.

Conclusion: The PMR and NMR have often been used as an indicator of the standard of a country's social, educational and healthcare systems. Strategies, which address inequalities both within a country and between countries, are necessary if there is going to be further improvement in global perinatal health.

654 NEONATAL MORTALITY OF LOW BIRTH WEIGHT INFANTS IN YAZD – IRAN

M. Golestan

Shahid Sadoughi University of Medical Science, Pediatrics, yazd, Iran

Objective: Low birth weight (LBW) is one of major determinants of neonatal survival as well as postnatal morbidityandthe second leading cause of infant mortality after congenital anomalies. The main objective of the present study was to determine neonatal mortality rate (NMR) in LBW infants in Yazd, central city of Iran.

Materials and Methods: In a descriptive cross-sectional study, all births of four maternity hospitals of Yazd – Iran in 2006, evaluated and mortality rate in LBW population over the course of the first month of extra uterine life determined.

Results: 8.4% (507 of 6016 births of all newborns were LBW. 18.7% (95/507) of all LBW neonates died. Two- third (95/143) of all neonatal deaths occurred in LBW. NMR in LBW, MLBW, VLBW and ELBW were 23, 11.5, 62.5 and 117 times more than that of normal weight newborns, respectively. Nearly 65% of all LBW neonatal deaths occurred in first 24 hours after birth. Overall NMR, ENMR and LNMR in LBW were 187, 118 and 9.8 in 1000 live births, respectively.

Conclusion: LBW accounted for two-third of neonatal deaths. Therefore, a reduction in incidence of LBW and preterm births should be part of the overall preventive strategy towards reducing neonatal mortality.

656 LOW BIRTH WEIGHT PREVALENCE AND IT'S RISK FACTORS IN YAZD – IRAN

R. Fallah

Shahid Sadoughi University of Medical Science, Pediatrics, Yazd, Iran

Objective: Low birth weight(LBW) is a population health problem and is a significant contributor to neonatal death in both industrialized and developing countries. The study investigated the prevalence and risk factors of LBW in Yazd, central city of Iran.

Materials and Methods: In a case – control study, all births taking place in all maternity hospitals of Yazd – Iran in 2006, evaluated. For each LBW neonate, two control cases (neonate whose birth weight exceeded 2500 grams) were included.

Results: The overall prevalence of LBW was 8.8%. While 1.5% and 7.5% were ELBW and VLBW respectively which represented 0.13% and 0.6% of the whole sample, respectively. LBW was significantly associated with birth interval < 1 years, twin birth, teenage pregnancy, preterm labor, working outside of home and low BMI of mother, prim parity and finally maternal disease. No effect of delivery route and mother educational level seen.

Conclusion: For reduction in incidence of LBW, careful perinatal care and impairment of neonatal transport, having skilled attendance at delivery and screening of pregnant mothers for important risk factors of LBW, such as low birth interval, maternal disease and twin pregnancies to provide them with prenatal health care facilities, is necessary.

Keywords:Low Birth Weight, Neonate, VLBW, ELBW

657 PREVALENCE, ETIOLOGY & RISK FACTORS OF INTRACRANIAL HEMORRHAGE IN NEONATES URMIA 2001–3

A. Macooie

Urmia Medical Science University, Pediatric, Urmia, Iran

Background: Intracranial Hemorrhage (ICH) is one of the major causes of the neonatal mortality and morbidity. With improvement in prenatal care, survival rate of premature neonates has been increased. These neonates are at increased risk of many disease states including ICH. Aim of this study is to determine the prevalence and the role of various factors in developing ICH.

Materials and Methods: It is a retrospective and descriptive study that was done on neonates, which were admitted in the neonatal and NICU ward from April of 2001 to March of 2003. ICH was diagnosed by cranial sonography, brain CT scan or at autopsy.

Results: 52 of 3742 newborn had ICH (1/38%) and mortality rate was 23%. 38(73/1%) of hemorrhagic events were occurred in the first 5 days of life. Prevalence of different types of ICH was 1-Subaracnoid hemorrhage (40%), 2-Intraventricular hemorrhage (36%), 3-Intra parenchymal hemorrhage (21%) and 4-Subdural hematoma (3%). The prevalence of sepsis, asphyxia and RDS were high in ICH cases. The commonest symptoms and signs of patients were hyporeflexia (75%), convulsion (60%), respiratory distress (40%), apnea (32%) and hypotonia (25%).The most important Para clinical finding was bloody CSF (36%).

Discussion: The close prevalence of SAH and IVH may be the result of lower chance of prematures survival. The most common associated disease was sepsis instead of asphyxia. We recommend bedside cranial sonography in all neonates with gestational age < 30 weeks, birth weight < 1500 grams and those having disease or risk factors for ICH.

658 TRIPLETS PREGNANCIES IN UNIVERSITARY HOSPITAL IN CANARY ISLANDS (SPAIN)

L. Valle-Morales, F. Cabrera, M. Medina, E. Cortés, A. Arencibia, T. Figueras, J.A. García

Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Spain

Introduction: obstetrical management of multiple pregnances has ever been a controversal cuestion cause their monitoring is very difficult and there is a high risk of maternal and fetal complications. Ten per cent of perinatal mortality is due to multiple pregnancies, becoming more frequent largely due to the increase in assisted reproduction techniques, increasing not only the incidence of twuin pregnancies but also of pregnancies with three or more fetuses.

Objective: to analyze the triplets pregnancies perinatal onset recorded in Materno Infantil Hospital in Canary Islands, from 1992 to 2007.

Results:

Conclusion: the management of multiple pregnancies, especially those of three or more fetuses, is a challenge for the obstetrician, which should be accustomed with their prenatal care, due to increased incidence of these by the progressive increase in assisted reproduction techniques. It is imperative handling prenatal aggressive and thorough in these pregnancies of three or more fetuses to reduce the incidence of complications and minimize the effect of these.

659 IS HRV USEFUL TO EVALUATE THE NEONATES WITH HYPOXIC ISCHEMIC ENCEPHALOPATHY?

D. Aliefendioglu¹, T. Dogru², M. Albayrak³, E. Misirlioglu³

¹Kirikkale University, Pediatrics, Neonatology Unit, Kirikkale, Turkey;²Kirikkale University, Cardiology, Kirikkale, Turkey;³Kirikkale University, Pediatrics, Kirikkale, Turkey

Objective: The measurement of heart rate variability (HRV) reveals information on the functional state of the autonomic nervous system (ANS). Moreover, several diseases are known to be accompanied by changes in HRV. Currently, there are no data on HRV within samples of asphyctic newborns. The objective of this study was to evaluate the changes in HRV after asphyxia in newborns.

Method: Twenty-two newborns (14 male, 8 female) with HIE and 24 term babies having similar gestational and postnatal age for control were included in this study. Asphyctic babies were divided into two groups according to the clinical severity [Grup I(n = 12) moderate HIE and Grup II (n = 10) severe HIE]. Low (LF) and high frequency (HF) components and their ratio were evaluated in 24-hour periods in newborns with HIE and control subjects.

Results: Indices of HRV that represent sympathetic activity of the autonomic nervous system [normalized low-frequency (LFn), and the ratio between LF and HF (LF/HF)] were lower whereas index that represent parasympathetic activity [normalized high-frequency (HFn)] was higher in HIE group when compared to control. The cut-off value of Hfn for HIE was 0.263 (sensivity 100% specifity 91.7%, area under the curve 0.966, p < 0.001).

Conclusion: HRV may be useful and a noninvasive tool in evaluating newborns with HIE.

660 NEONATAL HYPOCALCAEMIA DUE TO PRIMARY HYPERPARATHYROIDISM OF THE MOTHER IN PREGNANCY: CASE REPORT

E. Apazidou, C. Gaitana, E. Papadimitriou, A. Kalaitzi, K. Adamou, V. Alexandropoulou-Tsikrika

University Hospital of Larissa, Neonatal Department, Larissa, Greece

Introduction: Primary hyperparathyroidism during pregnancy poses significant risks to the mother and the fetus. Prompt diagnosis and effective management can improve outcomes for both.

Case report: We describe the case of an apparently healthy female neonate born after a 38 weeks gestation to a 35-year old mother with primary hyperparathyroidism diagnosed before conception. The mother remained asymptomatic during pregnancy and her calcium levels were under 12.5 mg/dl. On the third day of life the infant was started on oral calcium supplements because of mother's problem. At the end of the first week of life she presented tachypnea and severe hypocalcaemia (total serum Ca 5 mg/dl), hypomagnesaemia (serum Mg 1, 44 mg/dl) and hyperphosphatemia (serum P 9, 1 mg/dl). No convulsions were noted. The intact parathyroid hormone levels were abnormally low. She was given Alphacalcidiol (One-Alpha) and calcium supplements up to 3 months of age. Calcium levels returned to normal in a few days and parathormone levels became normal at the age of 3 months of life. Till then she remained asymptomatic with a normal growth.

Conclusion: In this case fetal parathyroids suppression due to maternal hypercalcaemia resulted in transient neonatal hypoparathyroidism and late onset hypocalcaemia. Early calcium supplements prevented seizures but not hypocalcaemia. Treatment with oral calcium supplements and alphacalcidiol maintained normocalcaemia despite low parathormone levels.

661 TREATMENT OF IRON DEFICIENCY IN VIETNAMESE PREGNANT WOMEN

L. Avril¹, M. Moulin¹, S. Boussetta², D.T. Ha³, C. Taieb²

¹Pierre Fabre Medicament, Strategic Marketing, Castres, France;²Pierre Fabre SA, Public Health's Economic and Quality of Life Department, Boulogne-Billancourt, France;³University Hopital, Gynecology and Obstetric Department, Ho Chi Minh- Ville, Viet Nam

Objective: To evaluate iron deficiency symptoms and frequency during the different stages of pregnancy; to describe and analyze food habits/diet and common preventive pharmacological treatment of iron deficiency during pregnancy.

Material and Methods: An observational and prospective study was carried out in Vietnam on 347 pregnant women divided into 3 groups according to their pregnancy stage. Each woman completed a questionnaire on her diet and current iron treatment. Different parameters were evaluated: socio-demographic criteria, iron deficiency etiology, concomitant diseases, previous pregnancies, clinical data, current diet and treatment.

Results: Patients were aged in mean 28.3 ± 4.6. Iron deficiency was suspected in almost 31.0% of the women. The most frequent iron deficiency symptoms reported all through the pregnancy were sensitivity to the cold (21.4%), Irritability (12.9%) and concentration's difficulties (10.8%).

Half of these women had a poor iron diet. Women who already had a previous pregnancy had a food iron intake higher than those who never had children (28.8 mg/day vs 25.4 mg/day, PANOVA = 0.012). In addition, the more pregnancies they had, the richer their diet was in iron (PANOVA = 0.02). Their iron intake in their diet was similar all through the pregnancy (26.7 mg ± 12 mg).

Over 87.0% of the women were prescribed iron and folic acid. The most prescribed preparation was a combination of ferrous sulphate and folic acid (53.9%).

Conclusion: In addition to nutritional advice to help pregnant women have a well balanced diet, iron supplementation is necessary in most cases.

662 BODY IMAGE DURING PREGNANCY AMONG IRANIAN WOMEN

H. Bayrampour¹, M. Noroozi², H.A. Abedi³

¹University of Manitoba, Department of Applied Health Sciences, Winnipeg, Canada;²Isfahan University of Medical Sciences, Department of Midwifery, Isfahan, Iran;³Isfahan University of Medical Sciences, Faculty of Nursing, Isfahan, Iran

Background: Previous studies have shown a need for exploring body relative experiences and concerns during the pregnancy period.

Methods: Twelve pregnant women, who were receiving prenatal care at one of three health centers in the city of Isfahan in Iran, took part in open-ended, face-to-face interviews. Participants had a mean age of 24.6 years, were of varied gestational ages (16 to 36 weeks), and 58% were primigravidas and 42% were multigravidas. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a phenomenological approach (Colaizzi seven stage method).

Results: Four major themes central to women's experience of their pregnant bodies were identified; “body appearance perception”, “body function perception”, “feedback from others”, and “growing fetus”. Satisfaction or dissatisfaction about body changes and factors affecting these appraisals are addressed by the first three themes, and the “growing fetus” theme reflects women's experiences of growing “a human” in their body.

Conclusions: Body appearance and function perceptions, feedback from others, and awareness of the growing fetus contribute to forming a woman's body image during pregnancy. Identifying various sources in constructing body image during pregnancy shows the importance of familial and social support roles in improving body experiences. By providing necessary information and training to pregnant woman, her family members, and health care providers, we can help women to experience a positive body image during pregnancy. Since pregnant women are motivated to improve their body appearance and function during pregnancy, this presents an opportune time for health care providers to encourage healthy lifestyle changes.

663 THE ST VINCENT DECLARATION 20 YEARS ON – MATERNAL AND NEONATAL MORBIDITY IN PREGNANT WOMEN AFFECTED BY PREGESTATIONAL DIABETES

C. Burrell, W. Johal, S. Kelly

Ipswich Hospital, Obstetrics & Gynaecology, Suffolk, United Kingdom

Background: The St Vincent Declaration (1989) declared that women affected by diabetes should achieve similar pregnancy outcome compared with unaffected women. The CEMACH Diabetes National Enquiry (2007) showed the rate of caesarean section was 67% versus 22%, preterm delivery 36% versus 7%, macrosomia ≥ 4kgs–21% versus 11% for women affected by diabetes and the general maternal population respectively.

Objective: To determine maternal and neonatal morbidity in a cohort of pregnant women affected by pre-gestational diabetes.

Method: This study reviewed 180 diabetic women who became pregnant between Jan 1, 2000–December 31, 2007 in a hospital in East of England. Women were identified from the Diabetes Registry.

Results: Women affected by diabetes Type 1 (121/180–67.2%) and Type 2 (59/180–32.8%) were managed in a Multidisciplinary Antenatal Clinic. They were offered pre-pregnancy counselling, fetal echocardiograph, folic acid supplementation, retinal assessment and HbA1c testing each trimester. Results showed that 149 (82.8%) were live-birth, 79 (43.9%) LSCS, 18 (10%) preterm delivery, 41 (22.8%), macrosomia ≥ 4kgs, 28(15.6%) miscarriage, and 8 (5.6%) congenital abnormality-[all 8 women had HbA1c > 6.1% Type 1 diabetes (n = 4) and Type 2 diabetes (n = 4)]

Conclusion: Diabetes affects about 1:250 women, this is increasing due to advancing maternal age, obesity and ethnic diversity. Bell et al. (2008) study showed 82% live-birth, 14% miscarriage, 7.6% congenital abnormality and 62% LSCS rate. The recent NICE Guideline (2008) showed that Obstetricians still face challenges of increase maternal and fetal morbidity.

664 TRIAL OF LABOR IN WOMEN WHO DELIVERED BY CESAREAN SECTION AFTER PREVIOUS CESAREAN SECTION

O. Caramelo, S. Saleiro, S. Franco, P. Moura

Coimbra's University Hospital, Department of Genetics, Human Reproduction and Maternal-Fetal Medicine, Coimbra, Portugal

Objective: To examine indications for repeated cesarean delivery in women with and without trial of labor, with assessment of perioperative maternal complications and fetal outcome.

Methods: Retrospective assessment of 352 women who delivered by cesarean section after previous cesarean section, managed in our institution between January 2006 and December 2007.

Results: Women who underwent a repeat cesarean delivery without TOL (n = 172), 87% were submitted to an “elective” cesarean, comprising maternal indications (62%) which include a cesarean delivery within the previous 18–24 months, and a history of more than one previous cesarean section. Emergency cesarean in 13% and other indications in 25%. Among the 180 women with repeat cesarean delivery who had a TOL, 26% had a non reassuring fetal heartrate, 22% a cephalopelvic disproportion, 21% a failure to progress, 17% had a failed labor induction and another 14% with other surgical indications. The average duration of labor was 6.24 ± 3.38 hours. NICU admission in groups without/with TOL was 22 vs 3 babies (p < 0.016). Women's perioperative complications did not vary significantly between both groups.

Conclusions: The most common cesarean indications in women undergoing a repeat cesarean delivery without TOL was maternal indication, and non reassuring fetal heart rate was the most common indication in the group submitted to a TOL. There were no differences in perioperative maternal complications; however, a statistic difference was found in the admission rates to the NICU group without TOL.

665 FIBROSIS CYSTIC AND PREGNANCY. A CASE REPORT

C. Christodoulaki¹, M. Kalloniatou¹, M. Christodoulaki², C. Cimioni¹, P. Georgogiannaki¹, D. Gentzidis¹, M. Kampanieris¹, A. Tsopelas¹, G. Daskalakis¹

¹General Hospital of Chania, Crete, Obstetrics and Gynaecology, Chania, Greece;²General Hospital of Chania, Crete, Neonatal Intensive Care Unit, Chania, Greece

Introduction: Increasing number of children with fibrosis cystic are surviving into adulthood with women fertility well reserved.

Material and Methods: We present the case of a 28-year old female with fibrosis cystic that successfully gave birth at a child at 34 weeks of pregnancy.

During pregnancy she had three admissions in the hospital due to pulmonary infections two times and the third for deterioration in her lung function with worsening dyspnea and decline of the FEV 1 at 60% the infections were treated successfully with ceftazidime and piperacillin and she had a good response to bronchodilators and nebulised corticosteroids. At the 25 weeks she presented a borderline gestational diabetes well controlled with diet.

Results: Pregnancy regarding women with fibrosis cystic is a challenge for the mother and the medical group.

666 THE COMPARING OF PREGNANCY OUTCOMES IN PREGNANT WOMEN WITH TYPE 1 DIABETES AND WITH GESTATIONAL DIABETES

K. Cyganek¹, I. Kaim², H. Huras², J. Sieradzki¹, A. Reroń²

¹Jagiellonian University, Krakow, Poland;²Jagiellonian University, Obstetrics and Perinatology, Krakow, Poland

The task of this study was to assess metabolic control of pregnant women with T1DM or GDM and to compare the pregnancy outcomes in both groups. We included 134 pregnant women. Among them, there were 30 women with T1DM, while 104 subjects with GDM, 42 treated by diet (G1) and 62 by diet and insulintherapy (G2). We analysed HbA1c level and mean blood glycaemia (MBG) in III trimester of pregnancy, as well as the pregnancy outcomes for all groups. Those groups differ between age, G1 women were statsistically older than G2 and T1DM. T1DM women have the highest HbA1c in the III trimester of pregnancy as compare to G1 and G2 group (5.8 ± 0.7 vs. 5.2 ± 0.3, and 5.8 ± 0.7 vs. 5.5 ± 0.5). T1DM and G1 group had a similar degree of metabolic control as measured by MBG (98.9 ± 18.0 mg% vs. 89.1 ± 21.7), but G2 had the highest MBG level as compare to T1DM (104.5 ± 10.2 mg% vs. 98.9 ± 18.07), and G1 (104.5 ± 10.2 mg% vs. 89.1 ± 21.7). There was a significantly better pregnancy outcomes in both GDM group as compared to T1M in respect to caesarean delivery (70.6% vs. 35.6% and vs. 39.7%), congenital malformations (6.7% vs. 2.4% and vs. 0%). We found statistically higher frequency of pregnancy induced hypertension in T1DM as compare to G1 group (6.7% vs. 2.4%) and G2 as compared to G1 (16.1% vs. 2.4%). We demonstrated that regardless of types of diabetes elevated maternal glucose level is associated with worse pregnancy outcomes.

667 FREQUENCY AND SEVERITY OF NAUSEA & VOMITING DURING PREGNANCY AND ITS RELATED FACTORS IN THE HEALTH CENTERS OF HAMEDAN, IRAN

M. Danesh Kojuri, S. Savafi, F. Hosseini

Iran University of Medical Sciences, Nursing Midwifery College, Theran, Iran

Objective: The objective of this study was determining the frequency and severity of gestational nausea and vomiting and its related factors.

The subjects of this study were 700 pregnant women with a gestational age of 6 to 16 weeks. The sampling was performed in different stages and in the prenatal clinics of 12 health centers in which in turn were randomly selected from 38 centers.

This study was a cross-sectional; data was collected using a questionnaire.

Results: frequency of gestational nausea and vomiting was found to be 69.7%. 37.4% was mild, 46.7% moderate, and 16% was severe. The results obtained revealed a statistically significant correlation between age and gestational nausea and vomiting (p = 0.000) its severity (p = 0.02), using Chi-square test, a statistically significant correlation was found between gestational nausea and vomiting and a history of migraine headaches (p = 0.009), a history of spinning-induced nausea (p = 0.000), smell-induced nausea (p = 0.000), a maternal history of gestational nausea (p = 0.000), the number of pregnancies and deliveries and a history of premenstrual syndrome (p = 0.000), age at menarche (p = 0.015), and taking OCPs (p = 0.003).

Discussion: The results revealed that gestational nausea and vomiting is considerably frequent and that it is related to several factors including lower age at pregnancy; lower age at menarche; taking OCPs; undesirable pregnancy; and lower level of social supports, having a more incidence in all these groups. Therefore, it is suggested that these factors being considered when providing prenatal care.

Keywords:Nausea, vomiting, gestational nausea and vomiting nausea and vomiting severity, related factors

668 SURGICAL COMPLICATIONS DURING PREGNANCY

G. Daskalakis, M. Theodora, E. Anastasakis, O. Komita, G. Partsinevelos, S. Mesogitis, N. Papantoniou, A. Antsaklis

Athens University, 1^st Department of Obstetrics and Gynaecology, Athens, Greece

Objective: To investigate and report our experience from the surgical complications during pregnancy.

Methods: This is a retrospective analysis of case records between 2003 and 2006.

Results: In a four-year period we had eleven cases that underwent surgical intervention during pregnancy. There were four cases of acute appendicitis and six cases of adnexal masses. The adnexal masses involved two cases of hemorrhagic cysts, one of a large endometrioma, two of serous cysts with acute abdominal pain and one borderline ovarian cyst. We also had a case of a large subserous necrotic fibroid that was extended in the left half of the abdominal cavity. The mean diameter of the adnexal masses was 9 cm (range: 6–14 cm). In all but one case in which we used laparoscopy, a classical abdominal approach was used. All women gave birth to normal infants, and ten out of eleven delivered at term. The other delivered at 34 weeks following premature preterm rupture of membranes.

Conclusion: Although operative interventions should be avoided during pregnancy, they should be performed when necessary. The outcome of pregnancy seems to be good, following a close surveillance.

669 ANALYSIS OF THESIGNIFICANCE OF PLACENTA WEIGHT IN IMPAIRED GLUCOSE TOLERANCE PATIENTS

L. Driul¹, A. Citossi¹, A.P. Londero¹, G. Poloni¹, M. Della Martina¹, R. Furlan², L. Tonutti³, F. Macagno³, D. Marchesoni³

¹Clinic of Obstetrics and Gynaecology, University Hospital of Udine, Udine, Italy;²Unit of Neonatology, University Hospital of Udine, Udine, Italy;³Unit of Diabetology, University Hospital of Udine, Udine, Italy

Objective: We performed a retrospectivecase-control study to determine whether a disproportionately high placentalweight, in pregnancies complicated by impaired glucose tolerance, is associatedwith a negative perinatal outcome.

Methods: We categorized 111 IGT pregnancies delivered since 2000 to 2007 andcompared with a OGTT normal control group of 109 women which delivered in 2005.Data were analyzed using R (version 2.4.1). We used t-test, chi-square test,and logistic regression. We considered statistically significant p < 0.05.

Results: The placenta weight in the IGT groupis higher. The mean weight in the IGT group is 636.68 g (sd 493.46–779.91), and in the control group is 593.67 g (sd 455.86–731.48), the differenceachieves statistical significance (p < 0.05). In a monovariate logisticregression analysis placental weight has no influence on neonatal hypoglycaemiaOR 1.0 (CI, 0.99–1.009, p 0.87), but it seems to be protective against fetalmalformations OR 0.99 (CI, 0.989–0.998, p < 0.05). In a multivariatelogistic regression analysis placenta weight never reach significance, consideringthe following outcomes: neonatal hypoglycaemia, hypertensive disorders of pregnancy,respiratory distress syndrome, obstetric trauma, neonatal malformations. In thesame multivariate logistic models IGT is an independent predictor for neonatalrespiratory distress syndrome OR 4.89 (CI 1.09–22.02, p < 0.05).

Conclusion: The placental weight issignificantly higher in the IGT group, but we do not find correlation betweenplacenta weight and the outcomes considered in our study.

670 PRENATAL ULTRASOUND DIAGNOSIS OF ACROCEPHALOPOLYSYNDACTILY SYNDROME: CASE REPORT

M. Dumitrescu¹, D. Albu¹, C. Albu¹, E. Severin²

¹Medicine University Carol Davila Bucharest, Alco San Impex Clinic, Bucharest, Romania;²Medicine University Carol Davila Bucharest, Bucharest, Romania

Acrocephalopolysyndactily syndrome is a rare genetic disorder also called Carpenter Syndrome (CS). The main features of CS are craniosynostosis, congenital heart disease, polydactyly, genital anomalities, and short stature. CS is an autosomal recesive disorder.

Objectives: To identify both craniofacial and limbs malformations associated with CS.

Methods: A 28-year-old pregnant female was referred at 21 weeks' gestation for a routine prenatal ultrasound.

Fetal monitoring was made by ultrasound scans for fetal growth, congenital malformations, and amniotic fluid volume. We also collected information about family medical history.

Amniotic fluid samples were taken to perform prenatal cytogenetic diagnosis.

Results: Ultrasound examination revealed a single fetus with an abnormal fetal craniofacial and limbs development, and oligohydramnios. Craniofacial abnormalities as a sonographic marker suggested the posibility of a chromosomal anomaly. More associated fetal anomalies was detected. Karyotype indicated a normal cytogenetic female: 46,XX. Autopsy findings confirmed the ultrasound diagnosis.

Conclusions: The case was sporadic. The complex pattern of fetal anomalies identified suggested the possibility of CS. As a gene detect for CS is unknown, the diagnosis of this condition remains a clinical one. The discovery of single or multiple fetal malformations requires not only complete echographic assessment, but also detailed post-abortum examination to allow optimal use of diagnostic aid programmes.

671 ANTIPHOSPHOLIPID ANTIBODIES IN PREGNANCIES WITH INTRA UTERINE GROWTH RESTRICTION

Z. Fardiazr¹, M. Mohajery¹, R. Torab²

¹Medical Science Tabriz University, Department of Obstetric& Gynecology, Tabriz, Iran;²Medical Science Tabriz University, Medical Science Faculty, Tabriz, Iran

Introduction: Intra uterine growth retardation (IUGR) has been various reasons including placental dysfunction due to thromboembolisim. In this study we assessed antiphospholipid antibodies in patient with IUGR as a reason of placental insuficiency.

Methods:In this cross sectional study we chose 124 pregnant Women with IUGR fetus for assess antiphospholipid antibody including anticardiolipin and lupus anticoagulant (IgG and AgM) and compare them with 124 normal pregnancy.

Antibodies in both group was assess by enzyme linked immunoassay method for tow time and analyzed by SPSS software and statistical methods including t- test and chi- square.

Results: IgM anticardiolipin antibody was significantly more than in the IUGR group. IgG anticardiolipin, IgG and IgM anticoagolan antibody was not significant different between two group. Hypertention in Patient with positive antibodies was significantly more than the other patient.

Conclusion: Antiphospholipid antibodies are higher at the pregnancy with IUGR. Assessment of this antibodies is recommended for prediction IUGR in high risk group.

Keywords:Antiphospholipid Antibody, IUGR

672 THROMBOLYTIC THERAPY IN AN ISCHEMIC STROKE IN A LATE PREGNANCY

C. Fellemans¹, D. Chochrad², D. Thomas¹, G. Bauherz³, S. Collignon⁴

¹Hospital Center of Etterbeek-Ixelles, Gynecology, Brussels, Belgium;²Hospital Center of Etterbeek-Ixelles, Intensive Care, Brussels, Belgium;³Hospital Moliere Longchamps, Neurology, Brussels, Belgium;⁴Hospital Center of Etterbeek-Ixelles, Emergency, Brussels, Belgium

Background: Pregnancy is a procoagulant state. Accident vascular Cerebral occurs is an exceptional event in pregnancy occurring more frequently in the third trimester and post partum. Thrombolytic agents with tissue plasminogen activator (rtPA) is an approved therapy for ischemic stroke, myocardial infarction, pulmonary embolism, thrombosis of cardiac valve prosthesis, deep venous thrombosis but the data are limited during pregnancy.

Summary of case: At 37 weeks of pregnancy a 37 years old woman is admitted in the emergencies for a left hemiplegia. The patient was anticoagulated with low molecular heparine weight for aortic valvular mechanic prosthesis. A cerebral scanner excludes the presence of a hemorragic cerebral stroke and concludes to a cardioembolic stroke. A cardioechography don't visualize any cardiac thrombus. Within 3 hours of the onset of the symptoms, a thrombolysis with rtPA is realized. During the first 24 hours a nearly complete regression of the neurologic defect was observed but the patient presented important headache. A second cerebral scanner established the secondary appearance of a hemorrhage in the right cerebral hemisphere. 48 hours after the thrombolysis, a Caesarian-section is realized and delivered a healthy infant. At 3 months, the evolution of the patient is limited to a minimal hemiparesy.

Discussion: Thrombolysis during pregnancy is not without consequences: maternal death, maternal hemorrhage, fetal death but despite these concerns the outcome of the mother is relatively good with the use of these agents.

Conclusion: This report describes the use of rtPA in the setting of stroke in late pregnancy.

673 THE DESCRIPTION AND FREQUENCY OF THE POSTPARTUM DEPRESSION'S SYMPTOMS AMONG PARENTS THAT CHILD IS BEING HOSPITALIZED IN THE NEONATAL INTENSIVE CARE UNIT

M. Czarnecka¹, N. Konofalska¹, J. Łuczak–awrzyniak¹, A. Bukowska¹, J. Gadzinowski²

¹Gynecological and Obstetrical Clinical Hospital of the University of Medical Sciences in Poznań, Psychologists Team, Poznań, Poland;²Gynecological and Obstetrical Clinical Hospital of the University of Medical Sciences in Poznań, Department of Neonatology, Poznań, Poland

The aim of the study was to measure the frequency of postnatal depression's symptoms among both parents that child is being hospitalized in the Neonatal Intensive Care Unit in our hospital. Moreover, the authors tried to observe the levels of experienced emotions/troubles and check statistically if there are any differences among them between the group of the mothers and the fathers. 62 women and 35 men were questioned with prepared questionnaire. Their child was mainly hospitalized in NICU just after the delivery at the 24–42 week of gestation. Edinburgh Postnatal Depression Scale was used to measure the symptoms of the depression. 87% of the mothers and 31% of the fathers had symptoms of the postpartum depression. The most intensive feeling among the parents was the sadness and the fear. Statistical analysis proved important differences at p < 0.05 among these variables. Moreover, women more often cried, blamed themselves and had more problems with sleeping than men. Both parents achieved low scores in the question about suicidal thoughts and had medium scores when questioned about their positive thinking about the future. Statistical analysis proved frequent occurrence of the symptoms of postnatal depression among parents that child is being hospitalized in the NICU, especially among the mothers. There are significant differences between parents in experiencing individual symptoms of depression. High scores in EPDS should be a background of introducing more intensive psychological interventions and cooperation with the medical stuff from NICU to prevent or minimize postnatal depression's symptoms among parents.

674 HYPOGLYCEMIA INDUCES A NITRATIVE STRESS IN PRETERM NEWBORNS

C. Ghaddhab¹, J.-L. Wayenberg², N. Lefevre³, D. Vermeylen¹, E. Damis⁴, S. Bottari⁵

¹Hôpital Universitaire Erasme, Neonatal Intensive and Non-Intensive Care Unit, Brussels, Belgium;²RHMS, Department of Paediatrics, Baudour, Belgium;³HUDERF, Neonatal Intensive Care Unit, Brussels, Belgium;⁴Clinique Edith Cavell, CHIREC, Neonatal Intensive and Non-Intensive Care Unit, Brussels, Belgium;⁵Centre Hospitalier Universitaire & INSERM U884, Grenoble, France

Introduction: Recent data suggest that free radical injury occurs in the neonatal brain after hypoglycemia in animal models. We developed an assay allowing the quantitative determination of nitrated plasma albumin (nitralbumin) as a biological marker of peroxynitrite generation. Our aim was to investigate the potential nitrative stress induced by hypoglycaemia in premature newborns.

Material and Methods: Using a double-sandwich ELISA, we measured venous nitralbumin concentration at day 1 of life in 24 preterm infants without any other obvious cause of nitrative stress such as infection, asphyxia and hyperglycemia. Glucose levels of each infant were monitored every 3–4 hours using a strip method. For each patient, we calculated the area under curve (AUC) of the glycaemia levels during the 12, 18 and 24 hours preceding blood sampling (AUCG12, AUCG18 and AUCG24). Statistical analysis was performed with non-parametric tests.

Results: A significant inverse correlation was found between nitralbumin and AUCG12 (r = −0.69, p = 0.002) and between nitralbumin and AUCG18 (r = −0.66, p = 0.003). Moreover nitralbumin concentrations differed significantly between patients whose AUCG12 was lower versus higher than 50 mmol.h/l (p = 0.01) and AUCG18 was lower versus higher than 75 mmol.h/l (p = 0.004). No confounding factors such as sex, term, oxygen exposure, and haemodynamic course were associated with higher nitralbumin concentrations.

Conclusion: Low glycaemia levels during the first day of life are associated with increased albumin nitration in preterm newborns. This suggests the occurrence of nitrative stress implying a risk of end-organ damage due to protein nitration and lipid peroxidation.

675 MATERNAL AND FOETAL OUTCOME IN BETA-THALASSAEMIC WOMEN

A. Giacobbe¹, A. De VIvo², L. Maggio Savasta², A. Priolo², R. de Dominici², A. Mancuso²

¹University of Messina, Department of Gynecological, Obstetrical Sciences and Reproductive Medicine, Messina, Italy;²University of Messina, Messina, Italy

The aim of our study was to evaluate the maternal and foetal outcome in Beta-thalassaemic pregnant women.

Six women referred to our department in order to plan a pregnancy. All patients suffered from osteopenia/osteoporosis, four women had undergone splenectomy, two cholecystectomy, one patient suffered from thyroid dysfunction and one from diabetes mellitus. The maternal age at conception was 30.1 ± 6.5; three patients conceived spontaneously, while in the other 3 cases, ovulation was induced. Iron chelation therapy with desferrioxamine was stopped as soon as the pregnancy was confirmed. The mean Hb level was 9.5 ± 0.7 g/dl during pregnancy in all patients and this was achieved by regular blood transfusions of 2 units of young washed packed red cells every 2 or 3 weeks with maternal. 2 pregnancies were uncomplicated, while in the remainder, a number of complications, i.e. gestational hypertension, cardiac arrhythmia, GDM, renal colic, stillbirth and abruptio placentae at 25 weeks of gestation with subsequent CID and abdominal subtotal hysterectomy occurred. All patients delivered by CS except for the pregnancy complicated by stillbirth who delivered vaginally. The birth weights ranged from the 10^th to 50th percentile as a consequence of the chronic foetal hypoxia. In the case ended in stillbirth a restricted intrauterine growth was evidenced. The 5 min Apgar score was good (median 9; range 8–10) in all cases.

Given this results, pregnancy is a practicable event in TM women, but the risk of serious maternal and foetal complications requires a close multidisciplinary monitoring.

676 PROGESTERONE IN RECURRENT FIRST TRIMESTER BLEEDING – OUR EXPERIENCE

C. Grigoriu¹, A.F. Anca², R. Bohaltea³, M. Grigoras⁴, C. Parau⁴, V.V. Horhoianu³

¹Medial University Bucharest, Ob/Gyn, Bucharest, Romania;²Medical University Hospital, Bucharest, Romania;³Medical University Bucharest, Bucharest, Romania;⁴University Hospital Bucharest, Bucharest, Romania

Introduction: The role of progesterone in implantation and placentation is still not well understood. However, treatment with progestative derivates in first trimester bleeding, with the sonographic appearence of subdecidual hematoma – i.e. poor established relations between product of conception and uterine bed – has remained a challenge for obstetricians.

Material and Method: We present a five years experience of the Clinic of Ob/Gyn, University Hospital Bucharest regarding treatment with progestatives of first trimester recurrent bleeding. We care yearly for about 3500 pregnant wome, which give birth in our clinic. Our study included 2950 patients which presented with recurrent bleeding in the first trimester of pregnancy.

Results: After excluding infectious diseases (Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealiticum), prooved luteal insufficiency or thrombophilia, we began progestative treatment (with two different products) daily, with seriated transvaginal sonographic examinations in 887 patients (30.06%). In this group, 682 patients (76.8%) had a good evolution, regarding the reducing of the decidual hematoma and stopping the vaginal bleedingin about 10 to 14 days of treatment.

Conclusion: Progesterone is effective in treating first trimester recurrent bleeding, with few side effects (hypotension and nausea) and good tolerability.

677 PRIMARY HEALTH CARE AND THEIR INFLUENCE ON PRO-BIRTHRATE POLICY IN THE PROVINCE OF VOJVODINA

Z. Grujic¹, I. Grujic², M. Bogavac¹, L. Milasinovic¹

¹Clinical Centre Vojvodina, Department of Obstetrics and Gynecology, Novi Sad, Serbia;²Health Center ‘Veljko Vlahović’, Department of Obstetrics and Gynecology, Vrbas, Serbia

Aims: The study was assumed to answer the question how to improve the women's health care at the primary level during prenatal, perinatal and postnatal period with the resulting giving birth to a healthy child and preservation of general and genital health of the woman and the consequent ability of nursing her child and giving birth to one more or more than one child.

Material and Methods: The investigation encompassed 300 patients of the generative age. The patients answered to the anonymous questionnaire containing 24 questions by underlying one of the offered answers or by addition of a text where necessary-concerning the primary health care and its influence on reproduction of the population of Vojvodina.

Results: One half of investigated patients did not use contraceptive devices. 32.66% of the patients visiting the health centers for the control of their pregnancies, 26.33% for the treatment of diseases, 11.33% for contraception advising, 2.66% for the treatment of infertility and 27.33% for other reasons. More than half of the polled patients thought that there was a need of improvement of the work in the women's health centers. The suggestions of 74.66% of the patients comprised organized lectures on different type of health care and family planning associated with the purchase of modern equipment for diagnostics (13.33%).

Conclusion: The primary health care has a significant place in the process of reproduction of the population and these results point to the necessity of its more active role in improvement of the women's health as well as in implementation of the measures of the population policy.

678 USE OF DRUG IN THE PREGNANCY

M. Yurdakul¹, T. Güner¹, Z. Koşum², F. Kabalcioglu³

¹Mersin Univercity, Mersin, Turkey;²Mersin Univercity, Midwifery Department, Mersin, Turkey;³Şanliurfa Univercity, Şanliurfa, Turkey

Objective: Using of drug can influence negative during the pregnancy. Some pregnants avoid of taking drug them which is given from doctor with the repice, some of them can be of using without the repice. İnformation to get about using of drugs in the pregnancy is quite important. The aim of this study was to evaluate situation of use drug during pregnany.

Method: Sample of investigation constitute 153 pregnant women who applied to Mersin maternal and child hospital and between the date on April 14, March 14 accepted this investigation. The questionnaire applied to the participants by face to face interview technique and the data obtained evaluated by SPSS 13.0 program.

Results: Average ages of pregnants 26.6, 45.8% of women, graduated from elementary school, 6 4.7% of pregnancies, have middle level economic situation, 86.9% of women, haven't got any health insurance. 83.7% of the pregnants who join to this study have antenatal care and have been determined that 41.8% of pregnancy is initial pregnancy. Furthermore 76.4% of pregrants convey that they have voluntarily pregnancy and 89.2% of them have not chronic sickness. In this study 32.6% of these pregnants have drug while their pregnancy. Using during in pregnants 5.7% taked not being order. First three drugs which pregnants use, are antiemetic, antibiotic and analgesic. More than half of pregnancies stated that during antenatal care they got information not about use of drug in pregnancy.

Keywords:Drugs, pregnancy, use of drug in pregnancy

679 PERCUTANEOUS HYDRODYNAMIC THROMBECTOMY FOR CONGENITAL DEEP VEIN THROMBOSIS IN A NEONATE

K. Ikeda¹, T. Kobayashi², T. Kobayashi¹

¹Gunma Children's Medical Center, Department of Cardiology, Shibukawa, Japan;²Gunma University Graduate School of Medicine, Department of Pediatrics and Developmental Medicine, Maebashi, Japan

Introduction: The deep vein thrombosis is a rare but serious complication in the perinatal period. Recently, a hydrodynamic thrombectomy catheter has been demonstrated to be efficient and safe in adult field. We performed a percutaneous hydrodynamic thrombectomy for the treatment of congenital deep vein thrombosis in a neonate.

Case report: A male infant with severe lower limb swelling, abdominal distention, and cyanosis was transferred to our medical center 3 hours after the delivery. Abdominal ultrasonography showed marked ascites and two large echogenic kidneys with no evidence of obstruction and an empty bladder. A thrombus was seen in the inferior vena cava that completely occluded the lumen of the vessel. Because the thrombus was especially large and thrombolytic therapy might cause pulmonary thromboembolism, we attempted catheter thrombectomy. First, to avoid distal embolism, a 6-Fr Fogarty embolectomy catheter was inserted into the umbilical vein and expanded. Second, we unsuccessfully attempted a thrombectomy using an aspiration catheter. Then to remove the thrombus, a hydrodynamic thrombectomy was performed using a Hydrolyser catheter. After the hydrodynamic thrombectomy, blood flow to the inferior vena cava and bilateral renal veins was restored with no distal embolism or vascular injury. But he died at 13 days old because of bleeding complications due to fibrinolytic therapy after the hydrodynamic thrombectomy.

Discussion: Our experience showed that hydrodynamic thrombectomy might be a useful tool for congenital deep vein thrombosis in pediatric field.

680 TELEMEDICINE AND PERINATAL DATABASE

M. Ivanisevic, J. Djelmis, D. Bljajic, J. Juras, E. Berberovic

School of Medicine, Department of Obstetrics and Gynecology, Zagreb, Croatia

Telemedicine has been defined as the use of telecommunications to provide medical information and services. Two different kinds of technology make up most of the telemedicine applications in use today. The first, called store and forward, is used for transferring digital images from one location to another. A digital image is taken using a digital camera, (‘stored’) and then sent (‘forwarded’) by computer to another location. This is typically used for non-emergent situations, when a diagnosis or consultation may be made in the next 24–48 hours and sent back. Perinatal ultrasonography is one of the most common applications of telemedicine in use today. There are many configurations of an interactive consultation, but most typically, it is from an urban-to-rural location. It means that the pregnant patient does not have to travel to an urban area to see a specialist, and in many cases, provides access to specialty care when none has been available previously. Inself-monitoring/testing telemedicine like tele-cardiotocography for the area obstetrics there is evidence that access to care can be improved when pregnant women have the opportunity to receive telehealth care at home rather than in-person care in a clinic or hospital. The use of telemedicine is small but growing. The evidence for its efficacy is incomplete. Many of the studies are small and/or methodologically limited, so it can not be determined whether telemedicine is efficacious. Use of recent innovations in the design of randomized controlled trials for emerging technologies would lead to higher quality studies.

681 MONOCHORIONIC DIAMNIOTIC TWINS: A CASE REPORT

E. Berberovic, M. Ivanisevic, B. Berberović, J. Đelmiš, D. Bljajić

Clinic for Women Diseases and Delivery, Medical School, Department for Diabetes and Fetal Growth, Zagreb, Croatia

We present a case report in which prenatal sonography at 21 weeks of gestation depicted a monochorionic diamniotic twin gestation with marked growth discordance noted in the second trimester and in 25 weeks of gestation hydrops fetalis of one twin. Because of the bad condition of twin with hydrops fetalis, Cesarean delivery was done at 30 weeks of gestation. The twin with hydrops fetalis died immediately after delivery, and another twin died after 15 days because of sepsis. Patohystological analysis of first twin depicted hydrops fetalis, and analysis of the second twin showed a bronchopulmonary dysplasia.

Conclusion: The monochorionic diamniotic twin pregnancy is rare, can be very complicated and must have special antenatal care. The cause of discordant growth in karyotypically normal twin pregnancies without evidence of twin-twin transfusion syndrome is not entirely clear. There may be other conditions responsible for discordant growth that occurs in second trimester of pregnancy.

682 ETHNIC INFLUENCE ON PERINATAL OUTCOME IN FLANDERS, BELGIUM

Y. Jacquemyn¹, E. Verreyken², G. Palit¹, S. Palit³, N. Benyahia⁴, G. Martens⁵

¹Antwerp University Hospital UZA, Obstetrics, Edegem, Belgium;²Antwerp University UA, Medicine, Wilrijk, Belgium;³Antwerp University Hospital UZA, Anaesthesiology, Edegem, Belgium;⁴Antwerp University Hospital, Obstetrics, Edegem, Belgium;⁵Study Center for Perinatal Epidemiolgy SPE, Brussels, Belgium

Aim: To compare the maternal and neonatal outcome in women fromTurkish and Moroccan descent versus autochthonous women in Flanders, Belgium.

Methods: Data were extracted from an existing database covering all deliveries in the Flanders region, Belgium, coupled with sociodemographic data from birth certificates. Data are presented as odds ratios and 95% confidence intervals (OR; CI-CI).

Results: The study period was January 1, 2001 to December 31, 2004, including 9094 Turkish, 12562 Moroccan and 231289 Flemish women resulting in respectively 9250, 12729 and 235561 neonates. As compared to Flemish women diabetes was more prevalent in both Turkish (1.4; 1.2–1.6) and Moroccan (2.4; 2.2–2.6) women but hypertension was significantly less frequent (respetively 0.5; 0.4–0.6 and 1.4; 1.2–1.6). Perinatal mortality was gigher in Moroccan (1.8; 1.6–1.2) but not different between Turkish (0.9; 0.7–1.2) and Flemish women.

Conclusion: Both Turkish and Moroccan women in Flanders have more diabetes and less hypertension, but Moroccon women still have a higher perinatal mortality, for Turkish women this has become identical to the autochthonous population.

683 EXTREMELY LOW BIRTH WEIGHT (ELBW) PRETERM NEWBORNS

N. Jincharadze

Childrens Central Hospital, Neonatology, Tbilisi, Georgia

Background: The chance, to rescue preterm newborn with extremely low birth weight(ELBW), is very little. For infants, who stayed alive, have been limited mental and motoric ability. Material: Were studied 78 newborns with ELBW. Were divided 2 groups. In the 1^st group – 39 newborns which were in the intermittent positive pressure ventilation (IPPV). 2^nd group 39 newborns – in nasal canul continuous positive airway pressure (N-CPAP).

Methods: Was open prospective research, agreed with clinical bioethics commission. All routine examination was made according to protocol.

Results: In the 1^st group 11 patients died; 18- had sepsis and meningitis; 6 – ventriculities, 5-hydrocephalia. In the 2^nd group – 4 developed ulkus – necrotizing enterocolitis with positive result; 27- sepsis; 8 – had not complication. In hospital entered 4 days newborn, 24 weeks gestation ages, 950 gr. birth weight. After patient's mother ultrasound investigation, was diagnosed – fetus had Poter Sindrome. On the 24 weeks of pregnancy was done abortion with medicament. In spite of abortion, fetus was rescued and born alive. After examination of newborn, Poter Syndrome was not proved. Patient was in the cuves in N-CPAP regime for a little time. Patient was discharged from the hospital of 3 months age (postconceptual age 37.5 week) and now develops normally.

Conclusion:

• 1. According the ultrasound examination, to stop the pregnancy, because of fetus abnormality, must decide radiology consultation.

• 2. ELBW preterm newborns may survive with adequate treatment and care.

• 3. ELBW preterm newborns must entered in high-risk group of sepsis.

684 INTRAVAGINAL PROSTAGLANDIN E2 FOR INDUCTION OF LABOUR AT TERM: COMPARISON OF A MULTIDOSE GEL AND SINGLE, CONTROLLED RELEASE PESSARY

S. Juverdeanu, M. Kyrgiou, S.M. Hughes

Royal Preston Hospital, Obstetrics and Gynaecology, Preston, United Kingdom

Aim: To determine whether a sustained release preparation of prostaglandin E2 (Propess) is more effective in inducing labour at term than the short acting Prostin gel.

Methodology: This prospective cohort study included inductions of labour (IOL) at term for various indications. Propess was used in the study group while the comparison group comprised of women induced with Prostin gel matched for age, parity, gestation and indication for induction. The outcomes studied included IOL failure rate, time to labour onset, CS rate, uterine hyperstimulation and number of preparations.

Results: A total of 120 women were recruited: 57 in the study and 63 in the comparison group. The induction failure rate was similar between the 2 groups (5.3% vs. 4.7% in the propess and prostin group, respectively). Caesarean section rate was similar in both groups (14% vs. 10%). Labour onset took on average 32 hours for Propess and 25 hours for Prostin. The hyperstimulation rate without fetal heart rate (FHR) changes was 12% vs. 4.6% in the study and control group, respectively. On average the number of preparations used was 1.9 for Propess and 2.3 for Prostin. Preliminary analysis of 120 out of 200 women revealed that both prostaglandin preparations had similar efficacy.

Conclusion: Although a substantial proportion of women who received Propess experienced hyperstimulation there were no associated FHR changes. Propess reduces the number of preparations needed and increases women's satisfaction. However it failed to demonstrate any other advantages over Prostin gel which appears to be more cost-effective.

685 TBC IN PREGNANCY A CASE REPORT

M. Kalloniatou¹, C. Christodoulaki¹, M. Christodoulaki², D. Gentzidis¹, C. Kimioni¹, P. Georgogiannakis¹, M. Kampanieris¹, A. Tsopelas¹, G. Daskalakis¹

¹General Hospital of Chania, Crete, Obstetrics and Gynaecology, Chania, Greece;²General Hospital of Chania, Neonatal Intensive Care Unit, Chania, Greece

Introduction: Since the appearance of the financial immigration in the wider area of Crete, among other challenges, we have faced the challenge of the re-expanding of Tuberculosis. These immigrants are coming mostly from countries with a semi-developed Health System.

There upon, we are presenting a case report based on TBC during pregnancy.

Methods-materials: Based on the data of our clinic we are presenting a 28 years of age, gravida, para 1, with a free personal and family history, and a non-complicated pregnancy, who comes our clinic on the 16th week of her pregnancy, presenting a dry cough.

After the clinical examination, a bronchodilator and an anti-mucous therapy was prescribed. The symptoms persisted for the following 10 days after the therapy began, whereas the cough transformed from dry into productive.

A chest X-ray was performed with the following findings: non-homogenous shadows in the right, middle and upper pneumonic field.

Saliva: Coch Vaccillus.

Siel Nielsen: Coch Vaccillus.

The patient was admitted in the pneumonology department. Vitamin B6 plus triple anti-TBC therapy (Isoniazide, Ethambutol, Rifampicin) was prescribed for the following 9 months.

Results: The development of TBC is regarded aggressive during pregnancy. Therefore, the opportune diagnosis and the luck of other aggravating factors in the history of the gravida, laid to the successful and uncomplicated encountering. Our gravida delivered through a natural labour and breastfeeding was permitted.

686 IS IT POSSIBLE TO OMIT 3 HOUR GLUCOSE TOLERANCE TEST BASED ON A CUT-OFF VALUE FOR GLUCOSE CHALLENGE TEST?

D. Karcaaltincaba, E.S. Guendag-Guven, O. Kandemir, E.S. Yalvac, M. Altay, H. Dede, A. Haberal

Etlik Dogumevi ve Kadin Hastaliklari Hastanesi, Ankara, Turkey

Objective: To evaluate the association between thresholds of markedly elevated (≥190 mg/dl) 50-g glucose challenge test (GCT) and 3 hour glucose tolerance test (GTT) for the diagnosis of gestational diabetes mellitus(GDM) and to determine a threshold value for GCT for which further test with GTT may be omitted.

Method: 21534 pregnancies were screened for gestational diabetes with 50 g glucose challenge test (GCT) between 2005–2007. Results of 244 pregnancies with markedly elevated (≥190 mg/dl) GCT who also underwent 3-hour GTT were analyzed. The chi-square test and logistic regression analysis were used.

Results: The mean age was 30.6 (±5.0). When GCT results were between 190 and 200 mg/dl (138 patients); 64(%45.1) patients had normal values, 41(%28.9) of them had one elevated value, 24(%16.9) of them had two elevated values, 9(%9.2) of them had all values were elevated. When GCT results were higher than 200 mg/dl (102 patient) only 21(%20.4) of patients had normal results. While 10(%9.7) of patients had all values were elevated, 27(%26.2) of them had one elevated value, 34 of them had two elevated values. Highest specificity and sensitivity cut-off value for GCT diagnosing GDM was found 198.5 mg/dl (%60.5 specificity,%58.1 sensitivity) using ROC curve.

Conclusion: Even GCT value of ≥ 200 mg/dl is not absolutely correlated with GTT, GCT is not a diagnostic test for GDM. However 3-hour GTT is time consuming, expensive and uncomfortable for patients. GCT value of 198.5 mg/dl or higher may be helpful diagnosing GDM and may obviate unnecessary GTT.

687 EVALUATION OF PERINATAL MORTALITY IN 37875 BIRTHS USING MODIFIED WIGGLESWORTH CLASSIFICATION IN TWO DIFFERENT PERIODS

S. Kavuncuoğlu, E. Yildiz Aldemir, S. Sadik Duran, S. Özbek, H. Yildiz, N. Baysoy

The Ministry of Health, Bakirköy Gynecology, Obstetrics and Pediatrics Hospital, Department of Neonatology, Istanbul, Turkey

In this study we compared the perinatal mortality rate and cause of deaths in between the years 1999–2007 in our hospital in 37875 births by using modified Wigglesworth classification (MWC).

Modified Wigglesworth classification form was filled up for each of the cases that are older than 22^nd gestational week (GW) and/or have a birth weight (BW) of at least 500 grams. Fetal and neonatal mortality was evaluated.

In our hospital between the dates 01 January–31 December 1999, a total of 21659 births, 335 fetal deaths and 174 early neonatal deaths were recorded. Between the dates 1 January–31 December 2007, 16216 births, 357 fetal deaths, 72 early neonatal deaths were recorded. With these datas fetal mortality rates (FMR), perinatal mortality rates (PMR) and early neontal mortality rates(ENMR) were calculated for the years 1999 and 2007.

In the evaluation of these results, in the year 2007, compared to those of year 1999, a slight increase in fetal morbidity rate and relatively perinatal mortality rate was seen. Cause of deaths showed us that deaths due to congenital anomalies and in utero mort fetus have increased where deaths due to prematurity and perinatal asphyxia have decreased significantly.

After the NICU opening in the year 2002, there has been an increase in the number of high risk pregnancy cases and also the need for monitoring high risk fetus and newborns. Thus the increase in the number of babies with congenital anomalies and in utero mort fetalis cases has also increased PNMR.

688 COMPARISON OF PERINATAL AND NEONATAL IUGR CASES THAT HAVE AND DON'T HAVE ABSENT END-DIASTOLIC FLOW IN UMBLICAL ARTERY DOPPLER

S. Kavuncuoğlu, E. Yildiz Aldemir, S. Özbek, E. Türköz, G. Yildirim, A. Gülkilik, N. Baysoy

The Ministry of Health, Bakirköy Gynecology, Obstetrics and Pediatrics Hospital, Department of Perinatology-Neonatology, Istanbul, Turkey

In this study we compared IUGR cases that have reverse flow or flow loss in umblical artery with cases without flow loss in the morbidity and mortality aspects.

Between the years 2002–2006, we analysed IUGR cases which have absent (ARED) or reversed enddiastolic flow (REF) in umblical artery doppler retrospectively. In this study we included cases which have normal fetal anatomy, less than 10^th percentile weight and have neonatal medical records while we discarded multiple pregnancies and congenitaly anomalies. Cases that have diastolic flow are referred as Group 1 and ARED and REF cases are referred as Group 2. These groups were compared in aspects of mortality and morbidity.

A total of 322 cases were evaluated and 310 cases were included in this study. Absent enddiastolic flow (ARED) was found in 117 cases and reversed enddiastolic flow(REF) in 46 cases. Maternal and perinatal analysis of the groups showed that smoking, hypertension, caesarean section delivery, oligohydroamniosis ratios were higher in Group 2.

Comparison of neonatal morbidity showed that Group 1 was 28.2% while Group 2 was 44.1% and RDS, sepsis and NEC were the leading causes. Need for intensive care and hospitalisation time was considered statistically significantly higher.

No difference was found in neonatal mortality in both groups. Abnormal umblical artery flow affects neonatal mortality and morbidity in areas such as; birth weight, oligohydramniosis, increases neonatal intensive care needs.

A good antenatal evaluation and maternal care would be sufficiant in prevention of IUGR and its negative effects.

689 THE BLOOD PROGESTERONE LEVELS IN NORMAL AND THREATENED ABORTION PATIENTS

Y.S. Kim, S. Jeon, S.D. Choi, J.G. Sunwoo, D.H. Bae

Soonchunhyang University Hospital, Department of Obstetrics & Gynecology, Chungnam, Korea

Objective: To compare the blood progesterone levels in normal and threatened abortion patients.

Background: Progesterone is essential to establish a pregnancy and to avoid abortion in the first trimester of pregnancy. So low serum levels of progesterone may account for spontaneous abortion within 12 weeks of pregnancy. Recent studies on the use of progesterone in threatened abortion patients have shown a reduction of the miscarriage rate.

Methods: A prospective, randomized blood progesterone sampling of normal and threatened abortion patients between 2006–2007 in our hospital. A multivariable analysis was done following factors: multiparity, previous abortion history, and blood loss.

Results: Blood progesterone level was higher in normal pregnant patients than in threatened abortion patients in same gestational weeks. But not significant in our study (p > 0.05).

Conclusions: More study are needed to diagnosis and treat of threatened abortion.

690 THE EFFECTS OF FOLLOW-UP SERVICES ON THE COMPLICATIONS OF NEWBORNS POSTPARTUM EARLY DISCHARGED

G. Koç, K. Eroğlu

Hacettepe University, Health Science Faculty, Ankara, Turkey

In recent years the comprehension of early discharge of mother and newborn after an uncomplicated delivery has been accepted. However, the newborn are at increased risk of various problems during the first week after early hospital discharge and throughout the postpartum period. The objective of this study is to assess the effectiveness of the developed home care services model for the early discharged newborns.

The sample size of this study consisted of 50 intervention and 50 control groups, total 100 infants. The researcher got acquainted with the mothers and the infants at delivery and postnatal care service of the hospital. Postpartum second, seventh, fifteenth days and sixth week they were visited at home. The data were analysed by conducting percentage and relative risk, Chi – square, importance of the difference between two averages tests.

In the control group 82.0% and in the intervention group 58.0% of the infants did not experience any problems during the postnatal six week period. The average weight gain of the infants in the control group was lower compared to the infants in the intervention group. The infants in the control group had more promlems like physiologic jaundice, infections of eyes and they readmitted more to the hospital compared to the infants in the intervention group.

Even though the newborn do not experience any problems during the hospital stay, they undergo various problems in the first six week of postpartum period. Thus, the mothers should be followed at home and being informed on infant care.

691 EXSANGUINOTRANSFUSION IN THERAPY OF NEONATAL HYPERBILIRUBINEMIA

J. Korac, M. Rascanin, M. Vusurovic, L. Sipka, D. Avramovic, D. Brankovic

Gynaeco-Obsterics Clinic ‘Narodni Front’, Neonatal Intensive Care Unit, Belgrade, Serbia

Aim: Analysis of neonates with indirect hyperbilirubinemia treated with exsanguinotransfusion.

Methodology: During 2007 in our Clinic were born 6109 children and final diagnosis Icterus had 1942 newborns. Thirteen of them was treated with exsanguinotransfusion. Analysis included next parameters: age of women in childbed, parity, diseases in pregnancy, the way of labor termination, gestational age, sex, body weight and Apgar score of newborns, mother and child's blood type, Coombs' test, hour of newborn's life in which intervention is done, complications of intervention, entire morbidity and neonatal outcome.

Results: In pathology of pregnancy Rh alloimmunisation dominates (5), then PIH (2) and gestational DM (1).

Six newborns were preterm delivered, while seven were full- term. Two newborns had body weight above 4000 g and four below 2500 g. All neonates had high Apgar score. Hemolytic disease was the main cause of jaundice (7); five due to Rh – and two because of OA – alloimmunisation. Other causes were asphyxia (4), RD (1), hipertrophy (5), prematurity (6).

According to bilirubin blood levels in WHO recomandations, it was indicated in most cases to do exsanguinotransfusion in first hours of life – in six neonates respectively; in second day in three and in third day in four neonates (twice in one child).

There was no any comlications during intervention.

All newborns were discharched in good condition.

Conclusion: Exsanguinotransfusion is rarely performed today because of good pregnancy control, fast diagnosis of hemolysis, prevention of Rh senzibilisation, phototherapy, and early and regular nutrition of neonates.

692 SPONTANEOUS QUADRUPLET PREGNANCY: HOW MANY ARE TOO MANY?

A. Lebre, S.V. Soares, M. Brandão, A. Gouveia, R.M. Rodrigues

Maternidade Júlio Dinis, Obstetrics, Porto, Portugal

Spontaneous quadruplet pregnancies are an extremely rare condition, with an incidence of one in 700.000 pregnancies. Compared with twin pregnancies they are associated with an even higher risk of pregnancy-associated hypertension and eclampsia, anemia, diabetes, abruptio placentae, premature rupture of membranes and fetal morbidity and mortality.

The authors report the case of a 22-year-old Caucasian woman with a spontaneous quadruplet pregnancy. The patient had a family history of twins and was herself a twin. At 26 weeks of gestation she was hospitalized for threatened preterm labour and submitted to tocolysis and corticoid therapy for lung maturation. She remained hospitalized for bed rest and maternal-fetal surveillance until the 29th week of gestation, when she was submitted to caesarean section due to preterm labour. Quadruplets had birth weights ranging between 1130 and 1320 grams. While three of them were dismissed after 2 months of hospitalization in the neonatal intensive care unit, one of the quadruplets died at D35 from sepsis and necrotizing enterocolitis.

693 SUCCESSFUL TREATMENT OF AORTIC THROMBOSIS AFTER UMBILICAL CATHETERIZATION WITH LOW-MOLECULAR-WEIGHT HEPARIN

K.H. Lee, S.H. Kim, J.W. Kim

College of Medicine, Pochon CHA University Hospital, Pediatrics, Sungnam-si, Korea

Aortic thrombosis is one of the common complications caused by umbilical cord catheterization. There are three treatment options for aortic thrombosis: anticoagulation, thrombolysis, surgery. Low-molecular-weight heparin has several advantages over unfractionized heparin in the treatment of thrombosis. However, there is limited experience on using low-molecular-weight heparin in children, especially in the newborn. We experienced and report a neonatal case of aortic thrombosis caused by umbilical cord catheterization during intensive care because of congenital hydrothorax, which was successfully treated with low-molecular-weight heparin.

694 HYPOGLYCAEMIA INDUCES NITRATIVE STRESS IN THE TERM NEWBORN

N. Lefevre¹, S. Bottari², C. Ghaddhab³, E. Damis⁴, D. Vermeylen³, J.-L. Wayenberg⁵

¹HUDERF, Neonatal Intensive Care Unit, Brussels, Belgium;²Centre Hospitalier Universitaire & INSERM U884, Grenoble, France;³Hôpital Universitaire Erasme, Neonatal Intensive and Non-Intensive Care Unit, Brussels, Belgium;⁴Clinique Edith Cavell, CHIREC, Neonatal Intensive and Non-Intensive Care Unit, Brussels, Belgium;⁵RHMS, Department of Paediatrics, Baudour, Belgium

Introduction: Recent data suggest that peroxynitrite generation and subsequent protein nitration occurs in the neonatal brain after hypoglycaemia in animal models. Our previous studies demonstrated that albumin nitration increased during hypoglycaemia in preterm infants. Our aim was now to investigate albumin nitration after hypoglycaemia in term newborns.

Material and Methods: Using a novel double-sandwich ELISA, we measured nitrated albumin (nitralbumin) in venous plasma taken at days 1–2 of life from 16 term newborns at risk of hypoglycaemia and without any other obvious cause of nitrative stress. Glycaemia was monitored every 3–4 hours by a strip method. For each patient, we calculated the area under the curve (AUC) of the glycaemia levels during the 18 and 24 hours preceding blood sampling (AUCG18 and AUCG24) and the AUC under 2.5 mmol/l. Statistical analysis was performed with non-parametric tests.

Results: We observed significant correlations between nitralbumin and AUC's (AUCG24: r = −0.66, p < 0.05; AUCG24 under 2.5 mmol/l: r = 0.60, p < 0.05; AUCG18 under 2.5 mmol/l: r = 0.66, p < 0.01). Moreover, nitralbumin concentrations differed significantly between patients whose AUCG's under 2.5 mmol/l was lower versus higher than 27 and 0 mmol.h/l (for AUCG24 and AUCG 18, respectively).

Conclusion: Low glycaemia levels during the first day of life are associated with increased albumin nitration in term newborns. This indicates the occurrence of nitrative stress implying a risk of end-organ damage due to protein nitration and lipid peroxidation.

695 EFFECTIVENESS OF COMPUTER KARDIOTOCOGRAPHY RELATED TO WAY OF DELIVERY

Z. Madejski¹, A. Reroń², H. Huras², K. Rytlewski²

¹Saint Anna Hospital Miechow, Ob/Gyn, Krakow, Poland;²Jagiellonian University, Obstetrics and Perinatology, Krakow, Poland

The aim of the work was:

to estimate average values of particular digital parameters of cardiotocographic recordings in a group of pregnant women, who gave birth to babies in good condition, and in a group of pregnancies with newborns who scored below 7 points according to an APGAR scale.

to point out to the difference between values of digital cardiographic recordings, analyzed on the basis of criteria defined by FIGO and Dawes G. and Redman C. criteria.

The examined group consisted of 177 pregnant women, who underwent NS test just before the labor, and whose results were analyzed in detail. The tests were performed in Saint Anna Hospital from January 1^st 2003 till May 31st 2005. Using including criteria, two separate groups were created:

group I-composed of 162 women whose newborns scored 7 points and more in an APGAR scale in the first minute of life,

group II-composed of 15 women whose newborns scored below 7 points in an APGAR scale in the first minute of life.

The following conclusions were drawn on the basis of examinations:

• 1. In comparison to the classical cardiotocography, digital analysis of cardiotocographic recording is characterised by higher predictive value, which conditions its better use in assessment of fetal condition and the mode of delivery.

• 2. The method described by Dawes G. and Redman C. is a more advantageous alternative of assessing digital cardiotocographic parameters when compared to the criteria defined by FIGO.

696 THROMBOPHILIA IN PREGNANCY AND THERAPY DILEMMAS – DO WE OVERTREAT WOMEN WITH THROMBOPHILIA?

V. Mandic¹, Z. Mikovic¹, A. Egic¹, D. Filimonovic¹, N. Cerovic¹, M. Kovac²

¹Ob/Gyn University Clinic ‘Narodni Front’, High-Risk Pregnancies, Belgrade, Serbia;²National Institute for Blood Transfusion, Belgrade, Serbia

The dilemma in the treatment of thrombophilia during pregnancy is if it is always necessary to treat pregnant women after the detection of thrombophilia?

The aim of the study was to assess if there is a decrease in fetal and maternal complications in women with thrombophilia treated during the pregnancy.

Methodology: Clinical study included 106 women with thrombophilia. The patients were treated with LMWH and/or aspirin in pregnancies when the diagnosis was made. The therapy was given according to the type of thrombophilia and previous history of thrombosis and/or pregnancy complications. We compared all the pregnancies in all the patients that were not treated with all the treated pregnancies and assessed live-birth rate and fetal and maternal complications.

Results: Among 106 women with thombophilia there were: APL 29.25%; FVL heterozogocity 19.81%; FVL homozigocity 0.94%; factor II heterozygocity 7.55%; double heterozygos (FVL and FII) 1.89%; antithrombin deficiency 2.83%; PC deficiency 11.32%; PS deficiency 6.6%; MTHFR mutation homozygosity 16.98 and combined thrombophilia 2.83%.

There were totally 245 untreated and 134 treated pregnancies. In treated pregnancies there were higher incidence of live birth (85.82% vs 26.94%); and lower incidence of pregnancy complications: preeclampsia (8.76% vs 27.42%); fetal growth restriction (15.33 vs 29.03%) and placental abruption (1.46% vs 6.85%). Maternal thrombosis occurred in 3 untreated and in one treated pregnnacy.

Conclusion: Although controversial in cases with no history of thrombosis or pregnancy complications, the treatment with LMWH and/or aspirin improves pregnancy outcome in women with thrombophilia.

697 INTRAVENTRICULAR HAEMORRHAGE AND POSTHAEMORRAGIC HYDROCEPHALUS: SERIAL LUMBAR PUNCTURES VS SHUNT?

M. Marin Gabriel¹, C. Puente Sanchez², A. Lopez Escobar², C. Cantisano Bono², I. Llana Martin², P. Touza Pol², P. Pulido³, M. Miralles⁴, I. Romero², M. Benedit², V. Soler⁵

¹Hospital Madrid Torrelodones, Pediatrics, Torrelodones, Spain;²Hospital Madrid Torrelodones, Madrid, Spain;³Hospital Madrid Torrelodones, Neurosurgery, Madrid, Spain;⁴Hospital Madrid Torrelodones, Radiology, Madrid, Spain;⁵Hospital Madrid Monteprincipe, Madrid, Spain

Introduction: Intraventricular haemorrhage (IVH) and posthaemorrhagic hydrocephalus (PHH) are common causes of neonatal morbidity and mortality among preterm infants. Clinical management of PHH is not well standardized.

We aimed to determine the incidence of PHH after IVH grade III-IV in our hospitals and evaluate the effectiveness of serial lumbar tapping in this disorder.

Methods: We reviewed the medical records of the infants who developed IVH and PHH from 2006 to 2007 in the Madrid-Torrelodones and Montepríncipe Hospitals. Several variables were examined: number of lumbar punctures, median volume extracted, puncture and shunt complications, necessity of shunt implantation, and sedestation at 9 months corrected.

Results: Four newborns (mean GA: 28.2 weeks; mean birth weight: 1642.5g) developed grade III-IV IVH and PHH in this period (PHH incidence in grade III-IV IVH preterms: 57.1%). Repeated lumbar punctures were performed in three of them (median of 4.6 punctures/patient; median volume of 16.1 ml/tap), with a minimum interval between punctures of 24 hours. No complications were reported. Only one of the three patients who were submitted to lumbar punctures (33%) required a ventriculoperitoneal shunt and it was removed one month after the implantation because of meningitis.

Nowadays, three of the newborns included in this study are older than 9 months corrected age, and all of them have acquired sedestation.

Discussion: The low incidence of shunt implantations in our study make us recommend the practise of serial lumbar tapping as an alternative therapy before determining permanent shunt dependence in IVH and PHH newborns.

698 SKIN TO SKIN CONTACT AND TRADITIONAL CARE AT BIRTH. EFFECT ON RECOVER FROM HYPOTHERMIA AND ADMISSION TO NICU

M.A. Marin Gabriel, A. Lopez Escobar, C. Cantisano Bono, M. Benedit, I. Llana Martin, P. Touza Pol, I. Romero, C. Puente Sanchez, A. Carrillo, H. Carnicer, M. Garcia de Alvaro, L. Linares, E. Fernandez Villaba, A. Siles

Hospital Madrid-Torrelodones, Pediatrics, Torrelodones, Spain

Aims:

1. Determine whether skin to skin contact allows a better recovery from hypothermia

2. Determine if it modifies the number of patients admitted to the NICU.

Methods: Prospective case-control study. Patients were assigned to either one of these two groups 1) Immediately skin to skin contact (KC) (n = 137) 2) Traditional care (SC) (n = 137). This study was approved by the Hospital Ethical Comitee. Patients were included in the study after the acceptance of the inform consent. Newborns less than 35 weeks of gestational age, babies born from cesarian interventions and multiple births were excluded. Axillar temperature was measured. Hypothermia at birth was defined if the axillar temperature in the first minute after birth was less than 36°C.

Results: In 41 patients hypothermia was detected in the first minute of life (14.9%), 30 in the KC group and 11 in the SC group. Hypothermia was reverted in the first five minutes, in 80% (IC:65.7–94.3) of patients in the KC group and in 54.5% (IC:25.1–84.0) of babies in SC group (p = 0.12). Five (3.6%) patients in group KC against 12 (8.8%) patients in group SC needed to be admitted in the neonatal intensive care unit (p = 0.13).

Discussion: Skin to skin contact in the delivery room does not imply a better recovery from hypothermia in term and nearly term neonates. It neither modifies the number of patients needing admission to the NICU. Limitations: neonatal weight was lower in the KC group, which could alter the results.

699 COMPARISON BETWEEN SKIN TO SKIN CARE AND TRADITIONAL CARE AT BIRTH. EFFECTS ON THE MOTHER ANXIETY AND DEPRESSION

M.A. Marín Gabriel¹, A. Lopez Escobar¹, C. Cantisano Bono², M. Benedit Gomez², I. Llana Martín¹, C. Puente Sanchez¹, P. Touza Pol¹, I. Romero Blanco¹, M. García de Álvaro², L. Linares Lejarraga², E. Fernandez Villalba², A. Carrillo Herranz¹, H. Carnicer¹

¹Hospital Madrid-Torrelodones, Neonatal Intensive Care, Madrid, Spain;²Hospital Madrid-Torrelodones, Pediatrics, Madrid, Spain

Introduction: The aim of this study is to establish whether the skin to skin policy in the delivery room has any influence in maternal mood.

Method: This study is part of a prospective case-control study. Patients were assigned in the delivery room to:

• 1. Kangaroo care (KC)

• 2. Traditional care (SC)

Results: 165 mothers participated. Anxiety score was 4.7 ± 2.8 points (KC) and 5.2 ± 3.3 (SC) (p = 0.23). Distribution according to anxiety is shown on table 1 (p = 0.31). Table 1 KC (%) SC (%). No disorder 83.3 80.2. Bordeline disorder 14.3 12.3. Disorder present 2.4 7.4. Depression score was 2.1 ± 2.2 points (KC) and 2.2 ± 2.4 (SC) (p = 0.75). Distribution according to depression is shown on table 2 (p = 0.57). Table 2. KC (%) SC (%). No disorder 97.6 95.1. Bordeline disorder 1.2 3.7. Disorder present 1.2 1.2.

Discussion: The perform of skin to skin care started in the delivery room and hold during two hours does not reduce significantly the rate of anxiety/depression disorder in mothers after delivery. Our study regarded healthy newborns which did not need hospitalization.

The level of anxiety/depression in their mothers was less and thus, less likely to be influenced by any intervention in the delivery room.

700 THE EFFECT OF PRENATAL CARE ON CAUSES OF HOSPITALIZATION OF NEONATE IN HOSPITAL

M. Mirmohamad Ali¹, R. Kazempour²

¹Tehran University of Medical Sciences & Health Services, Nursing & Midwifery Faculty, Tehran, Iran;²Azad University of Medical Sciences & Health Services Marand Branch, Nursing & Midwifery, Marand, Iran

Background and Aim: The purpose of this study was to determine the effect of prenatal care on causes of hospitalization of neonate in hospital.

Methods and Materials: Study population was 150 mothers that their babies admitted to the neonatal ward or NICU and 150 mothers who gave birth a healthy baby as a control group.

The analysis was based on data from the birth certificate files and mothers.

Variables included demographic characteristics and adequacy of prenatal care ‘(based on ACOG Standards) obstetrical history and past Medical history … . Information obtained on the neonate included the cause of admission? ‘1-minute and 5-minute Apgar scores.

The most of mothers in the case and control groups obtained adequate (36% ‘39/3%) or intermediate (35/3% ‘36/7%) prenatal care.

Results: The most cause of admission of neonate in NICU was jaundice. In this study the other causes were infection ‘respiratory complication and preterm labor.

There was no statistically significant relationship between adequacy of prenatal care and the hospitalization of neonatal with jaundice (P = 0/98) ‘preterm and post term labor and growth retardation (P = 0/19) ‘Medical disorders (P = 0/26) and Minor Malformations (P = 0/62).

Conclusion: The benefits of regularly scheduled prenatal care visits are well-documented. However, this study demonstrates that increased accessibility to early prenatal care has not had as positive an effect on minority communities as expected. The authors suggest developing and incorporating new prenatal care strategies for minority women to help lower perinatal mortality.

701 THE SURVEY OF MATERNAL SATISFACTION ABOUT LABOR AND DELIVERY SUPPORTS IN TEACHING HOSPITALS OF TEHRAN

S.T. Mirmolaei, S. Rhimi Qasabeh, M. Modarres, A. Mehran

Nursing and Midwifery Faculty/Tehran University of Medical Sciences, Tehran, Iran

Introduction: Child birth is one of the most stressful situations in a woman's life. To gratify a woman for delivery she should be supported in different aspects: emotional.

Somatic, intellectual and …

Objective: To identify if mothers know the importance of being supported to a satisfying level in different somatic, emotional, and information aspects during labor and delivery.

Material and Method: In this descriptive study 400 post partum mother selected randomly and were interviewed with questionnaire in 10 teaching hospitals in Tehran University.

Data were processed in SPSS and tested with chi square and Fischer exact test.

Findings: Results showed that most of mothers knew the importance of somatic, informational, and emotional supports (in decreasing order of frequency). They had received inadequate emotional supports. But most of them were satisfied with (in decreasing order) informational, emotional and somatic supports. Satisfaction with supports had not meaningful association with the importance of supports in mothers but had correlation with reception of the supports (P < 0.05).

Conclusion: Being satisfied with supports despite their inadequacy may be due to the fact that mothers do the time of interview (just before discharge). No correlation between demographic variables and the value of importance in different supports show s that these are basic needs and all should be provided equally.

Keywords:Somatic, emotional, and informational supports, labor, delivery

702 A SURVEY ON THE LEVEL OF RECEIVED CARE AND SATISFACTION WITH PRENATAL CARE IN HOSPITALS AND HEALTH CENTERS IN TEHRAN UNIVERSITY OF MEDICAL SCIENCES

S.T. Mirmolaei¹, M. Azari¹, Z. Khakbazan¹, A. Kazemnezhad²

¹Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran;²Tarbiat Modarres University, Tehran, Iran

Introduction:. High quality prenatal care decreases maternal and neonatal mortality and morbidity. High quality care isn't possible unless by considering to opinions, demands and satisfaction of mothers who had received the prenatal care.

Objectives: To identify relationship between receiving level of prenatal care and satisfaction of pregnant women and to compare them in hospitals and health centers.

Findings: 53.4% and 14.8% of the pregnant women had received satisfactory and unsatisfactory prenatal care, respectively. Most of the pregnant women (54.7%) were satisfied, 23.7% and 21.6% were moderately and poor satisfied, respectively. There were significant association between the level of received care and (1)unemployed mothers (P < 0.3) and (2)number of visits (P < 0.001). Also, we have observed a significant relationship between satisfaction of participants and the kind of health-care providers (P < 0.01) and the number of visits (P < 0.001). There was a significant relationship between the level of received care and satisfaction of mothers (P < 0.001). The kind of setting of care delivery had a significant relationship with the level of received care and satisfaction of the mothers (P < 0.003, P < 0.005, respectively).

The results indicated that the level of received care and satisfaction of the participants in the health centers (health-care providers were midwives) were better than the hospitals (health-care providers were medical and midwiferystudents).

Conclusions: As a result, the level of received care and satisfaction of mothers were inadequate and in the hospitals were lower than the health centers. Standardization of prenatal care and improvement of educational programs in hospitals should be considered.

703 THE CONFORMITY OF BPP AND VIBROACOUSTIC STIMULATION RESULTS IN NON REACTIVE NON STRESS TEST IN SELECTED HOSPITAL OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES

M. modarres¹, M. Mirmohamad Ali², R. Aramy³

¹Tehran University of Medical Sciences & Health Services, Nursing & Midwifery Faculty, Tehran, Iran;²Tehran University of Medical Sciences & Health Services, Nosrat st. Toheid sq. Nursing & Midwifery Faculty, Tehran, Iran;³Arak University of Medical Sciences & Health Services, Nursing & Midwifery Faculty, Arak, Iran

Background: Objective clinical evaluation of fetal health is a primary goal of obstetric care. The most frequently used test in antenatal is the NST. Recently, the vibroacoustic stimulation combined with the NST has been shown to reduce non reactive results and shorten the testing period.

Methodology: A clinical trial design was chosen a randomized sampeling. 40 inpatient or outpatient pregnant women with non reactive NST in the first 20 minutes who received VAS in the NST unit were compared with BPP scores. A vibroacoustic stimulation with a tooth brusher was applied for a 3 seconds on the maternal abdomen overlying the fetal head and followed within 10 minutes. For all women the BPP score calculated and compared with VAS results. Data analysis was made by using the Fisher's Exact Test (p < 0.05). All statistical analysis were performed using an spss/win.

Findings: After VAS, 70% of the non reactive tracing became reactive. All cases with fetal reactivity response after a VAS had a subsequent BPP score of 8 (negative predictive value of 100%). In addition, all patients with a non reassuring BPP score were in the group of patients with absent reactivity criteria after VAS. The mean duration of time necessary to get a reactive result after VAS was found to be 5/5 minutes. False positive of VAS was lower than NST (83.3% VS 95%).

Conclusion: This study suggest that fetal response to VAS predicts a reassuring BPP score. VAS is safe and allows more efficient of prinatal services.

704 EXPERIENCE WITH PRENATAL DIAGNOSIS OF MULTIPLE ACYL-COA DEHYDROGENASE DEFICIENCY IN ONE SERBIAN FAMILY

R. Nikolic¹, S. Grkovic², Z. Puzigaca¹, U. Radivojevic¹, Z. Aleksov¹, M. Djordjevic²

¹Mother and Child Health Care Institute, Department for Human Reproduction, Belgrade, Serbia;²Mother and Child Health Care Institute, Pediatric Department, Belgrade, Serbia

Prenatal diagnosis for some organic acidemias is well established and know to be reliable but for some disorders there is less experience and the prenatal diagnosis may be experimental. Multiple acyl-CoA dehydrogenase deficiency (MADD) caused either by deficiency of the α- or β-subunit of electron transfer flavoprotein (ETF) or deficiency of ETF dehydrogenase is an autosomal recessive inborn error of metabolism. Each of these protein deficiencies leads to abnormal function of multiple acyl-CoA dehydrogenases, and thus to abnormal β-oxidation of fatty acids and metabolism of branched-chain amino acids. Affected individuals demonstrate increased excretion of glutaric acid, together with metabolites of the substrates of other blocked acyl-CoA dehydrogenases. We report our first experience with biochemical approach based on quantitation of specific organic acids and acylcarnitine esters in amniotic fluid to prenatal diagnosis at 17 weeks of gestation in a young, Serbian, non-consanguineous couple with a proband affected by MADD. Quantitative assay of glutaric acid performed by capillary gas chromatography showed normal value for 17 weeks of gestation. Quantitative assay of butirylcarnitine (C4), isovalerylcarnitine (C5), hexanoylcarnitine (C6), octanoylcarnitine (C8) and glutarylcarnitine (C5DC) performed by tandem mass spectrometry also showed normal values. The pregnancy was allowed to continue and the mother was delivered healthy female baby. In conclusion, MADD prenatal diagnosis should be performed using biochemical approach, with regard to available information and technologies.

705 FETAL HEMODYNAMIC PROFILE AND CARDIAC TROPONIN T AS A BIOCHEMICAL MARKER OF FETAL CARDIAC DYSFUNCTION

R. Nomura, F. Cabar, C. Verbenia, S. Miyadahira, M. Zugaib

University of Sao Paulo, Faculty of Medicine, Department of Obstetrics and Gynecology, Sao Paulo, Brazil

Objective: The aim was to determine the correlation between hemodynamic profile and cardiac troponin T (cTnT).

Methods: Eighty nine high risk pregnancies delivered between 2007 and 2008 were prospectively studied. All the patients delivered by cesarean and the Doppler exams were performed at the same day. Immediately after delivery, UA blood samples were obtained for pH measurement and cardiac troponin T (cTNT) levels. Group1 (n = 68) fetuses presented UA A/B < 5.0, group2 (n = 10) showed abnormal UA Doppler (A/B > 5.0) but with positive diastolic flow, and group3 (n = 11) presented absent or reversed end diastolic velocity (AREDV) flow in the UA. Statistical analysis included Kruskal-Wallis test.

Results: The group 2 and 3 delivered earlier (median 36 wks and 30 wks vs. 38 wks, p < 0.001). Doppler studies showed higher UA PI in the group 2 and 3 (median 1.58 and 2.6 vs. 0.87, p < 0.001). MCA Doppler PI median was 1.21 and 0.97 in the groups 2 and 3, lower than group 1 (PI = 1.60, p < 0.001). Ductus venosus PIV showed higher values in groups 2 and 3 (0.73 and 1.1) than in group 1 (PIV = 0.65, p < 0.001). Cardiac TnT was higher in the groups 2 and 3 (median 0.04 ng/mL [0.01–0.08] and 0.16 ng/mL [0.03–0.26]) than in group 1 (median 0.01 ng/mL [0.01–0.21], p < 0.001).

Conclusion: Elevated levels of cTnT were found in fetuses that presented abnormal UA Doppler in the umbilical artery and it represents an important toll in the management of placental insufficiency.

706 CARDIAC TROPONIN T AS A BIOCHEMICAL MARKER OF FETAL CARDIAC DYSFUNCTION AND DUCTUS VENOSUS DOPPLERVELOCIMETRY

R. Nomura, F. Cabar, V. Costa, S. Miyadahira, M. Zugaib

University of Sao Paulo, Faculty of Medicine, Department of Obstetrics and Gynecology, Sao Paulo, Brazil

Objective: Placental insufficiency may lead to cardiac dysfunction, and cardiovascular compromise is revealed by ductus venosus dopplervelocimetry. The aim was to determine the correlation between ductus venosus dopplervelocimetry and fetal cardiac troponin T.

Methods: Eighty nine high risk pregnancies were prospectively studied. All the patients delivered by cesarean section and exams were performed at the same day. The multiple regression included: maternal age, parity, hypertension, diabetes, gestational age at delivery, umbilical artery A/B ratio, diagnosis of UA absent or reversed end-diastolic velocity (AREDV), middle cerebral artery PI, and Ductus venosus PIV. Immediately after delivery, UA blood samples were obtained for pH measurement and cardiac troponin T (cTNT) levels. Statistical analysis included Kruskal-Wallis test and multiple regression with stepwise forward for analysis of independent variables.

Results: The results showed a positive correlation between abnormal DV-PIV and elevated cTnT levels in the umbilical artery. Multiple regression and stepwise forward procedure identified DV-PIV and the diagnosis of AREDV as independent factors related to fetal cTnT levels (p < 0.0001, F(2.86) = 63.5, R = 0.7722).

[cTNT]

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Conclusion: The DV-PIV correlated significantly with the fetal cTnT concentrations at delivery. AREDV and abnormal DV flow represents severe cardiac compromise demonstrated by myocardial damage and elevated fetal cTnT.

707 MAGNETIC RESONANCE IMAGING CHANGES IN PITUITARY GLAND WITH PROLACTINOMA DURING PREGNANCY: A CASE REPORT

Y. Ohtaka

Tokyo Metropolitan Toshima Hospital, Obstetrics & Gynecology, Tokyo, Japan

As hyperprolactinemia usually causes ovarial dysfunction, the data concerning the nature of prolactinoma during pregnancy is limited. We present the evolution of the pituitary changes in the patient with prolactinoma during pregnancy and postpartum.

Case: The nullipara of 29 years old diagnosed as microprolactinoma (6 × 6 mm) took a treatment for hyperprolactinemia by internal use of cabergolin. Because the pregnancy became clear, she canceled the medicine which continued internal use for 8 months by pregnancy the seventh week. The MRI on 16^th weeks revealed that the pituitary gland was significantly enlarged and swollen gland bulged superior margin. In consideration of pituitary gland tumors having increased, she started bromocriptine internal use. After that, the serum prolactin level gradually fell, and it was asymptomatic till she gave birth to a child of 2.280 g in 38 weeks. The MRI obtained on post partum day 13 revealed an enlarged pituitary gland with high intensities on T1-weighted images representing hemorrhage. The MRI on postpartum day 75 showed a smaller pituitary gland which may exhibit central necrosis. Generally, the pituitary gland enlarges throughout pregnancy, but should not exceed 10 mm during most of this period. Although enlargement of microprolactinoma is generally mild during pregnancy, this case represents significant enlargement and hemorrhage in post partum as same as macroprolactinoma. We believe MRI data may provide answers to some mechanisms involved in its patogenesis concerning the prolactinoma in pregnancy and postpartum.

708 AN ANALYSIS OF THE ASSESSMENT OF MEDICAL AND PSYCHOLOGICAL CARE DURING PREGNANCY AND DELIVERY – A PRELIMINARY REPORT

P. Ossowski, A. Reroń, K. Rytlewski, H. Huras, B. Gierat-Semik

Jagiellonian University, Obstetrics and Perinatology, Krakow, Poland

The aim of the study was to analyze the evaluation of medical care, social and psychological support during pregnancy and delivery, made by pregnant women.

Material and method. 100 women delivered between 01st Dec, 2007 and 31^st Jan, 2008 in the Department of Obstetrics and Perinatology of the Jagiellonian University Medical College.

Results. 36% outpatients was in panel and 64% in private obstetric-gynecological practices. Complete information about the course of pregnancy received 85%; 95.3% declared higher confidence towards obstetricians in private vs 82.9% (p = 0.035) in panel practice. 79.7% of women of private and 94.3% of panel practices independently searched for information about pregnancy (p = 0.048) in internet (73.8%) and magazines for women (54.8%). 91.3%(84) felt anxiety – 95.6% of health of their babies; 54.9% of duration of pregnancy. The most common (68%) feeling of anxietywas declared by 19–25 aged, with high schooleducation responders. 17% of responders delivered in the presence of partner. 35% pointedto lack of sufficient information on medical care and 20% felt the need for psychological support but 91% of all responders declared fulfilled of safety.

Conclusions. A high level of safety and satisfaction from the professional approach of medical personnel amongparturient women was proved, nevertheless 74% declared reservations concerning insufficientinformation and psychological support. This, especially in panel practices, led to an increase position of the media as a source of knowledge on the course of pregnancy. A strong subjective feeling of anxiety justifies greater role of a clinical psychologist in the supervision of pregnant women.

709 POSSIBLE EFFECTS OF PERINATAL FLUORIDE ADMINISTRATION ON BRAIN OXIDATIVE DAMAGE AND ALZHEIMER-LIKE NEURODEGENERATION DUE TO DECREASED MELATONIN LEVELS: A HYPOTHESIS

B. Ozucer¹, S. Saygili¹, B. Ustun¹, H.O. Seymen²

¹Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey;²Istanbul University, Cerrahpasa Faculty of Medicine, Physiology Department, Istanbul, Turkey

Introduction: Prescription and administration of Zymafluor and D-Fluoretten for dental prophylaxis has increased fluoride exposure during perinatal period. Although entrance of fluoride into Central Nervous System is prevented with blood-brain barrier in adult; its delicate structure during this period, absence over pineal gland and presence of hydroxyapatite crystals make this a favorible place for fluoride accumulation and toxicity. This has been shown to result in a significantly high fluoride concentration and dose-dependent decrease of melatonin metabolite excretion in experimental studies. Melatonin is an antioxidant molecule that has been shown to have neuroprotective role in Alzheimer-like neurodegeneration.

Objective: The aim of this study was to analyze the relation of fluoride accumulation in the pineal gland, its effects on cerebro-spinal fluid melatonin levels and Central Nervous System oxidative damage. In the present study, it is hypothesized that: perinatal fluoride exposure, especially its administration during the vulnerable perinatal period, can be a risk factor for central nervous system oxidative damage and Alzheimer-like neurodegeneration on the long-term.

Conclusions: Decrease of melatonin levels as a consequence of fluoride exposure is expected to be accompanied with impeded antioxidant and neuroprotective effects. Perinatal exposure of fluoride with the intention of dental prophylaxis can lead to serious neurotoxic effects that needs to be investigated.

710 FETAL TOBACCO SYNDROME AND FETAL MATURITY

M. Paqarada, G. Kongjeli, N. Kongjeli, B. Obërtinca, T. Gjergji-Maloku

Obstetrical-Gynecology Clinic, Obstetrics, Prishtina, Serbia and Montenegro

Scope of this research is impact of tobacco during the pregnancy, in fetal development, delivery stage and evaluation of fetal maturity.

Methods: In research are involved 120 pregnant women, 80 of them are smokers.

Final objectives are based on maternal and fetal status.

On maternal are hemoglobin concentrations, hematocryt and erythrocyte number, during the third trimester of pregnancy.

Perinatal ones includes delivery mode; vaginal or operative termination, birth weight, meconium stain of amnial liquid, Apgar score during the first five minutes, newborns gender, reference for further intensive care.

Results: It has been noticed the correlation with gestational age at birth in all three groups of women, specially those women who smoke more than 20 cigarettes a day, having higher incidence of premature birth. Maternal laboratory findings of this group are significant in erythrocyte number, hemoglobin concentrations, and hematokrit in 10–15% of all cases. Incidence of operative delivery was higher in group of smokers (over 20 cigarette per day).Birth weight was lower for approximately 300–400 gr. in second and third group. Apgar score on fifth minute was 37% lower. Intensive care of newborn was high.

Conclusion: Finding confirm that pregnant women that smokes especially that that smokes over 20 cigarettes per day, has high rate of maternal anemia and fetuses exposed to nicotine has disorders of cardiac rhythm, difficulties in adaptations during uterine contractions that affects the level of hypoxia.

711 MENAGEMENT OF DELIVERY AFTER IVF (IN VITRO FERTILIZATION) AND PARTICIPATION OF MULTI FETAL PREGNANCIES

M. Paqarada, G. Kongjeli, N. Kongjeli

Obstetrical-Gynecology Clinic, Obstetrics, Prishtine, Serbia and Montenegro

Purpose of study is to evaluate management of delivery after IVF (In Vitro Fertilization) and participation of multi fetal pregnancies.

In the period January 2006–December 2007, 172 pregnant woman (after IVF) have been studied, treated and their delivery managed in Obstetrical-Gynecological Clinic in Prishtinë.

Main objectives of the study were: maternal age, gestational age at the moment of delivery, modality of delivery, indications for Sectio Caesarea; gender, body weight & vitality of newborn, length of stay in the clinic and percentage of multi fetal pregnancies.

Results of after IVF delivery modality were: 97% of deliveries have been done with Sectio Caesarea, meantime participation of multiple pregnancies were 35%.

712 SPONTANIOUS RUPTURE OF MM.RECTI ABDOMINIS DURING PREGNANCY

Z. Partaloska-Sipinkarovska¹, S. Gorgonoska¹, S. Zlateski¹, S. Buklioski²

¹General Hospital “St. Petka” Struga, Department of Gynecology and Obstetric, Struga, Macedonia;²General Hospital “St. Petka” Struga, Struga, Macedoniaf

Purpose of the study: A case of a pregnancy with a spontaneous rupture of mm.recti abdominals in the tenth lunar month with a patient, a smoker even during her pregnancy.

Case report: The patient is 39 years old; our department checked her in with a strong pain in the left hypo gastric region with DG: graviditas m.l.X. Status post caesarean section (38 g.w.). This pregnancy is the forth to thepatient, she had two spontaneous deliveries, the third was with caesareansection because of placenta praevia. After she was checked in we did her vaginal examination andacordin that examination the labor wasn't started. Nonstress test:reactive. The results from the anamnesis were that the labor pain started from a strong attack of cough because the patient's smoking habit. The pain is spasmodic,very strong and she was restless. The physical examination of the left hypogastric region does not show any disorders. Laboratorial examinations were made by the protocol. Laboratorial examination waswell. The patient received a strong analgesic therapy that had small results. A laparatomy was decided to be made so the labor will be completed. A recaesarean section was made in the best order,after this anexploration was made on the left hypogastria region and a presence of haematom was detected as big as women's fist. The haematom was opened from where it was concluded that it was as a result of a spontaneous rupture of mm. recti abdominis,the same was sutured.

Conclusion: Smoking and chronically bronchitis in rare cases can caused this kind of complications that can jeopardize the pregnancy.

713 LECTIN PATHWAY ACTIVITY AND MANNAN-BINDING LECTIN LEVELS IN THE COURSE OF PREGNANCY COMPLICATED BY DIABETES TYPE 1

M. Pertynska-Marczewska¹, M. Cedzynski², A. Świerzko², M. Sobczak³, K. Cypryk⁴, J. Wilczynski⁵

¹Research Institute Polish Mother's Memorial Hospital, Reproductive Medicine and Gynaecology, Lodz, Poland;²Laboratory of Immunobiology of Infections, Centre of Medical Biology, Polish Academy of Sciences, Lodz, Poland;³Research Institute Polish Mother's Memorial Hospital, Specialized Outpatient Clinic of Foetal-Maternal Medicine and Gynaecology Department, Lodz, Poland;⁴Department of Diabetology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland;⁵Research Institute Polish Mother's Memorial Hospital, Foetal – Maternal Medicine and Gynaecology Dept., Lodz, Poland

Mannan-binding lectin (MBL) recognises various pathogens through their surface glycoconjugates and activates an antibody-independent lectin pathway (LP) of complement.

MBL deficiencies are associated with infections and diabetic microvascular complications. Moreover, there are indications that MBL is associated with pregnancy outcome.

The aim of the study was to evaluate the levels of MBL and the activity of LP in the course of pregnancy in diabetic mothers.

Material and Methods: 15 pregnant diabetic (PD), 16 healthy pregnant (P) at 1^st and 3rd trimester; 13 diabetic, non-pregnant (D), 15 healthy non-diabetic (C) women were studied. For statistical evaluation U Mann-Whitney' or Wilcoxon test were implemented.

Results: No significant differences in median MBL or LP levels were found in any studied group vs controls. We noticed, however, significant differences in MBL levels across 1^st and 3rd trimester levels in P and PD group. In regard to LP values, statistically significant differences were noticed in LP activity in P group. PD group did not differ significantly between trimesters but a trend could be followed (p = 0.06).

Conclusions: The increasing levels of MBL (and other innate immunity factors) in the course of pregnancy may be necessary to compensate for reduced T-cell function during a state of reduced adaptive immunity. Higher levels of MBL and LP would indicate a shift from adaptive to innate immunity.

Acknowledgments: This work was supported by Ministry of Science and Higher Education Scientific Research Committee grant nr. 2P05E 024 30.

714 PERINATAL MORTALITY IN GYNECOLOGY-OBSTETRICS CLINIC, TUZLA, BOSNIA IN PERIOD 1996–2005

F. Radoncic, A. Balic, I. Hudic

University Clinical Center Tuzla, Department of Obstetrics and Gynecology, Tuzla, Bosnia and Herzegovina

Problem: Perinatal mortality encompasses late fetal and early neonatal mortality. The aim of the study was to determine the incidence rate of perinatal mortality in analysed period.

Method of study: The present study covers a 10-year period (1996–2005), and on the basis of the existing delivery protocols and medical histories of pregnant women treated at the Gynecology-Obstetrics Clinic in Tuzla the following data were collected and analysed: number of births, number of stillbirths after the completed 28th week with the body weight bigger than 1000 grams at birth, number of stillbirths after the completed 28th week with the body weight bigger than 1000 grams.

Results: In the first postwar years (1996) a slight decrease of perinatal mortality from 26.3[euro] (1995) to 19.4[euro] was recorded, and then again in 2000 it slightly increased reaching 21.9[euro]. The ratio between fetal and early neonatal mortality was equalized and it showed a tendency of equal, gradual decline. When real peace was restored in the country the perinatal mortality dropped to 15[euro]; at this, it is interesting to note a significant decrease of fetal mortality which amounted to 7[euro], reaching the lowest rate of 6.1[euro] for the year 2005. The early neonatal mortality also recorded a significant decrease reaching 7.3[euro], but with a tendency of slight increase to 9.2[euro] in 2005.

Conclusion: Perinatal mortality at the Deaprtment for Gynecology-Obstetrics of the Univercity Clinic center in Tuzla is significantly less in the peace period (2001–2005) in comparison with the aftermath of war (1996–2000).

715 THE RELATIONSHIP BETWEEN NEONATAL WEIGHT AND UNINTENDED PREGNANCY

M. Ranjbar, S. Iranfar, P. Nadjadjfar

Kermanshah University Medical Science, Kermanshah, Iran

Introduction: In considering to complication of unintended pregnancy on maternal and fetus physical and emotional statuus, this survey was carried out on the relationship between unintended pregnancy and neonatal weight at Kermanshah University of Medical Sciences.

Materials and Methods: Cohort study was done on pregnant women. The questionnaire was used for collecting data and determine on unintended and intended pregnancy as case and control groups in respectively. The questionnaire was contained variables such as age, job, education, income, Para, number of abortion and act, also the informational form was used for some variables such as sex, weight and height of neonatal. All of collected data were analyzed by ×2 and exact fisher test, T test.

Results: From 144 pregnant women, 100% were housewife, 27.3% were illiterate, 46.4% had unintended pregnancy. There were not significant differences between neonatal weight and height in case and control groups.

Conclusion: There was unintended pregnancy approximately half of persons who were studied, in spite of, there were not the relationship between low birth weight and unintended pregnancy, but because of its complications it is necessary to do plan for decreasing rate of unintended pregnancy.

Keywords:Unintended pregnancy, neonatal weight, neonatal height

716 NEWBORN CHILDREN'S MORBIDITY FACTORS OF MOTHERS WITH GESTATIONAL DIABETES MELLITUS(GDM)

M. Rascanin, J. Korac, M. Vusurovic, L. Sipka, L. Avramovic, Z. Vujinovic, D. Brankovic

GAK‘Narnodni Front’, Neonatology, Belgrade, Serbia

Aim: Examine the importance of individual factors to children's morbidity of mothers with GDM and their interdependence.

Techniques: Retrospective analysis during 2005/2006 in GAK, “Narodni Front”, Belgrade includes 413 newborn children from GDM pregnancies.

Results: Avrerage age of mothers in tested group was 32 ± 5.33 while in control group it was 28.85 ± 5.23. In GDM group A1 is registered in the largest number of pregnancies (95.88%) while A2 is considerably less (4.12%).

Vaginal childbirth was completed in 56.42% pregnant women with GDM while in control group it was in 88.05%. Percentage of newborn male children is bigger inboth groups. Average gestational age in tested group is 38.0 ± 2.21, while in control group is 39.0 ± 1.8. Average value of Apgar score in 5 min in tested group was 9.32 ± 0.98 while in control group it was 9.71 ± 0.62. 23.48% hypertrophy newborns were in observed group while in control group there were 8.45%. 95.4% newborn children were released in good general condition and 98.51% from control group. In the structure of newborn children's morbidity hyperbilirubinemia is the most common namely 33.44% in group with GDM while 20.89% in control group. 1.53% of them had higher Htc and Hgb values, while other newborns had regular blood count. Hypoglycemia was registered with 12.83% newborns in GDM group while in control group it was 6.46%. Congenital anomalies in 1^st group were seen in 4.35% while in control group in 2.48%.

Conclusion: Analyzing morbidity structure significantly greater morbidity in newborn children of mothers with GDM was determined.

717 PREGNANCY IN NORTHERN KOSOVO AND NATO BOMBING

G. Relic¹, M. Bogavac², M. Relic¹, D. Cvetnic¹, R. Vlaskovic¹, B. Rajovic¹, S. Zakic¹

¹Medical Faculty of Pristina, Institute for Gynaecology and Obstetrics, Kosovska Mitrovica, Serbia;²Clinical Centre Vojvodina, Department of Obstetrics and Gynecology, Novi Sad, Serbia

Introduction: Foetal tissue is very sensitive when exposed to depleted uranium, which especially resulted in spontaneous abortion,blighted ovuma, premature deliveries and in a very frequent occurrence of the gestation trophoblastic diseasses.

Aim: To determine the frequency with which pregnancy disorders with women in Northern Kosovo occur after depleted uranium bombing.

Materials and Methods used: A retrospective study was done from January 1^st 2000 to December 31^st 2006.There were 5183 pregnancies. The data was gathered from the Department of gyn/obst in K.Mitrovica.

Results: Out of the total of 5183 pregnancies there were: 4349 deliveries, 794 miscarriages (227 spontaneous and 567 intentional) and 40 ectopic pregnancies. Out of the total of 5183 pregnancies there were: 24 molar pregnancies (0.46%) or 1:226 out of the total pregnancies. Considering that there were total of 4349 deliveries, the frequency of molar pregnancies is 0.55% or 1:180 deliveries. During the period in question there were 305 premature deliveries (7.24%), the greatest frequency was in 2000 (10.9%). Out of the total of 305 prematurely born children, 40(13.1%) was born dead. The greatest number of prematurely born dead children was in 2001(29.4%) (one third out of the total number of prematures).

Conclusion: The results of our retrospective study show that there was a greater frequency of molar pregnancies, premature deliveries, born dead prematures when compared with reference values in domestic and foreign records in the period in question. Considering the fact that the etiology of these pathologies is multi factoral a further prospective research needs to be conducted to get a more objective study on the effects of the depleted uranium.

718 PREMATURE RUPTURE OF MEMBRANES AT TERM OF MORE THAN 18 HOURS OF EVOLUTION WHIT GROUP B STREPTOCOCCAL NEGATIVE: RESULTS NEONATALES AND MOTHER

M.D. Ruiz, M.P. Carrillo, I. Perez, T. Aguilar, M. De la Torre, F. Montoya

University Hospital Virgen de las Nieves, Obstetrics and Gynaecology, Granada, Spain

Objective: To analyze mother and neonates infection complications obtained in pregnant women at term with Group B Streptococcus (GBS) negative that present premature rupture of membranes (PRM) of more than 18 hours.

Methodology: Retrospective observational study of 200 patients with PRM at term of more than 18 hours of evolution and GBS negative whose labour took place in the Hospital “Virgen de las Nieves” from Granada during the years 2006–2007. Antibiotic treatment was given only to the patients that presented fever intrapartum. The following information was analyzed: age, HIV and obstetrical risk. During the delivery were analyzed, time of rupture of membranes, duration of labour, fever, prophylactic antibiotics, vaginal examinations, intrauterine catheter, delivery beginning and ending. Mother and neonates infection complications were evaluated with fever, hemogram, hemoculture positive, C Reactive Protein and antibiotics.

Results: 13 cases (6.5%) suspect of sepsis neonatal, 2 cases (1%) confirmed with positive hemoculture for Enterococcus sp; 10 cases in the group of women with PRM of more than 24 ours and 3 cases in the group of women with PRM between 18–24 hours. Only 1 case (0.5%) of fever puerperal in the group of women with PRM of more than 24 hours. During delivery, 8 women presented fever and antibiotic treatment.

Conclusion: Although patients with long time PRM and without GBS have infection rate diminished, there is a considerable infection risk because of another germs. In conclusion, it is justified preventive measures in these patients including the use of antibiotics.

719 IN UTERO TESTOSTERONE EXPOSURE AND FEAR REACTIVITY IN INFANCY

P. Sarkar¹, K. Bergman², V. Glover², T.G. O'Connor³

¹Wexham Park Hospital, Department of Obstetrics and Gynaecology, Slough, United Kingdom;²Imperial College, Hammersmith Campus, Institute of Reproductive and Developmental Biology, London, United Kingdom;³University of Rochester Medical Center, Department of Psychiatry, New York, United States

Experimental animal investigations suggest that maternal stress during pregnancy can permanently modify neurodevelopmental systems in the offspring. However there is considerable debate about the mechanisms and supporting evidence. In this study we examined the association of a key early behavioral marker, fear reactivity, with prenatal exposure to testosterone which is thought to be implicated in prenatal stress-related programming. Women undergoing clinically indicated amniocentesis were recruited (median of 17 weeks gestation). Total testosterone was measured in paired amniotic fluid and maternal plasma samples (n = 264). All recruits leading to full-term healthy and singleton infants were invited to return at child age of 14 and 19 months. The Lab-TAB – Locomotor Version (Goldsmith and Rothbart, 1999) was used to assess infant temperament. Maternal mental health was assessed using the Spielberger State-Trait Anxiety Inventory to control for the heritability of anxiety-like traits in the child. Complete data on amniotic fluid testosterone and fear reactivity were available on 107 infants (54 females and 53 males). A significant association between amniotic fluid testosterone and fear reactivity was observed in males r(53) = 0.34, p = 0.01 but not in females (r(54) = −0.07, ns); the association was not significant when boys and girls were combined (r(107) = 0.07, ns). The association between prenatal testosterone and fearfulness in males remained significant when multiple covariates were included including postnatal maternal anxiety, stressful life events and depression. These findings on prenatal testosterone exposure and fear reactivity may be relevant to a growing set of studies assessing prenatal testosterone and behavioral phenotypes such as autism spectrum characteristics.

720 SYSTEMIC LUPUS ERYTHEMATOSUS AND PREGNANCY – REVIEW OF 51 GESTATIONS

R. Sousa¹, S. Marta¹, G. Carvalheiras², J. Sousa Braga¹, F. Farinha², G. Rocha³, C. Vasconcelos²

¹Hospital Geral de Santo António, Obstetrics, Porto, Portugal;²Hospital Geral de Santo António, Internal Medicine, Porto, Portugal;³Hospital Geral de Santo António, Nefrology, Porto, Portugal

Introduction: Systemic lupus erythematosus (SLE)occurs predominantly in childbearing age women. Its association with obstetric complications determines that these women should be considered high risk patients and therefore managed by a multidisciplinary team under a specific protocol.

Population: 51 gestations in 43 women with SLE (1993–2007).

Methods: Retrospective study analysing patients' characteristics, obstetrical and neonatal outcome.

Results: The mean age of women was 28.7 years. The mean previous duration of SLE was 6.3 years (range 1–21). The disease was considered active at conception (remission for less than 6 months) in 16 gestations. In 14 gestations there was previous renal impairment. There were 3 first trimester abortions, 1 intra-uterine fetal death at 24 gestational weeks (GW) and 1 termination of pregnancy at 20 GW. Of the 46 remaining gestations (≥24 GW), 26 had no obstetric complications. Nine pregnancies were complicated by a flare, 4 by transitory hypertension, 3 developed preeclampsia, 2 gestational diabetes, 1 intra uterine growth restriction, 2 oligoamnios and 2 preterm premature rupture of membranes. Renal involvement was the main manifestation in the lupic flares (10 cases).

The mean GW at birth was 36.6 (range 24–39). There were 8 preterm labours (6 for medical reasons). Two cases of neonatal lupus occurred. Six newborns needed care at the neonatal unit and 1 neonatal death occurred due to extreme prematurity.

Conclusion: The obstetric and neonatal prognosis in women with SLE is favourable as long as the pregnancy is carefully planned and closely managed by a multidisciplinary team.

721 SECOND TRIMESTER UTERINE ARTERY DOPPLER EVALUATION AS A PREDICTOR OF ADVERSE PERIANATAL OUTCOME

V. Stoykova¹, E. Pavlova¹, S. Ivanov¹, V. Mazneikova², J. Karagjozova¹, A. Nikolov¹, V. Djavolov¹

¹University Maternity Hospital ‘Majchin Dom’, Sofia, Bulgaria;²Hospital ‘ St. Sofia', Obstetrics and Gynecology, Sofia, Bulgaria

Objective: Therole of second trimester uterine arteryDoppler /UAD/ evaluation in a prediction of patients at risk of adverse perinatal outcome has been prooved in many studies up to now. We represent a preliminary data of an ongoing prospecive study for evaluation of the UAD as a preictor of an adverse perinatal outcome later in pregnancy.

Methods: 70 pregnant women at mean age of 29.05 ± 4.58 years were enrolled in the study by now. Of them 6 were excluded by a diferent reasons. All women were between 18 and 24 weeks of gestation /GW/. Conventional ultrasound and uterine artery Doppler with RI, PI, A/B ratio and notch evaluation was performed to all patients.

Results: 18 women (39.1%) had an adverse perinatal outcome. Of them 10 (15.6%) developed preeclampsia with or without IUGR. Seven patients delivered before 34GW. There were 3(4.6%) cases of isolated IUGR, 2(3.1%) placental abruption and 3(4.7%) intrauterine deaths. There is a SSD in the mean RI between the patients with or without pregnancy complications (0.63 and 0.49 respectively, p < 0.05). The calculated relative risk for RI above 95th centile was 3.5. Presence of notch increases the calculated risk to 11.4.

Conclusion: Our data support the hypotesis of the usefulness of the UAD evaluation alone as a sufficient predictor of the perinatal outcome. High sensitivity of the combination between elevated RI and uni – and/or bilateral notch are probably the best test for detection of patients at risk for adverce perinatal outcome later in pregnancy.

722 A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF CORTICOSTEROIDS FOR HYPEREMESIS GRAVIDARUM

A. Tabatabaii¹, L. Sekhavat¹, M. Mojibian²

¹Shahid Sedughi University of Medical Sciences and Health Services, Ob&Gy, Yazd, Iran;²Shahid Sedughi University of Medical Sciences and Health Services, Yazd, Iran

Objective: Hyperemesis gravidarum, a severe form of nausea andvomiting due to pregnancy for which there is no proven pharmacologicaltreatment. Corticosteroids are commonly used for the treatmentof nausea and vomiting due to cancer chemotherapy-inducedemesis and might prove useful in hyperemesis gravidarum. The aim of this study was to evaluate corticosteroids in prevent of hyperemesis gravidarum.

Methods: A randomized, double-blind, placebo-controlled trialwas conducted in 96 women with hyperemesis gravidarum during thefirst half of pregnancy. 48 women were randomizedto received intravenous methylprednisolone (125 mg) was followed by an oral prednisone taper (40 mg for 1 day, 20 mg for 3 days, 10 mg for 3 days, 5 mg for 7 days) and 48 women receivedan identical-appearing placebo regimen. All women also receivedVit B6 100 mg daily. The primary study outcomewas the number of women requiring rehospitalization for hyperemesisgravidarum.

Results: A total of 96 women delivered at our hospital andhad pregnancy outcomes available for analysis 15women in study group required rehospitalization and 28 women in placebo group. (31.3% vs. 58.3%, P = .00, for corticosteroids versus placebo, respectively).

Conclusion: The addition of intravenous corticosteroids to the treatment of women with hyperemesis gravidarum reduced the need for rehospitalization later in pregnancy.

723 THE COMPARATIVE STUDY BETWEEN THE ROLL OVER TEST AND SERUM HEMATOCRIT LEVEL IN EARLY DETECTION OF PREECLAMPSIA

Z. Taghizadeh, F. Golboni

Tehran, Nursing & Midwifery, Tehran, Iran

This is important to find a suitable screening test for preeclampsia. This study was an examination of tests and a randomized stratification to compare between roll over test and serum hematocrit level in 660 women were in 24–28 weeks of gestation. The data collection tools were; questionnaire, data recording form and biophysical data. The result of serum hematorictl level in 24–28 weeks and roll over test in 28–32 weeks was recorded. All of the women were followed up till delivery to detect the preeclamsia. The consequences of research were analyzed with SPSS version 15 soft ware.

Results: There was showed the significant differences in hematocrit and roll over test in preeclamptic and non preeclamptic women (p = 0.00). 58% sensitivity, 88.9% specificity, 33.7% positive predictive value and 95.7% negative predictive value for serum hematocrit and 63.8% sensitivity, 91.7% specificity, 42.5% positive predictive value and 96.33% negative predictive value for roll over test were accounted. The accommodation value was 80% and the difference value was 20%. The Mc Nemar test confirmed the analog of these two tests in early detection of preeclampsia (p = 0.258). using hematocrit level in 24–28 weeks of gestation as a simple inexpensive test and analog with roll over test can detect high risk preeclamptic women 4 weeks sooner than roll over test.

724 TERM PREGNANCY WITH 30 CM ADNEKSIAL MASS: A CASE REPORT

G. Toklucu, E. Akbay, H. Yalcinkaya, I.A. Özdemir

Bakirkoy MD Sadi Konuk Research and Training Hospital, Gynecology and Obstetric, Istanbul, Turkey

The association of an ovarian cyst with pregnancy is relatively rare; it may result in serious maternal and fetal complications and its treatment is still controversial. The most frequent histological type reported is mature cystic teratoma (50% of the cases), followed by functional cysts (13%), benign cystadenomas (20%) and ovarian cancer (0.6%). Most adnexal masses are asymptomatic and spontaneously resolve before the 16th week of amenorrhoea. On the other hand, some cases are persistent forms which can cause complications for the mother and fetus. Expectant management is recommended for most pregnant patients with asymptomatic, nonsuspicious cystic ovarian masses. Surgical intervention during pregnancy is indicated for large and/or symptomatic tumors and those that appear highly suspicious for malignancy on imaging tests. The extent of surgery depends on the intraoperative diagnosis of a benign versus a malignant tumor. Conservative surgery is appropriate for benign masses and borderline ovarian tumors. We report a case of giant ovarian cyst with multiseptation and severe ascide in pregnancy of 36 weeks of amenorrhea revealed by digestive and respiratory compression. Patient delivered by section. Histological type was benign mucinous cistadenoma. From this case, our aim was to discuss clinical and therapeutic problems of this association.

725 LEVELS OF NOISE: COMPARISON BETWEEN NEONATAL HELMET-CPAP AND CONVENTIONAL NASAL-CPAP

L. Camiletti¹, A. Udilano², N. Doglioni², M.P. Saccomani³, V. Zanardo², D. Trevisanuto⁴

¹University of Padova, Azienda Ospedaliera Padova, Clinical Engineering Unit, Padova, Italy;²University of Padova, Azienda Ospedaliera Padova, Padova, Italy;³University of Padova, Padova, Italy;⁴University of Padova, Azienda Ospedaliera Padova, Pediatric Department, Padova, Italy

Background: Previous work showed that the developing ears of preterm infants are continuously exposed to high noise levels during conventional nasal-CPAP. To improve the patient-ventilator interface we developed a new device (neonatal helmet-CPAP) to administer CPAP in preterm infants. In a short-term physiological study, neonatal helmet CPAP appeared to be a feasible method of supporting the breathing of preterm infants with a better tolerability compared with conventional nasal-CPAP.

Aim: to compare the noise levels generated by the neonatal helmet-CPAP with a conventional nasal-CPAP system.

Methods: Measurements were performed on the C scale (using a C-weighting filter). The phonometer (MK 5350, Mitek Industries, Phoenix, AZ, USA) was positioned in the pressure chamber of the device corresponding to the ear of the neonate (“ear zone”). For both CPAP systems, the noise levels were detected maintaining the gas flow rate (8 l/min) and the level of CPAP (5 cm H₂O) constant. For each device, we performed 6 measurements lasting 15 minutes; the noise level was calculated every 20 seconds. All measurements were obtained in the Neonatal Intensive Care Unit (NICU) in the afternoon (3.00–6.00 p.m.) for 2 weeks.

Results: Levels of noise are reported in the Table:

Noise level (dB).

Neonatal helmet-CPAP 68.5 ± 0.4*

Nasal-CPAP 62.8 ± 0.4.

*p < 0.01.

Conclusions: Neonatal helmet-CPAP produces higher noise levels than conventional nasal-CPAP. However, both CPAP systems produce potentially dangerous noise levels (>60 dB) for the developing ear of a preterm infant. The new CPAP devices need to take into account this crucial aspect.

726 DETERMINANTS OF ANXIETY AMONG MOTHERS OF INFANTS IN THE NICU: ROLE OF FAMILY PHYSICIANS ON COPING WITH THE STRESSORS

A. Uludag¹, I. Unluoglu¹, N. Tekin², A. Aksit²

¹Eskisehir Osmangazi University Medical Faculty, Dept. of Family Physicians, Eskisehir, Turkey;²Eskisehir Osmangazi University Medical Faculty, Dept. of Pediatrics, Division of Neonatology, Eskisehir, Turkey

Background: Parents with a a newborn baby hospitalized in NICU often present different problems. These situations are difficult to manage unless physician can get to the source of parental anxiety. We aimed to establish the stressing factors and expectations of mothers from NICU staff and the complimentary role of family physicians on maternal coping with the stress.

Methods: Study was conducted in 78 mothers of NICU patients. Socio-demographic characteristics were recorded. General health questionnaire (GHQ), a 30-item self-report questionnaire which focuses on the inability to carry out normal functions and the appearance of new and distressing psychological phenomena and The State-Trait Anxiety Inventory (STAI)-a self-report assessment device which includes separate measures of state anxiety and trait anxiety were assessed. The effect of socio-demographic characteristics, physical environment and procedures in NICU on maternal stress and symptoms of anxiety were searched.

Results: High anxiety related factors among the mothers were appearance of their small, fragile baby, prolonged hospital stay, low gestational age, presence of abortions or stillbirth in previous pregnancies, exposure to a technical environment and their higher educational status(p < 0.05). Maternal age, parity, frequency of visiting and giving expressed milk, lower income did not have any effect on anxiety. Conclusion: In busy and crowded NICU environment attention is primarily focused on baby. In Turkey, family physicians system has been established. Family physicians can take part to support psychosocial issues of the parents; when recognized, stresses were reduced by discussion, giving information. Parents can be oriented to psychiatrist when indicated.

727 INCREASING RATE OF CESAREAN DELIVERIES THE LAST 15 YEARS

A. Varvarigou¹, N. Fotiadis¹, P. Giannakopoulou¹, L. Mantagou¹, G. Decavalas¹, V. Tsapanos², S. Mantagos¹

¹University of Patras, Medical School, Pediatrics, Patras, Greece;²University of Patras, Medical School, Obstetrics & Gynecology, Patras, Greece

Background and Aims: The Cesarean Deliveries' (CDs) rate is still increasing in most parts of the world. We studied the trend of CDs rate in our Hospital and we examined the contributing factors.

Methods: The data from the Birth Registry of the Neonatal Unit were recorded from December 15, 1992 to December 30, 2006.

Results: Totally 14990 live births were recorded, 8090 boys. The overall incidence of CDs was 39%. The CDs rate per year increased from 23.5% to 46.4%. Logistic Regression Analysis showed an indepemdent negative effect on CDs rate of gestational age (OR 0.79), meconium stained amniotic fluid (OR 0.706), Apgar score 1^st min (OR 0.73), spontaneus conception (OR 0.105), parity (OR 0.877) and a positive effect of ruptured membranes (OR 3.330) and size at birth (SGA or LGA).

(OR 1.203). The obstetrician's younger age and lower academic degree affect negative the CDs rate (OR 0.877).

Conclusions: The higher than the expected CDs rate observed in our hospital is attributed to the increased number of:

• a) High risk pregnancies referred to us and

• b) Elective of all previous CDs, as it is our policy.

728 THE IMPACT OF OBESITY ON GLYCEMIC CONTROL AND NEONATAL OUTCOME AMONG PREGESTATIONAL DIABETIC WOMEN

E. Vazquez Vera, V.H. Gonzalez Quintero

Univeristy of Miami, Obstetrics and Gynecology, Miami, United States

Objective: To evaluate the impact of obesity on glycemic control and neonatal outcome among pregestational diabetic women (PDM).

Study design: A retrospective study was performed using clinical data available on PDM who received prenatal care and delivered at our institution.

Demographics including age, classification of diabetes, race/ethnicity and weight gain during pregnancy were collected.

In order to evaluate glycemic control, glycocylated hemoglobin (HbA1c) and average glucose levels for each trimester were abstracted and analyzed.

Neonatal outcomes included rates of hypoglycemia, respiratory distress (RDS), hypocalcemia and macrosomia. These variables were stratified between 2 groups: Obese women (BMI > 29) and non-obese women (BMI < 29).

Results: A total of 940 cases were available for analysis. More than half of these women were obese. Sixty-seven percent were classified as class B PDM. Other demographic variables were similar between the two groups. HbA1c were similar among obese and non-obese women in each trimester; 8.6 ± 2.1 vs. 9.4 ± 7.2, p = 0.205 during the first trimester, 7.6 ± 3.6 vs. 7.4 ± 4.1 p = 0.343 during the second trimester and 6.1 ± 1.4 vs. 7.11 ± 4.7 p = 0.343 during the third trimester. The rates of neonatal complications were similar between both groups.

Conclusion: Obesity in women with PGM does not affect adversely glycemic control and neonatal outcome. Glycemic control was achieved by multidisciplinary approach to the patient with BMI > 30. The rising trend in Diabetes and Obesity demands a greater level of preventive actions among this population.

729 ADVANCED ABDOMINAL PREGNANCY

C. Veríssimo, T. Matos, F. Matos, I. Rocha, F. Nogueira

Hospital Fernando Fonseca, Women's Department, Amadora, Portugal

Introduction: Almost all cases of abdominal pregnancy follow early rupture of a tubal pregnancy into the peritoneal cavity. A portion of the placenta usually remains attached to the tubal wall and the periphery grows beyond the tube, implanting on surrounding structures. Advanced abdominal pregnancy (>24 weeks of gestation) with a live fetus is rare. Physical exam may reveal a displaced cervix, abnormal lie and easily palpable fetal parts. Sonographic diagnosis is missed in nearly half of the cases. Surgical intervention is always needed but may precipitate catastrophic hemorrhage. Management of the placenta is a controversial issue.

Objectives: To determine the incidence of advanced abdominal pregnancy in our institution and to report the clinical cases.

Methods: Retrospective study, including all deliveries from 1997 until 2007.

Results: 52814 deliveries; 1 advanced abdominal pregnancy (incidence ∼1:50000).

Case report: A 24-year old primigravida was admitted in the 34th week of gestation because of abdominal pain. She had a reassuring CTG with no contractions. Sonographic exam: breech presentation, severe oligohydramnios, reduced fetal movements and a “heterogeneous total placenta previa”. A cesarean-section was scheduled. Abdominal pregnancy was diagnosed during surgery. A live male infant was extracted: 2285 g, Apgar score: 8-9-10. Half of the placenta was left in place. She was re-operated two days after because of hemoperitoneum; a total hysterectomy, extraction of the placenta and a partial small bowel resection were performed. Postoperative period was uneventful.

Conclusions: Thorough evaluation and multidisciplinary approach are crucial to achieve favorable maternal and fetal outcome.

730 BABY FRIENDLY HOSPITAL INITIATIVE: LONG-TERM OUTCOMES

K. Vitkauskas

Health Care Center of Plunge, Plunge, Lithuania

Background: At the beginning of 20^th century breastfeeding for a year and longer was common all over the World. In 1920's in Lithuania 65 percent of six-months babies were breastfed and the average duration of breastfeeding was 8.5 months. However harmful practices of delayed breastfeeding initiation, separation mother from newborn, and strict feeding rules, that were difficult to fulfill, destroyed both mothers' and doctors' confidence in breastfeeding and led to the capitulation to bottle-feeding with formula. In early 1980's there was the deepest fall of breastfeeding rates to just 3 percent at 6 months of children's age with the average duration of 2 months. Later more intense promotion of breastfeeding was based mainly on revealing of breast-milk benefits. In 1991 the Baby-Friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF. The substantial changes started in Lithuanian maternity hospitals through implementation of the Ten Steps to Successful Breastfeeding too.

Aim and method: Our intention was to explore breastfeeding duration in Lithuania before beginning of implementation of BFHI and some time later. The data were collected twice: in 1991 and 2005. Each time about 9000 children's medical records were examined in 100 cities, towns and villages throughout the country.

Results: It was found that 6 percent of children born in year 1991 were breastfed at 6 months of age and the average duration of breastfeeding was 2.35 months. In 2005 the indices were 23 percent and 3.7 months respectively.

Conclusions: The significant increase of breastfeeding duration proves lasting benefit of BFHI.

731 SPONTANEOUS QUADRUPLET PREGNANCY: REPORT OF A CASE

A. Yalinkaya, K. Kangal, M. Barut

Dicle University Faculty of Medicine, Department of Obstetrics and Gynecology, Diyarbakir, Turkey

Objective: To presents a sponteneous quadruplet pregnancy without any complication in 20 years old woman.

Case: A 20 year old (G2P1) woman, after her first birth, she had not used any medications for become pregnant or contraception methods. She had become pregnant spontaneously three years later. She had not applied to doctor during her last pregnancy for antenatal care. When beginning of her birth pain, she was applied to an obstetrician, and she referred to our clinic for multiple pregnancy. On ultrasound examination we were detected a healthy quadruplet and approximately 35 weeks of gestation, and uterine contractions were found on cardiotocography. We were performed cesarean section and delivered four babies, one of male and three of them female, and their weight were 1900 g, 2100 g, 2100 g and 2300 g, respectively. The first and fifth minutes APGAR scores of them were 6–8. The patient was discharged postoperative day 6 without any complications.

Conclusion: Spontaneous Quadruplet pregnancy is extremely rare seen. In general, multiple pregnancies have more complications than singleton during gestation and after birth. Our case had spontaneous quadruplet pregnancy without any complication during pregnancy and later. Therefore, we thought that this case should be considered for publication.

732 THE HIGH RATE OF VENTILATORY SUPPORT IN OBSTETRIC CHOLESTASIS

S.T. Yousif, G. Burke

Mid-Western Regional Maternity Hospital Limerick, Limerick, Ireland

Objective: To determine the perinatal outcome of cases of obstetric cholestasis (OC).

Methods: A retrospective study was carried out at a large Irish tertiary maternity hospital of all cases of OC over a 61-month period. Outcome measures included gestational age at delivery, mode of delivery, admission to the neonatal unit, neonatal ventilatory support and maternal complications. Diagnosis was made on the basis of elevated serum bile acids in patients with pruritus or a past history of OC.

Results: 1792 Samples were sent for estimation of serum bile acid levels. 99 Patients had abnormal bile acid levels. 103 Infants were delivered, including one intrauterine fetal death, one early neonatal death and 101 live births. There were 8 sets of twins. Mean gestation at presentation was 34 weeks. Gestational age at delivery ranged between 31 and 39 weeks. The rate of elective delivery was 71.5% (46.3% were induced and 25.2% had elective caesarean sections). 7.3% Laboured spontaneously before 37 weeks. The rate of admission to neonatal intensive care unit was 24.8%, of which 7.9% were ventilated and 6.9% had CPAP. Major malformations included congenital heart disease and tracheo-oesophageal fistula. Postnatal sepsis, postpartum haemorrhage and toxaemia of pregnancy were among the maternal complications.

Conclusions: In a large series of consecutive cases, obstetric cholestasis was associated with increased perinatal mortality and with high rates of neonatal unit admission and ventilatory support, possibly the result inappropriately early obstetric intervention or, as has been suggested previously, a poorly understood pathological mechanism. Twins were disproportionately represented.

733 EVALUATION OF ADOLESCENT PREGNANCIES' SOCIO-DEMOGRAPHIC FEATURES AND ANTENATAL CARE

M. Yurdakul, T. Güner

Mersin Univercity, Mersin, Turkey

Objective: The aim of this study was to evaluate the adolescent pregnancies' socio-demographic features, their health problems and to determine whether they received antenatal care.

Methods: 70 adolescent pregnancies who are 19 and under in Mersin Woman and Child Hospital, in Tozkoparan and Mezitli primary health centers and maternal and child health center, on March 1–30, 2008 were subjected for evaluation. The questionnaire applied to the participants by face to face interview technique and the data obtained evaluated by SPSS 13.0 program.

Results: Average age for adolescent pregnancies was 18.1, 55.7% primary school graduates, 90% was unemployed and housewives. 44.3% had no formal marriage. Husband of the pregnancies 45.7% primary school graduates, 62.9% were unemployed. The mean age of marriage of the adolescents was 16.4; 30% got married due to their families' decision, 34% were relatives to their husbands.

87.1% of adolescent pregnancies had their first pregnancy. 80% had not used family planning methods. 22.9% of had health problems during pregnancy. 37.1% received regular antenatal care and during this period most of them undergo blood urine test, height and weight measurements, blood pressure. Few of them received GTT.

62.9% of pregnancies stated that during antenatal care they got information about nutrition and vaccine in pregnancy but not about family planning or the effects of adolescent pregnancy on the mother and the baby health. Adolescent pregnancies expressed their needs of information about newborn care and family planning methods.

Keywords:Adolescent pregnancy, antenatal care

734 A CASE OF AN OVARIAN CYST IN A FEMALE FETUS

S. Zlateski¹, S. Zlateska², Z. Partaloska¹, S. Gorgonoska¹

¹General Hospital-Struga, Gynecology and Obstetrics, Struga, Macedonia;²General Hospital-Ohrid, Neonathology, Ohrid, Macedonia

Aim: Presentation of an ovarian cyst in a female fetus is the main goal of this paper.

Method: Abdominal ultrasound was the most important technique used through the examination process.

Results: In this paper a 25 year old primigravida was examined. The patient was carrying a female fetus in which an ovarian cyst was found in the 29 week of gestation. The spherical cyst with smooth internal surface was located in the right ovary and was 26 mm in diameter. The regular ultrasound controls showed that the dimension of the cyst remained unchanged during the whole pregnancy. Differential diagnosis included: mesentheric cyst, kidney cyst, urachus cyst, and retroperitoneal teratoma. There were no complication during the pregnancy. The patient in the 39 week of gestation gave birth to a female newborn 50 cm long, 3400 g heavy and APGAR SCORE 8/9. The ultrasound examination of the 6 week old newborn showed no presence of the cyst. Due to the fact that the cyst disappeared after the labor we consider that it was provoked by the placental gonadotropines.

Conclusion: The influence of the placental gonadotropins can cause an appearance of a cyst on the ovarium in the female fetus, which is not a real neoplasm. In this case we found that, several weeks after labor, when the action of the placental gonadotropins is terminated the cyst spontaneously disappeared. In addition, some complications are observed such as cyst torsion which can cause acute abdomen.

735 VACTERL ASSOCIATION WITH POTTER SEQUENCE

A.B. Akcan¹, S. Erişir Oygucu¹, E. Mihci¹, G.A. Gökhan², N. Oygür¹

¹Akdeniz University, Department of Pediatrics, Antalya, Turkey;²Akdeniz University, Department of Pathology, Antalya, Turkey

Aim: We report a neonate, having spectrums of VACTERL association and Potter sequence due to cystic renal dysplasia.

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Case report: A female neonate was born vaginally at 36 weeks of gestation. Parents were first degree consanguineous. She was resuscitated,and intubated immediately after delivery. She had a characteristic Potter face, bilateral webbing, separated eyes, prominent epicanthal folds, micrognathia, low set ears, short neck and clinodactyly. Upper limbs were malformated and pes equinovarus deformity of the left foot and rocker bottom of the right foot. There were scoliosis of lumbar vertebrae. Imperforated anus was also detected. She died on the second day of life. Postmortem examination revealed tracheoesophageal fistula with esophageal atresia and cardiomegaly. Both kidneys were smaller than original size and showed cystic renal dysplasia. Both ureters were normal. Genital system was normal. Karyotype analysis was normal (46, XX).

Conclusion: Upper urinary system involvement is common in VACTERL association. However cases, reported in literature, have nonserious renal abnormalities and generally have a good outcome. VACTERL association and Potter sequence due to cystic renal dysplasia is an unusual combination and is extremely rare. We recommend investigating Potter sequence in the spectrum of congenital anomalies of the VACTERL association.

736 A FETUS WITH TRANSLOCATION TYPE OF TRISOMY 13 SHOWING CONTROVERSIAL ALLELIC RATIO IN QF-PCR

A. Alpman¹, H. Akin¹, F. Hazan¹, F. Akercan², H. Onay¹, O. Cogulu¹, F. Ozkinay¹

¹Ege University Faculty of Medicine, Department of Medical Genetics, Izmir, Turkey;²Ege University Medical Faculty, Department of Obstetrics and Gynecology, Izmir, Turkey

QF-PCR is an accurate and reliable method used in prenatal diagnosis of common aneuploidies. In QF-PCR STR(short tandem repeat) markers found on chromosoms are amplified which indicate the number of chromosomes and duplications or deletions specific to the related regions.

When a normal and abnormal allele pattern is obtained for a chromosome special attention should be paid as there may be partial chromosomal imbalances. We present a case which was referred to our department for prenatal genetic diagnosis because of abnormal ultrasonographic findings in the fetus (bilateral choroid plexus cysts and diaphragma hernia). QF-PCR parallel to cytogenetic analysis was performed. In QF-PCR, 4 markers for chromosome 13 were found to be normal except 1 marker in the 13q13 region for which the allelic ratio was found to be 1:1.5 and 2 markers were uninformative. Regarding pathological utrasonographic findings in the fetus another commercial kit was used which found 3 markers to be normal whereas the allelic ratio for the marker at the same locus was 1:1. 68. Blood samples of the parents were analysed by QF-PCR and their allelic ratios were found to be normal for all markers. We reported an inconclusive result for chromosome 13. Cytogenetic analysis revealed a fetal karyotype 46,XY,t(13;13)(q12;q12). Interestingly, markers close to the translocation region were abnormal whereas more distal markers showed normal allelic patterns.

The pregnancy was terminated due to translocation type trisomy 13. Discrepancies in allelic ratios should be carefully evaluated in QF-PCR since they may reflect structural abnormalities in the fetus.

737 PARTIAL MOLAR PREGNANCY WITH NORMAL FETAL KARYOTYPE: A CASE REPORT

M. Altay¹, O. Kandemir¹, S. Yalvac¹, A. Haberal²

¹Ankara Etlik Maternity and Women's Health Academic and Research Hospital, Perinatology, Ankara, Turkey;²Ankara Etlik Maternity and Women's Health Academic and Research Hospital, Gynecology, Ankara, Turkey

We presented a a case of partial molar pregnancy with a fetus with normal diploid karyotype. Partial molar pregnancy is rarely associated with normal fetal karyotype. Therefore we wanted to present this case report.

The patient was 28 years old, gravida 2, para 1, with 1 living child. She has been married for 11 years. She was applied to our hospital for the first time at the 9th week of her pregnancy with complaint of slight bleeding. Ultrasonographic examination revealed a solid and cystic heterogenous areas above the gestational sac with a fetus with positive cardiac activity with a gestational age of 8 weeks. She had the diagnosis of partial molar pregnancy. We offered her to terminate the pregnancy. However, she wanted to continue her pregnancy although she knew about the partial molar pregnancy and its complications, after she got information. Later, during her follow-up, we did triple test, and the test showed increased risk for trisomy 21, and we performed amniocentesis. Figure 1 and 2 shows ultrasonographic pictures of the fetus and the molar placenta, before amniocentesis. The amniocentesis revealed that the fetus had normal diploid karyotype which was 46,XX.

Hydatidiform mole originates from the placental trophoblastic tissue. Its incidence is 0.1% of all pregnancies. It is classified into two, as complete and partial molar pregnancies, according to clinical presentations, histologic findings and fetal karyotype. (Table 1.)

Partial molar pregnancy is mostly associated with abnormal fetal karyotype, which is triploidy in 90% of the cases.

738 THE OPINIONS OF THE ANCIENT DOCTORS ABOUT THE FORMATION OF THE PLACENTA, THE FETAL MEMBRANES AND THE OMPHALIC VESSELS

S. Barbis¹, M. Christodoulaki¹, G. Tsoukalas², A. Kotta¹, E. Kourmoulis¹, E. Xydaki¹, A. Stamatakis¹, N. Nikolaidis³, I. Tsoukalas¹

¹General Hospital of Chania, Neonatal Intensive Care Unit, Chania, Greece;²Health Centre of Skopelos, Skopelos, Greece;³Aristotle University of Thessaloniki, Papageorgiou Hospital, 2^nd Neonatal Intensive Care Unit, Thessaloniki, Greece

Introduction: The discovery of the fetal membranes is part of the knowledge that was born in our country.

Aim: Recording the opinions of the Ancient Greek and Byzantine writers.

Method: Indexing the work of the writers referred to the topic.

Results: Empedoklis was the first to discover that there are two layers surrounding the embryo. There is the inner layer which is thinner and softer and is called “amnion”, and the outer layer which is located towards the uterus and is called “chorion” (placenta).

Hippocrates believes that the membrane formation starts after the “union” of the two “genomes” and they progressively increase. Their formation depends on the warm temperature of the maternal cavity.

Aristotle believes that the membranes are formed to serve a biological need, they cover the fetus and separate it from the uterus. The fetus remains inside the fluids.

He named the amniotic fluid “prophoros” ( = the one who is preceding).

These must be confirmed by anatomical observations.

The fetus is connected to the placenta via the “umbilicus”. The opinions of the writers (Empedoklis) concerning the place where the “four” omphalic vessels are implanted, differ. Most of them believe that the veins are implanted in the liver and the arteries in the heart. They know the “allantois” which was believed to transfer the fetal urine to the maternal urinary bladder.

Conclusion: It is surprising how our ancestors interpret this topic. The discovery of Empedoclis is important as well as the fact that the medical terminology is the same we use today.

739 Y; 15 TRANSLOCATION

S. Uludağ, B. Bulut, A. Benian, C. Şen, R. Madazlı

Istanbul University Cerrahpasa Medical Faculty, Obstetrics and Gynecology, Istanbul, Turkey

We detected a cervical cystic hygroma at 14 weeks of gestation, in a phenotypically normal 26 years old patient.

Cytogenetic analysis; GTG banding with 450 bands and 20 metaphase counted, revealed 46 XX, der(15)t(Y;15)(?;q10) confirmed by FISH using q12 specific probe for Y choromosome.

Maternal and paternal karyotype were normal. At 20 th week the pregnancy was terminated. The autopsy of the specimen revealed “nuchal edema, hypertelorism, depressed nasal bridge, micrognathia”.

Discussion: In a study by [1], (Y;15) translocation the female offspring was confirmed to be inherited from the paternal side.

In a study of [2] cytogenetic analyses of the three children with Evans Syndrome had Y;15 translocation along with their father with no congenital abnormalities.

However, a mother transmitted the chromosomal abnormality to her son who had azoospermia [3].

In our case, the affected fetus was female. So far, no case has been reported to have (Y;15) translocation and co-existing cystic hygroma.

740 DE NOVO (Y;15) TRANSLOCATION WITH COEXISTING CYSTIC HYGROMA

B. Bulut¹, S. Uludag¹, V. Baltacı², A. Benian¹, A. Simsek¹

¹Cerrahpasa School of Medicine, Obstetrics and Gynecology, Istanbul, Turkey;²Ufuk University, Medical Genetics, Ankara, Turkey

A case is presented in which a de novo (Y;15) translocation was detected during investigation of a cystic hygroma, with a review of the pertinent literature. Both maternal and paternal karyotypes were studied and found to be normal. The ultrasound examination showed normal anatomy except nuchal edema, micrognathia and good visualisation of genital tubercle but not the scrotum. The autopsy of the specimen revealed “fetus at 20 weeks with normal female genital anatomy and nuchal edema,hypertelorism, depressed nasal bridge, micrognathia”.

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741 PRENATAL ULTRASOUND AND GENETIC DIAGNOSIS OF EDWARDS SYNDROME ASSOCIATED WITH OMPHALOCELE

D. Albu, C. Albu, E. Severin, M. Dumitrescu

Medicine University Carol Davila; Alco San Impex Clinic, Bucharest, Romania

An omphalocele is a birth defect known as a ventral wall defect, which involves the abdominal area of the fetus. Omphalocele causes the abdominal organs to herniate into the base of the umbilical cord. The diagnosis of omphalocele is usually made by ultrasound, in many cases following an elevated second trimester maternal serum alpha-fetoprotein test. Omphalocele can be isolated or associated with structural anomalies.

Aims of the study: To detect omphalocele and associated anomalies at ultrasonography in early pregnancy; to evaluate the risk of chromosome abnormalities and outcome of fetal omphalocele.

Patient and Methods: A 40-yearold Caucasian female, pregnant for the first time, was referred at 14 weeks' gestation for a routine prenatal ultrasound. The woman and her husband had normal general health and were not genetically related. Fetal endovaginal ultrasonography was performed in the pregnant woman at 14 weeks of gestation. Triple test and amniocentesis were offered to determine the fetal karyotype. FISH technique was used for detection of chromosome abnormalities. Transabdominal ultrasonography was performed at 18 weeks of gestation.

Results: Omphalocele was detected in the singleton fetus and no associated structural anomalies were detected. Abnormal karyotype was found and trisomy 18 was associated with omphalocele. The pregnancy was terminated at parents'requeste.

Conclusion: Omphalocele isolated or nonisolated can be detected before birth based on sonographical findings. Fetuses with omphalocele are at an increased risk for other birth defects and chromosome abnormalities.

742 THE MOST APPROPRIATE SAFETY METHOD OF TRISOMY 13 PRENATAL DETECTION – CASE REPORT

C. Albu¹, D. Albu¹, E. Severin², M. Dumitrescu¹

¹Medicine University Carol Davila; Alco San Impex Clinic, Bucharest, Romania;²Medicine University Carol Davila, Bucharest, Romania

Early sonographic evaluation of the fetal face has acquired a special importance because noticeable features in the phenotypefacilitate the diagnosis of syndrome-like or chromosomally induced clinical conditions.

Objective: To specify the most appropriate safetymethod of trisomy 13 prenatal screening.

Patients and Methods: Patient selection: A 27-year-old Caucasian female, pregnant for thesecond time, was referred at 16 weeks' gestation for a routine prenatal ultrasound. The woman and her husband had normal generalhealth and were not genetically related. There was no history of abnormal children in their families.

Methods: routine ultrasonographyat 16 weeks of pregnancy; selective ultrasonography for detection of fetal abnormalities; triple test; amniocentesis.

Results: Ultrasound examination revealed a single fetus with anabnormal foetal facial development: microphtalmia, cleft lip and palate, bilateral club foot, hyperechogenic focus andpolyhydramnios. Cleft lip and palate as a sonographic marker suggested the possibility of a chromosomal anomaly, such as trisomy13 or trisomy 18. Triple test was not sensitive to the presence of trisomy 13. Chromosome analysis was recommended and fetalkaryotype demonstrated 47,XY, + 13. After an extensive counseling the parents decided to terminate the pregnancy with trisomy 13.

Conclusions: Chromosomal analysis is recommended in all cases with similar types of facial clefts prenatally diagnosed becausemany of the features of trisomy 13 and trisomy 18 overlap. In this case report, lip-jaw-palatal cleft was a strong and useful screeningtool for the detection of trisomy.

743 EARLY PRENATAL DIAGNOSIS OF A FETUS WITH PATAU SYNDROME: CASE REPORT

D. Albu^1,2, C. Albu^1,2, E. Severin¹, M. Dumitrescu¹

¹Medicine University Carol Davila, Bucharest, Romania;²Alco San Impex Clinic, Bucharest, Romania

Sonographic evaluation of the fetal face has acquired a special importance because noticeable features in the phenotype facilitate the diagnosis of syndrome-like or chromosomally induced clinical conditions.

Microcephaly, facial clefts, microphtalmia, cleft lip and palate is suggestive for a chromosomal anomaly.

Objective: To specify the most appropriate safety method of trisomy 13 prenatal screening.

Patient selection: A 27-year-old female was referred at 16 weeks' gestation for a routine prenatal ultrasound.

The woman and her husband had normal general health and were not genetically related.

There was no history of abnormal children in their families.

Methods: Routine ultrasonography at 16 weeks of pregnancy; selective ultrasonography for detection of fetal abnormalities; triple test; amniocentesis.

Results: Ultrasound examination revealed a single fetus with an abnormal fetal facial development: microphtalmia, cleft lip and palate, bilateral club foot, hyperechogenic focus and polyhydramnios.

Cleft lip and palate as a sonographic marker suggested the possibility of a chromosomal anomaly, such as trisomy 13 or trisomy 18.

Triple test was not sensitive to the presence of trisomy 13.

Chromosome analysis was recommended and fetal karyotype demonstrated 47, XY, + 13. After an extensive counseling the parents decided to terminate the pregnancy with trisomy 13.

Conclusions: In this case report, lip-jaw-palatal cleft was a strong and useful screening tool for the detection of trisomy; chromosomal analysis is recommended in all cases with similar types of facial clefts prenatally diagnosed because many of the features of trisomy 13 and trisomy 18 overlap.

744 CARRIER DETECTION AND PRENATAL DIAGNOSIS OF CYSTIC FIBROSIS

D. Albu^1,2, C. Albu^1,2, E. Severin¹, M. Dumitrescu^1,2

¹Medicine University Carol Davila, Bucharest, Romania;²Alco San Impex Clinic, Bucharest, Romania

Objective: A couple had one child who died at the age of 6 months as a result of cystic fibrosis. Pregnant for the second time, the female partner requested genetic counseling and prenatal diagnosis.

Methods: The pregnant woman was tested for CF gene mutation and was found to be a carrier (N/DF508). Her husband didn't wish to be tested. Prenatal tests were performed on the samples derived from the fetus: chorionic villi (10 weeks of gestation) and amniocytes (14 weeks of gestation).

Results: The fetus was diagnosed as a homozygous normal.

Conclusions: The prenatal diagnosis by chorionic villi sampling plays a key role in the early prevention of cystic fibrosis in families at risk.

745 EPIDERMOLYSIS BULLOSA EPITHELIALTYPE IN NEWBORN, WITH SERIOUS BIRTH DEFECTS

A. Gerovassili¹, A. Anastassiou², D. Loukaki², K. Katsiardanis¹, A. Papazoglou², V. Varlami², E. Xirophotou², E. Maridaki², E. Leze², K.-P. Katsiardani²

¹Medical School, University of Thessaly, Biology and Genetics Department, Medical School, Larisa, Greece;²General Hospital of Volos, Paediatric Clinic, Volos, Greece

Introduction: EpidermolysisBullosa (EB) dermatopathies are diseases characterized from basic defect bullosa or bubble and can be since at birth or later on. They are inherited (genetically-determined) and autoimmune.

Aim: To inform the general pediatrician about the serious prognosis of them, the importance of prompt diagnosis and differential-diagnosis and therapy in collaboration with the dermatologist, in order to avoid life threatening complications.

Results-(case presentation): A girl (39wa) was bornfrom a 32yo (mother of 2 babies, were born with CS). She was referred within the first 24 hours in the ICU = Intensive Care Unit), (remained for 3 months). Prenatal-Perinatal record: womb-diaphragma, pathological diabetes curve (under diet) in her mother,polyhydramnio, Apgar score (1’ = 8, 5’ = 9). HBV, HCV, CMV, Rubella: ( −). Family genetic record: clear. Even though she was treated locally,she presented multiple eruption relapses, while she also suffered from septicemia(pseudomonas aeroginosa, treated with antibiotics). Biopsy of the dermal defect showed EB distortion, with epidermal type characteristics.

Conclusion: The gravity of the case is underline despecially when electrolytical disorders and possible contaminations can lead to septicaemic situations are not controlled. In addition the need of a plastic surgeon is important in order to rectify the problems of the joints with ankylosis that can not be benefited by physiotherapy, local treatment as well and the treatment of permanent injuries of the pituitary glands such as the esophagus. Lastly further testsshould be performed in order to determine if there is any mental retardationand prompt interaction is essential in order to provide all the necessaryinformation for relative support groups such as DEBRA (Dystrophic Bullosa Research Association).

746 TRISOMY18 CHIMERISM IN A PHENOTYPICALLY NORMAL TWININFANT

P. Gopalakrishnan¹, R. Jeenakeri², R. Geethanath², M. Drayton², D. Kumar³

¹Abertawe Bro Morgannwg University NHS Trust, Neonatology, Newport, United Kingdom;²University Hospital of Wales, Neonatology, Cardiff, United Kingdom;³University Hospital of Wales, Clinical Genetics, Cardiff, United Kingdom

Introduction: A chromosomalabnormality detected postnatally with antenatal normal karyotype in a phenotypically normal twin infant is extremely rare. Chimerism occurs when one tissue built from cells of progenitor cells from abnormal twin exchanged through placental anastamosis and gets embedded in stem cell lines of the normal twin and multiplies along with innate lines.

Case: We report a case of Trisomy18 due to chimerism in a phenotypically normal twin infant. A 41years old mother conceived by in vitro fertilization resulted in mono chorionic diamniotic twins. Amniotic fluid chromosomal analysis from twin1 sac showed normal 46XX pattern and from twin 2 sac showed 47XX + 18 pattern. Postnatal chromosomal analysis from twin 2 confirmed 47XX + 18 pattern in all 100 cells,however from twin one 90% of cells revealed 46XX pattern and 10% cells 47XX + 18 pattern. Initial thought was a probable twin to twin exchange of cells as twin1 was phenotypically normal, and a repeat karyotype on twin 1 was performed 4months latter revealed 47XX18 pattern in 12% of cells. This consistency of thepresence of Trisomy18 cells in phenotypically normal twin1, who had normal karyotype on amniocentesis is a case of “Trisomy18 chimerism in a normal infant”

Conclusion: In mono chorionic diamniotic twins the transferred stem cell line persists in the recipient's blood indefinitely. Hence to confirm the origin of abnormal cell lines in phenotypically normal infant of twin pregnancy, karyotype and Genetic analysis should be performed on tissues other than blood, like skin fibroblastculture cells.

747 AN ASSOCIATION BEETWEEN SELECTED CYTOKINE GENE POLYMORPHISMS AND THE RISK OF PRETERM DELIVERY IN THE POPULATION OF POLISH WOMEN

J. Kalinka

Medical and Environmental Pregnancy Health Hazards Unit, Department of Perinatology, 1th Chair of Gynecology and Obstetrics, Medical University of Lodz, Poland, Lodz, Poland

Objective: (IL1β[+3953]) (IL-1), interleukin-6 (IL-6 [−174C/G]), tumour necrosis factor alpha (TNF-alpha [−308G/A]) and interleukin-1 receptor antagonist (IL1RN) in the population of Polish women. (The main aim of this study was to examine a relationship between spontaneous preterm delivery (PTD) and the carriage of polymorphic genes that code for selected cytokines: interleukin-1beta.

Methods: A case- control study was performed. Case subjects were defined as those who experience a delivery at less than 37 weeks of gestation due to either spontaneous premature rupture of membranes or preterm labour while control subjects gave birth at term. Detailed demographic, medical and obstetric data were collected based on structured questionnaire and medical record. Venous blood were collected after the delivery and analyzed by restriction fragment length polymerase techniques for the presence of each of the allelic variants. Multivariable analyses included demographic and genetic variables.

Results: Sixty five case subjects and 63 controls subjects were assessed. Allele 2 of IL1RN (IL1RN * 2) were more prevalent among women with PTD (45.2%) as compared to mothers with term delivery (30.2%). Women that carried IL1RN allele 2 were found to be at an increased risk for preterm delivery OR = 2.74; (1.02–4.13). There was no correlation between IL1β, IL-6 and TNF-alpha gene polymorphisms and the risk of PTD.

Conclusions: Carriage of intron 2 of the interleukin-1 receptor antagonist allele 2 (IL1RN * 2) was associated with an elevated risk of preterm delivery in population of Polish women.

748 EAR-PATELLA-SHORT STATURE (MEIER-GORLIN) – SYNDROME FATAL COURSE IN PREMATURE BABY – DESCRIPTION OF ADDITIONAL FEATURES

N. Kau¹, J.M. Mackenzie², E.S. Gray³, P. Booth¹, A. Abdelhadi¹

¹Aberdeen Maternity Hospital, Neonatal Unit, Aberdeen, United Kingdom;²Aberdeen Royal Infirmary, Neuropathology, Aberdeen, United Kingdom;³Aberdeen Royal Infirmary, Paediatric Pathology, Aberdeen, United Kingdom

Aims: To describe a case at the negative edge of the disease spectrum, with left lobar emphysema and lissencephaly type I.

Methods: Case description with presentation of postmortem results.

Results:

Antenatalfindings: Severe IUGR, bilateral talipes. Delivery by caesarean section formaternal pyrexia and GBS, PROM > 24 hrs, breech presentation.