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XXXIII Alpe Adria
Meeting of
Perinatal Medicine
XXV Alpe Adria
Perinatal Congress
30th September – 01st October 2011.
Zagreb – Croatia
Programme &
Book of Abstracts
3
30th September – 1st October 2011. Zagreb, Croatia
CONGRESS ORGANIZERS:
Alpe Adria Association for Perinatal Medicine
Croatian Society of Perinatal Medicine of the Croatian Medical Association
Department of Obstetrics and Gynecology, Clinical Medical Center – Zagreb
School of Medicine University of Zagreb
Alpe Adria association for Perinatal Medicine
is an Association of Obstetricians and Neonatologists
from Austria, Croatia, Hungary, Italy and Slovenia.
SCIENTIFIC COMMITTEE:
Ante Dražančić, Croatia Marjan Pajntar, Slovenia
Emilja Juretić, Croatia Attila Pàl, Hugary
Marina Ivanišević, Croatia Hajnalka Orvos, Hungary
Sergio de Marini, Italy Gàbor Németh, Hungary
Gianpaolo Maso, Italy Bernard Resch, Austria
Yoram Meir, Italy Uwe Lang, Austria
Tanja Premru-Sršen, Slovenia Wolfgang Walcher, Austria
Lilijana Kornhauser Cerar, Slovenia
LOCAL ORGANIZING COMMITTEE:
Josip Đelmiš, Marina Ivanišević, Emilja Juretić
Secretary: Josip Juras, Marina Horvatićek
Department of Obstetrics and Gynecology, Clinical Medical Center - Zagreb,
Adress: Petrova 13, 10000 Zagreb, Croatia.
Phone +38514604740
Fax +38514604740
E-Mail: josip.djelmis@zg.t-com.hr
josipjuras@gmail.com
ORGANISATION
4
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
EMA – Poduzeće za zastupanje i trgovinu, Vlaška 106, 10000 Zagreb, Croatia
Providens d.o.o. Kaptol 24, 10000 Zagreb, Croatia
Novo Nordisk Hrvatska, Oreskoviceva 23, 10000 Zagreb, Croatia
Abbott Laboratories d.o.o., Koranska 2, 10000 Zagreb
LIST OF SPONSORS
5
30th September – 1st October 2011. Zagreb, Croatia
TABLE OF CONTENTS
6
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
TIME LIMIT:Introductory lectures – 20 minutes
Invited lectures – 15 minutes including discussion
Free communication – 10 minutes including discussion
REGISTRATION AND REGISTRATION FEE: Please register per e-mail: josipjuras@gmail.com or by Fax +38514604740
There is no registration fee at Alpe Adria Perinatal Meeting.
CREDIT POINTS: There are 15 points for Croatian active and 10 for passive participants.
The foreign participants will get a certifi cate of attendance.
LOCATION OF THE CONGRESS: Auditorium of Clinical Medical Center – Zagreb, Rebro, Kispaticeva 12, Zagreb, Croatia.
INFORMATION
7
30th September – 1st October 2011. Zagreb, Croatia
Programme
XXV Alpe Adria
Perinatal Congress
8
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
FIRDAY, 30th SEPTEMBER
MORNING SESSION
8.00 - 9.00 REGISTRATION AND OPENING CEREMONY
TOPIC 1: GESTATIONAL DIABETES
9.00 – 9.40 INTRODUCTORY LECTURES
Chair:
Yoram Meir (Italy), Uwe Lang (Austria)
Obstetrics: Hungary
1. Bito Tamas, Nemeth Gabor, Zita Gyurkovits, Orvos Hajnalka, Attila Pal.
Department of OB/GYN. University of Szeged, Hungary.
Gestational diabetes mellitus – obstetric aspects.
Neonatology:
2. Sergio de Marini.
Division of Neonatology, Burlo Garofolo Children’s Hospital Trieste, Italy.
Pediatric aspects of gestational diabetes mellitus.
9
30th September – 1st October 2011. Zagreb, Croatia
9.40 - 11.00 INVITED OBSTETRIC LECTURES
Chair:
Gàbor Németh (Hungary), Josip Đelmiš (Croatia)
1. Marton Virag, Bito Tamas, Zita Gyurkovits, Nemeth Gabor, Orvos
Hajnalka, Attila Pal.
Department of OB/GYN. University of Szeged, Hungary.
Comparison of obese and non-obese patients complicated
with gestational diabetes.
2. E Magnet, S Schneuber, Uwe Lang, K Schuster, Th Panzitt.
Department of OB/GYN. Medical University of Graz, Austria.
“One Year HAPO criteria in Graz - a report”.
3. P Podnar, L Steblovnik, I Verdenik, M Tomazic, H Mole,
Tanja Premru Sršen.
Department of OB/GYN. University of Ljubljana, Slovenia.
GDM - guidelines and perinatal results in Slovenia.
4. Yoram Meir, Ruggero Trevisan, Alessia Memmo, Raffaele Tinelli, Paola
Lanza, Daniela Perin, Barbara Giacomazzo, Gabriele Falconi, Andrea
Cocco, Cristina Tumbarello, Giovanni Mammana.
OB/GYN Complex Unit. “San Bassiano” Hospital, Bassano del Grappa,
Vicenza, Italy.
Trends and obstetrical aspects concerning Gestational
Diabetes before and after the new IADPSG diagnostic criteria:
The Bassano del Grappa experience.
5. Oleg Petrović, Vajdana Tomić*.
Department of OB/GYN. University Hospital Center Rijeka,
Croatia.*Department of OB/GYN. Mostar Clinical Hospital,
Mostar,Bosnia and Herzegovina.
Probably new diagnostic outcome-based criteria for
gestational diabetes mellitus.
10
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
11.00 - 11.30 COFFEE BREAK
11.30 - 12.45 INVITED PEDIATRIC LECTURES
Chair:
Emilja Juretić (Croatia), Bernhard Resch (Austria)
1. Zita Gyurkovits, Judit Bakki, Bito Tamas, Marta Katona*,
Nemeth Gabor, Attila Pal, Orvos Hajnalka.
Department of OB/GYN. *Department of Paediatrics.
University of Szeged, Hungary.
Neonatal outcome of gestational diabetic pregnancies between
2008-2010 at University of Szeged.
2. Nicholas Morris, Bernhard Resch, Wilhelm Müller.
Department of Neonatology. Medical University of Graz, Austria.
Hypertrophic cardiomyopathy in infants of gestational
diabetics.
3. Petja Fister, Gregor Nosan, Darja Paro Panjan.
Department of Neonatology. University Children’s Hospital Ljubljana,
Slovenia.
Gestational Diabetes: Fetal Growth, Perinatal and Neonatal
Features - Experience from 88 cases.
4. de Marini Sergio.
Division of Neonatology, Burlo Garofolo Children’s Hospital Trieste, Italy.
5. Emilja Juretić1, Marcela Ilijić Krpan1, Dunja Anzulović2, Josip Juras3, Iva
Kuliš1, Iva Rukavina1.
1Department of OB/GYN, Division of Neonatology.
2Division of Anaesthesiology and Intensive Care,
3Department of OB/GYN.
Clinical Hospital centre Zagreb. Medical Faculty Zagreb, Croatia.
Neonatal outcome in pregnancies complicated by gestational
diabetes mellitus.
11
30th September – 1st October 2011. Zagreb, Croatia
12.45 - 13.15 SPECIAL LECTURES SESSION
Chair:
Marina Ivanišević (Croatia), Sergio de Marini (Italy)
1. Gernot Desoye.
Department of OB/GYN. Medical University of Graz, Austria.
GDM: The role of the Placenta and beyond
13.15 - 14.30 LUNCH
14.30 - 16.30 FREE COMUNICATION SESSION
Chair:
Walcher Wolfgang (Austria), Vito Starčević (Croatia)
1. Gernot Desoye.
Department of OB/GYN. Medical University of Graz, Austria.
DALI – A European Effort to Prevent GDM.
2. G Trutnovsky, M Dorfer, E Magnet, Thomas Panzitt.
Department of OB/GYN. Medical University of Graz, Austria.
Gestational Diabetes: Women’s concerns, mood, quality of life
and treatment satisfaction.
3. Philipp Reif, Thomas Panzitt, Franz Moser, Bernhard Resch*, Josef
Haas, Uwe Lang.
Department of OB/GYN. *Division of Neonatology. Department of
Pediatrics Medical University of Graz, Austria.
Short-term neonatal outcome in diabetic versus non-diabetic
pregnancies complicated by nonreassuring fetal heart rate
tracings.
4. Vito Starčević, Dunja Anzulović, Josip Juras, Mislav Herman, Jozo
Blajić.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of
Medicine, University of Zagreb, Croatia.
The infl uence of glycemia control on incidence of
Preeclampsia/ eclampsia in GDM pregnancies.
5. Josip Juras, Marina Ivanišević, Mislav Herman, Horvatiček Marina,
Dunja Anzulović.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of
Medicine, University of Zagreb, Croatia.
The impact of prepregnancy BMI and weight gain during
pregnancy on pregnancy outcome among women with GDM.
12
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
6. Mislav Herman, Marina Ivanišević, Josip Juras, Horvatiček Marina, Jozo
Blajić.
Department of OB/GYN. Hospital Medical Centre Zagreb, Croatia.
Pregnancy outcome in patients with optimally treated
gestational diabetes mellitus.
7. Gyorgy Vajda1, Z Bagosi2, T Oroszlán2, B Gasztonyi2.
Dept. Ob&Gyn1, Dept. Int.Med2. Zala County Hospital. Zalaegerszeg,
Hungary.
The interdisciplinary care of diabetes in pregnancy.
8. Alenka Višnić¹, Snježana Škrablin², Davor Hulina³.
Department of OB/GYN, Hospital of Pakrac1, Department of OB/GYN.
Hospital Medical Centre Zagreb. School of Medicine,
University of Zagreb, Croatia.
Delaying the delivery after premature rupture of membranes:
cost – benefi t analysis
9. Reich O.
Department of OB/GYN. Medical University of Graz, Austria.
P16/Ki-67 dual-stained cytology testing may predict post-
partum outcome in patients with abnormal pap cytology during
pregnancy.
10. Nenad Veček, Branko Radaković, Tomislav Župić, Davor Petrović,
Snježana Škrablin. Department of OB/GYN. Hospital Medical Centre
Zagreb. School of Medicine, University of Zagreb, Croatia.
Diagnostic ranking weights as supporting system in tertiary
fetal anomaly screening center.
11. L Steblovnik, I Verdenik, M Tomažić, Tanja Premru Sršen.
Department of OB/GYN. University of Ljubljana, Slovenia.
BMI and GDM as predictors of adverse pregnancy outcome
in Slovenian population in the years 2005-2009.
19.00 DINNER
Restaurant – Okrugljak, Mlinovi 28, Zagreb
13
30th September – 1st October 2011. Zagreb, Croatia
SATURDAY, 1st OCTOBER
MORNING SESSION
TOPIC 2: HYPERTENSIVE DISORDERS
8.00 - 8.40 INTRODUCTORY LECTURES
Chair:
Snježana Gverić Ahmetašević (Croatia), Atila Pal (Hungary)
Obstetric:
1. Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Management after severe forms of Preeclampsia/Eclampsia/
HELLP Syndrom.
Neonatology:
1. Gregor Nosan.
Department of Neonatology, Division of Pediatrics, University Medical
Centre Ljubljana, Slovenia.
Neonatal consequences of Hypertensive disorders in
pregnancy.
8.40 - 10.00 INVITED OBSTETRIC LECTURES
Chair:
Mila Červar Živković (Austria), Sergio de Marini (Italy)
1. Nemeth Gabor, Zita Gyurkovits, Orvos Hajnalka, Bito Tamas, Attila Pal.
Department of OB/GYN. University of Szeged, Hungary.
Hypertension and pregnancy outcome (one year experience).
2. C Stern, D Ulrich, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Pregnancy outcome in women with previous Preeclampsia:
A 5-year follow up.
3. B Sajina Stritar, M Drušković, N Tul Mandić, Tanja Premru Sršen.
Department of OB/GYN. University of Ljubljana, Slovenia.
Uterine arteries doppler in fi rst trimester.
14
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
4. Giuseppina D’Ottavio, Matteo Ceccarello, Giovanni Di Lorenzo, Vera
Cecotti. Department of Obstetrics and Gynaecology, Institute for
Maternal and Child Health – IRCCS “Burlo Garofolo” – Trieste, Italy.
First trimester pregnancy screening: PLGF, PAPP-A, PP-13,
uterine artery doppler and maternal caracteristics in the
prediction of hypertensive disorders.
5. Snježana Škrablin, Vesna Elveđi Gašparović, Nenad Veček, Trpimir
Goluža, Alenka Višnić.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of
Medicine, University of Zagreb, Croatia.
Aggressive versus expectant management of severe
preeclampsia in preterm gestations.
10.00 - 10.30 COFFEE BREAK
10.30 - 11:45 INVITED PEDIATRIC LECTURES
Chair:
Judit Kiss (Hungary), Mislav Herman (Croatia)
1. Judit Kiss.
Department of Paediatrics. University of Szeged, Hungary.
Hypertension and neonatal consequences.
2. F Reiterer.
Department of Neonatology. Medical University of Graz, Austria.
Management of hypertension in the newborn.
3. Gregor Nosan.
Department of Neonatology, Division of Pediatrics, University Medical
Centre Ljubljana, Slovenia.
Neonatal hypertension.
4. Italy – not recieved
5. Snježana Gverić Ahmetašević, Ana Čolić, Sonja Anić Jurica.
Department of paediatrics. Hospital Medical Centre Zagreb. School of
Medicine, University of Zagreb, Croatia.
Neonatal outcome of preeclamptic pregnancies.
15
30th September – 1st October 2011. Zagreb, Croatia
11.45 -13.35 FREE COMMUNICATION SESSION
Chair:
Snježana Škrablin (Croatia), Marko Vulić (Croatia)
1. E Weiss, F Prüller, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Thrombophilia screening in women after Preeclampsia/
Eclampsia/HELLP-Syndrom. A 5 years follow-up.
2. Mila Červar Živković1, M Dieber Rotheneder1, S Barth1,4, T Hahn1,3,
G Kohnen2, B Huppertz3, Uwe Lang1, Gernot Desoye1. 1Department of Obstetrics & Gynaecology. 3Institute of Cell Biology,
Histology and Embryology, 4Institute of Biochemistry and Molecular
Biology. Medical University of Graz, Austria. 2Department of Pathology,
Western Infi rmary, University of Glasgow, UK.
Endothelin-1 stimulates proliferation of fi rst trimester
trophoblasts via the A- and B- type receptor and invasion
via the B-type receptor.
3. M Dieber Rotheneder, S Beganovic, M Fellner, Uwe Lang, Gernot
Desoye, Mila Červar Živković.
Department of Obstetrics & Gynaecology, Medical University of Graz,
Austria.
Endothelin/endothelin receptor system is upregulated
in preeclampsia with or without fetal growth restriction
in contrast to gestational diabetes.
4. K Mayer Pickel, M Mörtl, W Schöll, C Stern, Uwe Lang, Mila Červar
Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Individual Treatment of Antiphospholipid Syndrome
in Pregnancy.
5. C Stern, E Mautne, M Deutsch, K Mayer-Pickel, Uwe Lang, Mila Červar
Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Quality of life in women after hypertensive pregnancy
disorders.
6. E Steinbauer, N Weiss, F Prüller, C Stern, M Häusler, Uwe Lang,
Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Special Management of Thrombophilia in Pregnancies after
Preeclampsia/Eclampsia/HELLP Syndrom.
16
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
7. T Idris, S Gramm, M Häusler, Uwe Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Uterine artery Doppler in high risk pregnancies; the prediction
for maternal hypertensive diseases and intrauterine growth
restriction (IUGR).
8. Vassiliki Kolovetsiou, C Stern, C Meyer-Pickel, D Ulrich, T Idris, Uwe
Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
The management of chronic hypertension in pregnancy.
9. Vassiliki Kolovetsiou, C Stern, T Idris, D Ulrich, C Meyer-Pickel, Uwe
Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
A retrospective evaluation of the classifi cation of hypertensive
diseases in pregnancy at the Department of Obstetrics and
Gynecology, Medical University of Graz, Austria.
10. Marko Vulić, Damir Roje.
Department of Obstetrics and Gynecology. University Hospital Split.
Croatia.
Perinatal outcome in gravida older than 35 years with
preeclampsia.
11. Vesna Sokol.
Department of OB/GYN. Hospital Medical Centre Zagreb.
School of Medicine, University of Zagreb, Croatia.
HELLP Syndrome.
12. Vesna Elveđi Gašparović, Snježana Škrablin, Trpimir Goluža, Petrana
Beljan*, Kristina Kotorac*, Rikić Josipa*.
Department of OB/GYN. Hospital Medical Centre Zagreb.
*School of Medicine, University of Zagreb, Croatia.
Perinatal outcome in women with recurrent preeclampsia
versus preeclampsia in nulliparas.
CLOSING CEREMONY
17
30th September – 1st October 2011. Zagreb, Croatia
Th e Book of Abstracts
Alpe Adria
Perinatal Congress
18
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
GESTATIONAL DIABETES MELLITUS – OBSTETRIC ASPECTS.
Bito Tamas, Nemeth Gabor, Zita Gyurkovits, Orvos Hajnalka, Attila Pal.
Department of OB/GYN. University of Szeged, Hungary.
Gestational diabetes mellitus (GDM) is a disturbance of the carbohydrate metabolism with different se-
verity and with onset or fi rst recognition dutring the ongoing pregnancy. From this defi nition it is cleare,
that GDM is not a homogenous entity, furthermore, those pregnant women with previous GDM should
considered to be pregestational diabetic patient. The progressive decrease in insulin sensitivity due to
the increasing placental hormone production by increasing gestational age leads to the impaired glu-
cose tolerance. GDM is one of the most frequent complications during pregnancy with increased risk of
maternal, fetal and neonatal complications and also means a risk for subsequent developement of type
2 diabetes mellitus both in the mother and her offspring. Therefore, universal screening (every pregnant
women without known diabetes mellitus or impaired glucose tolerance) for GDM is recommended at
gestational weeks of 24 to 28, but those with risk factor(s) for GDM (obesity, diabetes in family, previ-
ous pregnancy with stillbirth or fetal marformation, policystic ovary syndrome) should undervent earlier
screening. The most widely accepted diagnostic methods are the 2 hours 75g or the 3 hours 100g oral
glucose tolerance tests (recommended by the WHO and ADA, respectively). Once GDM is diagnosed,
quantitative diet is recommended with calory intake of 1200 to 1400 kcal divided to 5 to 6 meals per
day. Approximately, 10% of the gestational diabetic cases requires insulin treatment based on the daily
glucose profi le. Of course, fetal growth and intrauterine well-being as well as further complications
(pregnancy induced hypertension) should be controlled by the follow-up. Termination of pregnancy
after the gestational weeks of 38 is recommended in case of insulin treatment, alteration of fetal growth
or amniotic fl uid volume and previous s tillbirth. Monitoring of fetal hearth rate is recommended during
labor. Elective caesarean section is recommended in case of estimated fetal weight over 4500g. The
insulin requirement decreases rapidly after delivery. The reclassifi cation of the carbohydrate metabo-
lism 6 weeks after delivery then yearly follow-up is recommended.
INTRODUCTORY LECTURES – GESTATIONAL
DIABETES MELLITUS
19
30th September – 1st October 2011. Zagreb, Croatia
PEDIATRIC ASPECTS OF GESTATIONAL DIABETES MELLITUS.
Sergio de Marini.
Division of Neonatology, Burlo Garofolo Children’s Hospital Trieste, Italy.
XXXxxxx
20
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
COMPARISON OF OBESE AND NON-OBESE PATIENTS COMPLICATED WITH GESTATIONAL DIABETES.
Marton Virag, Bito Tamas, Zita Gyurkovits, Nemeth Gabor, Orvos Hajnalka, Attila Pal.
Department of OB/GYN. University of Szeged, Hungary.
Introduction. The adverse impact of overweight on pregnancy outcome has been published in nu-
merous articles; however, patients with GDM were commonly excluded from the examined population
in these publications.
Objective. The aim of this study was to evaluate the effect of overweight on pregnancy outcome in
patients with GDM.
Method. Different data of women with GDM, who gave birth in the University of Szeged Faculty of
Medicine Department of Obstetric and Gynecology between 2007 and 2009, were retrospectively
analyzed. Two groups (BMI < 30, BMI > 30) were generated based on body mass index (BMI) and
pregnancy outcomes were compared.
Results. In the group of normal weight and overweight (BMI < 30) 231 patients were included; the
obese group contained 125 women. The rate of cesarean section in the obese group was signifi cantly
elevated as compared to the group of BMI < 30 : 42.8% and 53.5%. In the obese group, the umbilical
cord pH and the blood glucose level of the newborns were not signifi cantly lower.
Conclusion. Similar tendencies were prevailed in pregnant women with GDM according to the in-
crease of BMI than in the nonGDM population, however the growth of cesarean section prevalence was
less remarkable. In spite of our previous expectation, there was no signifi cant difference in the rate of
patients with insulin treatment between the two groups.
INVITED OBSTETRIC LECTURES
21
30th September – 1st October 2011. Zagreb, Croatia
“ONE YEAR HAPO CRITERIA IN GRAZ - A REPORT”.
E Magnet, S Schneuber, Uwe Lang, K Schuster, Th Panzitt.
Department of OB/GYN. Medical University of Graz, Austria.
Introduction. Gestational diabetes is defi ned as an impaired glucose disorder, which is fi rst diagnosed
in pregnant women. The oGTT is an implementation in the “Mutter Kind Pass” as screening instrument
for GDM.
Based on the fi ndings of Weiss in the seventies and eighties, the Grazer Department used rigorous cut
off levels (90/160/140 mg/dl) to diagnose GDM, determined by capillary blood samples. In our own data
collection of 1993 – 2003 we found an incidence rate of 4-5% GDM.
According to the consensus panel recommendations from the IADPSG (The International Association
of the Diabetes and Pregnancy Study Groups) , which are based on the HAPO study, the method of
glucose measurement was changed from capillary blood samples to venous blood plasma samples.
Also, an adaptation of the cut off levels (92/180/153mg/dl) was implemented.
Recent literature indicates that the newly proposed criteria for diagnosing gestational diabetes will re-
sult in a gestational diabetes prevalence of 17.8%, doubling the numbers of pregnant women currently
diagnosed.*
This study examines whether the different measurement methods of the oGTT have an impact on the
incidence of gestational diabetes in patients at the Department of Obstetrics and Gynecology at Medi-
cal University Graz.
Methods. Overall 200 pregnant women were included in this analysis. In 100 patients glucose mea-
surement was obtained by capillary extraction; venous extraction was performed in the remaining 100
patients. Statistical analysis was carried out by using SPSS and Microsoft Offi ce Excel.
Results. In our recent data we found an incidence of 16% GDM before the adaptation of collection
methods and cut off levels. An increase of 2% was observed using the new procedure (18% GDM).
Compared to the data collection of 1993 – 2003 that showed an incidence rate of 4 -5 % GDM, a qua-
druplicating of this disease became evident.
Reasons for this may be a changed life style, an increasing average BMI and the severe increase of
metabolic syndrome in Europe.
* E. A. Ryan, Diabetologia. 2011 March; 54(3): 480–486.
SLOVENIA
22
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
GDM - GUIDELINES AND PERINATAL RESULTS IN SLOVENIA.
P Podnar, L Steblovnik, I Verdenik, M Tomažić, H Mole, Tanja Premru Sršen.
Department of OB/GYN. University of Ljubljana, Slovenia.
Xxxx
23
30th September – 1st October 2011. Zagreb, Croatia
TRENDS AND OBSTETRICAL ASPECTS CONCERNING GESTATIONAL DIABETES BEFORE AND AFTER THE NEW IADPSG DIAGNOSTIC CRITERIA: THE BASSANO DEL GRAPPA EXPERIENCE.
Yoram Meir, Ruggero Trevisan, Alessia Memmo, Raffaele Tinelli, Paola Lanza, Daniela
Perin, Barbara Giacomazzo, Gabriele Falconi, Andrea Cocco, Cristina Tumbarello,
Giovanni Mammana.
OB/GYN Complex Unit. “San Bassiano” Hospital, Bassano del Grappa, Vicenza, Italy.
Background. In 2008-09 after the publication of the HAPO study1, the International Association of Diabetes
and Pregnancy Study Groups (IADPSG) developed the revised recommendations for diagnosing GDM2. On
the 27th of march 2010 an Italian National Consensus Conference on GDM diagnostic criteria was held in
Rome and the IADPSG recommendations were fully adopted3. In November 2010 an offi cial “Antenatal Care
Guideline” of the Italian Ministry of Health was issued and in the chapter concerning GDM, the accepted
diagnostic criteria for this condition are the WHO and NICE criteria4. As a consequence, controversy and
discrepancy concerning GDM diagnostic criteria among health care professionals are the rule in Italy.
Purpose of this study was to analyze the obstetrical trends before and after the introduction of the new GDM
diagnostic criteria and to evaluate their clinical impact in our settings.
Population and Methods. Between 01/01/2009 and 31/05/2011, 3305 singleton pregnancies were deliv-
ered in the OB/GYN Unit of Bassano del Grappa (Vicenza, Italy). Since previous diagnostic criteria, based on
a two step approach: screening with OGCT 50 gr – thresholds 95/140 and eventual subsequent OGTT 100
gr of glucose with thresholds 95/180/155/140 was the rule predominantly adopted in Italy until the fi rst tri-
mester of 2010, the population was divided into 2 groups: I group: those who delivered between 01/01/2009
and 31/05/2010 (old criteria): 1950 cases II group: those delivered between 01/06/2010 and 31/05/2011
(mixed criteria): 1355 cases The pregnancy and delivery registry database was consulted in order to analyze
the frequency of GDM, the mode of delivery, the frequency of macrosomia and eventual neonatal brachial
plexus injury, and the association with hypertensive disorders in the 2 groups examined. For statistical
analysis the chi square and the Fischer exact test were used. Statistical signifi cance was reached if p< 0,05.
Results. In 103 out of 1950 (5,3%) pregnancies were complicated by GDM in the I group, while the same
diagnosis was put in 180 out of 1355 (13,3%) pregnancies in the II group. Babies weighting > 4000 gr ac-
counted for 12,6% and for 9,4% of the babies in groups I and II, respectively. Non elective caesarean section
rate (previous CS, abnormal presentation, and other elective indications were excluded) were 24,3% and
17,8% in groups I and II, respectively. Hypertensive disorders were associated in 9,7% and in 7,8% of GDM
cases in groups I and II respectively. No case of shoulder dystocia with brachial plexus injury was registered
in either group.
Conclusions. Although not adopted by all gynecologists, the IADPSG revised criteria almost triplicated
(5,3 → 12,3%) the frequency of GDM diagnoses in our settings. The incidence of macrosomia, the caesare-
an section rate and the association with hypertensive disorders demonstrate clearly that we are dealing with
differently characterized populations. The dilution of serious consequences of hyperglycemia in pregnancy
in a wider population makes it harder to correctly focalize the clinical attention and intensity of surveillance.
To many pregnancies with very mild glycemic disorders, possibly without any perinatal consequence, will be
tagged as complicated pregnancies and as such treated. With the high caesarean section rate in Italy and
the fear of litigation, instead of lowering CS rate, the introduction of the revised criteria will probably cause
further increase in operative deliveries, hospital admissions and costs to the health care system.
References.1. The HAPO Study Cooperative Research Group. Hyperglycemia. and adverse pregnancy out comes.
N Engl J Med 2008;358:1991-2002.
2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel International
Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and
classifi cation of hyperglycemia in pregnancy Diabetes Care 2010;33:676-82.
3. AAVV. Conferenza nazionale di consenso per raccomandazioni e implementazione delle nuove linee guida
per lo screening e la diagnosi del diabete gestazionale (GDM). Disponibile all’indirizzo:
http://www.simel.it/notizie/documento-102873
4. Linea Guida Nr. 20: Linea Guida del Ministero della Salute: Gravidanza fi siologica. Consultabile nel sito
internet http://www.snlg-iss.it
24
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
PROBABLY NEW DIAGNOSTIC OUTCOME-BASED CRITERIA FOR GESTATIONAL DIABETES MELLITUS
Oleg Petrović, Vajdana Tomić*
Department of OB/GYN. University Hospital Center Rijeka, Croatia.*Department of OB/GYN. Mostar Clinical
Hospital, Mostar,Bosnia and Herzegovina.
Abstract. The aim was to assess reliability of the current gestational diabetes mellitus (GDM) diagnos-
tic criteria for prediction of specifi c adverse pregnancy outcomes, and to establish probable new diag-
nostic outcome-based criteria. A cohort study was conducted on 1,002 pregnant women who were
selected on the grounds of the risk factors for GDM. The participants underwent a modifi ed glucose
tolerance test (OGTT) with 75g of glucose. Information on OGTT results and pregnancy outcomes that
were collected from medical records has been used for identifi cation of specifi c GDM adverse out-
comes. Macrosomia, caesarean section due to cephalopelvic disproportion, infant’s stay in the NICU
> 24 hours, and neonatal hyperbilirubinemia were identifi ed as specifi c adverse pregnancy outcomes.
In the study group of participants with one or more specifi c adverse outcomes, mean glycemic values
during the modifi ed OGTT (4.2±1.0 mmol/L at 0 min, 6.8±1.7 mmol/L at 30 min, 7.9±2.1 mmol/L at 60
min, 7.7±2.3 mmol/L at 90 min and 7.5±2.3 mmol/L at 120 min) were signifi cantly higher than mean
glycemic values in the control group of participants without specifi c adverse outcomes. In conclusion,
with newly proposed GDM diagnostic criteria and determination of serum HbA1c concentrations in
8 – 12 week intervals, antenatal control of hyperglycemia and its complications may be more effi cient.
Detected higher rates of GDM burden health care system, but it is expected to reduce additionally the
associated fetal and maternal morbidity.
25
30th September – 1st October 2011. Zagreb, Croatia
NEONATAL OUTCOME OF GESTATIONAL DIABETIC PREGNANCIES BETWEEN 2008-2010 AT UNIVERSITY OF SZEGED.
Zita Gyurkovits, Judit Bakki, Bito Tamas, Marta Katona*, Nemeth Gabor, Attila Pal,
Orvos Hajnalka.
Department of OB/GYN. *Department of Paediatrics. University of Szeged, Hungary.
Objective. To evaluate the neonatal complications in infants born to mothers with gestational diabetes
mellitus (GDM).
Methods. Between 01 January 2008 and 31 December 2010, a retrospective analysis was carried
out at University of Szeged, Department of Obstetrics and Gynaecology, with regard to the neonatal
outcome of gestational diabetic pregnancies.
Results. During this three years period, 561(6.7%) neonates were born to gestational diabetic mothers,
out of the total of 8332 neonates. Out of the 561 infants, 106 (18.9%) were born preterm, before 37th
weeks of gestation. 291 (51.9%) were delivered by caesarean section, 8 (1.4%) by operative vaginal de-
livery, and 262 (46.7%) by vaginal delivery. 101 (18.0%) neonates were large for gestational age and 30
(5.3%) small for gestational age. Congenital anomaly was diagnosed in 21 (3.7%), hypoglycaemia in 58
(10.3%), respiratory disorder in 16 (2.8%), polycythaemia in 29 (5.2%), hyperbilirubinaemia in 161 (28.7%)
and cardiomyopathy in 2 (0.4%) cases. 27 (4.8%) neonates were admitted to the Neonatal Intensive
Care Unit. We have lost one fetus in utero at 29 weeks of gestation, but there was no neonatal death.
Conclusions. Serious perinatal complications specifi cally associated with GDM are rare. The tight
glycemic control prior to conception and during pregnancy can prevent an excess rate of congenital
malformations, birth trauma, respiratory disorders. Hypoglycaemia and macrosomia have been dem-
onstrated to be the predominant adverse outcomes in cases of GDM.
INVITED PEDIATRIC LECTURES
26
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
HYPERTROPHIC CARDIOMYOPATHY IN INFANTS OF GESTATIONAL DIABETICS
Nicholas Morris, Bernhard Resch, Wilhelm Müller.
Department of Neonatology. Medical University of Graz, Austria.
Over the past two decades fetal echocardiography has become a well established tool in the prenatal
assessment of structural and functional heart disease.
Accurate evaluation of cardiac morphology and function are now possible due to high resolution imag-
ing and Doppler interrogation. Nevertheless there remains a paucity of knowledge and therefore rec-
ommendations on the assessment and management of fetal and neonatal cardiomyopathies.
Small case series and case reports describe the antenatal diagnosis, post natal management and clini-
cal course of this heterogenous group of patients.
Maternal diabetes is one of the leading causes of Hypertrophic obstructive Cardiomyopathy (HOCM) in
neonates, with Typ I and Typ II Diabetes being responsible for most of these cases. Gestational diabe-
tes is more common than pregestional diabetes but only in few cases responsible for HOCM.
The aim of this review of the literature was to establish recommendations for the prenatal and postnatal
management of infants of gestational diabetics, with the aim to recognise patients at risk of HOCM
requiring monitoring, possibly treatment and follow up, but also to avoid unnecessary investigations.
Based on the reviewed literature, in diet-controlled gestational diabetics we recommend routine ultra-
sound screening of fetal morphology with additional monthly ultrasounds from 24 weeks of gestation
onwards to monitor fetal growth.
In all fetuses of insulin dependant gestational diabetics and in all macrosomic fetuses we recommend
an additional ultrasound examination performed in a higher level centre.
In infants with antenatally diagnosed HOCM, treatment and follow up should be determined on an
individual case base with input from a paediatric cardiologist. Very few of these cases will be of clinical
signifi cance.
We do not recommend routine echocardiography in newborns of gestational diabetics unless there is
suspicion of structural heart disease from antenatal scans or concern from clinical examination.
27
30th September – 1st October 2011. Zagreb, Croatia
GESTATIONAL DIABETES: FETAL GROWTH, PERINATAL AND NEONATAL FEATURES - EXPERIENCE FROM 88 CASES.
Petja Fister, Gregor Nosan, Darja Paro Panjan.
Department of Neonatology. University Children’s Hospital Ljubljana, Slovenia.
Background and Aims. Diabetes is the most common medical complication of pregnancy. The pur-
pose of this study was to examine the clinical characteristics of newborns of mothers with gestational
diabetes (GD).
Methods. In a retrospective study of newborns, admitted to our department in the last 8 years, the
entire inpatient charts were reviewed and data on the fetal growth, perinatal and neonatal features and
neurodevelopmental outcome in infants of mothers with GD were studied. Macrosomia was defi ned as
BW>90th percentile or > 4000 g, being SGA as BW and/or BL<10th percentile, and normal ponderal
index (PI=BW/BL3) as 2.32-2.85g/cm3. Collected data was compared to data on general population
from national perinatal informational system for a 8-year period.
Results. Eighty-eight newborns (54 boys, 34 girls) of mothers with GD, GA 38±1 weeks, BW 3473±816
g, BL 51±4 cm, and HC 35±6 cm were admitted for evaluation. Twenty-six (29.5%) were born prema-
turely. Their birth measures were not signifi cantly different compared to general population. Macroso-
mia was observed in 36 (40.1%) and microsomia in 5 (5.7%) newborns. An increased PI was observed in
11 (12.5 %) and decreased PI in 17 (19.3%) newborns. Their average Apgar scores 1 and 5 minutes after
birth were 8 and 9, respectively. 14/88 (15.9%) newborns had perinatal asphyxia. Perinatal asphyxia
was present in 6 out of 26 born prematurely.
GD was controlled by diet in 64 cases and treated with insulin in 16 cases. The average HbA1c levels
in mothers with GD were above normal (6.24%±1.07). Complications in pregnancy were present in 31
cases, among them preeclampsia in 13, spontaneous abortions in previous pregnancies in 14, treat-
ment because of infertility in 7, and other complications in 15 cases. There were signifi cantly more
premature deliveries (29.5% vs. 7.8%) in the GD group compared to general population. There were 56
vaginal deliveries, 31 caesarean sections and 1 vacuum extraction in the study group.
Hypertrophic cardiomyopathy developed in 11/47 (23.4%) of newborns of mothers with GD. Twenty-
four newborns had congenital anomalies (27% vs. 5.7% in general population), in majority of cases
cardiac and genitourinary. RDS was present in 17/88 cases (19.3%), birth injuries in 20/88 (22.7%),
hypoglycaemia in 20/88 (22.7%), hypocalcemia in 6/88 (6.8%), polycytaemia 12/88 (13.6%) and the
need for phototherapy because of hyperbilirubinemia in 34/88 (38.6%). The neurological evaluation in
the neonatal period was optimal in 60 and nonoptimal in 28 cases and US of the brain was normal in
20 and abnormal in 30 cases.
Conclusions. In comparison to general population the newborns of mothers with GD were more often
born prematurely, had more congenital anomalies, and there was a greater incidence of hypertrophic
cardiomyopathy.
28
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
XXX
Sergio de Marini.
Division of Neonatology, Burlo Garofolo Children’s Hospital Trieste, Italy.
Xxxx
29
30th September – 1st October 2011. Zagreb, Croatia
NEONATAL OUTCOME IN PREGNANCIES COMPLICATED BY GESTATIONAL DIABETES MELLITUS.
Emilja Juretić1, Marcela Ilijić Krpan1, Dunja Anzulović2, Josip Juras3, Iva Kuliš1, Iva
Rukavina1.
1Department of OB/GYN, Division of Neonatology. 2Division of Anaesthesiology and Intensive Care, 3Department of
OB/GYN. Clinical Hospital centre Zagreb. Medical Faculty Zagreb, Croatia
Background. Gestational diabetes mellitus (GDM) is a condition in which women without previously di-
agnosed diabetes exhibit high blood glucose levels during pregnancy. Diagnose is obtained by 75g/2h
oral glucose tolerance test. GDM poses a risk for mother and child, related to high blood glucose levels
and its consequences. The main risks GDM imposes on the baby are growth abnormalities, linked to
higher rate of Caesarean section (SC) and delivery trauma, and chemical imbalances after birth.
Objective. To determine the impact of gestational diabetes on neonatal complications compared to
healthy pregnancies.
Study design. We retrospectively analyzed GDM pregnancies from 10-year period, delivered in our
hospital, and compared the data to similar number of healthy pregnancies (Control group, C). A total of
3396 newborns from singleton pregnancies were enrolled in the study. Analyzed variables in newborns
were: preterm birth, SC, birth weight, neonatal macrosomia (≥4000 g), perinatal asphyxia, transitory hy-
poglycaemia, transitory tachypnoea, RDS, perinatal infection, hyperbilirubinaemia, cephalhaematoma,
clavicular fracture, brachial plexus paresis, and congenital malformations.
Results. The statistically signifi cant difference was found in following variables: preterm birth (GDM
14.5%, C 6.87%, p<0.001), rate of SC (GDM 36.9%, C 16.8%, p<0.001), birth weight (GDM 3500±699g,
C 3362±762g, p<0.001), neonatal macrosomia (≥4000 g) (GDM 23.8%, C 15.4%, p<0.001), perinatal
asphyxia (GDM 5.5%, C 1.8%, p<0.001), transitory hypoglycaemia (GDM 3.5%, C 0.3%, p<0.001), RDS
(GDM 1.0%, C 0.4%, p=0.024), hyperbilirubinaemia (GDM 17.3%, C 12.0%, p<0.001), and congenital
malformations in total (GDM 4.2%, C 2.8%, p=0.032).
The following variables: transitory tachypnoea, perinatal infection, cephalhaematoma, clavicular frac-
ture, and brachial plexus paresis, did not differ signifi cantly between groups.
Conclusion. GDM does not only bear higher risk for neonatal complications linked to advanced baby
growth and chemical imbalances, but also for preterm birth, perinatal asphyxia, RDS and congenital
malformations. No signifi cant difference between the groups regarding birth trauma is probably due
to higher rate of SC in GDM group. With fi rmer blood sugar control may be possible to avoid some of
adverse neonatal outcomes in GDM pregnancies.
30
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
GDM: THE ROLE OF THE PLACENTA AND BEYOND
Gernot Desoye.
Department of OB/GYN. Medical University of Graz, Austria.
Xxxx
SPECIAL LECTURE
31
30th September – 1st October 2011. Zagreb, Croatia
DALI – A EUROPEAN EFFORT TO PREVENT GDM?
Gernot Desoye.
Department of OB/GYN. Medical University of Graz, Austria.
Europe is facing a rapidly growing threat from Type 2 diabetes (T2D), which is undoubtedly associated
with an unhealthy diet and a more sedentary lifestyle. Evidence is accumulating that GDM may play a
role in this process. Thus it provides a signifi cant opportunity for preventing future T2D. Not only is GDM
prevalence on the rise, but intrauterine exposure to hyperglycaemia predisposes the offspring to diabe-
tes and obesity. Another putative contributing factor is low vitamin D status, which is also increasing in
prevalence and may have causal links with both obesity and decreased glucose tolerance.
The overall aim of the DALI project funded by the European Commission is to identify the best available
measures to prevent GDM in an ongoing pregnancy. Additional aims are 1) to provide a cost-benefi t
calculation of GDM prevention for health care systems, 2) to establish the current status of GDM across
Europe and facilitate the adoption of a single diagnostic approach, and 3) to establish a pan-European
cohort of mother-offspring pairs for future analyses with a central biobank and data base. The consor-
tium comprises 11 partners from academia and 2 SMEs (small-medium-enterprises) from 11 European
countries.
For the main purpose, a randomised controlled trial will be conducted in 10 European countries. In each
country, 88 women (BMI ≥ 29) will be recruited before 12 weeks of pregnancy. Women will be followed
for about 7 months (from 12 weeks of pregnancy until delivery). The women will be randomised to life-
style intervention, vitamin D intervention or no intervention at all.
Women receiving the lifestyle interventions (physical activity, diet or a combination of these two) will
have personal contact with a lifestyle coach as soon as possible after randomisation. All coaches are
trained in motivational interviewing techniques. The same coach will deliver the nutrition and/or physical
activity interventions. In the intervention programme, one-to-one contacts will be offered, along with
telephone follow-up. Women receiving the vitamin D intervention will receive a daily dose of either 500,
1000 or 1500 IU per day, depending on the dose that will result in the best blood levels as determined
in a pilot study.
The main outcome measures of the trial are: fasting blood glucose, weight gain during pregnancy and
insulin sensitivity.
1) The group comprises: A. van Assche (BE), R. Corcoy (ES), P. Damm (DK), G. Di Cianni (IT), G. Desoye
(AT), R. DeVlieger (BE), F. Dunne (IR), D. Hill (CH), A. Kautzky-Willer (AT), M. Klemetti (FI), A. Lapolla (IT),
E. Mathiesen (DK), P. Rebollo (ES), D. Simmons (UK), F. Snoek (NL), M. Tikkanen (FI), D. Timmerman
(BE), M. van Poppel (NL), E. Wender-Ożegowska (PL), A. Zawiejska (PL).
FREE COMMUNICATIONS
32
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
GESTATIONAL DIABETES: WOMEN’S CONCERNS, MOOD, QUALITY OF LIFE AND TREATMENT SATISFACTION
G Trutnovsky, M Dorfer, E Magnet, Thomas Panzitt.
Department of OB/GYN. Medical University of Graz, Austria.
Objective. To explore qualitatively motivational factors and concerns of women treated for GDM.
To examine prospectively health related quality of life (HRQL), mood state and treatment satisfaction.
To examine differences between treatment regimes.
Research Design and Methods. Observational cohort study of 27 diet-treated and 18 insulin-treated
women with GDM. A semistructured interview was conducted right after diagnosis. The WHO Qual-
ity of Life questionnaire (WHO- QOL- BREF), the Multidimensional Mood State Questionnaire (MDBF),
and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) were administered repeatedly until late
pregnancy.
Results. Qualitative analysis of the initial open interviews identifi ed fi ve dominant themes The majority
of women showed high motivation and willingness for treatment in order to do “the best for the baby”.
Treatment satisfaction was generally high with no signifi cant changes over time. However, there was a
signifi cant reduction of QOL and the bipolar dimensions ”well-being” and “nervosity” from fi rst assess-
ment until late pregnancy. There were no signifi cant differences between treatment groups.
Conclusions. Acknowledgment of women’s concerns and comprehensive information may reduce
prolonged psychological distress, and improve treatment motivation and compliance.
33
30th September – 1st October 2011. Zagreb, Croatia
SHORT-TERM NEONATAL OUTCOME IN DIABETIC VERSUS NON-DIABETIC PREGNANCIES COMPLICATED BY NONREASSURING FETAL HEART RATE TRACINGS.
Philipp Reif, Thomas Panzitt, Franz Moser, Bernhard Resch*, Josef Haas, Uwe Lang.
Department of OB/GYN. *Division of Neonatology. Department of Pediatrics Medical University of Graz, Austria.
Objective. Whether pathologic changes in fetal heart rate tracings during labor indicate the risk of fetal/
neonatal acidosis in the same way and to the same extent in deliveries of diabetic versus non-diabetic
women is not well known. Do fetuses of diabetic mothers cope less effectively with fetal distress than
those of non-diabetic women in labor? In this study we analysed the impact of nonreassuring fetal heart
rate patterns and suspected fetal distress during active labour on the short-term neonatal outcome in
diabetic compared to non-diabetic mothers.
Materials and Methods. In a retrospective cohort-study we compared the short-term neonatal out-
come including Apgar score at 5 minutes, arterial und venous umbilical cord blood pH in 57 deliver-
ies of women with gestational diabetes and 114 healthy controls (matched pairs). The patients were
selected out of all deliveries (n=590) with suspected fetal distress during active labor and one or more
fetal scalp pH sampling performed at the Department of Obstetrics and Gynecology, Medical University
Graz, Austria during the years 2008-2009.
For statistical evaluation we used Wilcoxon-U-test, t-test as well as Pearson’s Chi-square-test and
Fisher’s exact test.
Results. Arterial umbilical cord blood ph was signifi cantly lower in the diabetic group (7.215 vs. 7.250,
p=0.007). Venous umbilical cord blood pH did not show any difference. Apgar scores at 5 minutes
were similar in the diabetic and the control group (Apgar score ≥ 8: 96.5% vs. 95.6%, p=1.000). Fetal
scalp blood pH sampling showed a trend to lower intrapartum pH values in the diabetic group (pH >
7.25: 14.1% vs. 7.1%, p=0.166).
Conclusion/Discussion. Newborns of women with gestational diabetes and nonreassuring fetal
heart rate tracing during labour have a moderately elevated risk of peripartum acidosis without conse-
quences on neonatal postpartum adaption. Thus, no general changes in obstetric management seem
to be necessitated.
Special attention to pathological changes in fetal heart rate patterns and to the more rapid decline in
fetal pH during periods of fetal distress may be warranted in women with gestational diabetes during
active labour. More frequent fetal scalp pH testing to rule out clinically relevant fetal acidosis needs to
be discussed.
34
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
THE INFLUENCE OF GLYCEMIA CONTROL ON INCIDENCE OF PREECLAMPSIA/ ECLAMPSIA IN GDM PREGNANCIES.
Vito Starčević, Dunja Anzulović, Josip Juras, Mislav Herman, Jozo Blajić.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
Inadequate regulation of glycemia in women with gestational diabetes mellitus is associated with an
increased risk of pre-eclampsia and other complications through pregnancy. The GDM subjects who
developed pre-eclampsia were signifi cantly younger, had a higher nulliparity rate, were more obese,
and gained signifi cantly more weight during pregnancy.
Aim of the study. A retrospective analysis of prospectively collective data of 1354 in GDM pregnant
women through period between 2001 to 2010 was performed to determine the rate of pre-eclampsia.
The aim of the study is to analyze the incidence of preeclampsia and other risk factors in GDM pregnant
women.
Study design and methods. During the period 2001-2010, we followed up 1354 consecutive un-
selected pregnancies in women with gestational diabetes mellitus. Glycemic control was assessed
by HbA1c at the time of diagnose. Pre-eclampsia was defi ned as RR>140/90 mmHg combined with
albuminuria of >0.3 g/L. The occurence of pre-eclampsia was also associated in a control group com-
prising 2387 unselected pregnant women.
Results. Pre-eclampsia developed in 35 women (2,6%) with gestational diabetes and in 27 women
(1,1%) of the controls; χ2=11,119 (CI 95% 0,57 – 2,56), p<0,001; RR = 2,29 (CI 95% 1,39 – 3,76) p<0,001.
After adjustment by logistic regression, both the FBG and PBG and their changes during pregnancy
remained signifi cant predictors for pre-eclampsia. The odds for pre-eclampsia increased by a factor
of (1.2) for each 1 mmol/L increment in initial FBG level and PBG level, and decreased by factor of (0.8)
for each 1 mmol/L decreased of FBG or PBG level achived during pregnancy.
Conclusion. The results suggest that in GDM pregnant women had an independent and signifi cant
association between GDM and pre-eclampsia. The occurrence of pre-eclampsia in these women is
closely related to the plasma glucose level at GDM diagnosis and how well the maternal glucose level
is controlled. A model based on clinical data yielded predicted the development of pre-eclampsia in
women with GDM.
35
30th September – 1st October 2011. Zagreb, Croatia
THE IMPACT OF PREPREGNANCY BMI AND WEIGHT GAIN DURING PREGNANCY ON PREGNANCY OUTCOME AMONG WOMEN WITH GDM.
Josip Juras, Marina Ivanišević, Mislav Herman, Marina Horvatiček, Dunja Anzulović.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
Introduction. Obesity is one of risk factors for impaired glucose metabolism, preeclampsia and ad-
verse pregnancy outcome. Prepregnancy body mass index correlates with perinatal outcome, but
weight gain during pregnancy seems to have an important infl uence on birth weight.
Aim. The aim of this study was to explore weather prepregnancy BMI or weight gain during pregnancy
had bigger infl uence on perinatal outcome among GDM women vs. controls.
Materials and methods. This is a historical cohort study. The data of one decade period till 2010 from
our clinic was analyzed. It included 3741 singleton pregnancies. Women were divided into 4 subgroups
according to their diagnosis and prepregnancy BMI.
Results. Both BMI and maternal weight gain were positively correlated to neonatal birth weight, but
weight gain had bigger correlation coeffi cient than BMI (r=0.256, r=0.158; p<0.001, respectively). There
was a statistically signifi cant difference between subgroups in birth weight and ponderal index. The
biggest birth weight and ponderal index had children form GDM mothers with BMI ≥25, the smallest
were in control group with BMI <25. The results of standard multiple linear regression showed that
maternal weight gain had higher infl uence to birth weight than BMI (R2=0.011, ΔR2=0.114; p<0.001).
GDM women with BMI ≥25 had the highest rate of macrosomic neonate (30.1%) among other groups
(χ2=103.053; p<0.001). The rate of preterm birth was likewise highest (9.2%, χ2=12.92; p=0.005). Ac-
cording to greater weight gained women had macrosomic neonate more often. The likelihood ratio for
women who gained 10-16 kilos was 0.895, but with 20-24 and 24-30 kilos gained rates were 1.577 and
2.965, respectively. Having GDM there is 1.61 RR of having macrosomic neonate in relation to control
group. GDM women with BMI ≥25 had 1.49 RR (95% CI 1.41 – 1.85; p<0.001) for macrosomic child in
relation to GDM women with BMI <25 (95% CI 1.22 – 1.81; p<0.001).
Conclusion. Considering BMI and weight gain as predictor parameters for perinatal outcome it can be
concluded that weight gain has higher predictive value compared to BMI. Women with larger BMI and
weight gain have more adverse perinatal outcome and is getting poorer as BMI and weight continue
to rise.
36
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
PREGNANCY OUTCOME IN PATIENTS WITH OPTIMALLY TREATED GESTATIONAL DIABETES MELLITUS.
Mislav Herman, Marina Ivanišević, Josip Juras, Marina Horvatiček, Jozo Blajić.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
Pregnancy is characterized by insulin resistance and hyperinsulinemia, thus it may predispose some
women to develop diabetes. The resistance stems from placental secretion of diabetogenic hormones,
as well as increased maternal adipose deposition, decreased exercise, and increased caloric intake.
These and other endocrinologic and metabolic changes ensure that the fetus has an ample supply of
fuel and nutrients at all times. Gestational diabetes occurs when pancreatic function is not suffi cient
to overcome the insulin resistance created by changes in diabetogenic hormones during pregnancy.
The term “gestational diabetes” has been used to defi ne women with onset or fi rst recognition of ab-
normal glucose tolerance during pregnancy. However, in 2010, the International Association of Diabetes
and Pregnancy Study Group (IADPSG recommended a change to this terminology. In this system,
diabetes diagnosed during pregnancy is classifi ed as overt or gestational.
The rationale for this change is that an increasing proportion of young women have overt but as yet
unrecognized type 2 diabetes due to the increasing prevalence of obesity and lack of routine glucose
screening/testing in this age group.
Several adverse outcomes have been associated with diabetes during pregnancy: preeclampsia, hy-
dramnios, fetal macrosomia, fetal organomegaly, birth trauma, operative delivery, perinatal mortality,
neonatal respiratory problems and metabolic complications (hypoglycemia, hyperbilirubinemia, hypo-
calcemia, erythremia).
There are also potential long-term consequences to the infant, such as development of obesity and
diabetes during childhood, impaired fi ne and gross motor functions, and higher rates of inattention and/
or hyperactivity.
For the mother with gestational diabetes, there is a 10 percent likelihood of overt diabetes mellitus im-
mediately after the index pregnancy. The likelihood of developing overt diabetes in the years following
the pregnancy has been estimated to be as high as 40 percent within 20 years.
Identifying women with GDM is important because appropriate therapy can decrease maternal and
fetal morbidity, particularly macrosomia. An effective treatment regimen consists of dietary therapy, self
blood glucose monitoring, and the administration of insulin if target blood glucose concentrations are
not met with diet alone.
37
30th September – 1st October 2011. Zagreb, Croatia
THE INTERDISCIPLINARY CARE OF DIABETES IN PREGNANCY.
Gyorgy Vajda1, Z Bagosi2, T Oroszlán2, B Gasztonyi2.
Dept. Ob&Gyn1, Dept. Int.Med 2. Zala County Hospital. Zalaegerszeg, Hungary.
The frequency of occurrence of diabetes in pregnancy has risen in the last few decades. We have
experienced a similar tendency in Zala County recently. This fact established the base of necessity
in organizing an interdisciplinary work team for the better management. On the basis of this, two of
our internists and neonatologists with diabetological skills and two of our obstetricians with skills for
ultrasound were involved. With the help of their team work the recognition rate has improved, and with
our care the extremely high birth weight rate has decreased, so we could introduce our preconception
care.
Out of 1283 normal deliveries, 139 combined with GDM, which means 10.8%. The preterm birth rate
reached 14.83%, and in our care group there was no major anomaly. Our data suggests that the mul-
tidisciplinary diabetes care gave the chance to a better outcome.
38
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
DELAYING THE DELIVERY AFTER PREMATURE RUPTURE OF MEMBRANES: COST – BENEFIT ANALYSIS
Alenka Višnić¹, Snježana Škrablin², Davor Hulina³.
Department of OB/GYN, Hospital of Pakrac1, Department of OB/GYN. Hospital Medical Centre Zagreb. School of
Medicine, University of Zagreb, Croatia.
Premature rupture of membrane (PROM) happenes, by definition, before 37th week of gestation.
Incidence is 3% of all pregnancies. It causes signifi cant perinatal morbidity and foetal death. Prolonging
the PROM – delivery interval (delivery delay = DD) is an usual practice to achive optimum of newborn
maturation. Such a procedure, however, increases the risk of neonatal complications. Purpose of this
study is to determine cost-benefi t ratio comapring advatages and disadvantages of delivery delay in
such cases.
We analysed, retrospectively, a number of 501 pregnancies where the PROM occurred, in time period
of four years (01/1/2007 – 12/31/2010). Pregnancies were divided in groups according a) gestation
period of PROM ( PROM before 24th week, PROM between 24th and 32nd of gestation and a group
where PROM occurred after 32nd week of gestation). The same pregnancies were divided by b) the
term of delivery in a group with a delivery before 32nd week of pregnacy, and a group whwre the de-
livery occurred after 32nd week of gestation with subgroups where division was based on c) delivery
delay (DD less than a day, DD 24 – 48 hrs, DD 2 – 5 days, DD more than 5 days). Newborns outcome
was analysed considering body weight, pulmonary complications, neurological complicatins
and perinatal infections. All those parameters were correlated considering group division of preg-
nancies and compared. The number of healthy newborns was noted and related with key features
for each group of pregnancies. Body weight is in direct positive correlation with the term of delivery and
not affected by the gestation period of PROM or delivery delay . In the group of newborns delivered in
a period between 24th and 32nd gestation week (N=207) range of weight is 490 – 1520 g (M=1256,32;
SD=387,081). In a group delivered after 32nd week of gestation (N=272) body weight ranges between
730 and 2860 g (M=2322,83; SD=510,646).
Pulmonary complications differs signifi cantly regarding gestation period of PROM. In a groups with
PROM before 32nd gestation week the incidence of pulmonary complications was 38,6%. In a grup
where PROM occurred after 32nd week of gestation that incidence was 5,8%. Delivery delay affected
the incidence of pulmonary complications : in the groups with the delay less than 5 days that incidence
was 14,41%, but with delaying the delivery more of 5 days incidence increases up to 25,4%. Term of
delivery didn’t have an impact on pulmonary complications. Neurological complications are related to
delivery delay. We noted a 33,3% incidence in groups with DD less than 5 days. If the delivery delay is
prolonged more then 5 days icidence increases to 61,9%. Neurological complications are affected by
the term of delivery also. In groups of newborns delivered before 32nd gestation week the percentage of
nerological complications noted was 48,1%, but this percentage decreased to 31,5 if delivery was after
32nd week of gestation. Perinatal infection was found positively correlated with delivery delay. In groups
with DD less than 5 days we found 56,3% of infections but, if delivery delay was prolonged more than
5 days, infections increased up to 70,1%. Gestation period of PROM affected the incidence of perinatal
infections: the earlyer PROM occures, the higher the incidence was observed. 58,9% of infections in
groups with gestation period of PROM up to 32 weeks, and a decrease of incidence to 42% if PROM
took a place after that time. The relative number of healthy newborns delivered is in a negative cor-
relation with gestation period of PROM: 13,3% in groups with PROM before 32nd gestation week and
28,9% in a group with PROM occurrance after that time, as it is wit the delivery delay: 17,8% with DD
less than 5 days, and 3,6% if delivery was delated more than 5 days. The signifi cance of our observa-
tions was calculated by „p“ value as follows: p<0,001 observing body weight differences; p=0,0186 for
pulmonary complications; p<0,001 in case of neurological complications differences observed, and
p<0,003 for observed perinatal infections. The difference in numbers of healthy newborns delivered
were signifi cantly different regarding gestation period of PROM and delivery delay with p value less
than 0,001. Inevitable conclusion is that delivery delay after premature rupture of membranes does not
allways produce a benefi t for newborn child. There is a point in time when the benefi ts meet negative
consequences of delivery delay. That point is still to be discovered.
39
30th September – 1st October 2011. Zagreb, Croatia
P16/KI-67 DUAL-STAINED CYTOLOGY TESTING MAY PREDICT POST-PARTUM OUTCOME IN PATIENTS WITH ABNORMAL PAP CYTOLOGY DURING PREGNANCY.
O Reich.
Department of OB/GYN. Medical University of Graz, Austria.
40
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
DIAGNOSTIC RANKING WEIGHTS AS SUPPORTING SYSTEM IN TERTIARY FETAL ANOMALY SCREENING CENTER.
Nenad Veček, Branko Radaković, Tomislav Župić, Davor Petrović, Snježana Škrablin.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
Key words: malformed fetus, fetal malformation, prenatal diagnosis, autopsy
Objectives. To compare autopsy fi nding with prenatal sonographic fi ndings of malformation in tertiary
fetal anomaly screening center, in order to evaluate degree of agreement between US and pathological
diagnosis according to proposed diagnostic ranking weights.
Methods. In this prospective study, 29 autopsies between 2007 and 2010 were considered. Diagnos-
tic weights were determined on the basis autopsy fi nding. According the number and distribution of
malformations four diagnostic weights (DW) were created. A: fetus with single simple malformation, B:
fetus with single complex malformation, C: fetus with 2 or more simple malformations and D: fetus with
2 or more complex malformations and simple malformations. In comparison of US fi ndings and autop-
sies, only a total total agreement between US and autopsy fi ndings were considered as comprehen-
sively assessed malformed fetuses. Concordance in prental and postnatal diagnosis of malformation
was considered as correctly diagnosed malformation, otherwise the malformation was cosidered as
undiagnosed. The frequency of comprehensively assessed fetuses were, according to the diagnostic
ranks were calculated. The diffrences were test by Chi-square test with α<0.05.For each weigh rank
undiagnosed malformtions were listed and the mean number of malformtion is calculated.
Results. Of total 29 fetuses, 16 of them (55.1%) were comprehensively assessed, 11/11 (100%) A-DW,
½ (50%) B-DW, 3/10 (30%) C-DW and 1/6 (16.6%) D-DW (χ2,p=0.002). Of 102 malformations, 45 of
them (55.88%) were correctly diagnosed. In B weighted fetusus of 5 malformations, 2 (40%) were not
diagnosed correctly (truncus arteriosus communis and VSD). In C weighted fetuses from 42 malforma-
tions, 18 (42.85%) were not diagnosed 2 maior (encephalocoele and lung hypoplasion) and 16 minor:
facial- 4 cases chelopatashysis, 4 cases of subtle fi st anomalis, ASD, VSD, thymal aplasia, urether du-
plex, megaureter, atopic kidney, lobulated liver and subtle foot malformation. In D weighted fetuses from
44 malformations, 25 (56.81%) were not diagnosed 11 maior and 15 minor malformations. List of maior
malformation consistes of: 2 cases of anal atresia, fi bular and radial agenesis, hypoplasio and aplasio
of lungs, meningomyelocoele, AV canal (4). List of minor malformations consisted of 4 cases of genial
defects (bilateral gonadal agenses and 2 cases aplasia external sexual organs), 3 cases subtle palmar
defects, 3 cases of facial defects (bilateral anotia and mandibular hypoplasia), 2 cases of thymal defects
(hypoplasia nd ectopia), rectovaginal fi stula, unilateral renal agensis. Mean number of malformations
according to weight rank: A=1, B=2.5, C=4.2, D=7.3.
Conclusion. This study showed solid degree of agreement between US and autopsy fi ndings in fe-
tuses with prenatal ultrasonic diagnosis of malformations and proved relations between diagnostic
weights and diagnostic accuracy. We recommend the use of proposed diagnostic weights as support
system in tertiary fetal anomaly screening center.
41
30th September – 1st October 2011. Zagreb, Croatia
BMI AND GDM AS PREDICTORS OF ADVERSE PREGNANCY OUTCOME IN SLOVENIAN POPULATION IN THE YEARS 2005-2009.
L Steblovnik, I Verdenik, M Tomažić, Tanja Premru Sršen.
Department of OB/GYN. University of Ljubljana, Slovenia.
42
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
INTRODUCTORY LECTURES – HYPERTENSIVE
DISORDERS
MANAGEMENT AFTER SEVERE FORMS OF PREECLAMPSIA/ECLAMPSIA/HELLP SYNDROM.
Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
The concept of diagnostic and treatment in patients with the history of severe complications of hyper-
tensive disorders in pregnancy used in the Unit for hypertensive disorders of Dept. Ob. Gyn., Medical
University Graz will be presented.
43
30th September – 1st October 2011. Zagreb, Croatia
NEONATAL HYPERTENSION.
Gregor Nosan.
Department of Neonatology, Division of Pediatrics, University Medical Centre Ljubljana, Slovenia.
Abstract. Hypertension is defi ned as systolic and/or diastolic blood pressure ≥ 95th percentile based
on normative data for age, gender and weight. The incidence of neonatal hypertension is 0.2 to 3% of
all neonates admitted to neonatal intensive care units, occurring more frequently with concurrent con-
ditions like indwelling umbilical artery catheter or broncopulmonary dysplasia. A focused history and
a careful diagnostic evaluation should lead to determination of the underlying cause of hypertension
in most infants. Treatment consists of identifying and correcting any underlying cause of hypertension
and when indicated, initiating pharmacologic therapy to lower blood pressure. Depending on the un-
derlying etiology, most infants will resolve hypertension over time, although a small number may have
persistent BP elevation throughout childhood.
44
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
HYPERTENSION AND PREGNANCY OUTCOME (ONE YEAR EXPERIENCE).
Nemeth Gabor, Zita Gyurkovits, Orvos Hajnalka, Bito Tamas, Attila Pal.
Department of OB/GYN. University of Szeged, Hungary.
Introduction. Hypertension during pregnancy is still a common and severe, potentially divastating
complication. Although, ideally the diagnosis of that condition should involve the use of biomarkers that
refl ect the underlaying pathophysiology of the disease process, the lack of suitable clinical assays has
forced the clinicians to diagnose the condition based solely on the clinical presentation.
Objective. To compare the impact of pregnancy-induced hypertension and chronic hypertension on
pregnancy outcome.
Results. The maternal and fetal data of pregnancies complicated with hypertension admitted between
the 1st of January 2009 and 31st of December 2009 to the Department of Obstetrics and Gynaecol-
ogy, University of Szeged, were analyzed by the authors. In this period 137 preeclamptic patients were
admitted to the department. Int he 24% of the all cases vaginal and int he 76% Cesarean section were
performed. The majority of the Cesareans was indicated because of intrauterine distress (27,8%). In
6.6% of all the cases HELLP syndrome was developed, in one case in the puerperial period. In 12.4%
diabetes and in 10.2% was in the history. The 10.2% of the cases was occured after using assisted
reproductive techniques.
Conclusions. In our study population, hypertension during pregnancy was associated with signifi -
cantly increased morbidity and mortality rates. Women with chronic hypertension are at greater risk for
adverse outcome than those with pregnancy-induced hypertension. Hypertension during pregnancy
remains a disease begging for supportive biological measures linked to the underlying pathophysiology
of the disease, and more studies needed to move u sin the right direction toward this goal and to the
improvement of maternal and fetal mortality and morbidity rate.
INVITED OBSTETRIC LECTURES
45
30th September – 1st October 2011. Zagreb, Croatia
PREGNANCY OUTCOME IN WOMEN WITH PREVIOUS PREECLAMPSIA: A 5-YEAR FOLLOW UP.
C Stern, D Ulrich, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Hypertension is a common medical disorder in pregnancy and preeclampsia is a severe complication,
affecting mother and fetus. Women in pregnancy after preeclampsia have a substantially higher risk of
getting preeclampsia again.
154 pregnant women after the history of previous preeclampsia were observed in followed pregnancy
in Unit for hypertensive diseases between 2006- 2010.
Patients underwent a precise diagnostic workup for the previous disorder, including assessment of
blood coagulation function or other underlying diseases to evaluate the risk profi le. The special obstet-
ric care program with maternal and fetal outcome will be presented in the invited lecture.
46
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
UTERINE ARTERIES DOPPLER IN FIRST TRIMESTER.
B Sajina Stritar, M Drušković, N Tul Mandić, Tanja Premru Sršen.
Department of OB/GYN. University of Ljubljana, Slovenia.
47
30th September – 1st October 2011. Zagreb, Croatia
FIRST TRIMESTER PREGNANCY SCREENING: PLGF, PAPP-A, PP-13, UTERINE ARTERY DOPPLER AND MATERNAL CARACTERISTICS IN THE PREDICTION OF HYPERTENSIVE DISORDERS.
Giuseppina D’Ottavio, Matteo Ceccarello, Giovanni Di Lorenzo, Vera Cecotti.
Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” –
Trieste, Italy.
Introduction. Hypertensive disorders in pregnancy are major causes of maternal and fetal mortality
and morbidity (1). Despite the physiopathology of these conditions is well known there is no an early
and accurate screening method as in aneuploidy. Until now the fi rst approach is based on maternal
history, in order to detect a high-risk pregnancy group.
Currently, based on combined aneuploidy screening model, there is increasing interest in the use of
multiparameter predictive tests, combining maternal history, several maternal serum biomarkers and
uterine artery Doppler velocimetry (UtA); the combination of different predictive factors covers the mul-
tiple physiopathologic pathways and improves the detection rate of the screening. Because there are
several and heterogeneous biomarkers involved in the placental dysfunction, the attention of different
research groups is focused on different biomarkers: some analytes are currently obtained as part of
aneuploidy screening (PAPP-A, ß-hCG); whereas, others have been proposed specifi cally for these
adverse pregnancy outcomes (PlGF, PP-13). So far, the predictive ability of any single one of these is
generally poor and the results of integrated models are divergent (2-4).
Objective. The aim of the present study was to examine, in an unselected population, the diagnostic
accuracy of fi rst trimester UtA Doppler velocimetry for the detection of subsequent hypertensive dis-
orders, associated with several serum biomarkers (PAPP-A, PlGF and PP-13) and maternal history, in
order to detect a high risk group of women in early term pregnancy.
Materials and methods. This is a prospective cohort study of unselected pregnant women followed
by Prenatal Diagnosis and Gynaecologic Unit of IRCCS Burlo Garofolo in Trieste. All women recruited
were followed from fi rst trimester ultrasound screening for aneuploidy to delivery with morphologic and
biometric ultrasound. We enrolled 2138 singleton pregnancy from October 2007 to April 2009 and per-
formed a combined screening test for Down syndrome between 11th-13th gestational weeks, adding
UtA Doppler evaluation in each trimester. At the moment of the fi rst ultrasound women’s anamnestic
data were collected and blood samples were obtained to dose PAPP-A,ß-hCG, PlGF and PP-13.
As outcomes we considered gestational hypertension (GH), early-onset preeclampsia (PE), late-onset
PE and PE (both early and late-onset) and compared all of them with the unaffected group.
Firstly the distribution of data was tested for normality using the Kurtosis and Skweness tests: none of
them resulted normal, so we’ve chosen the closest one to the normality. Then we analyzed the correla-
tion between all possible predictive factors (UtA PI, UtA RI, UtA Notch, NT, CRL, PAPP-A, ß-hCG, PlGF
and PP-13) and maternal characteristics in order to calculate their MoM values. MoM were calculated
on healthy women and secondly corrected on the single features that were statistically related to the
biomarkers. Using Mann-Whitney test we compared MoM of the unaffected group to every outcome, in
order to detect statistically signifi cant differences between them. Then we evaluated a bivariate analysis
regression to fi nd the linkage between our outcomes, maternal characteristics and all predictive mark-
ers and were assessed the odds ratios. We performed two different multivariate regression analysis.
In the fi rst one we included all the maternal variables and markers simultaneously, both statistically
signifi cant or not, based on Nicolaides et coworkers’ results4; so sensitivity models were calculated for
fi xed specifi city rates from the ROC curves. The second multivariate regression was performed starting
48
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
from the saturated model, and using the stepdown procedure, we exluded, one by one, all factors not
statistically signifi cant (p>0.05), starting from the factors with higher p values. Finally, all the variables
were dichotomized, and sensitivity models only for statistically signifi cant parameters were calculated
for fi xed specifi city rates from the ROC curves.
Results. We built one statistical model for each outcome: gestational hypertension (GH), early-onset
preeclampsia (PE), late-onset PE and PE (both early and late-onset), in order to verify the accuracy of
UtA Doppler, biochemical markers and maternal history and fi nally created the sensitivity models from
ROC curves. The best results were obtained in PE and early-onset PE models.
Using the multivariate logistic regression with all the variables (also with p>0.05):
• PE model: the sensitivity was 40, 60, 60 and 67% respectively with 95, 90, 85 and 80% of
specifi city.
• Early-onset PE model: the sensitivity was 67, 67, 75 and 84% respectively with 95, 90, 85 and
80% of specifi city.
• Using the multivariate logistic regression with stepdown procedure the results were slight worse:
• PE model: the sensitivity was 32, 40, 48 and 60% respectively with 95, 90, 85 and 80% of
specifi city.
• Early PE model: the sensitivity was 67, 75, 75 and 75% respectively with 95, 90, 85 and 80% of
specifi city.
Conclusions. The integration of maternal history with several biochemical markers and UtA Doppler
velocimetry seems to be the most appropriate approach for the establishment of an accurate fi rst tri-
mester screening test for hypertensive disorders, along the lines of the test used for Down’s syndrome.
The strength of our study was the prospect design and the use of a robust statistical methodology with
stepdown logistic regression that gives quite comparable results to other authors’ approach. Probably
the inclusion of new biomarkers will improve detection rates of the screening, by covering different
physiopathologic pathways, as shown by Kusanovic et al.: using the unbalancing of pro-angiogenic
and anti-angiogenic factors (PlGF vs s-Eng e sFlt-1), they generated a screening test with high perfor-
mance, both in term of sensitivity and specifi city (about 100 and 98% respectively) (5).
References.
1. Sibai BM. Caring for women with hypertension in pregnancy. J. Amer. Med. Ass. 2007; 298,
1566-2007.
2. Giguere Y, Charland M, Bujold E, et al. 2010. Combining biochemical and ultrasonographic
markers in predicting preeclampsia: a systematic review. Clin Chem 56: 361–374.
3. Zhong Y, Tuuli M, Odibo AO. 2010. First-trimester assessment of placenta function and the
prediction of preeclampsia and intrauterine growth restriction. Prenat Diagn 30: 293–308.
4. Akolekar R, Syngelaki A, Sarquis R, Zvanca M, Nicolaides KH. Prediction of early,
intermediat and late pre-eclampsia from maternal factors, biophysical and biochemical markers
at 11–13 weeks. Prenat Diagn 2011; 31: 66–74.
5. Kusanovic JP, Romero R, Chaiworapongsa T, et al. A prospective cohort study of the value of
maternal plasma concentrations of angiogenic and antiangiogenic factors in early pregnancy
and midtrimester in the identifi cation of patients destined to develop preeclampsia. J Matern
Fetal Neonatal Med 2009;22(11):1021–38.
49
30th September – 1st October 2011. Zagreb, Croatia
AGGRESSIVE VERSUS EXPECTANT MANAGEMENT OF SEVERE PREECLAMPSIA IN PRETERM GESTATIONS.
Snježana Škrablin, Vesna Elveđi Gašparović, Nenad Veček, Trpimir Goluža, Alenka
Višnić.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
Preeclampsia (EI) still remains the leading cause of fetal and maternal morbidity and mortality. It is
unpredictable in its onset and progression and thought to be incurable except by termination of preg-
nancy. The delivery is always appropriate therapy for the mother, but may not be so for the child if
remote from term . That’s why, in recent years, a different treatment approach with severe preeclamp-
sia remote from term has been proposed: aggressive management with immediate delivery after initial
stabilisation of patient or conservative, expectant management, until the occurrence of maternal or fetal
danger or gestational age of at least 34-36 gestational weeks.
In the present report maternal and fetal outcome of severe preeclampsia, defi ned by ACOG criteria,
remote from term will be presented. A total of 168 pregnancies cared for during a 10 year period will be
analyzed. After initial stabilization of blood pressure and initialization of the therapy that would prevent
convulsions, aggressive management was offered to 65 of pregnancies while the other 103 were man-
aged conservatively. Maternal complications and neonatal outcome between the two groups will be
presented.
50
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
HYPERTENSION AND NEONATAL CONSEQUENCES.
Judit Kiss.
Department of Paediatrics. University of Szeged, Hungary.
INVITED PEDIATRIC LECTURES
51
30th September – 1st October 2011. Zagreb, Croatia
MANAGEMENT OF HYPERTENSION IN THE NEWBORN.
F Reiterer.
Department of Neonatology. Medical University of Graz, Austria.
Abstract. Although the incidence of neonatal hypertension is rather low (0.2-3%) it may be identifi ed in
various clinical situations in the NICU. Most cases of hypertension are of renovascular origin frequently
related to an umbilical artery catheter-associated thromboembolism. An important nonrenal cause of
hypertension is bronchopulmonary dysplasia (BPD), a disease occurring mainly in extreme low birth-
weight infants in which hypertension may either result from hypoxemic episodes or and iatrogenically
due to medications like corticosteroids or methylxanthines given to treat the underlying pulmonary
conditions. Coarctation of the aorta needs to be considered in all neonates with hypertension. In any
case of hypertension a careful diagnostic evaluation including patient history, physical examination ,
laboratory and imaging studies as indicated should be performed. Once the underlying cause of hyper-
tension has been determined numerous medications are available for either intravenous therapy, oral
therapy or both, depending on the cause and the severity of the hypertension. As long term sequelae
of hypertension and antihypertensive therapies are unknown at this time management should include
closely monitoring of the infants even after their hypertension has resolved.
52
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
Italy
53
30th September – 1st October 2011. Zagreb, Croatia
NEONATAL OUTCOME OF PREECLAMPTIC PREGNANCIES.
Snježana Gverić Ahmetašević, Ana Čolić, Sanja Anić Jurica.
Department of paediatrics. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
Objective. The purpose of this study was to compare neonatal outcomes of pregnancies with pre-
eclampsia according to birthweight (BW) and the number of nucleated red blood cells.
Study design. We analysed newborns who were born from pregnancies with preeclampsia during
eight years in our Hospital center. The women who had premature rupture of membranes or some
other disorders were excluded from the study, as well as newborns with malformations and chromo-
somal anomalies.
Apgar score in 1st and 5th minute, hypo/hyperglycaemia in fi rst days of life, respiratory support, infec-
tions, brain ultrasound fi ndings at discharge, and neonatal outcome were analysed. The newborns
were divided into 2 groups : small for gestational age and appropriate for gestational age. We also
compared newborns with and without nucleated red blood cells as the mark of chronic hypoxia.
Results. In this study there were no signifi cant differences between newborns according to birth-
weigth. But, we found signifi cantly low BW, GA, Apgar score in the newborns with higher number of
nucleated red blood cells also signifi cantly higher rate of infections, abnormal ultrasound fi ndings and
abnormal neonatal outcome.
Conclusion. The newborns with the higher number of nucleated red blood cells showed signifi cantly
higher morbiditiy than the newborns without nucleated red blood cells. The chronic hypoxemia in
pregnancies with preeclampsia with higher number of nucleated red blood cells as one of the major
signs, is morbidity carrier.
54
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
THROMBOPHILIA SCREENING IN WOMEN AFTER PREECLAMPSIA/ECLAMPSIA/HELLP-SYNDROM. A 5 YEARS FOLLOW-UP.
E Weiss, F Prüller, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
FREE COMMUNICATIONS
55
30th September – 1st October 2011. Zagreb, Croatia
ENDOTHELIN-1 STIMULATES PROLIFERATION OF FIRST TRIMESTER TROPHOBLASTS VIA THE A- AND B- TYPE RECEPTOR AND INVASION VIA THE B-TYPE RECEPTOR.
Mila Červar Živković1, M Dieber Rotheneder1, S Barth1,4, T Hahn1,3, G Kohnen2, B
Huppertz3, Uwe Lang1, Gernot Desoye1.
1Department of Obstetrics & Gynaecology. 3Institute of Cell Biology, Histology and Embryology, 4Institute of
Biochemistry and Molecular Biology. Medical University of Graz, Austria. 2Department of Pathology, Western
Infirmary, University of Glasgow, UK.
Objective. To test the hypothesis that ET-1 effects are mediated by different receptor subtypes (ETRs:
ETR-A, ETR-B).
Methods. The location of ETRs in trophoblast cell columns (weeks 6-12) was investigated by immuno-
histochemistry and autoradiography. Trophoblasts were isolated from fi rst trimester human placentas
and proliferative and invasive subpopulations separated using an integrin α6 antibody. Cells were incu-
bated for 24h with 10μM ET-1 and different ETR-antagonists: PD142893 (unselective), BQ-610 (ETR-A)
and RES-701-1 (ETR-B). After ETR downregulation by antisense oligonucleotides, proliferation (thymi-
dine incorporation, protein synthesis) and invasion (Matrigel invasion) were measured. ETR expression
in isolated cells was analyzed by Western blotting and sqRT-PCR.
Results. Both ETRs are expressed in both subpopulations in the cell column with predominance of
ETR-A in the proximal part and proliferative subpopulation, whereas ETR-B is present at similar levels
in both subpopulations. These results were confi rmed at the mRNA level. ET-1 increased proliferation
(max 267% of control) and invasion (max 288% of control) of fi rst trimester trophoblasts. The mitogenic
ET-1 effect was inhibited (p<0.05) by 40-80% with each receptor antagonist, and by 44% and 40%, re-
spectively, by ETR-A and ETR-B antisense-oligonucleotides. The invasion promoting effect was almost
completely blocked in the presence of the ETR-B antagonists.
Conclusion. The effect of ET-1 on cell proliferation in fi rst trimester trophoblasts is mediated by both
ETRs, while its effect on invasion is mediated predominantly by ETR-B. These effects are in line with
receptor subtype location.
56
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
ENDOTHELIN/ENDOTHELIN RECEPTOR SYSTEM IS UPREGULATED IN PREECLAMPSIA WITH OR WITHOUT FETAL GROWTH RESTRICTION IN CONTRAST TO GESTATIONAL DIABETES.
M Dieber Rotheneder, S Beganovic, M Fellner, Uwe Lang, Gernot Desoye, Mila
Červar Živković.
Department of Obstetrics & Gynaecology, Medical University of Graz, Austria.
Introduction. In addition to its vasoregulative function, in the human placenta endothelin-1 (ET-1) also
regulates cell differentiation, proliferation, invasion and apoptosis. ET-1 effects are signaled through two
receptor subtypes ETR-A and ETR-B. We tested the hypothesis that the expression of ET-1 and ETRs
is altered in preeclampsia (PE), fetal growth restriction (FGR) and in gestational diabetes (GDM) and dif-
fers between early (gestational week ≤ 34) and late (GW >34) third trimester pregnancies.
Methods. The study included women (GW 28-41) with PE (blood pressure >140/90 mmHg, protein
>300mg/24hrs; n=16), with FGR (<10th birthweight centile and pathological umbilical blood fl ow; n=7)
and PE+FGR (n=5) and with GDM (±insulin treatment n=21), as well as age-matched controls (n=20).
ET-1, ETR-A and ETR-B mRNA and ETR-A and ETR-B protein were quantifi ed in placental tissues by
real-time PCR and immunoblotting.
Results.
Table 1: mRNA expression in third trimester pregnancies:
Fold changes versus age-matched controls (p-values)
GW ≤ 34 GW > 34
ETR-A ETR-B ET-1 ETR-A ETR-B ET-1
PE2.6
(0.04)
3.0
(0.01)
3.5
(0.01)
0.6
(0.05)
2.0
(0.02)
0.4
(0.05)
PE+FGR5.1
(0.05)
3.4
(0.04)
6.9
(0.003)- - -
FGR n.s n.s.3.8
(0.02)
0.6
(0.05)n.s. n.s.
GDM - - -0.5
(<0.001)
0.8
(0.05)
0.4
(<0.001)
-: not determined, because no material available, n.s.: not signifi cant
In early third trimester pregnancies ETR-A protein was upregulated (+26%) only in PE. There were no
changes in ETR-B protein. In late third trimester pregnancies ETR-A (-17%) and ETR-B protein (-33%)
were downregulated in GDM. ETR-B protein was also downregulated in FGR (-23%) and PE (-35%).
Discussion. The upregulation of the ET/ETR system in PE is correlated with the severity of the disease:
mild-late<severe-early<PE+FGR). The ET/ETR system is downregulated in GDM.
(Grants: 12243, Jubilee Funds , Austrian National Bank and Kulturamt Stadt Graz)
57
30th September – 1st October 2011. Zagreb, Croatia
INDIVIDUAL TREATMENT OF ANTIPHOSPHOLIPID SYNDROME IN PREGNANCY.
K Mayer Pickel, M Mörtl, W Schöll, C Stern, Uwe Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Introduction. The antiphospholipid syndrome (APLS) is an autoimmune disease, characterized by
vascular thrombosis, pregnancy loss and presence of antiphospholipid antibodies in maternal circula-
tion. A very rare form of APLS, catastrophic antiphospholipid syndrome (CAPS) is triggered by preg-
nancy, infection and surgery and presents a life-threatening condition with multiorgan failure.
Patients and Methods. Nine women with the diagnosis of APLS were observed in Dept. Ob. Gyn.
Graz from 2007 to 2011. All patients were treated with low weight molecular heparin (LWMH), seven
patients received 100 mg aspirin daily because of previous poor pregnancy outcome. Additionally, four
pregnant women were treated by corticosteroids, one with plasmapheresis and one with immuno-
apheresis, respectively.
Results. One pregnancy was complicated by early-onset preeclampsia and extreme IUGR at 27th
week of gestation and terminated by caesarean section, the child suffered under extreme growth re-
tardation with the neurological signs of ataxia and dyspraxia. Three patients developed CAPS and the
pregnancies were terminated by caesarean section between 27-32 weeks of gestation with the good
maternal and neonatal outcome. Five pregnancies showed no additional complications until the time
of the delivery, two of them were terminated by vaginal delivery at 37th-39th weeks, and three were
terminated by caesarean section because of suspect intrauterine asphyxia by routine control at 34th
week of gestation, two children were healthy, the third one died immediately after delivery because of a
terminal asphyxia. Eight women had a normal childbed and one developed the cerebral venous sinus
thrombosis despite of LWMH therapy.
Summary. APLS is associated with many severe pregnancy complications and should be treated in a
tertiary care by individualized, interdisciplinary management including the possibility to use a controlled
LWMH-therapy, aspirin and corticosteroids but also the other therapy options as plasmapheresis or
immunoapheresis, if necessary.
58
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
QUALITY OF LIFE IN WOMEN AFTER HYPERTENSIVE PREGNANCY DISORDERS.
C Stern, E Mautner, M Deutsch, K Mayer-Pickel, Uwe Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Background. Preeclampsia/eclampsia and HELLP-Syndrome (PRE/E/H) are serious experiences in
life, changing the psychological profi le and need even more psychological treatment of affected per-
sons. In the present study the physical and mental stress in the group after PRE/E/HELLP were com-
pared with the healthy non-pregnant group.
Methods. 87 patients after PRE/E/H answered a questionnaire concerning their physical and mental
quality of life (SF-12 questionnaire for general state of health). They were divided into 4 groups according
to the type of disease: early- onset (<34.week of GA, 21%) and late-onset preeclampsia (>34. week of
GA, 31%) as well as superimposed PE (11%) and HELLP-syndrome (29%). Comparison was made with
the reference values from the SF-12 questionnaire.
Results. The negative affection of quality of mental life was signifi cant in all patients after P/E/H, after
early-onset preeclampsia (P=0,003), after late-onset preeclampsia (P=0,004) and after HELLP-syn-
drome (P=0.002). These with late-onset preeclampsia were also physically impaired (P=0.01). However,
women after superimposed PE were neither physically nor mentally hindered.
Conclusion. This study shows that women after the serious complications associated with severe
P/E/H are substantially reduced in their physical and mental quality of life. Medical care for these wom-
en at risk of adverse pregnancy outcome should provide individual and multidisciplinary management.
Parameters of health-related-quality-of-life should be involved to improve pregnancy outcome.
59
30th September – 1st October 2011. Zagreb, Croatia
SPECIAL MANAGEMENT OF THROMBOPHILIA IN PREGNANCIES AFTER PREECLAMPSIA/ECLAMPSIA/HELLP SYNDROM.
E Steinbauer, N Weiss, F Prüller, C Stern, M Häusler, Uwe Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Objective. The aim of the study was to analyze the maternal and fetal outcome after the use of in-
dividual prophylaxis in patients with “St. p. preeclampsia/eclampsia/HELLP syndrome or diagnosed
thrombophilia at the Department of Obstetrics and Gynecology, Medical University Graz.
Patients and methods. All patients who had been observed in the Unit for management of hyper-
tensive pregnancies between 2006 and 2010, were included in the analysis (Group 1, n=89). In the
addition, the patients found in the database PIA of the LKH Graz searching for the key word entries
preeclampsia, eclampsia, HELLP, hypertonia, SIH, IUGR and thrombophilia were included in the study
as the control (Group 2, n=209). Patient data was collected from the databases Medocs, PIA and sta-
tistically analyzed.
Results. The use of prophylaxis was 95% in patients with thrombophilia (“T+prophylaxis”) and 58%
in patients with “St. p. P/E/H”. In the subgroup “T+prophylaxis” 81% didn’t develop any disease, 5%
had mild preeclampsia, 5% severe preeclampsia and 5% suffered from HELLP syndrome. 17% of
the children of the same subgroup had IUGR and 34% were premature. In the group “St. p. P/E/
H+prophylaxis” 67% had no disease, 13% had mild preeclampsia, 21% had severe preeclampsia and
5% had HELLP syndrome. IUGR occurred in 10% and preterm birth in 5% of cases. Only 43% of the
patients in the group without prophylaxis (“St. p. P/E/H-prophylaxis”) had no disease. 18% had mild
preeclampsia, 39% had severe preeclampsia and 18% had HELLP syndrome. 3% of the children had
IUGR and 52% were premature. In the group 2, 32% of the women developed mild preeclampsia, 57%
severe preeclampsia and 19% HELLP syndrome. IUGR occurred in 32% of the cases and preterm birth
in 74%.
Only 3 patients suffered from eclampsia. An abortion was carried out once and an intrauterine fetal
death occurred four times.
Conclusion. Maternal outcome in subgroup “St. p. P/E/H+prophylaxis” was better compared to sub-
group “St. p. P/E/H-prophylaxis”, but the differences were not signifi cant. Fetal outcome didn’t differ
between the groups. Patients with thrombophilia received prophylaxis in almost every case and only
19% of this patient group had complications.
60
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
UTERINE ARTERY DOPPLER IN HIGH RISK PREGNANCIES; THE PREDICTION FOR MATERNAL HYPERTENSIVE DISEASES AND INTRAUTERINE GROWTH RESTRICTION (IUGR).
T Idris, S Gramm, M Häusler, Uwe Lang, Mila Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Introduction. Hypertensive pregnancies are associated with serious maternal and fetal complications.
The optimal management in pregnancy and the timing of pregnancy termination includes a carefully
weighing of risk-benefi t ratio for each individual patient.
Patients and Methods. 189 pregnant women with chronic hypertension and/or with the history of
some serious hypertensive pregnancy complications in previous pregnancies were observed in the
Unite for Hypertensive Pregnancies of Dept. Ob. Gyn. Graz from 2006-2010. The uterine Doppler ex-
aminations were performed at 11-14 and 20-24 weeks of gestation. The presence of bilateral uterine
notching with an increase of pulsatility index (PI) in both examinations was interpreted as pathologic.
The maternal and fetal outcomes were analysed.
Results. Pathologic uterine artery Doppler was measured in 12% of examined patients. In these preg-
nancies, 70% developed various hypertensive complications combined with an intrauterine growth
restriction (IUGR) in 50 %.
Summary. Pathologic uterine Doppler is a helpful marker for hypertensive complications and fetal
growth restriction in high risk pregnancies, but the predictive value is not higher than established in
common population.
61
30th September – 1st October 2011. Zagreb, Croatia
THE MANAGEMENT OF CHRONIC HYPERTENSION IN PREGNANCY.
Vassiliki Kolovetsiou, C Stern, C Meyer-Pickel, D Ulrich, T Idris, Uwe Lang, Mila
Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Introduction. The complications of hypertensive disorders in pregnancy are a leading cause of ma-
ternal and fetal/neonatal mortality and morbidity. We propose that the specifi c management in tertiary
care hospital could decrease the high incidence of preeclampsia/eclampsia/HELLP Syndrom in preg-
nancies with chronic hypertension with or without history of preeclampsia/eclampsia/HELLP Syndrom.
Patients and Methods. The appearance of preeclampsia in 189 pregnancies with chronic hyperten-
sion with or without history of preeclampsia/eclampsia/HELLP Syndrom in previous pregnancies were
analyzed after the specifi c management in special unit for hypertensive disorders of Dept. Ob. Gyn in a
5 year period between 2006 and 2011.
Results. 44% of pregnancies with chronic hypertension developed preeclampsia, in the group of
54% women treated with methyl-dopa in 53% and in the group of 40% patients treated with calcium
antagonists in 72%. Patients with previous history of preeclampsia/eclampsia/HELLP Syndrome were
additionally treated with 100 mg aspirin and developed preeclampsia in 40%.
Conclusion. The data show a high incidence of preeclampsia in women with preexisting hyperten-
sion despite of established medication and intensive observation in high specialized unit of tertiary care
hospital.
62
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
A RETROSPECTIVE EVALUATION OF THE CLASSIFICATION OF HYPERTENSIVE DISEASES IN PREGNANCY AT THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, MEDICAL UNIVERSITY OF GRAZ, AUSTRIA.
Vassiliki Kolovetsiou, C Stern, T Idris, D Ulrich, C Meyer-Pickel, Uwe Lang, Mila
Červar Živković.
Department of OB/GYN. Medical University of Graz, Austria.
Introduction. Hypertensive disease is the most common maternal disorder in human pregnancy. The
disease ranges from a mild elevation of blood pressure in preexistent hypertension and pregnancy
induced hypertension (PIH), mild preeclampsia to severe preeclampsia, eclampsia and HELLP Syn-
drome. The right classifi cation of the form is necessary to assess the appropriate therapy patterns.
Methods. The medical documentation of Dept. Obstet. Gyn. of Medical University Graz was re-eval-
uated according to the documented clinic and laboratory fi ndings in medical histories of 687 patients
with the diagnosis of listed hypertensive disorders managed between 2006 and 2010.
Results. A failure classifi cation was found in 7% of all analyzed histories. The most common failures
were false positive diagnosis of HELLP Syndrome which should be classifi ed as severe preeclampsia
(11%), false diagnosis of superimposed preeclampsia (22%) and the classifi cation of an actually severe
preeclampsia as a mild preeclampsia (21%).
Conclusion. The primary detection of hypertensive disorders in pregnancy is standardized and well
integrated in the daily work of obstetrician, but the emergency situations in these patients hinder the
exact clinical classifi cation and an adequate management.
63
30th September – 1st October 2011. Zagreb, Croatia
PERINATAL OUTCOME IN GRAVIDA OLDER THAN 35 YEARS WITH PREECLAMPSIA
Marko Vulić, Damir Roje.
Department of Obstetrics and Gynecology. University Hospital Split. Croatia.
Objective. To compare perinatal outcome in gravida older than 35 years with and without preeclamp-
sia.
Materials and methods. We conducted a retrospective study that included 626 women older than
35 years who delivered in the University Hospital Split between 01.01.-31.12.2007. Information was
taken from the maternal delivery records. Out of 626 women, 48 had and 578 had not preeclampsia.
Investigated variables were week of delivery, birth weight, Apgar score, parity and mode of delivery.
For statistical analysis we used Chi square test. Signifi cance of differences was accepted at p<0,05.
Results. In gravida older than 35 years with preeclampsia there were increased prevalence of preterm
deliveries (Chi=11,134; p=<0,05), SGA (Chi=12,2898; p<0,05) and LBW babies (Chi=24,322; p<0,05).
Nuliparity was associated with occurence of preeclampsia in those gravida (Chi=7,984; p <0,05). Preva-
lence of Cesarean section was increased in study group (Chi=6,5212; p<0,05). There were no differ-
ences in the APGAR score between two groups (Chi=0,499; p=NS).
Conclusions. In gravida older than 35 years preeclampsia has negative impact on the perinatal out-
come.
64
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
HELLP SYNDROME.
Vesna Sokol.
Department of OB/GYN. Hospital Medical Centre Zagreb. School of Medicine, University of Zagreb, Croatia.
HEELP syndrome is multiorganic disease characterised by hemolysis, elevated liver enzymes and a low
platelet count.
The syndrome probably represents complication of prexistsing preeclampsia in 10-20% women, al-
though it can be presented as individual clinical entitiy.
HELLP syndrome develops in approximately 1-2 per 1000 pregnancies overall. Most frequently, the
disease is diagnosed between 28- 36 weeks of gestation. In 30% women the disease develops post-
partum.
The most common clinical presentation of the disease is abdominal pain and tenderness in the midepi-
gastrium or in the right upper quadrant. Many patients also complain about nausea and malaise, which
may be mistaken for a nonspecifi c viral illness! Hypertension and proteinuria are present in approxi-
mately 85% of cases, but these symptoms also may be absent in women with otherwise severe HELLP
syndrome. 1-25% of women develops one of the serious complications which includes disseminated
intravascular coagulation (DIC), abruptio placentae, acute renal failure, pulmonary edema, subcapsular
liver hematoma, and retinal detachment.
The diagnosis of HEELP syndrome is based on the following criteria: microangiopathic hemolytic ane-
mia with an elevated LDH or indirect bilirubin and a low serum haptoglobin concentration (≤25 mg/dL),
platelet count ≤100,000 cells/microL, serum LDH ≥600 IU/L or total bilirubin ≥1.2 mg/dL and serum
AST ≥70 IU/L. Additional laboratory testing can be helpful (PT, aPTT etc.) to differentiate HELLP syn-
drome from various diseases with similar clinical presentation.
The cornerstone of therapy is delivery especially if there is a case of pregnancies ≥34 weeks of gesta-
tion, nonreassuring fetal status and a presence of severe maternal disease. For pregnancies less than
34 weeks of gestation in which maternal and fetal status is reassuring the delivery is suggested after a
course of glucocorticoids to accelerate fetal pulmonary maturity. The outcome for mothers with HELLP
syndrome is generally good, but serious complications may occur. The risk of recurrence in future
pregnancies appears to be increased.
From January, 2005. to June 2011. approximately 50 pregnant women with HEELP syndrome were
treated and delivered at the Department of Gynecology and Obstetrics, University Hospital Center, Za-
greb. The clinical course of the disease during pregnancy, labor and post- partum period was reviewed
retrospectively. Clinical data were ascertained after reviewing and collecting all data from the patients’
personal medical documentation.
65
30th September – 1st October 2011. Zagreb, Croatia
PERINATAL OUTCOME IN WOMEN WITH RECURRENT PREECLAMPSIA VERSUS PREECLAMPSIA IN NULLIPARAS.
Vesna Elveđi Gašparović, Snježana Škrablin, Trpimir Goluža, Petrana Beljan*, Kristina
Kotorac*, Rikić Josipa*.
Department of OB/GYN. Hospital Medical Centre Zagreb. *School of Medicine, University of Zagreb, Croatia.
Preeclampsia has generally been described as a disease of nulliparas. Women with a history of pre-
eclampsia are at risk for recurrence in future pregnancies with a rate of 20-25%.
Aim. The aim of this study was to compare perinatal outcome of recurrent preeclampsia in multiparas
with that of preeclampsia in nulliparas.
Methods. A retrospective 10-year period study from medical records of term pregnancies in women
with preeclampsia who delivered at Petrova University Hospital; 30 women with recurrent preeclamp-
sia were compared with 125 women who developed preeclampsia as nulliparas. Maternal and fetal
variables that were compared included maternal blood pressure, serum biochemistry, rate of preterm
delivery, rate of abruption placentae and neonatal outcome.
Results. Women with recurrent preeclampsia (n=30) compared with nulliparous women (n=125) had a
smaller increase in mean maternal blood pressure (25.3+/-17.1mmHg vs 33.4+/-11.3; t=3.161 p=0.002),
had less proteinuria (++ 29.1% vs 56.3,χ2=6.116 p=0.013) and had born children with a heavier birth-
weight (3034.3g+/-726.3 vs 2478.8 g +/- 867.7; t=-3.242; p=0.002). We found no statistical difference in
the gestational age at delivery, maternal serum biochemistry parameters and rate of abruptio placentae
in compared groups.
Conclusion. Recurrent preeclampsia seems to be less severe and have better perinatal outcome than
preeclampsia in nulliparas.
66
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
Alpe Adria
Perinatal Congress
Authors’ Index
67
30th September – 1st October 2011. Zagreb, Croatia
AUTHORS’ INDEX
Anić Jurica Sonja
Anzulović Dunja
Bagosi Z
Bakki Judit
Barth S
Beganović S
Beljan Petrana
Bito Tamas
Blajić Jozo
Ceccarello Matteo
Cecotti Vera Cocco Andrea
Červar Živković Mila
Čolić Ana
de Marini Sergio
Desoye Gernot
Deutsch M
Di Lorenzo Giovanni
Dieber Rotheneder M
Dorfer M
Drušković M
Đelmiš Josip
Elveđi Gasparović Vesna
Falconi Gabriele
Fellner M
Fister Petja
Gasztonyi B
Giacomazzo Barbara
Giuseppina D’Ottavio
Goluža Trpimir
Gramm S
Gverić Ahmetašević Snježana
Gyurkovits Zita
Haasf Josef
Hahn T
Häusler M
Herman Mislav
Horvatiček Marina
Hulina Davor
Huppertz B.
Idris T
Ilijić Krpan Marcela
Ivanišević Marina
Juras Josip
Juretić Emilja
Katona Marta
Kiss Judit
68
XXXIII ALPE ADRIA MEETING OF PERINATAL MEDICINE
Kohnen G
Kolovetsiou
Kotorac Kristina
Kuliš Iva
Lang Uwe
Lanza Paola
Magnet E
Mammana Giovanni
Marton Virag
Mautner E
Mayer Pickel K
Meir Yoram
Memmo Alessia
Meyer-Pickel C
Mole H
Morris Nicholas
Mörtl M
Moser Franz
Müller Wilhelm
Nemeth Gabor
Nenad Veček
Nosan Gregor
Oroszlán T
Orvos Hajnalka
Pal Attila
Panzitthomas T
Paro Panjan Darja
Perin Daniela
Petrović Davor
Petrović Oleg
Podnar P
Premru Sršen Tanja
Prüller F
Radaković Branko
Reich O
Reif Philipp
Reiterer F
Resch Bernhard
Rikić Josipa
Roje Damir
Rukavina Iva
Sajina Stritar B
Schneuber S
Schöll W
Schuster K
Sokol Vesna
69
30th September – 1st October 2011. Zagreb, Croatia
Starčević Vito
Steblovnik L
Steinbauer E
Stern C
Škrablin Snježana
Tinelli Raffaele
Tomazić M
Tomić Vajdana
Trevisan Ruggero
Trutnovsky G
Tul Mandić N
Tumbarello Cristina
Ulrich D
Vajda Gyorgy
Verdenik I
Višnić Alenka
Vulić Marko
Walcher Wolfgang
Weiss E
Weiss N
Župić Tomislav
70
30th September – 1st October 2011. Zagreb, Croatia
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