Poster Abstracts

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ean while 90% of the control group had natural delivery. The inci- ...... realizar treinamento desses profissionais em cuidados, cuidados e patologias, a fim ...... pregnancy, comparing manual with electric vacuum aspiration. Method: ...... Bruna F. Bottura; Gustavo Barison; ...... Caio Alves Mendonça1; Ariella Baeza Bonazzio1.
DOI: 10.1002/ijgo.12583

ABSTR ACTS

P OS T ER A B S T R AC T S

vaginal, rectal or urethral repairs. Since there is no common approach, each patient should be evaluated and managed individually.

EP0001 | A CASE REPORT OF A SUCCESSFUL PREGNANCY IN A PATIENT WITH HISTORY OF “CLOACA” MALFORMATION THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.4 MEDICAL DISORDERS IN PREGNANCY Shabnam Sattari; Anne Berndl University of Toronto, Toronto, Canada

Objectives: Cloaca is the embryogenic structure that differentiates to GI, Urinary and Gynecologic tracts. Cloaca anomalies are rare with incidence of 1/20000 to 1/50000 births, and the affected

EP0002 | A CASE REPORT OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) IN A PATIENT WITH PRE-­ECLAMPSIA

THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.5 HIGH RISK PREGNANCY Lucas deAraújo Barros1; Paola Fonseca Minuzzi2; Islam Maruf Ahmad Maruf Mahmud2; Greta da Rocha2; Nicole Kraemer Redeker2; Magno Tauceda Borges2; Luiz Carlos Porcello Marrone2 1

Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; 2Ulbra, Canoas, RS, Brazil

infants often undergo major surgeries to achieve optimal function. There is minimal information surrounding pregnancy management

Objectives: To describe clinical, neuroradiological and evolution-

and outcomes for women with cloacal anomalies. We report on a

ary findings in a patient with posterior reversible encephalopathy

pregnant woman with a cloacal anomaly and review previous cases

syndrome (PRES). It is characterized by progressive symptoms of

reported in the literature.

headache, altered mental status, severe hypertension, cortical blind-

Method: This case report is based on chart review of a 38-­year-­old,

ness and seizures, and is diagnosed by cerebral magnetic resonance

G1P0 woman with threatened preterm labor at 23 weeks and 5 days

imaging (MRI).

of gestation, as well as a review of the literature using the Ovid data-

Method: Report a case of pre-­eclampsia associated with posterior re-

base. It took place at Sunnybrook Health Sciences Center in Toronto,

versible encephalopathy syndrome (PRES) 24 hours post childbirth.

Canada. Our study subject had multiple prior abdominal surgeries

Results: A 17-­year-­old female, with a history of pre-­eclampsia, pre-

due to cloacal abnormality, anal atresia and right nephrectomy. She

sented severe holocranial headache with no analgesic relief associ-

had recurrent UTIs and was self-­catheterizing for a long time. She

ated with visual changes 24 hours after childbirth. A week after, she

had a history of infertility and conceived through IVF via donor em-

had a seizure episode with focal onset in the right upper limb. During

bryo. Photographs were taken prior to and during delivery with writ-

an evaluation, she was post-­ ictal and presented blood pressure:

ten consent of the patient.

190/100mmHg. Submitted to brain MRI that showed hyper signal

Results: The Neonatology, Urology and General surgery teams were

in occipital and temporal lobes bilaterally in FLAIR. After controlling

involved in her management. She had PPROM, followed by chori-

blood pressure levels, the patient presented complete improvement

amnionitis and abnormal fetal heart tracing at gestational age of 25

of the symptoms and a new brain MRI evidenced the complete re-

weeks and 3 days. The fetus was in breech presentation. She under-

gression of the changes.

went an emergency caesarean section with a sub-­umbilical midline

Conclusions: Pregnancy and postpartum more frequently lead to

abdominal incision to decrease the risk of devascularisation second-

PRES.MRI contributes significantly to the diagnosis of this neuro-

ary to her multiple abdominal surgeries, and a classic uterine incision.

toxic state, evidencing edema of white and gray matter mainly in the

The operation was uncomplicated and alive preterm fetus was born.

occipital and parietal lobes of the brain and, to a lesser extent, in the

Conclusions: Preterm birth and multidisciplinary management have

temporal and frontal lobes, bridge and cerebellum. Several clinical

been noted in the literature. We reemphasize a multidisciplinary

studies have indicated that eclamptic seizure activity may occur in

team approach, preconception consultation, early referral to the

patients with minimal elevations in blood pressure. It is possible that

high-­risk obstetric team and close prenatal follow ups in these pa-

blood pressure alone is not the exclusive cause, and that endothelial

tients. Birth may be complicated by prematurity and its sequelea,

dysfunction, which is a hallmark of preeclampsia, is also a contribut-

previous surgical scars and a desire to prevent damage to previous

ing factor.

The FIGO World Congress book of abstracts was created in July 2018. Some changes to the programme will have been made since July 2018. If an abstract cannot be found via abstract/session number, then please check the author index to find the session by the author instead. © 2018 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. Int J Gynecol Obstet. 2018; 143 (Suppl. 3): 543–991

wileyonlinelibrary.com/journal/ijgo  |  543

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544      

EP0003 | A CASE REPORT: PRENATALCARE TO A PATIENT WITHLIVER TRANSPLANTATION THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.5 HIGH RISK PREGNANCY Renata Paoli1; Adolfo Liao2 1

Hospital Israelita Albert Einstei, São Paulo, SP, Brazil; 2Hospital Israelita Albert Einstein, Hospital Municipal da Vila Santa Catarina São Paulo, SP, Brazil

Objectives: Brazil has become the largest public transplant system in the world. And the third largest in volume of liver transplants. In Brazil in 2015, 1809 liver transplants were performed. The waiting list in February 2016 had 1978 names. Pregnancies in these females are considered to be at high risk and have several complications reported in the literature for these fetus and these female: preterm delivery, (30%) low birth weight, pre-­eclampsia, (15%), diabetes, miscarriage. However there are no reports of maternal death..This case has the target to relate the favorable evolution in pregnancy liver transplantation. Method: In 2015 were realized: the prenatal’s assistance to the patient and the data collect during the medical appointment, as well the review of literature to support it. The PUBMED was the database used in this case, its research was made on this way: mesh terms [pregnancy and liver transplantation],refined 5 years. All these dates in 2015 were realized: the prenatal’s assistance to the patient and the data collect during the medical appointment, as well the review of literature to suport it. Results: 30 years old, GIVP2NA0 followed up the transplant team at our institution. She had idiopathic autoimmune primary biliary cir-

Objectives: Mother’s brain death during pregnancy is a very complicated condition that not only requires a rational medical management plan, but also the need for careful decision making about its legal and ethical situation is two so much. Medical management along with legal and ethical considerations in the pregnant women with brainstem death can lead to the delivery of a healthy child and the organ donation. The aim of this study was to review the counseling principles for the fetus survival after the mother’s brain death. Method: For compiling the current review article, researchers searched in websites, validated journals and databases including PubMed, Google Scholar, Scientific Information Database (SID), Magiran and Scopus with keywords such as brain death, fetal life, pregnant woman and special care in the period of 2009 to 2017. Results: The review of articles led to organization of the mother’s brain death in three main categories included moral, legal and medical perspectives. Legally to continue life with preservative treatment, it requires legal and regulatory guidelines. Ethically the healthcare service must comply ethical considerations in terms of not imposing excessive costs to the family and no applying the inappropriate or excessive equipment for their own benefit and also carefulness in the patient judgment. Also medically it includes all measures to protect the mother and the fetus. Conclusions: In order to manage the fetus survival after the mother’s brain death, pay attention to its various legal, ethical and medical aspects and making decisions with the best therapeutic solutions for the pregnant woman with brain death is necessary.

rhosis, needed a liver transplant, in 2005, retransplantation 2014, whose to recurrence of the disease. Started with 31 sem 5/7, 2015, using tacrolimus meticorten. Liver function no changes. No diagnosis Gestational Diabetes, low blood pressure, doppler without alterations. Pregnancy evolved without intercurrences, up to 40 weeks and 1/7 was chosen for cesarean delivery, due to the presence of fluid meconium in amnioscopy. male, weight 2905 grams and Apgar 1º/5min=9/10. Conclusions: Pregnancy should not be discouraged in transplanted patients, but rather well planned and accompanied by experienced physicians in fetal medicine, high risk pregnancy and transplantation. The pregnant woman should be aware of the risks to her and the fetus, and the team aware of the growing demand that is required.

EP0005 | ABDOMINAL PREGNANCY WITH LATE RUPTURE, CASE REPORT OCCURRED IN 2016

THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.1 PRENATAL DIAGNOSIS Iasmin Araújo; Jorge Sidney Pinheiro deMoraes; Tamires Gomes de Albuquerque Corrêa Ufpa, Belém, PA, Brazil

Objectives: Ectopic gestation is characterized by extrauterinenidation of the blastocyst. The incidence reported in an American article is 2% of all pregnancies and most implants occur in the

EP0004 | A REVIEW OF COUNSELING PRINCIPLES FOR THE FETUS SURVIVAL AFTER THE MOTHER’S BRAIN DEATH THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.4 MEDICAL DISORDERS IN PREGNANCY

uterine tubes (90%). The objective of this study was to clarify a case of ruptured ovarian ectopic gestation. The case report has the function of elucidating the rare casuistry, and can define more effective behaviors for unusual situations within the routine of Gynecology and Obstetrics. Method: This is a descriptive study of the Case Report, using ret-

Zohreh Shahhosseini ; Zeinab Hamzehgardeshi ; Afsaneh Yahyanejad2

rospective information obtained directly from the patient’s medical

1

Results: A.R. S, female, 35 years old. She reported that she began

1

1

Sexual And Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran; 2Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran

records and analyzed with Word 2010. to experience diffuse body pruritus two days before, associated with the stoppage of fetal movements. She was hospitalized at

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FSCMPA on March 17, 2016 due to abdominal gestation, 31 weeks,

Objectives: The connection between adnexal mass and pregnancy

and fetal death.

is rare. The incidence is 1/8000 and the risk of malignancy is 1 in

Conclusions: There are several discussions about the case: late di-

12000 to 1 in 47000 pregnancies. Persistent tumors treatment and

agnosis contributing to fetal death, hysterectomy and unilateral oo-

follow-­up is controversial in the literature. Factors such as symp-

phorectomy risks and prenatal quality.

tomatology, size, ultrasonographic features, pregnancy age and acceptance of the treatment should be considered. Case Report: B.C.A.H.G., 30 years old, white, healthy, first pregnancy, 24 weeks.

EP0006 | ACARDIAC TWIN: THE OVERLOOKED DIAGNOSIS. A RECENT CASE REPORT AND REVIEW OF LITERATURE

THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.5 HIGH RISK PREGNANCY Patrick Omondi Moi University School of Medicine, Eldoret, Kenya

Family history of breast cancer. 12-­week ultrasonography (US): complex cyst in left ovary (LO) of 6, 7×5, 5×5, 3 cm. Tumor markers: CA 19-­9:10, 2; CA125 14, 7; CEA 0, 6. Method: 33-­week US: cyst with septum without flow or solid projection of 17, 4×9, 9×18, 2 cm. IOTA index inconclusive. Magnetic resonance at week 34: pelvic cyst of 19, 3×11, 2×8, 5 cm. Patient remained asymptomatic. Discussed the risks of malignancy, torsion, rupture with the patient and decided to proceed with the pregnancy until 37 weeks. Cesarean delivery and left oophorectomy performed

Objectives: Acardiac twinning is an uncommon, unique and complex

at week 37. Anatomical-­pathological result: borderline tumor with

vascular complication seen in multifetal pregnancies sharing a pla-

some foci of intraepithelial lesion and micro invasion in LO and fi-

centa. Alternatively referred as Twin Reverse Arterial Perfusion se-

broma in the right annex. Follow-­up with oncologist, tumor markers

quence (TRAPS), it comprises, an often normal donor twin pumping

and imaging tests.

deoxygenated arterial blood, in retrograde manner, through an often

Results: Discussion: The approach of ovary tumors in pregnancy is

acardiac dysmorphic counterpart.

controversial. The persistent cysts can cause torsion, rupture or ob-

Method: Recently, a much higher incidence of 2.6% in monochori-

struct the delivery. US evaluates de risk of malignancy by the IOTA

onic twin pregnancies has been cited for this rather severe form of

index.

fetal-­fetal transfusion anomaly. Furthermore, mortality in those af-

The treatments are: needle puncture for simple cysts, monitoring

fected exceeds 50% for the donor twin, commonly from heart failure

or surgery. Surgery is an option after the first trimester for tumors

and complications of prematurity. To the best of our knowledge no

larger than 10 cm or with malignancy signs. For suspicious ones de-

cases of acardiac twin pregnancy with a surviving donor twin have

tected in the third trimester is recommended to wait or induce fetal

been described and published in East and central African literature.

maturity.

Results: As such, we describe the case of a 28 year old para 0+1

Conclusions: In this case, based on the literature, a discussion with

gravida 2 presenting in the second late trimester with an acardiac

the patient about the outcomes and the signing of the consent

twin pregnancy complicated by polyhydramnios of the normal donor

term we chose to wait until week 37 due to significant increase

twin, inadvertently diagnosed as twin gestation with a single fetal

of the cyst size only in the 3rd trimester and undetermined IOTA

demise of a grossly malformed twin. The case was expectantly man-

index.

aged, resulting in eventual spontaneous preterm delivery in early

Conclusion: There are no randomized trials and patient management

third trimester and survival of the donor twin.. In addition, we review

is based on case reports. There is no evidence of worse prognosis

current literature on the pathogenesis, diagnosis, management op-

and adverse events due to delayed treatment to await fetal maturity.

tions and prognosis of monochorionic twin pregnancies complicated

Decisions should be cautious and the risks exposed.

by this sequence. Conclusions: Although a rare condition, acardiac twin is perhaps more common than generally stated and thus necessitates a thorough clinical and sonographic evaluation as well as high index of suspicion in monochorionic multifetal pregnancies as highlighted in this case.

EP0007 | ADNEXAL MASS AND PREGNANCY THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.1 PRENATAL DIAGNOSIS Rafael Tristao; Gabriela Figueiredo; Talita Angimahtz Faceres, São José do Rio Preto, SP, Brazil

EP0008 | ADVERSE OUTCOMES IN PREGNANT WOMEN WITH SICKLE CELL DISEASE: COMPARISON OF DIFFERENT GENOTYPES

THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.4 MEDICAL DISORDERS IN PREGNANCY Flávia Anchielle1; Ana Laura Ferreira1; Manuela Freire Hazin Costa1; Marina Lucena Gonçalves Dias2; Aderson da Silva Araújo3; Ariani Impieri1 1

Imip, Recife, PE, Brazil; 2Faculdade Pernambucana de Saúde, Recife, PE, Brazil; Hemope, Recife, PE, Brazil

3

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546      

Objectives: To compare the clinical and obstetric complications

rupture of membranes (9.05%). There was agreement between the

among pregnant women with sickle cell disease (SCD) according to

APGAR index and the acidosis diagnosis by cord pH in 1238 cases

genotypes.

(78.85%), with disagreement in 332 cases (21.15%) (Kappa=0.072).

Method: A cross-­sectional study was conducted involving 89 women

When assessing the base excess, there was agreement in 1243 cases

with SCD and a prior history of pregnancy between September 2015

(79.17%) and disagreement in 327 cases (20.83%) (Kappa=0.128).

and April 2016 in Recife, Brazil. A Pearson’s chi-­square test and

Conclusions: The neonatal diagnosis of asphyxia based on APGAR

Fisher’s exact test were used to evaluate the associations between

index presents a low Kappa correlation to predict the confirmation

genotypes and complications.

of neonatal asphyxia diagnosed by specific markers measurable by

Results: Of 89 women, 83% had sickle cell anemia (HbSS), 9.0% had

the umbilical cord blood gases in newborns below 37 weeks of ges-

hemoglobinopathy SC(HbSC), and 8.0% had hemoglobinopathy Sβ-­

tational age.

thalassemia. The participants’ mean age was 31±7.4 years. Blood transfusions were more frequently in HbSS patients than in those with the HbSC (p=0.007). Vaso-­occlusive crisis and infection occurred mainly in HbSS, but with no statistical significance. Low birth weight, prematurity, abortion, and hypertensive syndromes were more frequent in the HbSS and HbSC women than in Sβ-­thalassemia, with no statistically significant difference. Fetal intrauterine death occurred only in women with the HbSS (14.9%). Conclusions: No differences were observed among the genotype groups according to pregnancy complications; however, the HbSS was associated with increased blood transfusions compared to the HbSC.

EP0010 | AN EXPERIENCE OF USE OF ZUSPAN REGIMEN FOR PREECLAMPSIA & ECLAMPSIA AT UNIVERSITY HOSPITAL

THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.5 HIGH RISK PREGNANCY Girija Shivarudraiah1; Attibele Palaksha Manjunatha2; Vanita Pireira2; Tamima Al Dughaishi2 1 Sultan Qaboos University Hospital, Muscat, Oman; 2Sultan Qaboos University Hospital, Muscat, Oman

Objectives: Preeclampsia and eclampsia continue to be one on

EP0009 | AGREEMENT BETWEEN CLINICAL AND LABORATORY DIAGNOSIS METHODS OF NEONATAL ASPHYXIA THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.3 ASSESSMENT OF FETAL WELLBEING Marcelo Matias1; Charles Francisco Ferreira2; Handria Rodrigues da Silva3; Jose Geraldo Ramos2; Sergio Martins-Costa2 1

Ppggo/Famed/Hcpa/Ufrgs, Famed, Ulbra Porto Alegre, RS, Brazil; 2Ppggo/ Famed/Hcpa/Ufrgs, Porto Alegre, RS, Brazil; 3Grupo de Pesquisa: Climatério e Menopausa/Famed/Hcpa/Ufrgs, Porto Alegre, RS, Brazil

the leading cause of maternal morbidity and mortality globally. Administration of magnesium sulphate ( MgSo4) is one of the prime treatment modalities in these situations. We aim to analyse the outcome of the patients who received intravenous magnesium sulphate regimen (Zuspan) for severe preeclampsia and eclampsia in our setup. Method: This is a retrospective study over 4 years from Jan 2007 to Dec 2010. All women who received magnesium sulphate for severe preeclampsia and eclampsia as per Zuspan regimen were included. Data was collected from delivery registry and from hospital electronic patient records. The demographic profile were retrieved. Other parameters of MgSo4 like total duration of use, complications and labour outcome were recorded. Toxicity of the drug was moni-

Objectives: To verify the relation between preterm birth and arterial

tored using clinical parameters. Statistical Package for the Social

blood gas analyses collected at birth in preterm newborns attended

Sciences (SPSS v21) was used for analysis.

at a School Hospital.

Results: Total of 82 women received magnesium sulpv hate for se-

Method: A retrospective cross-­sectional descriptive study including

vere preeclampsia and eclampsia. The incidence of severe preec-

newborns born between 2011 and 2016, at the Obstetric Center

lampsia is 1.58 %. Of the 82 patients one (1.21%) women had

of a School Hospital (Porto Alegre, RS, Brazil), below 37 gestational

eclampsia and 81(98.78) has severe preeclampsia. HELLP syndrome

weeks, compared the clinical diagnosis of asphyxia by APGAR index

was seen in 10(12.2%).Mean age was 31.37 years & 46.34% were

and laboratory diagnosis (pH and base excess collected from the

primigravida. Among them 43% women received MgSo4 along with

umbilical cord blood at birth). The Kappa concordance test was ap-

induction of labour and continued 24 hours postpartum. MgSo4

plied between both methods. Database typing and analyzes were

used for 24 hours in 56% of cases. The mean duration of MgSo4 was

performed in the SPSS, version 18.0, and the significance was set

30.82 hours. No women received calcium gluconate for MgSo4 tox-

at 5%. The Ethical Institutional Review Board approved this project

icity. There were no side effects observed with intraenous MgSo4.

(CAAE: 57087916.3.0000.5327).

Conclusions: The incidence of eclampsia was very low in our set

Results: It was included 1570 medical records of newborns. The major-

up due to timely use of MgSo4 regimen. The intravenous Zuspan

ity of women was white (77.8%), nulliparous (35.8%), with median[95%

MgSo4 regime is well tolerated among Omani women with severe

CI] gestational age of 35.00 [35.00–37.00] weeks. The main gestational

preeclampsia and eclampsia. There were no side-­effects or compli-

risk factors identified were preterm labor (57.96%) and premature

cations observed due to MgSo4.

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EP0011 | ANALYSIS OF OBSTETRIC AND GYNECOLOGICAL NEAR MISS OCCURRENCES IN AN EMERGENCY MEDICAL SERVICE THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.4 MEDICAL DISORDERS IN PREGNANCY Cijara Leonice Freitas1; Adson Vale2; Andrea Sueli Bullio Vale3; Renata Lima Pessoa4 1

Maternidade Escola Januario Cicco, Natal, RN, Brazil; 2Ufrn, Natal, RN, Brazil; 3 Hospital Jose Pedro Bezerra, Natal, RN, Brazil; 4Samu Natal, Natal, RN, Brazil

Objectives: To analyze the epidemiological profile of severe maternal morbidity/near miss based on the criteria established by Waterstone (2001) in an Emergency Medical Service. Method: This is a descriptive research, with a quantitative approach and documentary analysis performed through the Medical Regulation Management System of an Emergency Medical Service in the city of Natal/RN. The data collection was performed through a form, which addressed socio-­demographic issues, gestational data and vital signs of the patients attended by the service, of the occurrences of obstetric and gynecological attended, from January 2012 to December 2015. The data collected was tabulated and analyzed through the software Microsoft Office Excel 2010 and Statistical Package for the Social Science. Results: The sample consisted of 1,227 occurrences. The results indicated that women attended had a mean age of 24 years and the mean gestational age was 33 weeks. Regarding place of occurrence, 62% originated from residences or public roads and 38% were transfers between health institutions. Regarding the clinical data, the mean arterial pressure was 94.7 mmHg, which corroborates the fact that 8% of the occurrences presented as main cause of hypertensive disorders, among them gestational gestational hypertension, preeclampsia and eclampsia. The cases characterized as near miss, 8% met the criteria established by Waterstone. Conclusions: It is evident that the women who presented an emergency situation were young and the majority was in the gestational

Objectives: IUGR is associated with increased morbidity and mortality, both antepartum and postpartum. In prematurely born infants IUGR essentially worsen the prognosis. Association of IUGR with folate pathway genes polymorphisms (MTHFR, MTR, MTRR) and thrombophilic mutations (F V Leiden, F II prothrombin, F VII proconvertin) well shown in different studies, although most data refers to maternal genotype. Role of neonate’s genome in IUGR development is not well explored. Objective of this research was to evaluate association of genetic polymorphisms with IUGR development in premature newborns. Method: Retrospective analysis of 109 pairs of premature newborns and their mothers was made. 25 cases were classified to IUGR group. Blood samples of both mother and child were analyzed with real-­time PCR for polymorphisms of 21 genes (8 genes of coagulation factors, 4 genes of folate pathway, 9 genes associated with blood pressure regulation). Correlation analysis and Decision Trees algorithm were applied to determine combinations of polymorphisms and clinical/ laboratory parameters (obtained during antenatal period) strongly associated with IUGR. Results: IUGR was strongly associated with maternal MTHFR polymorphisms (alike other studies). Among infant’s genes strongest association with IUGR showed fibrinogen (FGB, G 455 A) gene polymorphism in combination with increased pulsatility index in umbilical (UA PI) and uterine arteries (UtA PI). It is known that FGB gene (G 455 A) mutation leads to increased concentration of plasma fibrinogen, which rises risk of thrombotic events. Conclusions: Placental dysfunction (increased UA PI and UtA PI) and MTHFR mutations are well known factors of IUGR, but infant’s FGB gene polymorphism wasn’t referred to growth restriction syndrome before. Results of our study demonstrate association of neonate’s FGB gene (G 455 A) polymorphism with IUGR. This corresponds to some earlier studies demonstrated hyperfibrinogenemia in fetal lambs with intrauterine growth retardation. Thus, the premature neonates with IUGR should be suspected for FGB (G 455 A) gene mutation and referred to the risk group of thrombotic complications.

period. Regarding the cases characterized as near miss was identified that the main pathology that affected pregnant women was preeclampsia or eclampsia, this finding corroborates with the significant number of emergency calls that had the main cause of arterial hypertension. These findings characterize the gestational and obstetric risk situations of patients, as well as the clinical profile found in an emergency medical service, providing an expanded view of this type of occurrence.

EP0012 | ANOTHER RISK FACTOR OF INTRAUTERINE GROWTH RESTRICTION (IUGR) THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.3 ASSESSMENT OF FETAL WELLBEING Anna Gugueva; Irina Bushtyreva; Victor Chernavskiy; Muhammed Aiman Gali Rostov-­On-­Don State Medical University, Rostov-­On-­Don, Russia

EP0013 | ANTICOAGULATION IN PREGNANT: ANTIPHOSPHOLIPID ANTIBODY SYNDROME, HEART DISEASE AND THROMBOCYTOPENIA THEME: AB 01 MATERNAL FETAL HEALTH/SUB-THEME: AB 1.4 MEDICAL DISORDERS IN PREGNANCY Annie Caroline Magalhães; Rogério Caixeta Universidade Federal de Mato Grosso, Hospital Universitário Julio Muller Cuiabá, MT, Brazil

Objectives: Report on the challenge of anticoagulation in pregnant women with antiphospholipid syndrome (APS), heart disease and thrombocytopenia. Method: GPB, 32 years, sextigesta (five early abortions), carrier of APS and persistent atrial fibrillation. Discontinued digoxin and warfarin in early pregnancy. Referred to our service, in the 20th week of

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548      

gestation, with dyspnea. Echocardiography showed valvular thick-

Results: A total of 151 pregnant women were interviewed. The mean

ening and ejection fraction 30%. Optimized treatment with meto-

maternal age was 31.2 y (SD 5,6y); and the mean gestational age at

prolol 100 mg/day, furosemide 40 mg/day and low molecular weight

interview was 29.2 wks (SD 6.1 wks). The smoking was positive in 9

heparin (LMWH) full dose 80 mg/day. After one month’s, there was

(6.0%) of population. The mean BAI total score was 11.7 (SD 9.6) and

sudden drop platelet, with nadir of 31000. Suspension with LMWH

no significant difference was found when compared smokers (BAI

and started fondaparinux 2.5 mg/day. After one week, we observed

median 11) and non-­smokers (BAI median 9, p=0.418). The smoking

improvement in platelet levels (96000).

was significantly associated with alcohol consumption: Alcohol con-

Results: Interruption at 33 weeks by maternal cardiac decompensa-

sumption was positive in 5/9 (55.6%) smoker pregnant women, and

tion. Newborn male, weight 1665 g, Apgar 9 and 9. Suspended fon-

in 33/142 (23.2%, pT

weight by the WHO standardization calculator.

were detected respectively in the CHRNG gene.Case3 was also

Results: The algorithm successfully dated 93.1% of newborns

detected two heterozygous pathogenic mutation c.1240C>T and

within 2-­weeks of their ultrasound gestational age. Additionally,

c.1027G>A in the GLAN gene.Two heterozygous pathogenic muta-

27.5% of newborns were perfectly matched and only 0.9% were

tions c.2299C>T (p.Arg767*)and c.2773C>T (p.Arg925Cys)of the

off by five or more weeks when compared to their ultrasound ges-

NPR2 gene were detected in Case 4.

tational age. The algorithm derived preterm birth rate was 7.2%

Conclusions: Targeted sequencing capture techniques can signifi-

compared to 6.6% by ultrasound. Within this sample, the preterm

cantly improve the positive prenatal diagnosis rate of difficult fetal

birth rate by birthweight only (BW