S370 Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396

O971

Introducing evidence based perinatal practices package (EB

PPP) in 5 large regions of Russia: International project carried

out in yet another country

N. Vartapetova, O. Shvabskiy, A. Trushkov

Objectives: A lot of interventions are typically used during

pregnancy and labor in Russia. Introducing EB PPP can make

deliveries safer and client satisfaction – higher. The USAID-funded

Maternal Child Health Initiative (MCHI) introduced EB perinatal

protocols in the pilot Russian maternities.

Methods: MCHI retrospectively analyzed medical records of 14 026

deliveries (5822 in 2003 and 8204 in 2006) in 5 regions of Russia;

the analysis covered 2 time periods: January, 1 – April, 30 2003

(before the project was started) and September, 1 – December, 31,

2006 (3 years after the project had started). Statistical data was

processed using the SPSS software.

Results: The average frequency of cesarean sections decreased

from 20, 8% in 2003 to 18, 9% in 2006 (p =0.030). The average

number of medicines used during labor (excluding those for

epidural analgesia) decreased from 3, 83 in 2003 to 0, 79 in 2006

(p =0.000). The use of non-medical methods of pain relief during

labor increased from 5, 3% in 2003 to 80, 1% in 2006. The number

of newborns with Apgar score <7 at 5 minutes decreased from 2.0%

in 2003 to 1, 2% in 2006 (OR=0.615 (95% CI 0.468–0.807). The use

of dry cord care increased from 2.2% in 2003 to 25.2% in 2006.

The number of rooming-in increased from 43.6% in 2003 to 76.5%

in 2006 (OR=0.27; 95% CI 0.25–0.29). 14, 2% of newborns were

transferred to other hospitals in 2003 as compared to 10, 4% in

2006 (OR=0.70; 95% CI 0.63–0.79). The amount of deliveries in the

pilot maternities increased by 40.9%.

Conclusions: Introducing EB PPP made maternities more appealing

to clients and increased delivery rates; it reduced the number of

interventions and medical prescriptions during labor as well as the

postpartum period, and the number of newborns with Apgar score

<7 at 5 minutes.

O972

Pregnancies complicated by mild pre-eclampsia: How high

risk are they?

A. Varughese, J. Walsh, M. Robson, C. O’Herlihy. National Maternity

Hospital, Holles Street, Dublin 2, Ireland

Background: The management of patients with mild pre-eclampsia

varies considerably between centres and clinicians. Some have a

policy that all patients with pre eclampsia regardless of severity

should be managed in hospital due to the unpredictable nature of

the disease, while many centres, including our own, manage mild

disease on an outpatient basis.

The degree of proteinuria is often used as a marker of severity in

deciding how intensive monitoring should be. On this basis we have

audited the outcome of pregnancies complicated by pre-eclampsia

with mild proteinuria, between 0.3 grammes and 0.5 grammes in

a 24 hour period, who were delivered in the National Maternity

Hospital, Dublin, Ireland in the year 2008.

Methods: We performed a retrospective chart review of all patients

in the National Maternity Hospital over a 12 month period with

pre-eclampsia and mild proteinuria.

Results: There were 54 patients with mild proteinuria between

0.3 g and 0.5 g. Of these there were 8 preterm deliveries and 1

stillbirth. Overall the risk of preterm delivery, caesarean delivery

and intrauterine growth restriction were all significantly increased.

Conclusion: The incidence of adverse obstetric outcome was

significantly increased in women with preeclampsia associated

with mild proteinuria. These pregnancies are certainly high risk

and should be managed as such.

O973

Doppler velocimetry and microscopic lesions of placenta in

fetal growth restricted pregnancies

N. Vedmedovska1, I. Melderis2, D. Rezeberga1. 1Riga Stradins

University, Riga Maternity Hospital, 2University Children Hospital

Objectives: The aim of the study was to find an association between

the uterine and umbilical arteries blood flow patterns and placental

microscopic lesions in normal and complicated by intrauterine fetal

growth restriction (FGR) pregnancies.

Material and Methods: We started our study in May 2007. Uterine

and umbilical Doppler waveforms were recorded within 14 days of

delivery (range 2h to 14 days) in 35 cases of antenataly confirmed

diagnosis of fetal growth restriction (FGR group) and 35 cases of

normally developed fetuses (control group). All included cases were

singleton pregnancies. Placentas were obtained after delivery and

microscopically examined; conventional histological methods were

use. The research protocol was confirmed in the Ethical Committee

of the Riga Stradins University.

Results: Both groups were similar in respect to age, parity, marital

and employment status (p > 0.05). Gestational age, birth weight,

weight of the placenta and incidence of spontaneous delivery in

the FGR group were significantly lower (P < 0.05).

In the patients with FGR, the total rate of placental pathological

findings (intervillous fibrine deposition, thickening of the villous

trophoblastic basal membrane, cytotrophoblast proliferation,

inervillous infarction, stromal fibroses) were significantly higher in

the presence of abnormal a.uterina (mean PI value>1.2 or presence

of early diastolic notch) and/or Absent or Reversed End Diastolic

flow (ARED) in a.umbilicalis Doppler velocimetry compared to the

normal a.uterina and a.umbilicalis Doppler pattern (100%, 100%,

80%, 60%, 60% vs 91%, 55%, 64%, 18%, 18% respectively). The number

of placental lesions was not significantly different between FGR

cases and control placentas, when the Doppler velocimetry in both

arteries was normal (91%, 55%, 64%, 18%, 18% vs 91%, 60%, 57%, 40%,

31% respectively).

Conclusions: Abnormal Doppler velocimetry of a.uterina and

a.umbilicalis in FGR pregnancies may predict ischemic placental

lesions that are responsible for its diminished perfusion and

cause of intrauterine growth restriction in anatomically and

chromosomally normal fetuses.

O974

Recurrent endometrial carcinoma

E. Velasco Sanchez, R. Guisado Lopez, M. Morillo Conejo, J. Arjona

Berral, P. Jimenez, S. Pena Lobo Ferreira Goncalves, I. Jeronimo

Franco. Hospital Universitario Reina Sofıa

Objectives: To acknowledge the recurrence of endometrial

carcinoma in the last thirty years in our healthcare area, Cordoba-

Spain. To know which are the most affected organs on those

patients who had recurrence of this disease. To evaluate the

incidence of recurrence endometrial carcinoma depending on the

stage of disease and treatment received. To compare our casuistic

with the published literature.

Methods and Materials: Retrospective study of the database of the

Oncology Department that belongs to Hospital Universitario Reina

Sofıa, from 1980 till 2008. The inclusion criteria of this study were:

to have an hystological diagnosis of endometrial carcinoma and

a minimal follow up of three months untill five years. We have

recovered 604 patients wich met this criteria during that time of

period. We already know 141 cases of recurrence, but at the time

being, we still have left 100 cases to analyse.

Results: Results will be completed as soon as the 100 cases left are

fully analyzed.

Conclusions: Endometrial carcinoma is the most frequent

gynecological cancer. The study of our casuistic and its comparision

with the published literature, allows us a better knowledge of