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Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413S729

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Does substance abuse increase prematurity and low
birth weight?
K. Khashia1 , T. Breslin1 , N. Swamy2 , J. Patrick1 . 1 Royal Oldham
Hospital, 2 Royal Glamorgan Hospital
Background: Poly substance abuse tends to be common. Substance
abuse can be associated with IUGR, pre-term labour, and low birth
weight of babies. These women do need a lot of social support in
their pregnancy and hence involvement of drug laison midwife is
To assess obstetric and neonatal outcome of women with
substance abuse;
To assess whether substance abuse is associated with IUGR, preterm labour, and low birth weight of babies;
To assess if referral was made to the drug liason midwife.
Patients identied Euroking maternity database;
Review of 66 case notes of women with substance abuse in
pregnancy across 3 hospitals in the Penine Acute NHS trust
(Rochdale informary/North Manchester general hospital and
Royal Oldham hospital);
Time period 1/1/2006 to 30/06/2007.
All women with substance abuse should be under consultant lead
shared care;
All women should have growth scan at 28 weeks;
All women should be referred to drug liaison midwife.
Results: Poly substance abuse was common, with most of them
using cannabis(76%) and methadone use in 20%. 24% were teenage
pregnancies. 23% booked late after 20wks. 83% were under
consultant led shared care and drug laison midwife was involved
in the care of 43%. There was history of smoking in 88% and
alcohol intake in 44%. 14% were subjected to domestic violence.
Prematurity and lowbirth weight were noted in 15%. There were
suspected congenital anomalies in 3%. The caesarean section rate
was 16%.
Conclusion: Consultant led shared care and involvement of a drug
laison midwife to offer support does improve the outcome of a
high risk pregnancy.
Maternal serum placental protein (PP13) as a potential marker
for early pre-eclapsia
X. Ma, B. Chen, X. Xin. Department of Ob/Gyn, Xijing Hospital, Fourth
Military Medical University
Objective: To evaluate rst-trimester maternal serum placental
protein 13 as a screening test for preeclampsia (PE).
Methods: In prospective nested casecontrol studies, PP13 levels
were measured during 1st, 2nd and 3rd trimesters in women who
developed PE vs matched controls.
Results: Placental protein 13 (PP13) is a 32-kd dimer protein
produced only in the placenta which belongs to one of 56 members
in one super family. PP13 is thought to be involved in normal

implantation. As pregnancy progresses the level of pp13 in maternal

serum slowly rises. The PP13 values in women who went to
develop late-onset PE were lower in 1st trimester (613) weeks
but ontinuously increased to exceed the level of unaffected women
in the 3rd trimester.
Conclusion: PP13 has been found to be a useful marker at 613
weeks of pregnancy for early serum screening to assess the risk to
develop preeclampsia.
Hyperemesis gravidarum and Wernickes Syndrome
O. Oviedo Moreno, J. Macedo Pereira, A. Romay Bello, R. Rodriguez
Rabanal, G. Jimenez Alba. Hospital Clnico San Carlos, Madrid
Objectives: Hyperemesis gravidarum is the condition of incoercible
nausea and vomiting in pregnancy, preventig the proper food, with
a low morbidity at present thanks to hydroelectrolitical support.
One of the most feared reversible complication is Wernickes
Syndrome, by reduced intake of thiamin and other B vitamins.
Thiamine is a coenzyme in the metabolism of carboydrates. Its
decit cause decrease in consumption, cerebral glucose metabolism
abnormalities and neural function. Its a medical emergency, fatal
to 20% of cases. Classic triad is characterized by ophthalmoplegia,
ataxia and confusional disorders.
Methods: We present the case of a 21 years old, primigravida
with multiple episodes of incoercible vomiting and intolerance
to the oral alimentation since sixth week of pregnancy with a
poor response to treatment, complicated peripancreatic reaction
to developments en 12 weeks, ataxia, peripheral polyneuropathy
and confusional disorders in three-month period, visual and
hearing hallucinations, uid and electrolyte imbalance affecting
heart. Neurological manifestations partially respond to thiamine
administration. Several fetal Growth Intrauterine restriction cause
caesarian section in 36 week. In the postpartum period, patient
moves well and its currently asintomatic.
Results: We must suspected Wernicke encephalopathy in patients
with cronic vomiting and neurological disorders beginning
treatment as soon as possible replacement thiamine.
Role of serum bile acids in diagnosis of intrahepatic cholestasis
of pregnancy and effect of ursodeoxycholic acid therapy on
bile acids and perinatal outcome
R. Mahey, N. Agarwal, A. Kriplani, A. Saraya, P. Garg. All India
Institute of medical Sciences, New Delhi
Objectives: Diagnosis of intrahepatic cholestasis of pregnancy (ICP)
may be difcult by liver function tests i.e. transaminases, alkaline
phosphatase and serum bilirubin levels because these are also
affected in other conditions. We conducted a prospective clinical
trial at All India Institute of Medical Sciences, New Delhi, India
to assess the role of serum bile acids in diagnosis of ICP, effect
of ursodeoxycholic acid (UDCA) therapy on bile acid levels and
perinatal outcome in relation to bile acid levels.
Materials and Methods: Baseline serum bile acids were assessed
in 100 cases, 50 of ICP (group I) and 50 asymptomatic pregnant
women (group II) between 1636 weeks POG. UDCA was
administered in dose of 300 mg thrice daily to group I which
was continued till delivery. Serum bile acids were repeated after
4 weeks of therapy or at time of labour whichever occurred
earlier. Other liver function tests were done at 2 week interval. All
parameters and perinatal outcome of study group were compared
with controlgroup.
Results: The mean serum bile acid levels in study group
were 76.4739.74 m mol/L. and that of control group were
29.185.67 mmol/L. (p value < 0.001). The severity of itching was
directly correlated with bile acid levels. After 4 weeks therapy
with UDCA the mean serum bile acids were 44.615.4 m mol/L
(41.6% reduction, p value < 0.001). There was signicant reduction