Maternal fetal medicine-perinatology

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Materna l Fetal M e d i c i n e - P e r i n a t o l o g y - Oral P r e s e n t a t i o n s

OraI-MFM&P-001 The value of uterine artery doppler at 11-14 weeks of gestation in the identification of women at risk of developing pre-eclampsia and fetal growth restriction

Tekcan C 1, Naki M M 1, C)zcan N 2, Cebi M 2, Kanadikirik F 1, Has R 3

Department of Obstetrics and Gynecology, GSztepe Research and Training Hospital,/stanbu/, Turkey 2 Department of Radiology, Sonomed,/stanbu/, Turkey 3 Department of Obstetrics and Gynecology, Faculty of Medicine, University of/stanbu/, Turkey

OBJECTIVES: To examine the value of uterine artery Dopp- ler at 11-14 weeks of gestation in the identification of women at risk of developing pre-eclampsia and fetal growth restriction. METHODS: Uterine artery Doppler was carried out at 11-14 weeks in 187 consecutive singleton pregnancies attending for routine antenatal care in GSztepe-Research-and-Educa- tion-Hospital. Bilateral uterine arteries were identified using color flow mapping and velocity waveforms were obtained using pulsed Doppler.The mean pulsatility index(PI),resistance index(RI),peak systolic over end-diastolic ratio(S/D), and early diastolic notching of-the-two arteries was determined and predictive value of-the mean PI,RI,S/D,and early diastolic notching >95th centile in the prediction of pre-eclampsia and/or fetal growth restriction was calculated. RESULTS: Satisfactory flow velocity waveforms were obtained from both uterine arteries in 177(94.6%) of-the 187 pregnancies examined and complete outcome information was obtained for 170(90.9%) of-the women.The 95th centile of-the uterine artery mean PI,mean RI,mean S/D was 2.81,0.91, and 15.27 respectively and did not change significantly with gestational age.The pregnancy was complicated by pre-eclampsia in 13(7.6%) cases and by fetal growth restriction in 10(5.9%) cases.The sensitivity of-a-mean P1>2.81, mean Rl>0.91,and mean S/D>15.27 for pre-eclampsia was 50%, 31.25%, 12.5% but for fetal growth restriction alone it- was 37.5%, 37.5%,and 25% respectively. CONCLUSIONS: Uterine artery Doppler at 11-14 weeks of gestation may identify half-of women develop severe pre-eclampsia and/or fetal growth restriction. KEY WORDS: uterine artery doppler, 11-14 weeks of gestation, preeclampsia, fetal growth restriction

OraI -MFM&P-002 First trimester screening with fetal neck translucency and nasal bone measurement

Aydogdu M, Frenz JP, Schr6der W Department of Gynecology and Obstretics, Klinikum-Bremen-Mitte, Bremen, Germany

(4,5%) and PAPP-A (MoM) under the 5 th percentile in N2=15 (7,5%) cases. N1=64 (9,4%) woman had a calculated risk more than 1:300 to have a fetus with down syndrom. Nasal bone measurements were documented in 296 cases, two had an absent nasal bone. We detected 6 cases with down syndrom, 3 Trisomie 18, 1 Trisomie 13 and 1 Turn- er.Fetal NT and nasal bone in the first trimester is a good marker to calculate the individuel risk of aneuploidy. Howev- er, it's necessary to have good technical equipment, good training and large experience. KEY WORDS: first trimester, neck translucency, nasal bone

OraI -MFM&P-003 The association of abnormal fetal heart rate patterns with nucleated red blood cells and l ipid peroxidation products at birth

Dede FS, Kovalak EE, Gelisen O, Dede H, Sariisik B, Haberal A Ankara Etlik Maternity and Women's Health Teaching Hospital, Ankara, Turkey

OBJECTIVES: To evaluate lipid peroxidation products and nucleated red blood cells in umbilical cord blood, as a marker for fetal hypoxia in pregnancies complicated by nonreassuring fetal heart rate tracings. METHODS: Umbilical cord blood samples were collected from 41 singleton term neonates presented with nonreassuring fetal heart rate patterns (study group) and 45 term normal neonates (controls) for determination of nucleated red blood cells, lipid peroxidation products and antioxidant activity. RESULTS: The median nucleated red blood cells per 100 white blood cells were 13 (range, 0-37) in the study group and 8 (range, 0-21) in the control group. The levels of lipid peroxidation products and antioxidant activity in the study group were higher than in normal pregnancies (p<0.001). Stepwise regression analysis have identified meconium stained amniotic fluid (R2=0.15, p<0.0001) and umbilical artery PC2 (R2=0.1, p=0.002) as independent variables associated with elevated NRBC counts and umbilical artery PCO2 (R2=0.15, p<0.0001) with lipid peroxidation products in patients with nonreassuring fetal heart rate patterns. CONCLUSIONS: Both lipid peroxidation products and antioxidant functions with nucleated red blood cells in the cord blood of newborns were found to be elevated in patients with nonreassuring FHR patterns during labor and can be used as a marker for fetal hypoxia. KEY WORDS: fetal heart rate, nucleated red blood cell, lipid peroxidation

Orat-MFM&P-004 Fetal pulse oximetry decreases cesarean section rate in prostaglandin induced deliveries

Between 11+0 and 13+6 week we do an extended fetal ultrasound examination at our department with well defined steps including the fetal neck translucency (NT) and nasal bone. To give a calculation of the risk for aneuploidy we use special software of the Fetal Medicine Foundation.Between 01/2002 and 12/2004 (36 month) we did N1=650 first trimester ultrasound examinations at our department with the ATL 5000. A total of N1=49 (7,5%) fetus had NT measurements above the 95 th percentile for the gestational age. Free-13- HCG (MoM) above the 95 th percentile we detected in N2=9

Caliskan E, Turkoz E, Corakci A, Ozeren S, Yucesoy I Department of Obstetrics and Gynecology, University of Kocaeli, Kocaeli, Turkey

OBJECTIVES: To compare cesarean delivery rates of women who were monitored via external fetal cardiotocogram alone or in combination with pulse oximetry. METHODS: Two hundred thirty women who had a maternal or fetal indication for delivery received 50 pg misoprostol every four hours for induction up to six doses. They were ran-

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Materna l Fetal M e d i c i n e - P e r i n a t o l o g y - Oral-, Video- , P o s t e r P r e s e n t a t i o n s

domized to follow-up with continuous external fetal monitorisation alone (group I n=116) or in combination with fetal pulse oximetry (group II n=114). Cesarean delivery was the main outcome measure RESULTS: The mean gestational age in group I was similar to group II (m1=38.8_+2, m2=38.6+2.1, p=0.26). Anterpartum risk factors including gestational diabetes, hypertension, premature rupture of membranes, intrauterine growth restriction, fetal anomaly and postterm pregnancies were similar in the two groups (p>0.05). Similar rates of tacysystole or hyperstimulation occured in the two groups (p>0.005). The cesarean section rate in group I (n=18,15,7%) was significantly lower than group II (n=31 26.7%; p=0.04). The number of newborns with cord blood pH<7.15 was similar in the two groups (n1=4, n2=4; p=0.9). CONCLUSIONS: Using pulse oximetry results in lower cesarean delivery rates without changing neonatal outcomes in prostaglandin induced deliveries. KEY WORDS: Fetal pulse oximetry, misoprostol, cesarean delivery rate, labor induction

OraI -MFM&P-005 Multivessel Doppler surveillance in preterm growth-restricted fetuses and associations with critical perinatal outcomes

Terzioglu N, K6hler W, Feige A Department of Obstetrics and Prenatal Diagnosis, Hospital Nuremberg South, Nuremberg, Germany

Objective Assessment of the relationship between abnormal arterial and venous Doppler findings and perinatal outcome in preterm growth-restricted fetuses with abnormal placental function. Methods 49 Patients with suspected intrauterine growth restriction (IUGR) underwent uniform fetal assessment including umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV) Doppler. Groups based on the last Doppler exam were: 1. UA resistance index (RI) >2 SD above the gestational age mean and/or absence or re- versal of enddiastolic velocities (UA-AREDV) (n=12, 24,5%), 2. MCA-PI >2SD below the gestational age mean ("brain sparing") in addition to abnormal UA-RI (n=19, 38,8%), 3. DV peak velocity index (PVIV) >2SD above the gestational age mean (n=18, 36,7%). The three risk groups were examined for their efficacy to predict critical outcomes (perinatal and neonatal death, respiratory distress (RDS), bronchopul- monary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), sepsis, acidemia and birth asphyxia) before 37 weeks' gestation. Statistical analysis was performed with SPSS 11.0 using the Mann-Whitney U- tests. Results Perinatal and neonatal mortality were highest in group 3. All postpartum complications were more frequent in fetuses with abnormal ductus venosus flow. The only statistically significant relation between arterial Doppler indices and outcome was the association between "brain sparing" and RDS. Conclusion Growth restricted fetuses with an abnormal ductus venosus flow have worse perinatal outcome compared to those where flow abnormality is confined to the umbilical or middle cerebral artery. In fetuses with "brain sparing", venous Doppler allows detection of further deterio- ration. The incorporation of venous Doppler into fetal surveillance is therefore strongly suggested for all preterm IUGR fetuses. KEY WORDS: doppler, survaillance, preterm, perinatal outcome

Video-MFM&P-001 Mechanical methods of labor reduction by double balloon devices(Pre-induction cervical dilators-PICD) and late pregnancy terminations by extra-amniotic instillation of diluted PG solutions

Atad j1, Auslender R 2, Bardicef M 2, Calderon 13, Leron E 4, Abramovici H 5 1Atad Development & Medical Services, Haifa, Israel 2 Department of OB & GYN, Carmel Medical Center, Haifa, Israel 3 Department of OB&GYN, Bnei-Zion Medical Center, Haifa, Israel 4 Department of OB & GYN, Soroka Medical Center, Beer Sheva, Israel 5 The Bruce Rappaport Faculty of Medicine, Haifa, Israel

OBJECTIVES: To demonstrate by a video presentation the induction of labor process using the pre-induction cervical dilators PICDs and late pregnancies terminations by extraamniotic instillation of diluted PG solutions in patients with intra-uterine fetal demise or fetal anomalies. METHODS: A pre-induction cervical dilator PICD consisting of a double balloon device catheter is introduced though the cervical canal,the uterine and the vaginal balloons of the device are inflated with 80 ml of N.S kept in place for 12 hours than removed. A cervical dilation of 3-4 cm at removal will al- low easy ARM and management of labor.The secong part of the video presentation will show the extra-anmniotic approach of late pregnancies termination due to fetal or maternal indications using a long tip double balloon device designed for this procedure. RESULTS: The results of 250 IOL in patients with non-fa- vorable cervical conditions and 340 consecutive late pregnancies termination will be presented CONCLUSIONS: 1.Pre-induction cervical dilators PICD catheters are safe and effective in inducing labor when cervical condiotions are unfavorable and prolonged uterine contractions are preferably avoided.2. Extra-amniotic instillation of diluted PGE2 solutions through the double balloon (Type 3PICD) devices is a safe anf effective approach for late pregnancies terminations including patients who have delivered pviously by Caesarean section. KEY WORDS: labor induction, cervical dilatation, double balon device, PG solutions

Poster-MFM&P-001 Evaluation of the clinical outcomes M the pregnants with Type ! Diabetes Mellitus

Yermez E, Sanci M, Ata N, Sek~ I, Eraydin Ersen, Ispahi C SSK Ege Dogum ve Kadin Hastaliklari Egitim Hastanesi; tzmir

OBJECTIVES: Previous estimaiton of macrosomia and neonatal hypoglycemia in 92 pregnant women with type I Diabe- tes Mellitus(DM). METHODS: This case control study has been done in the pregnant women with type I DM who admitted to SSK Aegean maternity Hospital between january 2000 and december 2003. RESULTS: The duration of DM in the patients was 11,9+5,7 years; 34 of the patients were primigravid. The mean value of HbAlC during the pregnancy was 7,1%+0,7.No close re-

Maternal Fetal M e d i c i n e - P e r i n a t o l o g y - Poster Presentat ions

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lationship was found between the fasting and postbrandial blood glucose levels and HbA1C level at any time of pregnancy. However, a negative correlation has been found between neonatal blood glucose and maternal blood glucose level when the maternal blood glucose level was greater than 8 mM (144 mg/dl), neonatal blood glucose level was less than 2,5 mM or 34mg/dl. We didn't find any relation between HbA1C levels and the birth weight of the neonates (R=0.02, P>0.1). In the third trimaster, the fetal abdominal circumference was strongly correlated with the birth weight of the neonates(R=0.70, P<0.001). DISCUSSION: Neonatal hypoglycemia detected at the time of labor was in close relationship with maternal hyperglyce- mia but similar relationship was not found with HbA1C levels. Likewise there was no correlation between fetal macrosomia and HbA1C levels. KEY WORDS: Type I Diabetes Mellitus, pregnancy, macrosomia, neonatal hypoglycemia

Poster-M FM&P-002] C-reactive protein (crp) level establishment during pregnancy with a highly sensitive method: can we use it as a severe preeclampsia criteria?

Ertas IF 1, Kahyaoglu S 1, Turgay 11, Sut N 2, Yilmaz B1, Ozel M 1, Danisman N 1 1Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey 2 Department of Biostatiscs, Cerrahpasa University, Istanbul, Turkey

OBJECTIVES: To investigate CRP levels in normotensive, mild and severe preeclamptic pregnant women. METHODS: Prospective case control study has been performed for 115 normotensive healthy pregnant women and 98 women who were diagnosed as preeclampsia. Blood samples were obtained between 24-40 weeks of gestation at antenatal clinic and high risk pregnancy deparment of the hospital. CRP, an acute phase reactant, was measured in maternal serum using a highly sensitive assay on a Roche/Hitachi immunonephelometric analyzer with a detection limit of 0.1 mg/L. Main outcome measures were prepregnancy BMI, platelet count, hepatic function and kid- ney function tests. Mild and severe preeclampsia were defined according to the criteria of the International Society for the study of Hypertension in Pregnancy. Mean values of the case and control subjects were compared by Kruskal Wallis and Bonferroni post-hock tests. RESULTS: Mean serum CRP concentration in normotensive, mild and severe preeclamptic pregnant patients were 7.31, 8.81, 23.42 respectively. There was significant relationship between CRP values and hepatic function tests in severe preeclamptic patients (OR:9.75, 95%C1: 2.14-44.3; p<0.001). CONCLUSIONS: These findings suggest that high levels of CRP can become a useful, sensitive practical parameter in diagnosis and follow up of severe preeclampsia. KEY WORDS: C-reactive protein, pregnancy, preeclempsia

Poster -MFM&P-003 Placebo Controlled Trial of Heparin and Aspirin for Women with Recurrent Pregnancy Loss Associated with thrombophilia

Kocak I, 0sten C, Bese E Obstetrics and Gynecology, 19 Mayis University, Medical School, Samsun- Turkey

OBJECTIVES: To investigate whether low molecular weight heparin and low-dose aspirin increase the pregnancy rate in acquired thromphilia in women with recurrent pregnancy loss. METHODS: The participants were 50 women with a history of recurrent miscarriages (>3) and acquired thrombophilia; women with systemic lupus erythematosus or a history of thrombosis were excluded. Women with 3 or more fetal loses and persistently positive results for antiphospholipid antibodies were randomly allocated to receive subcutaneous low molecular weight heparin (50001U) and aspirin (80mg/daily) (n=25) or placebo (n=25). RESULTS: Viable infants were delivered in 11of 25 (%44) women in placebo group and 20 of 25 (80%) women treated with heparin and aspirin(p<0.005). CONCLUSIONS: A high success rate is achieved when low dose aspirin and low molecular weight heparin is used for treatment of acquired thrombophilia in pregnancy. KEY WORDS: Recurrent pregnancy loss, heparin, acetyl- salicyclic acid

Poster -MFM&P-004 Impact of Maternal Age on Perinatal Outcomes in Adolescent Pregnancies

Ingec M, Borekci B, Yilmaz M, Kadanali S Department of Obstetrics and Gynecology, University of Ataturk, Erzurum, Turkey

OBJECTIVES: To investigate the effects of maternal age in adolescent pregnancy on perinatal outcome. METHODS: The study group consisted of adolescent pregnant women under 19 years, and the control group of pregnant women between 20-29 years. Adolescent pregnancies were divided into three subgroups according to maternal age; ,=17, 18 and 19 years. RESULTS: The incidence of adolescent pregnancies was 4.08%. Eighty eight percent of mothers were primiparous. Mean gestational week of adolescence was two weeks earlier than controls (p<0.0001). There weren't differences between groups in frequency of anemia, PROM, IUGR, preeclampsia, congenital malformations, and perinatal mortality. As compared with controls, women of 18 years or less were at higher risk of preterm delivery (p<0.05), and had higher percentage of non-vertex presentation (p<0.001). Three subgroups of adolescent patients' mean birth weight was lower (p<0.0001), and rate of low birth weight (<2500 g) was higher (p<0.005) than controls. The incidence of eclampsia was higher in women of <17 years than controls (p<0.0001) and 19 years (p<0.001). CONCLUSIONS: Adolescent pregnancies have partially increased risk of adverse perinatal outcome. In pregnancies less than 18 years a higher risk of preterm delivery and less than 17 years a higher risk of eclampsia might be expected. KEY WORDS: maternal age, adolescent pregnancy, perinatal outcome

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M a t e r n a l Feta l M e d i c i n e - P e r i n a t o l o g y - P o s t e r P r e s e n t a t i o n s

Poster -MFM&P-005 Primary carcinoma of the fallopian tube: results of 4 cases

Ingec M 1, Kadanali S 1, Erdogan F 2, Kumtepe y1 1 Department of Obstetrics and Gynecology, University of Ataturk, Erzurum, Turkey 2 Department of Pathology, University of Ataturk, Erzurum, Turkey

OBJECTIVES: Primary carcinoma of the fallopian tube (PCFT) is a very rare and lethal neoplasm of the female genital tract. The purpose of this report is to evaluate diagnosis and treatment for our patients with PCFT. METHODS: Four patients with the diagnosis of PCFT treated between 1998 and 2002 were investigated through medical record. Diagnosis, treatment, and follow-up outcomes of patients were discussed. RESULTS: The age range at the time of diagnosis was from 36 years to 56 years. All patients were multiparous, and three patients were postmenopausal. None of the patients with PCFT was diagnosed preoperatively. Three patients underwent TAH, BSO, infra-colic omentectomy, and pelvic lymphadenectomy. Postoperatively, a combination of chemotherapy of paclitaxel, and cisplatin was given to them. This combination was repeated six times with 21 days intervals. TAH, BSO was performed to one patient and treated with combination of cyclophosphamide, adriamycin and cisplatin administered intravenously on day one every 28 days for six cycles. The serum levels of CA 125 were decreased <35 U/ml during chemotherapy in all patients. CONCLUSIONS: The serum CA 125 level can be useful postoperatively follow-up of patients with PCFT. Paclitaxel and cisplatin combination may be beneficial for adjuvant therapy. KEY WORDS: primary fallopian tube carcinoma,adnexal mass, serum CA 125, postoperative therapy

Poster -MFM&P-006 Perinatal outcomes of patients with a positive 1-hour glucose challenge test but negative diagnostic test for gestational diabetes

GQmOs I.I, Turhan NO Department of Obstetrics and Gynecology, Fatih University School of Medicine, Ankara, Turkey

OBJECTIVES: To determine the perinatal outcomes of patients with positive 1-hour glucose challenge test (GCT), but negative diagnostic test for gestational diabetes mellitus (GDM). METHODS: Pregnancy records of 283 pregnants were reviewed. Patients were screened for GDM with one-hour 50 g GCT at 24-28 weeks of gestation. Patients with GCT values are >130 mg/dL were refered for the 3 hour, 100-g OGTT. Positive GCT but negative for OGTT group (Group A) were compared retrospectively with the group of negative GCT (Group B). RESULTS: We identified 102 patients with positive GCT but negative for OGTT (Group A) and 132 patients with negative GCT (Group B). Pre-pregnancy BMI, gestational weight gain were significantly higher in group A than group B. Polihy- dramnios was also observed significantly more frequent in group A. Prevalance of preterm labor, pregnancy induced

hypertension, cesarean delivery, mean birthweight, proportion of babies admitted to NICU were higher in group A but were not statistically different from the patients with negative GCT. CONCLUSIONS: Pregnants with a positive GCT and negative OGTT seem to be at risk for developing obstetric complications. These patients must be followed up carefully during the antepartum and intrapartum period. KEY WORDS: Glucose challange test, pregnancy outcome, screening

Poster -MFM&P-007 Protein S deficiency and Factor V Leiden mutation in pregnancy

GL~mL~s II, Turhan NO Department of Obstetrics and Gynecology, Fatih University School of Medicine, Ankara, Turkey

Thrombophilias are inherited or acquired conditions that pre- dispose individuals to thromboembolism. Thrombophilic disorders increase the obstetric complications such as early pregnancy losses, fetal growth retardation, placental abrup- tion. Recurrent pregnancy loss affects 1% to 3% of women of reproductive age and a large proportion remain unexplained. Thrombophilic defects were found in 49% to 65% of women with pregnancy complications compared with 18% to 22% of women with normal pregnancies. We report a case of pregnant who had a history of recurrent pregnancy loss that complicated with protein S deficiency, Factor V Leiden mutation and antiphospholipid syndrome in her pregnancy. First she was admitted to hospital on 8th weeks of pregnancy with vaginal bleeding. That was the second early pregnancy loss of her. Laboratory findings revealed heterozigous Factor V Leiden mutation, protein S deficiency and positive antiphospholipid antibodies. Six months later, she came to our clinic for her third pregancy on 6th weeks. She was treated with Low Molecular Weight Hepadn (nadroparine calcium 0.4 ml) and 80 mg asetylsalicylic asid. Finally she had a healthy baby on 38th weeks of pregnancy with ceaserean section. KEY WORDS: thrombophilia, protein S deficiency, factor V leiden mutation, pregnancy

Poster-MFM&P-008 Prevalance of Helicabacter Pylori seropositivity in the first trimester of pregnancy

Tamburaci E 1, Gunduz 0 2, Akar M 1, Simsek M1, Zorlu G 1 Department of Obstetrics and Gynecology, Akdeniz Univer-

sity School of Medicine, Antalya/Turkey 2 Department of Public Health, Akdeniz University School of Medicine, Antalya/-lurkey

OBJECTIVES: To investigate the prevalance of Helicobac- ter pylori seropositivity in the first trimester of pregnancy by using serologic test results. METHODS: Fifty pregnant women with H.Gravidarum and 250 asymptomatic gestational age matched pregnant women without hyperemesis symptoms were enrolled in a prospective study. Serum samples collected from cases were investigated in terms of specific antibodies for H. py- Iori (immunoglobulin-lgG, IgA). Statistical analysis of the

Maternal Fetal M e d i c i n e - P e r i n a t o l o g y - Poster Presentations

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data obtained from the groups was analysedvia chi-square test. RESULTS: There was no statistically significant difference in the demographic characteristics between the study and the control groups (p>0.05). The prevalance of H Pylori seropositivity was 82% and 44% in hyperemesis gravidarum patients and the control group respectively. The difference was statistically significant (p<0.001). CONCLUSIONS: HP infection was found to be significantly more prevalent in hyperemesis gravidarum in our study. We suggest chronic infection of H. pylori as one of the important contributors to the pathogenesis of hyperemesis gravidarum even though it may not be the single cause of the disorder. KEY WORDS: Helicobacter pylori, hyperemesis gravidarum, first trimester of pregnancy.

Poster-MFM&P-009 The relationship between plasma homocysteine concentrations and severity of preeclampsia

Ingec M, Borekci B, Kadanali S Department of Obstetrics and Gynecology, University of Ataturk, Erzurum, Turkey

OBJECTIVES: The aim of this prospective study is evaluate plasma levels of homocysteine association with severity of preeclampsia. METHODS: This case-control study was performed with 32 mild preeclamptic patients, 25 severe preeclamptic patients, 16 eclamptic patients. The control group was matched with study groups for age, weight and gestational age at study, included 34 normotensive healthy pregnant women. Mater- nal plasma homocysteine concentration was measured prospectively at antenatal period by high performance liquid chromatography method. RESULTS: There were no significant differences in demographic characteristics between the study and control groups. As expected, the mean arterial pressure was higher in patients with eclampsia than control, and birth weight was higher in controls than study groups (p<0.0001). Mean plasma levels of homocysteine in women with severe preeclampsia (16.7+10.1 pmol/L) and eclampsia (16.5 • 9.6 pmol/L) were significantly higher than those in mild preeclampsia (7.7• pmol/L) and controls (6.7_+1.6 pmol/L) (p<0.0001). But, plasma levels of homocysteine were not significantly different between mild preeclampsia and controls. CONCLUSIONS: An increased plasma homocysteine concentration may be a useful marker of established severity of preeclampsia, but not useful for the prediction of mild preeclampsia. KEY WORDS: Homocysteine, preeclampsia, eclampsia, pregnancy

Poster -MFM&P-010 Amniocentesis Results of fetuses with an anomaly detected at the Prenatal Ultrasonographic Screening

Balci O, Gezgmc K, Acar A, Aky0rek C Department of Obstetric and Gynecology, Selcuk University Faculty Of Meram Medicine, KONYA, Turkey

OBJECTIVES: To evaluate the amniocentesis results of fetuses with an anomaly detected at the Prenatal Ultrasono- graphic Screening in our clinic. METHODS: 42 fetal anomalies were detected during the routine prenatal ultrasonographic scan of 638 cases. Amnio- centesis were performed in all of the cases with a fetal anomaly (n=42), and cytogenetic analysis results were evaluated. RESULTS: In 3 (%7.14) out of 42 cases, the amniotic fluid cells could not be cultured at the amniotic culture. There- fore, an repeat amniocentesis or cordocentesis was offered. One case accepted a cordocentesis to be performed, the others did not. In 40 cases with a karyotype result, totally 6 chromosomal abnormalities (%15) were detected. All of these cases had numerical chromosomal abnormalities, no structural chromosomal abnormalities were detected. CONCLUSIONS: Ultrasonography is a beneficial, non-invasive diagnostic method in the evaluation of fetal anomalies, and in the selection of candidates for prenatal invasive methods. KEY WORDS:Prenatal Ultrasonography, Fetal Anomaly, Amniocentesis. KEY WORDS: Prenatal Ultrasonography, Fetal Anomaly, Amniocentesis.

Poster-MFM&P-011 Placebo controlled trial of heparin and aspirin for women with recurrent pregnancy loss associated with acquired thrombophilia

Kocak [, 0stl3n C, Bese E Obstetrics and Gynecology 19 Mayis University, Medical School, Samsun-Turkey

OBJECTIVES: To investigate whether low molecular weight heparin and low-dose aspirin increase the pregnancy rate in acquired thromphilia women with recurrent pregnancy loss. Study design: The participants were 50 women with a history of recurrent miscarriages (>3) and acquired thrombophilia women with systemic lupus erythematosus or a history of thrombosis were excluded.Women with 3 or more fetal loses and persistently positive results for antiphospholipid antibodies were randomly allocated to receive subcutaneous low molecular weight heparin (50001U) and aspirin (80mg/daily)(25) or placebo (25). RESULTS: Viable infants were delivered of 11of 25 (%44) placebo and 20 of 25 (80%) women treated with heparin an- daspirin(p<0.005) CONCLUSIONS: A high success rate is achieved when low dose aspirin and low molecular weight heparin is used for acquired thrombophilia in pregnancy.Key Words:Thrombo- philia, acquired thrombophilia, recurrent pregnancy loss. KEY WORDS: Thrombophilia, acquired thrombophilia, recurrent pregnancy loss.

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Maternal Fetal M e d i c i n e - P e r i n a t o l o g y - Pos te r P resen ta t i ons

Poster-MFM&P-012 Fraser Syndrome: a case report diagnosed prenatally at 17 weeks old and postpartum examinations

Biri A 1, Guler 11, Himmetoglu 01, Karaoguz M y2, Balci Sevim 3 1 Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine,Ankara, Turkey 2 Department of Genetics, Gazi University Faculty of Medicine, Ankara, Turkey

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

ABSTRACT: We described a fetus who is delivered at 32.weeks of gestation by elective cesarian because of the fetal anhydria and unilateral hydronephrosis.A breech coming,1950 gr, 44 cm a newborn was delivered with multiple malformations and postpartum he didn't cry and siyanosis was appeared. After first interventions the newborns respiration didn't start and bradicardy occured. For this reasons entubation was needed but several trials concluded with lack of success. There was no response to resuscitation and newborn was accepted dead. The first physical examination of the newborn,tracheal atresia, webs, left microophthalmy, bilateral corneal opaque points, bilateral finger and toes syndactyly, hypospadias, low set ears were determined. Postpartum, by our first physical examination we determined bilateral finger and toes syndactylies, laryngeal atresia, hypospadias, micreoph- thalmia, development abnormality of right palpeprally, absence of the eyelash at the medially part of the right palpepra and there is a adherance between the palpepra and cornea, broad nose with low nasal bridge and the left corneal opasity. These and postmortem autopsy findings confirmed the diagnosis of Fraser syndrome.In this report we will focus on postpartum examinations of severe olygohidroamnios in families even if hiperechogenic lungs, previously similarly affected children. KEY WORDS: fraser syndrome, prenatal diagnosis, 17 weeks of gestation

Poster-MFM&P-013 Pregnancy termination in giant myomas: A case report

Tanriverdi HA, Usal D, Cinar E, Barut A Karaelmas University Medical School Department of Obstetrics & Gynecology

Myomas are complicating %1 to %4 of all pregnancies. Pregnancy stimulates the growth of myomas, and there is no clear consensus about the management modalities, follow up, pregnancy termination and operative indications. A thirty three year old women was addmitted to our clinic with two prior pregnancy termination attempts performed for an unwanted pregnancy. A transabdominal ultrasound was performed which revealed a giant myoma of 25x16x14 cm ex- tending to the xyphoid bone. The uterine corpus was in the right subhepatic area, in which a fetus of 9 weeks of gestation was documented. Pregnancy termination was succes- fully performed with prostoglandin induction after fetocide. Here we discuss about termination of pregnancy in patients with giant myomas where dilatation & curretage or Karman aspiration can not be performed. As an alternative procedure prostoglandin induction after fetocide is presented.

KEY WORDS: pregnancy termination, giant myoma, fetocide

Poster-MFM&P-014 Adnexal Masses During Pregnancy

Pilanci B, Imren A, Oztekin D, Kurt S, Tinar S Ministry of Health Ege Maternity Hospital, Izmir, Turkey

OBJECTIVES: Our purpose was to determine maternal and fetal outcome in patients undergoing surgery for pelvic mass in pregnancy. METHODS: 35 cases of adnexal masses associated with intrauterine pregnancy that required laparotomy or that were diagnosed incidentally at the time of ceserean section were reviewed. Age, gravidy, parity, gestational age, of the diagnosis, clinic presentation and histopatologic features, pregnancy outcomes of the cases were investigated. RESULTS: The incidence of adnexal masses in pregnant women who required surgical management was 4.8 in 10000 live births. A malignant tumor or a tumor of low malignant potential was found in 2.8% of cases. In 1 patient the only finding at the time of laparotomy was leiomyomas and 1 of them was tubular adenoma of rectum. There were 2 intrauterine growth restriction and 1 missed abortion in this cohort of patients. CONCLUSIONS: The incidence of an adnexal mass during pregnancy in our population is consistent with what has been reported in the literature. Most of the adnexal masses remain asymptomatic during pregnancy. For this reason these patient should be managed conservatively. Torsion and rupture of these masses are the complications that threaten both life of mother and fetus so cases should be fo- cused on persistantly. KEY WORDS: pregnancy, adnexal mass, surgery

Poster-MFM&P-015 Serum interleukins (1 beta, 6, 8, 10), tumor necrosis factor alpha and interleukin-2 receptor levels in patients with severe preeclampsia and normotensive pregnant women

Canoruc N 1, Kale A 2, Kale E 1, Yalinkaya A 2, Akdeniz N 2 1 Dicle University School of Medicine, Department of Clinical Biochemistry Diyarbakir, Turkey 2 Dicle University School of Medicine, Department of Obstetrics and Gynecology, Diyarbakir, Turkey

OBJECTIVES: The aim of this study is to compare the concentrations of serum interleukins(l~, 6, 8, 10), TNF-~ and interleukin-2 receptor levels in patients with severe preeclampsia and normotensive pregnant women. METHODS: One-hundred pregnant women were included in this prospective study. Pregnant women divided into two groups. Women with severe preeclampsia(n=50)were compared with normotensive pregnant women(n=50). Serum interleukin 113, 8 and TNFc~ levels were analyzed by immunometric assay using Immulite 2000 analyzer. Serum interleukin 6 and 10 levels were analyzed by solid-phase enzyme- labeled, chemiluminescent sequential immunometric assay using Immulite 2000 analyzer, Serum interleukin-2 receptor levels were analyzed by chemiluminescent assay method

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using Immulite 2000 analyzer. The Student-t test was used for statistical analysis. RESULTS: The mean+SD serum levels of Interleukin 113,6, 8,10,TNF-cc and IL-2R were 30.3+5.3, 16.9_+4.3, 5.9_+1.8, 3.8_+1.1, 6.6_+2.5 and 716.5_+20.8 respectively in preeclampsia group. The mean_+SD serum levels of 1~, 6, 8,10,TNF-cc and IL-2R in the normotensive pregnancy group were 9.43_+2.6, 9.5_+3.3, 12.4_+3.9, 2.7_+0.7, 4.4_+1.6 and 348.8_+35.9 respectively. CONCLUSIONS: Preeclampsia is associated with an imbal- ance between pro-inflammatory and anti-inflammatory cytokines in favor of pro-inflammatory cytokines and TNF-c~, interleukins and Interleukin-2 receptors may contribute to the pathophysiology of preeclampsia. KEY WORDS: pregnancy, interleukin, preeclampsia

Poster-MFM&P-016 Effect of fetal sex on apoptosis regulating proteins in trophoblasts of full - term human placenta

Gol M ~, Tuna B 2, Guclu S 1, Altunyurt S 1, Demir N ~ 1 Department of Obstetrics and Gynecology, Dokuz Eylul University Hospital Izmir, Turkey 2 Department of Pathology, Dokuz Eylul University Hospital, Izmir, Turkey

OBJECTIVES: To examine the effect of fetal gender on apoptosis regulating proteins in the trophoblast cells of human term placenta, with special regard to maternal serum and cord blood hCG levels. METHODS: Thirty - four uncomplicated, singleton, term pregnancies; 17 had male and 17 had female fetuses, were recruited in the study. Apoptosis regulating proteins were measured by using immuno-histochemistry for Bcl-2 and Bax antigens. Staining index values of the two proteins in trophoblasts were compared between the female and male placentas. RESULTS: Maternal serum and cord blood hCG levels were higher in pregnant women with female fetuses than in those carrying male fetuses. There were no sex differences in Bcl- 2 and Bax immunostaining rates of the syncytotrophoblast and cytotrophoblast cells. There were no correlations between maternal serum and cord blood hCG levels, and staining index values of the two proteins in trophoblast cells. CONCLUSIONS: The difference in maternal serum and cord blood hCG levels in correlation with fetal sex is not associated with apoptosis regulating proteins in the trophoblast cells of human term placenta. In addition, fetal gender does not affect trophoblast cell proliferation. KEY WORDS: apoptosis, fetal sex, human placenta

Poster -MFM&P-017 Adult-Onset Still's Disease Diagnosed During Pregnancy

Biri A 1, Ciftci B~, Senol E 2, Haznedarohlu S 3, Gucuyener K 4, Gursoy R 1 1 Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey 2 Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey 3 Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey 4 Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey

OBJECTIVES: Adult-onset juvenile rheumatoid arthritis diagnosed in pregnancy is very rare disorder. Because it re- sembles several infectious, malignant and other rheumato- logical disorder its diagnosis and treatment are often delayed. High-spiking fever with long duration during the orga- "~ogenesis period exposes fetus to the well-known terato- y~.n. CASE: A 28-year-old-woman with fever, eruptions, myalgia, arthralgia and fatigue accepted at 6 weeks' gestation in her first pregnancy. After the exhaustive evaluation she was diagnosed with Adult-onset Still's disease triggered with infectious mononucleosis. She was started on corticosteroid therapy that resulted in the remission of symptoms with healthy live-born infant. DISCUSSION: Adult-onset Stilrs disease must be considered in the evaluation of the fever of unknown origin. Al- though it is a diagnosis of exclusion, empirical steroid therapy may be used as a diagnostic tool. The association between disease and pregnancy had not been described however, in the present report we wanted to emphasize the ter- atogenity of maternal hyperthermia, which is the main symptom of the disease. On the other hand, we think that it is the first report in which EBV was confirmed as initiating factor in pregnant woman. KEY WORDS: Still's disease, adult-onset, pregnancy

Poster-MFM&P-018 Meckel- Gruber Syndrome With Dandy- Walker Malformation As A Rare Association of The Syndrome: Prenatal Sonographic Diagnosis

Kahyaoglu S, Turgay I, Gocmen M, Yilmaz B, Neslihanoglu R, Danisman N Department of High Risk Pregnancies, Zekai Tahir Burak Women's Health and Education Hospital, Ankara, Turkey

OBJECTIVES: MeckeI-Gruber syndrome is an autosomal recessive disorder which includes a triad of major abnormalities like renal cystic dysplasia, occipital encephalocele, and postaxial polydactyly. Autosomal recessive inheritance with a gene locus of 17 q21- 24, 11 q13 has been determined for this syndrome. METHODS: A 33 years old multiparous Turkish woman with a healthy term delivery and a spontaneous abortion at 12 weeks of gestation history has been referred for oligohydramnios at 26 weeks of gestation according to the last menstrual period. They were first degree relatives with her

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husband. At the sonographic examination; beside enlarged dysplastic kidneys, occipital encephalocele, marked hydro- cephaly and posterior fossa cyst with compressed cerebel- lary hemispheres consistent with a Dandy-Walker anomaly has also been demonstrated. Multiple abnormalities like occipital encephalocele, macrocephaly, frontal bossing, saddle nose, marked micrognathia, deep set ears, short neck, dis- tended abdomen, enlarged cystic dysplastic kidneys, postaxial polydactyly of both hands and feet, ambiguous genita- lia and talipes equinovarus have been recorded on the post- modem examination of the fetus. CONCLUSIONS: Meckel- Gruber syndrome is a lethal syndrome that can be diagnosed early in the first trimester with detection of Dandy- Walker anomaly as a central nervous system manifestation. KEY WORDS: Meckel- Gruber Syndrome, Dandy- Walker Malformation, prenatal diagnosis, ultrasonography

Poster -MFM&P-019 Thanatophoric Dysplasia: A Case Report With Prenatal Diagnosis And Postmortem Evaluation Demonstrating The Value of Nuchal Translucency Measurement For Early And Exact Detection

Kahvaoalu S, Turgay I, Gocmen M, Yilmaz B, Ozel M, Danisman N Department of High Risk Pregnancies, Zekai Tahir Burak Women's Health and Education Hospital, Ankara, Turkey

OBJECTIVES: Thanatophoric dysplasia (TD) is a lethal skeletal disorder which is characterized by short bowed long bones, flat vertebral bodies and narrow chest. Type 1 is most common and is characterized by curved long bones with a telephone receiver like configuration, platyspondyly, depressed nasal bridge, full forehead, polyhydramnios in the late second and third trimester. CASE: A healthy 19 years old G1 P0 Turkish woman was first evaluated on sonographic scan at 26 weeks of gestation and the fetus had an huge soft tissue with an echogenic appearance completely surrounding the head of the fetus and resembling cystic higroma was the leading feature during this examination.When retrospectively reviewed,nuchal translucency (NT)value of the fetus at 12 weeks of gestation was 3.8 mm. In postmortem examination, enlarged edema- tous head and hypoplastic extremities with hypoplastic torax were seen as leading features of the anomalous fetus. CONCLUSIONS: Increased NT value with hypoplastic thorax and short limbs gave chance to diagnose TD as early as 15 weeks of gestation for the second case. Diagnostic delay and unnecessary expectant management for overt TD or overtreatment for misdiagnosed TD may be lowered by using NT measurement. KEY WORDS: Thanatophoric Dysplasia, prenatal diagnosis, ultrasonography, nuchal translucency

Poster -MFM&P-020 Pentalogy of Cantrell: Prenatal Diagnosis Including a Wide Open Upper Cervical Spinal Defect As a Rare Association : A Case Report

Kahyaoglu S, Turgay I, Kokanali M K, Kunt C, Yapar E G Department of High Risk Pregnancies, Zekai Tahir Burak Women's Health and Education Hospital, Ankara, Turkey

OBJECTIVES: Cleft sternum with ectopia cordis is the major defect and sternochisis, abdominal wall, pericardial and dia- phragmatic defects are the other manifestations of the clas- sic pentalogy. Cardiac anomalies (including ventriculary septal defect, atrial septal defect, pulmonary stenosis, tetralogy of Fallot), neural tube defects, omphalocele, gastrochisis, malformation of the extremities and caudal regression, midline defects are other associated findings of the syndrome. METHODS: A 22 year- old primigravida woman was first seen in our institution at 16 weeks of gestation. During ultrasonographic examination; ectopia cordis, exencephaly, liver evisceration, low set upper limb, toracal kyphoscoliosis and hypoplastic thorax were demonstrated. Triple test result revealed increased maternal serum AFP level of 5.3 as multiple of median value. A prenatal amniosynthesis has been performed and normal fetal karyotype has been identified. Postnatal examination of the female fetus demonstrated all five components of pentalogy but an additional finding, upper cervical open spinal defect, has been seen that was not reported in the literature previously. CONCLUSIONS: As in this case, an open neural tube defect in the upper cervical region that has been demonstrated during ultrasonographic scan may serve parents to decide terminating the pregnancy with or without other major ana- tomic abnormalities. KEY WORDS: Pentalogy of Cantrell, cervical spinal defect, pregnancy, ultrasonography

Poster-MFM&P-021 Late Postpartum Eclampsia Presenting With Intense Vulvar Edema and Without Antenatal Preeclampsia

Taskin S, Yarci A, Bozaci EA, Atabekoglu C, SSylemez F Department of Obstetrics and Gynecology, Ankara University Medical Faculty, Ankara, Turkey

INTRODUCTION: This case is about an eclamptic patient admitted with serious vulvar edema who was not preeclamptic antenatally. CASE: 20-year old 32 week-twin pregnant women admitted to our clinic with vulvar edema for 24-hours. In physical examination she had very serious vulvar edema even avoiding adduction. Laboratory tests revealed hipoalbuminemia, proteinuria and anemia. In follow up her blood pressure was in normal range.Both fetuses were reactive in non-stress test, but there were reguler uterine contractions accompanied by cervical change. Despite the use of all tocolitic options, the contractions continued and servical changes increased, so delivery was held by cesarian section. At 60th hour she claimed that she had headache, cloudy-sight, and she had 2 tonic convulsions with 20 minutes interval, accompanied by high blood presure levels. After first convulsion as prophylaxis magnesium sulfate infusion was started and at the end of 24 hours it was stopped.

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CONCLUSIONS: Eclamptic patients may not have antenatal preeclampsia so postpartum signs and symptoms should be evaluated more carefully and clinicians should be aware of possible eclampsia. KEY WORDS: postpartum eclampsia, vulvar edema, preeclampsia

Poster-MFM&P-022 Correlations between serum adenosine deaminase activity and peripheral blood cell counts in hyperemesis gravidarum

Taskin S, Seval M, Bozaci EA, s B, Mammadova S, 0nl~3 C Department of Obstetrics and Gynecology, Ankara University Medical Faculty, Ankara, Turkey

OBJECTIVES: The purpose of this trial is evaluating the relation between serum ADA activity and peripheral blood cell counts with hyperemesis gravidarum. METHODS: Serum levels of ADA were measured in women with hyperemesis gravidarum (n=36) and normal pregnancies (n=35). Peripheral blood cells counts were also measured. The relationship between ADA and peripheral blood cell counts were investigated. RESULTS: Serum total ADA activities averaged 21,28_+4,76 U/I and 12,5_+6,2 U/I in hyperemesis gravidarum and normal pregnancies, respectively. Mean ADA activities of hyperemesis gravidarum was significantly higher than normal controls (p<0,001). Peripheral monocytes, lymphocytes and neutrophiles counts were significantly higher in hyperemesis gravidarum than normal pregnancies (p<0,001). The increase of ADA activity correlated with lymphocytes and monocytes but not with neutrophiles. CONCLUSIONS: Increase activity of ADA reflects the increase activity of cellular immunity in hyperemesis. We suggest cellular immunity play an important role in hyperemesis gravidarum pathophysiology. KEY WORDS: pregnancy, hyperemesis gravidarum, serum ADA

Poster-MFM&P-023 The relationship between hormone levels and hyperemesis gravidarum

Seval M, Taskin S, (3zmen B, GQlery(Jz D, Sahincioglu O, OnlL~ C Department of Obstetrics and Gynecology, Ankara University Medical Faculty, Ankara, Turkey

OBJECTIVES: We evaluate the relation between serum hormone levels in hyperemesis gravidarum and normal pregnancies. METHODS: Serum levels of estradiol (E2), progesterone (P), prolactine (PRL), beta human chorionic gonadotropin (BHCG) and thyroid hormones were measured in women with hyperemesis gravidarum (n=40) and normal pregnancies (n=40). RESULTS: Mean TSH, E2, BHCG, progesterone, and PRL levels of hyperemesis gravidarum were significantly higher than normal controls (p<0,05). Mean fT3, and fT4 levels were not significantly different between two groups.

CONCLUSIONS: The pathophysiology of hyperemesis gravidarum is still unknown however its etiology is multifac- toial, with various hormonal and immunologic factors. Our results point to high levels of TSH, E2, BHCG, progesterone and PRL activities are contributing and correlating with occurrence of the hyperemesis gravidarum. KEY WORDS: hyperemesis gravidarum, pathophysiology, serum hormone levels

Poster-M FM&P-024 Determinants of cord blood leptin levels in preeclampsia, growth retardation and normal pregnancy

C)ztQrk N, Yalvac S, Caliskan E, Erten A, DSlen I, Haberal A T C. Health Ministery Ankara Etlik Maternity And Women's Health Teaching Hospital, Ankara Turkey

OBJECTIVES: To investigate the predictors of cord blood leptin level in pregnancies with fetal growth retardation, preeclampsia and normal pregnancies. MATERIAL AND METHODS: Thirty-two pregnant women with intrauterine growth restriction (IUGR), 28 women with preeclampsia and randomly selected 36 normal pregnant women were enrolled. Umbilical cord blood samples were collected for measurement of leptin, cortisol and blood gas after delivery. RESULTS: Cord blood leptin level was significantly lower in the IUGR group (8.9_+9 ng/ml, p=0.01) compared to control group (18.8_+15.8) but not different from preeclampsia group (14.8+15.8). Cord blood cortisol level was significantly higher in the preeclampsia group (27.8+13.4 Ug/dl, p=0.005) compared to control group (19.5_+9.2) and IUGR group (18.6_+12.7). Multiple lineer regression model revealed that fetal birth weight, fetal gender, gestational age, maternal hematocrite, cord blood cortisol level, cord blood hematocrite and presence of fetal intrauterine growth restriction were all independent predictors of cord blood leptin level. CONCLUSIONS: Regulation of cord blood leptin level is a complex process involving fetal gender and fetal anthropometric variables as well as cord blood cortisol, intrauterine growth and hypoxia. Leptin level is decreased in cases of placental insufficiency like IUGR but not in uncomplicated preeclampsia alone. KEY WORDS: pregnancy, preeclampsia, growth retardation, leptin

Poster-MFM&P-025 Bipolar cord coagulation in monochorionic twin pregnancy discordant for anencephaly

Gul A 1, Cebeci A 1, Gedikbasi A 1 , Erol 01, Ceylan Y1, Tekirdag AI 2

Maternal and Fetal Unit, Department of Obstetrics and Gynecology,/stanbu/Bakirkoy Women and Children Hospi- tal,/stanbu/, Turkey 2 Reproductive Medicine Unit, Department of Obstetrics and Gynecology,/stanbu/Bakirkoy Women and Children Hospi- tal,/stanbu/, Turkey.

OBJECTIVES: Bipolar coagulation of the umbilical cord in monochorionic twin discordant for anencephaly at 28 weeks. METHODS: For ligation of the umbilical cord, we used 3.5 mm laparoscopic trocar and 3.0 mm bipolar forcep. The pro-

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cedure was done after achievement of complete aseptic conditions and local anesthesia by injection of 1% lidocaine deep into myometrium. The trocar was inserted into amniotic cavity under ultrasonographic guidance. Bipolar forcep was passed through the trocar and the portion of the umbilical cord close to the placental insersion site was grasped. Bipolar coagulation started at power setting of 20W, and was applied during 30 seconds until arrest of flow. RESULTS: The procedure was completed in 30 minutes without maternal and fetal complications. Postoperative course of the patient and the surviving twin was uneventful. At 35 weeks of gestation, the patient was admitted in labor and delivered vaginally a live female baby and anencephalic female fetus weighing 2200 g and 530 g, respectively. Pla- cental examination revealed monochorionic diamniotic pla- centation weighing 450 g. The mother and the baby were discharged healthy. CONCLUSIONS: Cord ligation with ultrasound guided bipolar coagulation seems to be currently the best available option for selective feticide in monochorionic twin pregnancies. KEY WORDS: monochorionicity, twin pregnancy, cord coagulation, anencephaly

Poster -MFM&P-026 Successful intrauterine treatment with alcohol ablation in a case of acardiac twin pregnancy

Gul A, Cebeci A, Yildirim G, Asian H, Ceylan Y Maternal and Fetal Unit, Department of Obstetrics and Gynecology, Bakirkoy Women and Children Hospital, Istanbul, Turkey.

OBJECTIVES: We report an acardiac twin pregnancy treated with alcohol ablation in utero. METHODS: At 27 weeks of gestation, detailed ultrasonography revealed that the surviving twin was structurally normal with oligohydramnios (5.0 cm AFI) and IUGR (<5 centile). The dead twin was grossly hydropic, measured 12x14x18 cmo Relatively well developed spine and long bones of lower limbs were detected, but the head and the heart were absent. RESULTS: A 20-gauge needle guided with color Doppler USG was directed to abdominal insertion site of the single umbilical artery of the acardiac twin. After blood sampling for karyotyping, 1.0 mL of absolute alcohol was injected, resulting in immediate interruption of the arterial flow to the acardiac twin and the pump twin tolerated the procedure without incident.The size of the acardiac twin resolved over the following weeks and decreased to 5.0 cm in diameter. At 36 weeks of gestation, the patient delivered a live male baby weighing 1750 g and an acardiac twin weighing 390 g, and 480 g monochorionic placenta. After four days of hospitalization, the baby was discharged healthy. CONCLUSIONS: In acardiac twin pregnancy alcohol ablation of the blood supply of the acardiac fetus is minimally invasive and protects the pump twin. KEY WORDS: acardiac twin pregnancy, alcohol ablation, ultrasonography

Poster -MFM&P-027 Spontaneous Iliopsoas Hematoma M Heparin Anticoagulation: Cause of Fetal Loss During Pregnancy

Onan MA, Turp A, Kurdoglu M, Gunaydin G, Kurdoglu Z, Guler I, Erdem A, Himmetoglu O Department of Obstetrics and Gynecology, Gazi University Medical School, Ankara, Turkey

OBJECTIVES: Heparin anticoagulation therapy in pregnancy is together with unexpected potential hazards both to the mother and the fetus. Since they are rarely seen, we aimed to discuss the clinical features of a case ending with fetal demise due to an extensive retroperitoneal iliopsoas hematoma. METHODS: A 33 year old woman was referred to our clinic at 27 weeks' gestation with a diagnosis of preeclampsia and a history of stroke at 23 weeks' gestation. Due to a pro- thrombus formation in left atrium she had been maintained with warfarin anticoagulation after an initial treatment with heparin. At 28 weeks of gestation, her anticoagulation therapy was changed to heparin due to preterm delivery risk. At 32 weeks' gestation, she complained about left groin pain radiating to medial and posterior aspects of left thigh. One week later, symptoms of acute hemorrhagic shock developed. RESULTS: Radiological imaging revealed an extensive retroperitoneal iliopsoas hematoma in mother. The fetus died due to possible acute placental perfusion failure and was delivered by labor induction without any complication. CONCLUSIONS: Heparin therapy during pregnancy may cause serious maternal and fetal complications. Lower ex- tremity pain resembling to a radiculopathy can be the pre- mier sign of a life threatening concealed retroperitoneal hematoma. It is important to be aware of sudden complications of intravenous heparin treatment during pregnancy. Some- times large hematoma formation can occur just in this case, and present a life threatening condition both for mother and fetus. KEY WORDS: pregnancy loss, iliopsoas hematoma, heparin

Poster -MFM&P-028 Effects of Ritodrine Hydrochloride Tocolysis on Echocardiographic Parameters

Tulumbaci 01, Onan MA 1, Turkoglu S 2, Kurdoglu M 1 , Boyaci B 2, Tiras MB 1, Kurdoglu Z 1, Gunaydin G 1 1 Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey 2 Department of Cardiology, Gazi University School of Medi- cine, Ankara, Turkey

OBJECTIVES: The aim of this study was to determine the effect of ritodrine hydrochloride, used for tocolysis and having serious cardiovascular side effects, on echocardiographic parameters. METHODS: Sixty-two pregnant women were included in our study. The study and control groups were composed of patients with preterm labor (group A, n=30) and patients with uneventful pregnancies (group B, n=32), respectively. While the patients in group A were evaluated before and during treatment, those in group B were evaluated only once for

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ejection fraction and fractional shortening of the left side of the heart with echocardiography and for the regional systolic and diastolic functions with the tissue Doppler technique. RESULTS: For the left side of the heart, it was shown that while fractional shortening increased with tocolysis (p<0.05), neither the ejection fraction nor E/A ratio, showing diastolic function, changed significantly (p<0.01). While systolic function parameters (Sasep and Salat) increased due to the ino- tropic and chronotropic actions of the beta-mimetic agents (p<0.05), regional diastolic function parameters (Easep/Aasep and Ealat/Aalat) did not change (p>0.05). CONCLUSIONS: Ritodrine hydrochloride increases myocar- dial oxygen demand significantly. Therefore, it should be used sparingly or avoided altogether in patients with ischemic or structural heart disease. KEY WORDS: pregnancy, tocolysis, ritodrine, ecocardiography

Poster-MFM&P-029 Prenatal diagnosis of ~-thalassemia in East Mediterranean Region of Turkey

Kadayifci O, Demir SC, 0r0nsak IF, Ozg0nen T, Evr0ke IC Cukurova University Faculty of Medicine department of obstetrics and Gynecology Balcali Adana Turkey

OBJECTIVES: We aimed to review the genetic heterogenity of the ~-thalassemia in East Mediterranean region of Turkey and to evaluate our results. METHODS: We evaluated 158 couples who admitted to the Perinatology section of Obstetrics and Gynecology Depart- ment of Medical Faculty of University of Cukurova for prenatal diagnosis of i~-Thalassemia, between January 2000 and December 2002. For the diagnostic procedure Chorion Vil- lous Sampling (CVS) with a free hand technique is performed. RESULTS: After offering prenatal diagnosis to the 158 patients, 146 patients (92.41%) accepted prenatal diagnosis and 12 patients (7.59%) didn't accept the procedure. 47 fetuses were normal, 62 fetuses were carrier and 37 fetuses were effected. IVS-1-110 (G->A) was the most commonly seen mutation type. (n:47). CONCLUSIONS: To provide a successful programme for prenatal diagnosis of ~-Thalassemia we have to educate the people and also perform a tailor made approach according to the patients. KEY WORDS: Prenatal diagnosis, thalassemia, mutation

Poster-MFM&P-030 The factors that influence morbidity and morta l i t y in severe preeclampsia, eclampsia and hel lp syndrome

Demir sc , Evr0ke IC, Ozg0nen T, Kadayifci O, G0zel AB, Ur0nsak IF Cukurova University Faculty of Medicine Department of Obstetrics and Gynecology Balcafi Adana

OBJECTIVES: The aim of this study is to evaluate the pro- gnostic factors affecting morbidity and mortality in severe preeclampsia, eclampsia and Hellp syndrome cases. METHODS: In this study 2245 cases who delivered in Cu- kurova University Faculty of Medicine Department of Obste-

trics and Gynecology between 01.01.2002 and 31.12.2002 were evaluated retrospectively. Ninety -three cases with severe preeclampsia, 26 cases with eclampsia, 19 cases with HELLP syndrome and 6 cases with eclampsia and HELLP syndrome were included into this study. In this study severe preeclampsia cases were evaluated retrospectively for maternal complications. RESULTS: In this study the prevalance of preeclampsia was 20.1% (453/2245), the prevalance of severe preeclampsia, eclampsia and HELLP syndrome was 6.4% (144/2245). These ratios are higher than the English literature. The complication rate was 38% in severe preeclampsia cases. Among the severe preeclampsia cases 32 had eclampsia (22.1%) and 25 had HELLP syndrome (17.3%). The maternal mortality was statistically higher in the cases with jaundice. Also there was statistically significant relation between maternal complications and liver function tests, LDH levels and low platelet levels. CONCLUSIONS: The most important biochemical marker for the maternal mortality was bilirubin levels. KEY WORDS: Severe preeclampsia, eclampsia, HELLP syndrome

Poster-M FM&P-031 Helicobacter py lo r i pos i t i v i t y in pat ients wi th hyperemesis gravidarum

Uckuyu A 1, Ozcimen E E 1, Nisanoglu 01, Yanik F 2, Akgun S 3, Kuscu E 2 i Department of Gyneacology and Obstetrics, Baskent University, Konya, Turkey 2 Department of Gyneacology and Obstetrics, Baskent University, Ankara, Turkey 3 Department of Public Health, Baskent University, Ankara, Turkey

OBJECTIVES: In recent years helicobacter pylori has been suggested to be an etiologic factor in hyperemesis gravidarum (HG). The aim of this study was to analyze the association between HG and H. Pylori infection in our pregnant population. METHODS: The study group consisted of 43 symptomatic and 37 asymptomatic pregnant women admitted to our hospital between November 2004-March 2005. Serum immunoglobuline G antibody for H.pylori and helicobacter stool antigen (HpSA) were assayed in both groups. Chi-square test was used in the statistical analysis. RESULTS: The study and control groups did not reveal any significant difference with respect to the maternal age or the gestational age. The rate of serum H.pylori IgG positivity was 41.9% and 37.8% in the study and control groups respectively. The rate of HpSA positivity was 25.6% and 10.8% respectively. There were no differences between the two groups according to these two parameters (p>0.05). There wasn't any relation between H.pylori Ig G and HpSA either (p>0.05). CONCLUSIONS: Opposite to most of the studies which investigated the relationship between H.pylori infection and HG, our results indicate that H.pylori Immunoglobuline G and HpSA are not associated with HG. KEY WORDS: pregnancy, hyperemesis gravidarum, helicobacter pylori

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Poster-MFM&P-032 The Association of Triple Test Results with Adverse Perinatal Outcomes in Women with Healthy Newborns

Sayin NC ~, Canda MT 1, Ahmet N ~, Kurt 12, Varol FG 1 Department of Obstetrics and Gynecology, Trakya

University, Faculty of Medicine, Edirne, Turkey 2 Department of Biostatistics, Trakya University, Faculty of Medicine, Edirne, Turkey

OBJECTIVES: To investigate the relationship between triple test results and adverse perinatal outcomes in women who delivered healthy fetuses. METHODS: Patients whom had mid-trimester triple test data and delivered in our institution were included in the study (n=587). Women with multiple pregnancies, chronic diseases, diabetes mellitus, obesity and infants with chromosomal/congenital abnormalities were not included. Maternal serum AFP, HCG and estriol values were investigated in these women who developed preeclampsia (n=22), gestational diabetes (GDM) (n=43), preterm labor-birth (n=81), oligohydramnios (n=16) and macrosomia (n=50) with receiver operating characteristic (ROC) curve analysis and with Pearson correlation tests. RESULTS: Women with estriol values <0.82 MoM significantly developed oligohydramnios (p=0.017, AUC=0.68). Also, macrosomic infants was observed in women who had HCG values >0.88 MoM (p=0.043, AUC=0.589). However, calculated cut-off values for AFP, HCG and estriol values could not predict the development of preeclampsia, GDM and preterm labor-birth. Besides, we observed significant correlations between serum AFP values and fetal birth weight (p=0.014, r=-0.103) and gestational weeks at delivery (p=0.027, r=-0.093). CONCLUSIONS: Serum estriol or HCG values in triple test results may be associated with development of oligohydramnios and macrosomia in women with healthy and normal fetuses. KEY WORDS: pregnancy, triple test, perinatal outcome

Poster-MFM&P-033 Acute gastric dilatation complicating term gestation

Erkanli S 1, Caliskan K 2, Bagis T~, Kilicdag E 1, Tarim El, Kuscu E ~

Department of Ob Gyn, Baskent University School of Medicine, Adana, Turkey 2Department of General Surgery, Baskent University School of Medicine, Adana, Turkey

OBJECTIVES: We report an unusual case of acute gastric dilatation of uncertain etiology in a patient with term pregnancy. To the best of our knowledge this is the first report of acute gastric dilatation complicating term pregnancy. METHODS: 33 year-old gravida 5, para 1 patient who had a term pregnancy at 40 weeks and 3 days, presented to our clinic complaining of unrelenting pain on the epigastric and left costa-vertebral region. RESULTS: As there were no positive physical, laboratory or radiological findings, a nasogastric tube was placed, which did not show any blood or fecal material. 75 mg of im Pethi- dine HCI relieved her pain for the following half an hour. Ne-

vertheless, as her pain recurred even more severely, we decided to perform a laparatomy with a midline incision. After delivering the baby via cesarean section, an exploration was made and massive gastric dilatation was observed and de- compressed with massage and larger diameter nasogastric suction. CONCLUSIONS: Such a possibility should be kept in mind in a pregnant patient who has constant, unrelenting pain. Careful nasogastric decompression in such a case may prevent laparatomy if all other laboratory, physical, and radiological findings are unrevealing. KEY WORDS: acute gastric dilatation, pregnancy, complication

Poster-MFM&P-034 Urinary tract infection in pregnancy

Tutuncu L 1, Ardic N 2, Mungen E 1, Ergur AR1, Yergok YZ 1 i Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey 2 Department of Clinical Microbiology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey

OBJECTIVES: Urinary infection is one of the most common medical complications of pregnancy. It occurs in approximately 5-10% of pregnant women and may lead to serious maternal/fetal morbidity. We retrospectively evaluated the prevalence of urinary infection, causing microorganisms, risk factors and complications in our population to summarize the condition in our population. METHODS: The medical files of 1934 patients who gave birth in our department within last two years have been retrospectively evaluated. 1326 women who had a routine antenatal care and at least one screening urine culture for bacteriuria had been included to the study. Pregnant women who had a positive urine culture (n=106) had been compared with those who had a negative result (n=1220) for demographic characteristics and maternal/fetal complications. RESULTS: 1326 pregnant women were studied, of whom 106 (16.98%) were identified to have asypmtomatic bacteriuria. The level of education was lower in asyptomatic bacteriuria group, but the prevalance of preterm delivery, low- birth-weight infants and anemia were higher than the control group (p<0.05). Thirty cases of acute pyelonephritis (2.26%) were identified during the study period. CONCLUSIONS: All pregnant women should be screened for bacteriuria by urine culture at least once and they should be treated if the results are positive. KEY WORDS: pregnancy, urinary tract infection, treatment

Poster-MFM&P-035 The relationship of leptin with hipertansive diseases of pregnancy

C61cimen N, Sahin HG, Kamaci M Department of Obstetrics and Gynecology, YEtz(Jnc(J Yil University Facutly of Medicine, Van, Turkey

OBJECTIVES: To compare serum leptin levels of third trimester normotensive and hypertensive pregnant women, to evaluate the relation of it with blood pressure, to determine

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the association of this parameter with preeclampsia and correlation of it with maternal and fetal clinical findings. METHODS: The study was performed between February 2004 and September 2004. The study population consisted of 40 singleton preeclamptic women (20 mild and 20 severe preeclampsia) and 30 singleton pregnant women without any systemic diseases (control group) in the third trimester of pregnancy (between 34-42 weeks). Blood pressure, serum leptin levels and correlation of these parameters with maternal and fetal clinical findings were assessed. RESULTS: The highest leptin levels were found in the severe preeclamptic group (9.6-+7.2 ng/ml). A strong and positively significant association was found between the serum leptin level and systolic, diastolic blood pressure (p=0.0001). A weak, positively significant association was found between the serum leptin levels and blood urea, uric acid levels. CONCLUSIONS: Serum leptin levels were found significantly higher in mild and severe preeclamptic group compared to normotensive pregnant women. Hence, serum leptin levels may be an important hormonal parameter of preeclampsia. KEY WORDS: Leptin, pregnancy, hypertension

Poster -MFM&P-036 Prenatal diagnosis of osteogenesis imperfecta: a case report

Bezircioglu 11, Bicer M 1, Uysal D ~, Yigit S 2, Baloglu A 1 Department of Gynecology and Obstetrics, Izmir Ataturk

Education and Research Hospital 2 Department of Pathology, Izmir Ataturk Education and Research Hospital

OBJECTIVES: Osteogenesis imperfecta is a heterogeneous group of genetic disorders characterized by severe bone fra- gility, abnormal ossification and multiple fractures. We report here a terminated case of osteogenesis imperfecta diagnosed with obstetric ultrasonography during sixteenth week of pregnancy. CASE: A 19 year-old gravida 2, para 1 patient was referred to our institution following a secreening ultrasound which demonstrated skeletal anomalies of the fetus. Sonographic evaluation revealed that all long bones were short and an- gulated with multiple fractures, the chest was narrow and bell-shaped, the echogenity of the skull was decreased and visualization of the intracranial structures were increased. Termination of the pregnancy was decided due to the ultrasonographic findings predicting lethality. The diagnosis of Osteogenezis Imperfecta type II was confirmed by postmortem radiography and autopsy examination. CONCLUSIONS: Recent advances in obstetric ultrasonography, the early prenatal diagnosis of lethal skeletal dyspla- sias is now possible. In existence of ultrasonographic findings predicting lethality, the choice of termination method should be offered to parents after counselling about the fetal prognosis even if the specific ultrasonographic diagnosis is not available. KEY WORDS: osteogenesis imperfecta, prenatal diagnosis, ultrasonography

Poster -MFM&P-037 Impetigo herpetiformis: a case report

Bezircioglu 11, Bicer M 1, Karci L 1, Ozder F 2, Baloglu A 1 1 Department of Obstetrics and Gynecology, Izmir Ataturk Education and Research Hospital 2Department of Dermatology, tzmir Ataturk Education and Research Hospital

OBJECTIVES: Impetigo herpetiformis is a rare and potenti- ally life-threatening pustular dermatosis affecting mainly pregnant women. We report here a case of impetigo herpetiformis which occured in twenty-ninth week of pregnancy. CASE: A 32 year old gravida 2, paral pregnant woman who was referred to our institution because of congestive heart failure, gestational diabetes mellitus and oligohidroamnios in 27th gestational age was hospitalized. Eruptive pustular lesions which appeared in 29th week of the gestation has spread her entire body. Her pustular cultures were negative. A punch skin biopsy from a pustule on the trunk made the diagnosis of impetigo herpetiformis. The patient who developed spontaneous uterine contractions was treated with beta- methazone and tocolysis. The patient who did not respond to this treatment was taken to delivery at 30 weeks of gestation. The newborn showed no skin lesions after birth. The skin lesions of the mother improved in the second postpartum week. CONCLUSIONS: The rates of maternal mortality and fetal mortality and morbidity due to placental insufficiency are increased in impetigo herpetiformis. To reduce the mortality and morbidity rates the antenatal management of impetigo herpetiformis should be organized with a multidisciplinary approach. KEY WORDS: impetigo herpetiformis, pregnancy, management

Poster -MFM&P-038 Prenatal diagnosis of diastematomyelia: a review of eight cases

Has R 1, Yeksel A 1, B0yekkurt S 1, Tatli B 2, Kalelioglu 11 Department of Obstetrics and Gynecology, Istanbul

University Medical Faculty, lstanbut, Turkey 2 Department of Pediatrics, Istanbul University Medical Faculty, Istanbul, Turkey

OBJECTIVES: To discuss the prenatal diagnosis of diastomatomyelia and outline the outcome of isolated cases. METHODS: We present eight cases of prenatally diagnosed diastematomyelia. RESULTS: Postnatal outcome of four cases was available. One of them needed an operation which had tethered cord as a consequence of diastomatomyelia, and had minimal neurologic weakness on the lower extremities after surgery. Others were symptom free. Three of the babies had considerable hair bunch on the site of the diastomatomyelia in physical examination. Diagnosis of diastomatomyelia is confirmed in all cases with MRI and one of them also had a lipo- ma on the diastomatomyelia location. Among the remaining four cases, pregnancies are still continuing with normal alpha-fetoprotein (AS-AFP) and acetylcholine esterase (ACE) levels in two cases. Pregnancy terminated in a case, in which amniotic fluid was positive for AS-AFP and ACE, with a fetus had diastematomyelia associated with open spina bi-

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fida. Another case had miscarriage one month after the amniocentesis. CONCLUSIONS: Pregnancy should be managed differently depending on whether the diastematomyelia is isolated, or is in association with more serious neural tube defects. The cases without additional findings usually have good outcome, although surgery may be necessary, and there is a risk of neurologic compromise. KEY WORDS: diastematomyelia, prenatal diagnosis, ultrasonography

Poster-MFM&P-039 Fetal Morbidity Predictors in Twin Pregnancies

Kesim MD Aydin Y, Atis A Department of Obstetrics and Gynecology, 3th Clinic, Sisfi Etfal Research And Training Hospital, lstanbul, Turkey

OBJECTIVES: To investigate the factors effecting morbidity of twin pregnancies and to clarify the decision making for mode of delivery. MATERIALS AND METHODS: 110 women with twin pregnancy attended and delivered in our hospital were included. First group was consisted of 56 women delivered by cesarean section, and second group 54 vaginally delivered cases .Age, parity, gravidy, inter-delivery time, gestational weeks, fetal weights, first and fifth minute Apgar scores and mechanical ventilation need were recorded and compared. Morbidity of fetuses were evaluated as Apgar scores and ventilation need. RESULTS: Apgar scores and ventilation need were the same for the first fetuses in both cesarean and vaginal delivery. As totally evaluated (withouth consideration of presentation and weight of second fetus), there were no difference in Apgar scores and ventilation need for second fetuses. Both first and fifth minute Apgar scores were significantly lower and mechanical ventilation need was same in subgroup of pregnants whom second twins'presentation was breech (p<0,001). Subgroup of cases whose second fetus' presentation were non cephalic only fifth minute Apgar score was significantly lower in vaginal delivery (p<0,05). If second twin's weight was <1500gr, whatever the presentation was, morbidity predictors were the same in vaginal and cesarean delivery. CONCLUSIONS: If second fetus was breech both first and fifth minute apgar scores decreases and if second fetus's presentation was noncephalic fifth minute apgar score decreases in vaginal delivery.Whatever the presentation of second twin,mechanical ventilation need does not change in either mode of delivery. There was a lineer correlation between Apgar scores and gestational week KEY WORDS: Morbidity, twin pregnancy, predictors

Poster-MFM&P-040 Elective cesarean section for preterm fetuses in vertex presentation: Is it effective to improve the neonatal outcomes ?

Gezer A, Erkan S, Stmsek Y, Kahraman N, Uludag S, Altmok T Department of Obstetrics & Gynecology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

OBJECTIVES: Evaluation of the assumption that elective cesarean section (CS) improved the neonatal outcomes of the 'preterm fetuses in vertex presentation.' METHODS: The birth records of a university hospital between 1999 and 2004 were reviewed. CS performed without a trial of labor before the completion of 37 gestational weeks were included in the study group. Gestational ages were confirmed with data from first-trimester ultrasound. Multiple gestations, CS performed after rupture of membranes and CS during labor were excluded. The early neonatal and maternal outcomes were compared for the elective CS and vaginal birth groups. RESULTS: 61 elective CS and 117 preterm vaginal deliveries were eligible for the analysis. There were only small differences between the CS and vaginal birth groups: neither the rate of NICU admission (38% versus 33%) nor the neonatal mortality rate (3.3% versus 4.3%) differed significantly. There were 2 cases of maternal morbidity in the CS group; one postoperative anemia and one incision infection but none in the vaginal birth group. CONCLUSIONS: The data in this study did not demonstrate any beneficial effect of elective CS for the early neonatal outcome of preterm fetuses in vertex presentation despite the possible increase in the maternal morbidity. KEY WORDS: elective cesarean section, preterm fetus, outcome

Poster-MFM&P-041 Spontaneous rupture of the ovarian artery following spontaneus vaginal birth

Kale A, Erdemoglu M, AkdenJz N, Ozcan Y, Yahnkaya A Dicle University Faculty of Medicine Departments of Obstetrics and Gynecology Diyarbakir, Turkey

A 30 year old woman (G5P5) presented after spontaneous vaginal birth with abdominal pain, minimal vaginal bleeding and gradually decreasing hemoglobin level. She had a previous cesarean section. Intraabdominal hemorrhage was detected in ultrasound examination, and then emergency explorative laparotomy was performed. The uterus and ova- ries were seen normal, and approximately 1500 ml blood was aspirated in abdomen, and spontaneous rupture of left ovarian artery was bleeding. The left ovarian artery was su- tured primarily.There is no spontaneous ovarian artery rupture case during vaginal birth in the literature, therefore we thought that this case may be considered as for publication- Keywords: Vaginal birth, spontaneous ovarian artery rupture. KEY WORDS: Vaginal birth, spontaneous ovarian artery rupture

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Poster -MFM&P-042 The role o f Hel icobacter Pyior i in Hyperemesis Gravidarum

K6se G, Tuncel T, Aka N, Kumru P Haydarpasa Numune Training and Research Hospital, Department of Gynecology and Obstetrics, Istanbul/Turkey

OBJECTIVES: The aim of this study was to investigate the role of Helicobacter Pylori in hyperemesis gravidarum pa- teints. MATERIAL AND METHODS: 50 pregnant women who complained of nausea, vomiting and weight loss and were diagnosed as hyperemesis gravidarum after clinical and laboratory findings were investigated. 88 pregnant women who had no complaints were accepted as controls. In both groups, serum Helicobacter Pylori IgG was investigated. The results were compared using the Fisher's Exact Test. RESULTS: Helicobacter Pylori IgG was found to be positive in 48 of 50 patients (96%) who were diagnosed as hi- peremesis gravidarum, whereas the control group was sero- positive for Helicobacter Pylori IgG in 73 of 88 patients (82.9%). The intergroup difference was found statistically significant. CONCLUSIONS: Helicobacter Pylori infection has a role in the etiology of hyperemesis gravidarum. KEY WORDS: hyperemesis gravidarum, helicobacter pylori, ethiology

Poster-M FM&P-043 Comparison of single dose and seven day courses in the treatment of the pregnant women with uncomplicated urinary tract infection

GQven MA 1, Ciragil p2 KSU, Faculty of Medicine, Department of Obstetrics and

Gynecology, Kahramanmras/TURKEY 2 KSU, Faculty of Medicine, Department of Microbiology, Kahramanmaras/-FURKEY

OBJECTIVES: Comparison of bacteriologic efficacy of single dose 2g cefoxitin and 7 day courses of amoxicillin in the treatment of the pregnant with uncomplicated urinary tract infection (Group 1) or symptomatic pregnant women with 10(3)-10(5)/ml mid-stream bacteriuria (Group 2). METHODS: The pregnant women in the Group 1 and 2 between 6-34 gestation weeks were randomly selected for taking single dose cefoxitin (n:25) and 7 day courses of amoxicillin (n:23).There was no clinic difference according to demographic and patient character between the groups(p>0.05).The pathogens were identified by using of urine culture and repeat urine cultures were performed 10 days after initiation of therapy for bacteriologic evaluation of the patients. RESULTS: Bacterial eradication rates were 16/20 (80%) after single dose, cefoxitin and 15/18 (83%) in 7 day courses of amoxicillin in the Group 1. All pregnant women in the Group 2 were responded well to the treatment. There was no difference between cefoxitin and 7 day courses of amoxicillin according to bacteriologic evaluation in the both groups (p>0.05). CONCLUSIONS: There was no difference between efficacy of 2g cefoxitin and 7 day courses of amoxicillin therapy in the treatment of pregnants with uncomplicated lower urinary

tract infection or symptomatic pregnant women with 10(3)- 10(5)/ml mid-stream bacteriuria. KEY WORDS: urinary tract infection, pregnancy, treatment

Poster -MFM&P-044 Maternal serum concentrations of the metabolites of nitric oxide in preeclampsia

Tutuncu L, Ozdemir E, Mungen E, Ergur AR, Yergok YZ Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey

OBJECTIVES: The purpose of this study was to determine the serum levels of nitric oxide (NO) metabolites in pregnant women with preeclampsia and to find out if any relation between the pathogenesis of preeclampsia and NO levels. METHODS: In this prospective study, venous blood samples were collected from pregnant women with preeclampsia (n=30) and age-matched healthy pregnant women (n=30). The serum fractions of these samples were assayed for total nitrite/nitrate levels. The outcomes of the pregnancies were evaluated and groups were compared to each other for the clinical characteristics and NO metabolites. Student's paired t-test and x2 test were used for the statistical analysis. RESULTS: The mean total serum levels of nitrite/nitrate in pregnant women with preeclampsia and healthy pregnant women were 59.0_+15.55~tmol/L and 41.0_+10.37[~mol/L respectively. There were significantly higher total nitrite/nitrate levels in the maternal serum of preeclamptic women (p<0.05). Also, significantly higher nitrite/nitrate levels were found in severe preeclamptic women compared with those of mild preeclamptic and healthy pregnant women (p<0.05). CONCLUSIONS: Maternal serum levels of NO metabolites were higher in pregnant women with preeclampsia and it was directly related with the severity of the disease. This may be a compensatory mechanism to increase the blood flow to uteroplacental unit in preeclampsia. KEY WORDS: preeclampsia, nitric oxide, metabolites

Poster -MFM&P-045 The 100 gram oral glucose tolerance test results in twin and single pregnancies after art

GQven MA ~, Aktan E 2, Bozkurt K 2 i KSU, Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmras/-I-URKEY 20zel EGE IVF Center

OBJECTIVES: The aim of the study was to investigate if ART per se, and twinning in ART pregnancies have any effects on 100-g oral GTT results. METHODS: One hundred singleton IVF/ICSI-ET pregnancies (Group 1), 72 twin IVF/ICSI-ET pregnancies (Group 2), and 128 singleton spontaneous pregnancies (Group 3) were compared. This retrospective study was designed to compare singleton and twin IVF/ICSI-ET pregnancies and singleton spontaneous pregnancies with respect to the results of 100-g oral glucose tolerance test. RESULTS: Singleton IVF/ICSI-ET pregnancies and twin IVF/ICSI-ET pregnancies were similar regarding the results of 100-g oral glucuse tolerance test, although first and se-

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cond hour plasma glucose levels were higher in singleton IVF/ICSI-ET pregnancies than in singleton spontaneous pregnancies. CONCLUSIONS: The present findings indicate that glucose tolerances in singleton and twin IVF/ICSI-ET pregnancies were similar, although singleton IVF/ICSI-ET pregnancies have a higher level of glucose intolerance than that of spontaneous singleton pregnancies. KEY WORDS: 100g oral GTT, ART, twin pregnancy

Poster -MFM&P-046 Comparison of homocysteine, vitamin B12, folic acit levels in patients with mild-severe preeclampsia and normal healthy pregnant women.

GL~ven MA 1, Kilinc M 2, Ekerbicer H 3 1 KSU, Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmras/-FURKEY 2 KSU, Faculty of Medicine, Department of Biochemistry, Kahramanmaras/TURKEY 3 KSU, Faculty of Medicine, Department of Public Health, Kahramanmaras/TURKEY

OBJECTIVES: Our aim was to compare the levels of plasma homocysteine, serum vitamin B12, folic acid in patients with mild-severe preeclampsia with that of normal healthy pregnant women. METHODS: This study was prospectively conducted in 57 preeclamptic (18 mild, 39 severe preeclampsia) women and 25 healthy pregnant women. Serum folic acid, vitamin B12 and plasma homocysteine levels were measured by auto- mated chemiluminescence system and micro particles immunoassay in automatic analyser, respectively. All demographic data and perinatal outcomes were gathered. RESULTS: No significant difference was seen for demographic data between the group of women with preeclampsia and healthy pregnant women. As comparison of women with preeclampsia and normal healthy pregnant women; homocysteine levels were found to be high (p<0.05), folic acid and weight of newborns were found to be low (p<0.05). CONCLUSIONS: Homocysteine levels increase in women with preeclampsia. We contemplate that an increase in homocysteine and decrease in folic acid levels of women with preeclampsia may effect fetal development. KEY WORDS: preeclampsia, homocysteine, vitamin B12, folic acit

Poster -MFM&P-047 Prenatal diagnosis of Meckel Gruber syndrome presenting with renal agenesis: report of a case

G0ven MA 1, Ceylaner S 2, Ceylaner G 2, Gul g 3, Ertas E 4 7 KSU, Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmras/-FURKEY 2 Zekai Tahir Burak Womens Health Education and Research Hospital, Department of Genetics, Ankara/TURKEY 3 Gulhane Medical Military Academy, Department of Genetics, Ankara/TURKEY 4 Zekai Tahir Burak Womens Health Education and Research Hospital, Department of Obstetrics and Gynecology, Ankara/TURKEY

OBJECTIVES" To describe a case of MeckeI-Gruber syndrome presenting prenatally with an extreme clinical picture consisting of encephalocele and severe oligohydroamnios. METHODS: Routine antenatal ultrasonographic examination at 15 weeks of gestation in a 21 years old woman revealed a posterior occipital encephalocele and severe oligohydram- niosis, rising the suspicion of bilateral renal agenesis. RESULTS: Postmortem fetal evaluation confirmed the prenatal findings and also revealed a small omphalocele and hepatic fibrosis, allowing the diagnosis of MeckeI-Gruber syndrome. CONCLUSIONS: Renal agenesis, omphalocele and encephalocele are frequently detected findings at prenatal diagnosis. Patients with at least two of the above findings in association have been described, but nearly all of such cases had additional dysmorphic features indicating a recognizable syndrome. The findings in our case were not concordant with any other recognizable syndrome, and liver fibrosis was detected at autopsy allowing the diagnosis of MeckeI-Gru- ber syndrome. The concurrence of any kind of central nervous system abnormality and bilateral renal agenesis should initiate a search for fibrosis of the liver indicative of the Me- ckeI-Gruber syndrome. KEY WORDS: meckel gruber syndrome, renal agenesis, prenatal diagnosis

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Poster-MFM&P-048 Prenatal diagnosis of autosomal recessive type of robinow syndrome and differential diagnosis

G0ven MA 1, Ceylaner S 2, Batukan C 3, Ozbek A 4, Demirpolat G 5, Uzel M 6 1 KSU, Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmras/TURKEY 2 Zekai Tahir Burak Women's Health Education and Research Hospital, Department of Genetics, Ankara/TURKEY 3 Erciyes University, Faculty of Medicine, Department of Obstetrics and Gynecology, Kayseri/l-URKEY 4 Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Pediatrics, Kahramanmaras/TURKEY 5 Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Radiology, Kahramanmaras/TURKEY 6 Kahramanmaras Sutcu Imam University, Faculty of Medicine, Department of Orthopedics and Traumatology, Kahramanmaras/-I-URKEY

OBJECTIVES: Our aim was to present a prenatally diagnosed case with Robinow syndrome in a consanguineous cou- ple and discuss possible differential diagnosis in the view of literature. METHODS: A 28-year-old pregnant woman gravida 2 para 1 was referred to the obstetric clinic of Kahramanmaras Sut- cu Imam University presenting with a fetus having shortened upper and lower limbs at 33 weeks of gestation. Her medical history was unremarkable except for consanguinity. Prenatal ultrasonographic examination revealed a reduced humerus and femur length. Further, shortening of the forearm, frontal bossing, mild hipertelorism, reduced thoracic perimeter and hemi-vertebrae at the thoracic level were present. RESULTS: Meticulous neonatal examination was performed following an uncomplicated vaginal delivery at 39 weeks of gestation. Distinct facial appearance in addition to the prenatal findings formulated for the diagnosis of Robinow syndrome. Additionally, radiologic survey revealed and confirmed shortening of the upper extremities and thoracic hemivertebrae. CONCLUSIONS: We are documenting the case on the ac- count of its rarity and additional features. The main approach in the differential diagnosis of Robinow syndrome should determine whether hemivertebrae is isolated or part of a syndrome or association. KEY WORDS: Prenatal diagnosis, Robinow syndrome, differential diagnosis

Poster-MFM&P-049 Pregnancy-reduced severe gestational hyperlipidemia mimicking famil ial hyperlipidemias: a case report

Basaran A 1, Bozdag G 1, Dagdelen S 2, G0rlek A 2, Beksac S 1 1 Department of obstetrics and gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey 2 Department of endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey

BACKGROUND: Increased triglyceride and total cholesterol levels are well known characteristics of normal pregnancy.

The largest rise occurs in triglycerides suggested .to result from increased hepatic lipase activity with accompanying reduced lipoprotein lipase activity. Although not well documented whether hyperlipidemia during normal pregnancy is related to cardiovascular morbidity later in life, extremely elevated lipid levels during pregnancy itself might be a life-threatening complication for fetal-maternal outcome. CASE: We report a case of gestational diabetes with an extremely elevated triglyceride and total cholesterol levels mimicking familial mixed hyperlipidemia. Despite intensive diet and insulin treatment hypertriglyceridemia reached to a maximum level of 1866 mg/dl. At postpartum 4th week, TG, HDL, LDL, VLDL and total cholesterol were declined completely into the same levels as in prepartum state without any restrictive diet which were 262, 30, 55, 52 and 138 mg/dl respectively. CONCLUSIONS: Successful fetal and maternal outcomes were obtained with dietary lipid restriction, low molecular weight heparin and intensive insulin treatment. KEY WORDS: Gestational diabetes, hyperlipidemia, management

Poster-M FM&P-050 The efficacy of extraamniotic misoprostol instillation in the termination of second trimester pregnancies

Arici Ozkan A, Isparta T, Dikis FC, Civas SB, Ispahi C Department of Perinatology, Ege Maternity and Womens Health Research and Training Hospital, Izmir, Turkey

OBJECTIVES: To demonstrate the efficacy of extraamniotic misoprostol administration in the termination of second trimester major fetal anomalies and intrauterin fetal demise. METHODS: Extraamniotic misoprostol administration was performed on 20 patients who admitted to our hospital between February 2004-2005 with intrauterine fetal demise(IUFD)or major fetal anomalies which were discussed in the Perinatolo- gy Council and decided on pregnancy termination. Under anti- biotic prophylaxis,extraamniotic instillation was performed with 200 pg. misoprostol dissolved in 10cc.0.9% sodium chloride(NaCI)solution given through an insemination cannula.Si- multaneously, another tablet was placed in posterior vaginal fornix divided into two and moistened with 0.9%NaCl.Three hours after the procedure,maximum two tablets of misoprostol was given orally three hours apart.The period from extraamniotic instillation to abortion was recorded. RESULTS: The mean age of the patients was 28.75(20- 41)years. Nulliparity ratio was 30%(6cases),multiparity ratio was 70%(14cases)of which 36%(5cases)had prior cesarean section. The mean gestational age of the fetal anomaly group was 21(14-27)weeks and of the IUFD group was 18(15-26)weeks.Allergic reactions were observed in one patient(5%)and controlled easily with antihistaminics.ln two patients oral doses were not completed.The mean termination period was 12 hours 40 minutes(90"-36'10").No infection, uterine rupture or other complication was noted. CONCLUSIONS: Extraamniotic instillation of misoprostol is a safe,effective and fast alternative method with low cost in the termination of second trimester pregnancies. KEY WORDS: second trimester pregnancy, termination, misoprostol

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Poster-MFM&P-051 Nasal Bone Measurement Between 15 and 20 Gestational Weeks.

Kalelioqlu IK, Has R, Y~ksel A, Gilbaz E, Ibrahimoglu L, Ermis H, Yildirim A University of Istanbul, Department of Obstetrics and Gynecology, Istanbul, Turkey

OBJECTIVES: To determine the distribution and percentile of fetal nasal bone length at 15-20 weeks' gestation. METHODS: The fetal nasal bone was measured in a mid- sagittal view in 519 fetuses which had karyotyping between 15 and 20 completed weeks of gestation. RESULTS: Mean maternal age was 34.1 (min: 16 max: 45). Mean gestational age at measurement was 18.05 (min: 15.14 max: 20.85). Median values of nasal bone length between 15th and 20th weeks of gestation were 3.4, 3.8, 4.2, 4.5, 4.7 and 5.3, respectively. Median 5th percentiles of nasal bone length between 15th and 20th weeks of gestation were 2.4, 2.8, 2.9, 3.1, 3.4 and 3.4, respectively. A linear line found to be fitted with distribution of nasal bone length in mdigestation. CONCLUSIONS: A linear increase in mean fetal nasal bone length is detected between 15 and 20 weeks of gestation. KEY WORDS: 15-20 weeks' gestation, nasal bone

Poster -MFM&P-052 An Occipital Encephalocele Involving Cerebellum

Dane B 1, Yayla M 1, Dane C 1, Ozek M 2 1 * Department of Gynecology and Obstetrics, Haseki Educa- tion and Research Hospital, Istanbul, Turkey 2 **Department of Neurosurgery, Medical Faculty, Marmara University, Istanbul, Turkey

INTRODUCTION: Encephalomeningocele is a herniation of the brain and meninges through a congenital bone defect resulting from the failure of normal midline fusion of the cranial neural tube. The sonographic appereance varies with location, size of the cranial defect, brain involvement in the occipital cyst. CASE: The mother was 30 years old (G3P1A1). Her second pregnancy was terminated because of an anencephalic fetus. At 28 weeks of gestation the fetus was discovered to have an occipital cyst (approximate diameter 7cm) extended from the occiput, the high and Iow-echogenic shadows, thought to be cerebellar tissue and liquor, were observed in the cyst. The mother underwent caesarean section at 38 weeks of gestation. On the second day after birth surgical repair was performed, and the herniated brain tissues (containing the cerebellum) were resected. The patient had neither suction reflex, nor visual function at 7 months after birth. DISCUSSION: It has been reported that the prognosis of fetal encephalocele may be good, if herniation of neural tissue is limited. Despite this, if diagnosed in early pregnancy, the pregnancy should be terminated to avoid physical and men- tal handicaps. KEY WORDS: occipital encephalocele, cerebellum, ultrasonography

Poster -MFM&P-053 Prediction of Down Syndrome with Nasal Bone Measurement in Midtrimester: is i t feasib le?

Kalelioglu IK, Has R, YOksel A, Gilbaz E, Ibrahimoglu L, Ermis H, Yildirim A University of Istanbul, Department of Obstetrics and Gynecology, Istanbul, Turkey

OBJECTIVES: To determine whether nasal bone measurement is helpful to the screening of Down syndrome in midtrimester. METHODS: The study was performed between January 2004 and April 2005, and included all pregnant women referred for genetic amniocentesis. The fetal profile was examined in 519 consecutive normal fetuses and 10 Down syndrome fetuses between completed 15 and 20 gestational ages. RESULTS: Mean maternal ages were 34.1 (min: 16 max: 45) and 36.8 (min: 27 max: 44) in women with normal and Down syndrome fetuses, respectively. Mean MoM values of nasal bone were 1 in women with normal fetuses and 0.93 in women with Down syndrome fetuses. No statistical significant difference was found between MoM values of two groups. CONCLUSIONS: Measurement of nasal bone in midtrimester did not contribute to the screening of Down syndrome in our study. KEY WORDS: down syndrome, nasal bone, midtrimester

Poster -MFM&P-054 Adult-Onset Still Disease in Pregnancy: A Case Report

Dane B, Yayla M, Cem Dane, Salih Dural Department of Gynecology and Obstetrics, Haseki Education and Research Hospital, Istanbul, Turkey

INTRODUCTION: Adult-onset Still disease is a febrile disorder of unknown etiology that can present for the first time during pregnancy. Patients typically have symptoms of fever, malaise, and rash. The clinical, laboratory, and histological features are nonspecific, but an unexplained ferritine- mia can be the harbinger of its diagnosis. CASE: A 25-year-old women (gravida 3, para 2) was hospitalized at 20 weeks' gestation with fever, malaise, sore throat, lymphadenopathy and a diffuse erythematous macu- Iopapular rash for 10 days. On presentation her temperature was 39.5C. After the exclusion of other infectious, malignant, and inflammatory causes, a diagnosis of adult-onset Still disease meeting the Yamaguchi criteria was made. Se- rum ferritin level was >13,000 ng/mL (normal 10-400). She was treated with prednisone and had immediate improve- ment. Despite this, the dead fetus is delivered at 22 weeks of gestation with placental abrubtion. DISCUSSION: Patients with AOSD are usually subjected to multiple diagnostic procedures and laboratory tests as well as empiric treatment with antibiotics and other medications. As a result, diagnoses and treatments are often delayed. Corticosteroid therapy is generally safe and can achieve satisfactory response and perhaps better fetal outcome. KEY WORDS: still disease, pregnancy, treatment

Maternal Fetal Med ic ine -Per ina to logy - Poster Presentations

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Poster -MFM&P-055 Gossypiboma As An Adnexial Mass: A Foreign Body In Pregnancy

Dane C, Yayla M, Dane B, Cetin A, Kiray M Department of Gynecology and Obstetrics, Haseki Education and Research Hospital, Istanbul, Turkey

BACKGROUND: Gossypiboma is a rare tumor caused by gauze fibers retained during surgery. To our knowledge, a gossypiboma in the abdomen in pregnancy has not been previously reported in the literature. We describe the uitra- sonographic findings of a gossypiboma retained in the abdomen. CASE PRESENTATION: A 28-year-old woman at 38 weeks of gestation was presented with adnexial mass. A caesarean delivery had been performed 3 years ago. Obstetrics ultrasonography shows thick curvilinear hyper echoic band with distal acoustic shadowing in the pubic region. In caesarean section, a well-encapsulated, brownish soft-tissue tumor containing serous fluid was discovered in the central cavity, shown at histological investigation to be gauze fibers. CONCLUSIONS: The frequency incidence is not very well known; however general estimation is 1 in 1000 to 1500 for intra-abdominal operations. The best prevention of this condition can be achieved by meticulous count of surgical materials and also by routine use of surgical textile materials im- pregnated with a radio-opaque marker. The phenomenon of gossypiboma may end up in associated medico-legal implications. KEY WORDS: Gossypiboma, pregnancy, adnexial mass

Poster -MFM&P-056 Prenatal Diagnosis Of Bartter's Syndrome With Biochemical Examination Of Amniotic Fluid: Report Of One Case

Dane B 1, Yayla M 1, Dane C 1, Ataoglu E 2, D6ventas y3 1 * Department of Gynecology and Obstetrics, Haseki Education and Research Hospital, Istanbul, Turkey 2,* Department of Pediatrics, Haseki Education and Research Hospital, Istanbul, Turkey 3*** Department of Biochemistry, Haseki Education and Re- search Hospital, Istanbul, Turkey

INTRODUCTION: Antenatal Bartter syndrome is a variant of inherited renal-tubular disorders. This disorder typically presents as a life-threatening condition beginning in utero, with marked fetal poiyuria that leads to polyhydramnios and premature delivery. CASE: The mother with a fetus affected by Bartter syndrome was 26 years old (G5P2A2). She was found to have polyhydramnios at 26 weeks of gestation. Serial amnio drains were performed. The elevated amniotic chloride level (above 112 mmole/I) led to the antenatal diagnosis of ABS. The mother was treated with indomethacine. She delivered an infant girl at 32 weeks of gestation. The baby's urine produc- tion was in the normal range until four weeks after birth when it increased. Hypokalaemic alkalosis, low chloride and hyperreninaemia were present. DISCUSSION: After exclusion of other etiologies for polyhy- dramnion, the very rare, autosomal-recessive transferred hyperprostaglandin E syndrome (HPS) or Bartter syndrome has to be considered. The fetus affected with Bartter syn-

drome was characterized by elevated values for electrolytes in the amniotic fluid. Administration of indomethacin appears to be a promising approach for treating polyhydramnios and preventing premature delivery in HPS. KEY WORDS: Bartter syndrome, amniotic fluid, polyhydramnios

Poster -MFM&P-057 Evaluation of cervical length in threatened preterm labor

Delier H, Has R, Kalelioglu I, B(JyL)kkurt S Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul, Turkey

OBJECTIVES: The aim of this study was to determine the value of sonographic measurement of cervical length in dis- tinguishing true and false preterm labor. METHODS: Cervical length was measured by transvaginal sonography in 53 patients with singleton pregnancies presenting with regular uterine contractions at 24-34 weeks of gestation.Patients in active labor, with ruptured membranes or requiring urgent delivery were excluded.The primary outcome measure was delivery within 7 days of admission. RESULTS: Delivery within 7 days of presentation occurred in 4/53 (8%) pregnancies.Only 3 of 49 (6%)cases with cervical length >=15 mm delivered within 7 days while one of 4 (25%) patients with cervical length <15 mm delivered within 7 days.There was no significant contribution from cervical length in the prediction of delivery within 7 days.Both cervical length (OR=18.0) and history of preterm delivery (OR=13.7)were significant predictive factors for delivery before 34 weeks.Logistic regression analysis demonstrated that history of preterm delivery (OR=9.56) was the only significant contributor for delivery before 34 weeks while cervical length (OR=35.90)was the only significant factor for delivery before 32 weeks. CONCLUSIONS: In conclusion, sonographic measurement of cervical length can not distinguish between true and false labor, but helps to determine those at highest risk of delivery before 32 and 34 weeks. KEY WORDS: preterm labor, cervical lenght, ultrasonography

Poster-MFM&P-058 Distribution of Nuchal Fold Thickness in Midtrimester

Has R, Kalelioglu IK, Y~Jksel A, Gilbaz E, Ibrahimoglu L, Ermis H, Yildirim A University of Istanbul, Department of Obstetrics and Gynecology, Istanbul, Turkey

OBJECTIVES: To determine the distribution and percentile of fetal nuchal fold thickness at 15-20 weeks' gestation. METHODS: Fetal nuchal fold was measured in 267 fetuses known to be chromosomally and structurally normal in a transverse plane where both cerebellum and cavum septum pellucidum were visible. RESULTS: Mean maternal age was 33.6 (min: 16 max: 44). Mean gestational age at measurement was 18.25 (rain: 15.14 max: 20.85). Median values of nuchal fold thickness

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between 15th and 20th weeks of gestation were 2.6, 3, 3.2, 3.6, 4 and 4, respectively. 95th percentiles of nuchal fold thickness length between 15th and 20th weeks of gestation were 2.8, 4.7, 4.4, 5, 5.3 and 5.7, respectively. A linear line found to be fitted with distribution of nuchal fold tickness length in midgestation. CONCLUSIONS: A linear increase in mean nuchal fold thickness is detected between 15 and 20 weeks of gestation. KEY WORDS: nuchal fold thickness, midtrimester

Poster-MFM&P-059 Nuchal Fold Tickness Measurement for Down Syndrome Screening

Has R, Kalelioglu IK, Y0ksel A, Gilbaz E, Ibrahimoglu L, Er- mis H, Yildirim A University of Istanbul, Department of Obstetrics and Gyne- cology, Istanbul, Turkey

OBJECTIVES: To determine whether nuchal fold tickness measurement is helpful to the screening of Down syndrome in midtrimester. METHODS: The study was performed between January 2004 and April 2005, and included all pregnant women referred for genetic amniocentesis. Nuchal fold was examined in 563 consecutive normal fetuses and 12 Down syndrome fetuses between completed 15 and 20 gestational ages in a transverse plane where both cerebellum and cavum septum pellucidum were visible. RESULTS: Mean maternal ages were 34.3 (min: 16 max: 48) and 37.2 (min: 27 max: 44) in women with normal and Down syndrome fetuses, respectively. Median values of nuchal fold thickness were increased from 2.6 in 15th week to 4mm in 20th week of gestation, and 95th percentiles were increased from 2.8 to 5.7, respectively. Mean MoM values of nuchal fold tickness were 1 in women with normal fetuses and 1.3 in women with Down syndrome fetuses. A statistical significant difference was found between MoM values of two groups (p:0.008). At a cut-off level of 1.33 MoM, sensitivity was 42% and FPR was 10%. CONCLUSIONS: Nuchal fold thickness measurement con- tributes to detection rates of Down syndrome screening in midtrimester. KEY WORDS: nuchal fold thickness, down syndrome, midtrimester

Poster-MFM&P-060 The rate and indications of cesarean sections in our clinic during 15 years'period: A retrospective study

Yildiz A, K6ksal A, Celik N, Yetimalar H, Keklik A, Ivit H, Cukurova K Department of 3. Obstetrics and Gynecology, Atat(Jrk Research and Training Hospital, Izmir

OBJECTIVES: Study of cesarean section indications done in our clinics according to year distribution. METHODS: In this study 3652 cesarean section cases were studied retrospectively which were done in our clinics between January 1990 and December 2004. Indications accor-

ding to year distribution were analyzed statistically by Chi- Square test. RESULTS: Total birth number in 15 years was 18.498.365, cesarean rate was 19.74%. The rate of recurrent cesarean sections and fetal distress was significantly higher (p<0.001); but the rate of cesarean section operations which were done for the indications of Cephalopelvic disproportion, abnormal patterns of labor, breech presentations and presentation abnormalities were statistically lower (p<O.OOl). CONCLUSIONS: In this study the increase in cesarean sections rate was detected in years, the development of radiological techniques withdrawal of midforceps and vaginal breech presentations labor, detection of abnormal fetal heart rate patterns by the use of fetal monitoring systems, the affect of forensic medicine onto medical complications and malpractice cases, older maternal ages, socioeconomic and demographical factors and the believe of necessity of recurrent cesarean sections should be the reasons. KEY WORDS: Cesarean section, rate, indication

Poster-MFM&P-061 Adolescent Pregnancies: Obstetric and Perinatal Outcomes

Hizli D, Dilbaz S, Acer N, Deveci S, Dilbaz B, Haberal A Ankara Etlik Maternity and Women

OBJECTIVES: Retrospective analyze of obstetric and perinatal outcomes in adolescent pregnancies. METHODS: The study group consisted of 240 singleton pregnant women who were 16-18 years old. RESULTS: The median age was 17.69+0,51. The average antepartum hemoglobin level was 11.3 g/dl and 33.3% of the pregnants were anemic. Gestational diabetes mellitus, preeclampsia, ablatio placenta, preterm premature rupture of membranes and premature rupture of membranes were 0.4%, 2.0%, 0.4%, 0.4% and 3.7%. respectively. The rate of prematurity was 5% and postmaturity was 17%. The average time of active labor was found 4.7 hours. Spontaneous vaginal delivery was achieved in 88.3% of the cases whereas the cesarean rate was 11.7%. The average birth weight was 3117.3 g. CONCLUSIONS: In our study, cesarean section rate was less common (11.7%) and active labor period was shorter than the general population. This could be due to the better myometrial function and greater connective tissue elasticity. Anemia was common and might be caused by poor nutriti- on. We found no relation between young maternal age and low birth weight. In conclusion; obstetric risks in adolescent pregnancies are generally low, but we believe that adolescent pregnancies might be associated with considerable socioeconomic problems such as social exclusion, reduced education, career and economic prospects. KEY WORDS: adolescent pregnancy, outcome, cesarean section

Materna l Fetal M e d i c i n e - P e r i n a t o l o g y - Pos te r P r e s e n t a t i o n s

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Poster -MFM&P-062 The effect of antenatal betametasone use on fetal biophysical prof i le.

Cukurova K, K6ksal A, Yilmaz S, Ivit H, Yildiz A, Yetimalar H, Keklik A Department of 3. Obstetrics and Gynecology, Atat(Jrk Research and Training Hospital, Izmir

OBJECTIVES: To study the period and effect of steroids on fetal biophysical profile and to decrease the iatrogenic prematurity rates. METHODS: 30 singleton pregnancies in between 28-34 gestational weeks and having prematurity risks were included. We applied 12 mg IM betametasone every 12 hours. The cases were evaluated by biophysical profile before, 2 days and 4 days after the betametasone use. For the statistical analyses SPSS for Windows Program and Wilcoxon Signed Ranks Test were used. RESULTS: The decrease in mean scores of fetal respiration and fetal body movements in the 2nd day was significant (p<0.05). The decrease in 1., 2., 3. days for Nonstress test scores in 0., 1., 2., 3., 4. and 5. days was significant (p<0.05). The decrease in mean scores of fetal tonus and amniotic fluid volume between control day, second and forth days was not significant (p>0.05). If we evaluate biophysical profile as a whole, there was only a significant decrease in levels of second day (p<0.05). CONCLUSIONS: This study may lighten the safety of maternal steroid application by means of biophysical profile test. The cases regarded as fetal hypoxia during biophysical profile test maybe due to temporary effect of betametasone. KEY WORDS: Betametasone, biophysical profile, pregnancy

Poster -MFM&P-063 The incidence of intracranial lesions in cases with preeclampsia, eclampsia and the predictive value of magnetic rezonance imaging

Bicer Bulbul M, Karakaya E, Pehlivan M, Baloglu A Department of Obstetrics and Gynecology, Izmir Ataturk Education and Research Hospital

OBJECTIVES: The aim of this study was to investigate the neurologic signs, the incidence of the cranial lesions in Ma- gnetic Rezonance Imaging (MRI) and their characteristics and the relationship between clinical, laboratory and radiological findings in pregnancy induced hypertensive disorders. MATERIALS AND METHODS: A total of 30 cases who had the diagnosis of preeclampsia or eclampsia in 26th-39th weeks of gestation were investigated. All patients underwent a detailed neurological examination and cranial MRI. For all patients clinical, biochemical and hematologic markers were recorded. These findings were used for a comparison analysis of the cases with and without pathologic findings in cranial MRI evaluations. RESULTS: Of all patients, 12 had a pathologic finding in cranial MRI. The most common site affected was occipital lobe. There was no relationship between the severity of the blood pressure levels and the cranial lesions. A direct relationship between lactate dehydrogenase and uric acid and pathologic cranial imaging findings was detected. CONCLUSIONS: The pathologies detected in the cranial imaging in hypertensive disorders may extend to intracranial

hemorrhage. Therefore; imaging in patients with symptoms and neurologic findings may be helpful for the identification of the cranial pathologies. KEY WORDS: pregnancy, hypertensive disorders, Magnetic Rezonance Imaging

Poster -MFM&P-064 The percentiles of cord blood cardiac troponin I and creatine kinase mb in healthy term and preterm neonates

Caliskan E 1, Doger E 1 , Duman 0 2, Turker G 3, Ozeren S 1, Yucesoy 11

Department of Obstetrics and Gynecology, University of Kocaeli, Kocaeli, Turkey 2 Department of Biochemistry, University of Kocaeli 3 Department of Pediatrics, University of Kocaefi

OBJECTIVES: To determine the percentiles of cord blood cardiac troponin I and creatine kinase MB. METHODS: Cord blood cardiac troponin I and creatine kinase MB (CK-MB) levels of 378 newborns were measured via microparticle enzyme immunoassay. Our exclusion criteria were pregnant women with hypertension and newborns with intrauterine growth restriction, congenital anomaly, those with evidence of congenital sepsis, intrauterine hypoxia and early neonatal deaths. Intrauterine hypoxia was diagnosed if cord blood pH <7, base excess <-8 or if hypoxic ischemic encephalopathy was diagnosed during the follow-up. RESULTS: Multivariate analysis revealed that gestational age and fetal gender are important determinants of cord blood troponin I. Accordingly results of preterm and term infants were cumulated as percentiles per week yielded similar levels. The 90th percentile of cord blood cardiac troponin I in preterm newborns were 0,41 ng/ml for females, 2,2 ng/ml for males while it was 0,97 ng/ml for term females and 1,2 ng/ml for term males. The 90th percentile of cord blood creatine kinase MB was 7,58 ng/ml for preterm females, 8,92 ng/ml for preterm males and 12,7 ng/ml for term females and 13,1 ng/ml for term males. CONCLUSIONS: Percentiles of cord blood cardiac troponin I and creatine kinase MB may help diagnose pathological si- tuations KEY WORDS: Normogram, cord blood, Troponin I

Poster -MFM&P-065 Cord blood cardiac troponin i and creatine kinase levels in cases of poor neonatal outcome

Caliskan E, Doger E, Cakiroglu Y, Corakci A, Ozeren S Department of Obstetrics and Gynecology, University of Kocaeli, Kocaeli, Turkey

OBJECTIVES: To compare cord blood cardiac troponin-I and creatine kinase-MB levels in fetuses with poor neonatal outcome to completely healthy newborns. METHODS: Cord blood cardiac troponin-I and creatine kinase- MB (CK-MB) levels of 398 completely healthy newborns were measured via microparticle enzyme immunoassay. These were compared to the levels of fetuses with pH <7,15 (n:20), base excess <-8 (n:25) hypoxic ischemic encephalopathy (n:12), fetal anomaly (n:13) and early neonatal mortality (n:8).

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M a t e r n a l Fetal M e d i c i n e - P e r i n a t o l o g y - Poster Presentat ions

RESULTS: The mean troponin-I in healthy newborns was 0,4_+0,6 ng/ml and mean CK-MB was 6,8_+3,9 ng/ml. These values were 1,2_+2,1 ng/ml (p:0,03) and 5_+2,8 ng/ml (p:0,2) for newborns with cord blood pH <7,15. In cases with base excess <-8 the mean troponin I was 1,2_+1,9 ng/ml (p:0,02) and the mean CK-MB was 6,5_+3,7 ng/ml (p:0,5). Fetuses that died in the early neonatal period had significantly higher cord blood troponin-I levels (m:1,5+2,1 ng/ml; p:0,01) while CK-MB was not significantly different (m:6,9_+3,9 ng/ml; p:0,4). The levels in newborns with hypoxic ischemic encephalopathy and fetal anomaly were similar to healthy newborns. CONCLUSIONS: Cord blood troponin-I and creatine kinase MB can be used to identify those fetuses with intrapartum hypoxia and forthcoming neonatal death. KEY WORDS: Obstetric outcome, troponin I, creatine kinase MB

Poster -MFM&P-066 Fetal pulse oximetry safely decrease cesarean section rate due to non-reassuring fetal heart rate tracings

Caliskan E, Turkoz E, Ozeren S, Corakci A, Ozkan S, Yucesoy I Department of Obstetrics and Gynecology, University of Kocaeli, Kocaeli, Turkey

OBJECTIVES: To determine the effectiveness and safety of fetal pulse oximetry for decreasing cesarean section rate due to non-reassuring fetal heart rate (FHR) tracings. METHODS: Singleton pregnancies with vertex presentation without placenta previa were included (n=380) in the study. All pregnancies were followed-up via continuous external fetal monitorisation since admission until delivery. Cesarean delivery was performed when PC2 on pulse oximetry was <30%. Two experienced obstetricians unaware of the route of delivery or the obstetric outcome identified the FHR tracings that were non-reassuring with concensus. Fetal umbli- cal artery blood sampling for pH and base excess was obtained immediately after delivery RESULTS: The mean gestational age of the women were 38.5+1.9 wk (30.2-42.2) and the preterm birth rate was 13.7% (n=52). Evaluation of intrapartum tracings identified 65 cases (17.2%) with non-ressuring FHR but in fact only 25 cesarean deliveries (%6.6) was performed according to pulse oximetry findings (p<0.001). Seven newborns had Apgar scores <7 at 1st minute and one had Apgar score <7 at 5th minute. One (%0.3) newborn had cord blood pH<7 and fif- teen (%3.19) had cord blood pH <7.15 CONCLUSIONS: Fetal pulse oximetry is an effective method to reassure fetal well being during the intrapartum period and safely decreases the cesarean delivery rate due to non-reassuring FHR tracings KEY WORDS: Fetal pulse oximetry, Fetal Heart Rate, cesarean delivery

Poster -MFM&P-067 integrating cervical length measurement to routine antenatal screening and emergency cerclage when indicated

Caliskan E 1, Cakiroglu Y1, Dundar D 2, Doger E 1, Caliskan S 2, Ozeren S 1 1 Department of Obstetrics and Gynecology, University of Kocaeli, Kocaeli, Turkey 2 Department of Clinical Microbiology, University of Kocaeli, Kocaeli, Turkey

OBJECTIVES: To integrate cervical length measurement into antenatal screening and apply emergency cerolage when indicated. METHODS: Cervical length measurements of 400 pregnant volunteers were obtained on gestational weeks 12-14, 18-20 and 28-32. Whenever a cervical measurement <30 mm was observed, vaginal cultures were obtained, patients were tes- ted for bacterial vaginosis and weekly cervical length measurements were performed thenafter. Emergency cerclage was performed whenever complete cervical effacement and cervical dilatation was observed before 32nd week of gestation. Efficacy of cervical length measurement to prevent spontaneous preterm delivery <34 weeks of gestation was calculated. RESULTS: Spontaneous pretem birth <34 weeks of gestation occured in 15 women (3.8%) Using a 30 mm cut-off value, 12-14 weeks screening had a sensitivity of 26.7%, spe- cifity of 97.1%, positive predictive value of 26.7% and negative predictive value of 97.1%. These values were 26.7%, 96.9%, 25%, 97.1% respectively for 18-20 weeks screening and 11.1%, 91.9%, 3.1%, 97.8% respectively for 28-32 weeks screening. We performed five emergency oerclages according to the presented screening strategy between 20- 29 weeks of gestation all of which reached >34 weeks. CONCLUSIONS: Routine cervical length measurement will avoid unnecessary prophylactic cerclages and increase the success of emergency cerclages. KEY WORDS: Preterm birth, cervical insufficiency, cervical length measurement, cervical cerclage, screening

Poster -MFM&P-068 Cervical maturation and induction of labor by use of prostoglandin E1 analogue misoprostol

Cukurova K, KSksal A, Ivit H, Yetimalar H, Yildiz A, Keklik A, Aksakalli V Department of 3. Obstetrics and Gynecology, AtatOrk Research and Training Hospital, Izmir

OBJECTIVES: To investigate the use of misoprostol which is an analogue of prostaglandin E1 (PGE1) to obtain cervical maturation and labor induction. METHODS: 97 patients being applied misoprostol, were divided in two groups. 60 patients in group 1 were given 100 mcg (1/2 tablet) as a single dose and 37 patients in group 2 were given 50 mcg (1/4 tablet) per 3 hours for a maximum of 3 doses. RESULTS: 88.3% of patients in group 1 and 100% of the patients in group 2 had a vaginal birth within 24 hours. The period between the application of first dose and the beginning of uterine contractions was 103+/-50 minutes for group 1 and 98+/-53 minutes for group 2. Time for vaginal birth af-


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ter application of the first dose was measured to be 390+/- 83 minutes for group 1 and 383+/-92minutes for group 2. These2 differences were statistically insignificant. Maternal side effects, abnormal uterine contractions and fetal complications were fewer in group 2. CONCLUSIONS: We conclude that PGE1 is superior to PGE2 as cervical maturation and total time for labor is shorter, it is easy to store and use and it is more economic. KEY WORDS: Misoprostol, labor induction, success

Poster -MFM&P-069 Diagnostical means of mean platelet volume levels, serum uric acid levels and protein levels in 24 hours urinary output in diagnosis of preeclampsia and in differential diagnosis of mild-severe preeclampsia.

Cukurova K, K6ksal A, Onal G, Yildiz A, Ivit H, Keklik A, Yetimalar H Department of 3. Obstetrics and Gynecology, Atat(Jrk Research and Training Hospital, Izmir

OBJECTIVES: Early and accurate diagnosis of preeclampsia important as early treatment would lead us to manipulate prenatal and maternal outcomes. For this reason, diagnostic values of mean platelet volume (MPV), serum uric acid and protein levels in 24 hours urinary output were detected and evaluated for the diagnosis of preeclamsia and the differential diagnosis of mild-severe forms of preeclampsia. METHODS: 50 preeclamptic pregnant patient and 40 normal pregnant women as a control group were included in our study. Maternal mean platelet volume, serum uric acid and protein levels in 24 hours urinary output were measured and the groups were researched for a significant difference. RESULTS: Mean platelet volume, serum uric acid and protein levels in 24 hours urinary output in preeclamptic patients were higher than those of control group. Also MPV and protein excreation rate in 24 hours in urinary output of severe preeclamptic patients were higher significantly than those of mild preeclamptic patients. CONCLUSIONS: In this study, in differential diagnosis of mild-severe preeclampsia, MPV and protein excreation rate in 24 hours in urinary output were significant whereas serum uric acid level was not significant. KEY WORDS: Preeclampsia, proteinuria, platelet volume

Poster -MFM&P-070 Comparison of the effect of single and repeated courses of corticosteroids on fetal lung maturation and brain growth

Kafkasli A 1, Engin-Ustun y1, Boz M 1, Karadag N 2 1 Department of Gynecology and Obstetrics, In6nO University Faculty of Medicine, Malatya, Turkey 2 Department of Pathology, Indn(J University Faculty of Medicine, Malatya, Turkey

OBJECTIVES: To compare the effect of single and repeated courses of corticosteroids on fetal lung maturation, size at birth, head circumference and brain growth in fetal rats. METHODS: Forty two Sprague-Dowley rats were divided into 6 groups. Mature and premature pregnant rats were gi-

ven intramuscular betamethasone (0.5 mg/kg) at 16 or at 16-18 days of gestation. Controls (mature and premature rats) received equivalent volumes of sterile normal saline. Rats were delivered at 19 (preterm) and 22 (term) days. Af- ter cesarean delivery, we measured birth weight, length, head circumference, weight of whole brain, maximal cerebral anterior-posterior length and evaluated the lungs histo- pathologically. RESULTS: There were no significant differences in birth weight and whole brain weights between the premature rats receiving one dose and repeated doses of corticosteroid. Lung maturation in premature rats revealed %71.4 glandular stage in the rats receiving one dose of corticosteroid where as %42.9 glandular stage and %42.9 canalicular stage in rats receiving multiple courses. CONCLUSIONS: Administration of repeated courses of corticosteroids did not retard fetal birth weight and brain growth. KEY WORDS: corticosteroids, fetal lung maturation, brain growth

Poster-MFM&P-071 The Effect of Maternal Smoking On Placenta

Kesim MD Demirkaya BO., Atis A, Yavuz M Third Obstetrics and Gynecology Department, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.

OBJECTIVES: The goal of this research is to investigate whether cigarette smoking and exposure to smoking during pregnancy causes placental pathologies that effects fetal growth and development. METHODS: 78 placentas of women who had normal spontaneous birth in Sisli Etfal Training and Research Hospital, 3rd Obstetrics and Gynecology clinics were investigated. Statistical analyses were performed by using Graph pad Prisma V.3 Programme. RESULTS: In smokers, placental perivillous fibrin deposits, fibrinoid necrosis and villous basal membrane thickening were statistically higher (p<0.001, p<0.05, p<0.05, respectively). But, there were no statistical difference between cal- cification, chorioamnionitis, necrosis and congestion (p>0.05). CONCLUSIONS: The adverse effects of smoking on fetal growth are due to both the direct effect of hazardous metabolites found in cigarette smoke and also the placental pathologies. In this study, the findings have revealed that smoking affects the placentas which can be one of the reasons of growth restriction. KEY WORDS: Tobacco use, placental pathology, pregnancy

Poster -MFM&P-072 Maternal Mortafity Rates at Hacettepe University Hospital

Bozkurt T, Ozyuncu O, Bozdag G, Salman MC, Durukan T, Beksac S, Onderoglu L, Deren O, Ayhan A Hacettepe University, School of Medicine, Department of Obstetrics and Gynecology

OBJECTIVES: To review the causes of maternal mortality and show trends between years in Hacettepe University Hospital. METHODS: Causes of 128 maternal deaths seen between 1968 and 2005 were retrospectively evaluated.

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RESULTS: Maternal mortality rate was 143.4/100.000 live births. The most common causes of maternal mortality were infection and cardiac diseases. Among direct causes of maternal mortality, the most common causes were infection, hemorrhage and toxemia. Among indirect causes of maternal mortality, the most common cause was cardiac disease. Neoplasms were the most common group of non-maternal causes. The maternal mortality rate declined from 417/100.000 live births between 1968-1972 to 50/100.000 live births between 1998-2003. CONCLUSIONS: With adequate antenatal care, complications of pregnancy may be diagnosed earlier and be treated. When precautions for some problems that may lead to maternal mortality are taken maternal mortality rates will decli- ne. This study shows that, the preventive measures that are taken to decrease maternal mortality in our hospital are wor- king very effectively. KEY WORDS: maternal mortality rate, retrospective study

Poster-MFM&P-073 Usefulness of fetal sacral length to define the gestational age in turkish population

Tufekci C., KaralSk H., liter E., Cil L., KaralSk A.E, Akyol H. Department of Gynecology and Obstetrics, Bakirkoy Dr.Sadi Konuk Research and Training Hospital, Istanbul, Turkey

OBJECTIVES: Determination of the usefulness of fetal sacral length in second and third trimester and to prepare a nomogram for our population. METHODS: We included 1220 pregnant women from 15 to 42 weeks gestation that applied to our department. The fetal sacral length measurements are performed by 3.5 MHz lineer abdominal probe and evaluated with the basic parameters. RESULTS: Except 12 of the 1220 women we managed to measure the fetal sacral length. The variabilty for the estimation of the gestational week in the last trimester from fetal sacral length is found 21 days. The gestational week for the pregnancy can be easily calculated by a simple formula (Gestational week=0,93 x Fetal sacral length + 2,07). At this point of wiev, we can say that the fetal sacral length measurement in milimetres is nearly equal to the gestational week. CONCLUSIONS: These data support the hypothesis that fetal sacral length measurement is an important prosedure when used with the other basic parameters for the estimation of the gestational age. This parameter is especially use- full in patients who does not know their last mentruel period or did not visit any clinics at the first trimester. KEY WORDS: fetal sacral length, third trimester, nomogram

Poster-MFM&P-074 The Effect of Smoking During Pregnancy On Newborns

Kesim M. D., Demirkaya B. O., Atis A., Oruc Third Obstetrics and Gynecology Department, Sisfi Etfal Research and Training Hospital, Istanbul, Turkey

OBJECTIVES: The main goal of this research is to investigate the effect of cigarette smoking and exposure to smoking during pregnancy on the newborn.

METHODS: 218 pregnant women who had normal spontaneous birth in Sisli Etfal Training and Research Hospital, 3rd Obstetrics and Gynecology clinic were divided into four subgroups according to their smoking habbits. (1. Non-smokers, II. Passive smokers, II1. <5cigarettes/day smokers, IV. >5ci- garettes/day smokers). The birth weights, heights, head cir- cumferences, APGAR scores of 1 st and 5th minutes of the newborns were recorded. Their gestational weeks were detected by using the Ballard method. Fetal malnutrition was diagnosed clinically with the Canscore method. Statistical analyses were performed by using Graph pad Prisma V.3 Programme. RESULTS: With smoking, the weight, height, head circumference and Canscore values of newborns significantly decreased (p<0.0001, p<0.0001, p<0.0001, p<0.0001 respectively). Preterm and SGA newborns were found to be more frequent in the smoking group (p<0.05, p<0.001, respectively). CONCLUSIONS: The adverse effects of smoking on fetal growth are due to both the direct effect of hazardous metabolites found in cigarette smoke and also the placental pathologies. In this study, the findings have revealed that the fetal growth was adversely affected by smoking. KEY WORDS: Tobacco use, pregnancy, outcome

Poster-MFM&P-075 Massive mucmous cystadenoma in term pregnancy

Ekin M, Ulku M, Caglar P, Demirel C, GOng6r T, Mollamahmutoglu L Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey

Ovarian tumours are estimated to occur in about 1 in 1.000 pregnancies. With the widespread use of routine abdominal ultrasound examination during pregnancy, adnexal masses are observed with increasing frequency. Bening cystic tera- tomas are the most common ovarian tumours, followed by serous cystadenomas. The incidence of malignant tumours are 3%. Most patients are clinically asymptomatic at the time of presentation and most of these masses are pregnancy related and should resolve by 14-16 weeks of pregnancy. Massive ovarian tumours are rare today.In this case report we present a massive mucinous cystadenoma complicating pregnancy. Frequency, diagnostic procedures andclinical management of these ovarian tumours are being discussed. KEY WORDS: pregnancy, adnexal mass, ovarian tumour.

Poster-MFM&P-076 Cervical pregnancy in a patient using oral contraceptive preparations

Usta T, Ozdemir B, Ates U, Numanoglu N, Seyhan A, Sidal B Department of Obstetric and Gynecology, Vakif Gureba Research and Training Hospital ISTANBUL

BACKROUND: Cervical pregnancy is the implantation of fertilized ovum to the distal part of internal cervical ostium. In this case we report a patient presented with cervical pregnancy who is taking oral contraceptives (OC) regularly. CASE: A 39 year old woman applied to our hospital with the complaint of menstrual bleeding. We found a profuse cer-

M a t e r n a l Fetal M e d i c i n e - P e r i n a t o l o g y - Poster Presentat ions

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vical bleeding, enlarged and hourglass shaped uterus on gynecologic examination. The hemoglobin level was 7.4 g/dl, I~ hCG was 53119 mlu/ml. On transvaginal ultrasound examination; uterus was normal, cervix was very enlarged, heart beat (+) 8w4d fetus was implanted to the endocervix, internal cervikal os was closed. The patient was taking OC for 21 days a month for 6 months regularly. Because of our patients desire for preservation of her fertility, we chose conservative evacuation by suction curettage. No complication was seen. Two packs of blood transfusion was required. 13hCG level decrease to normal levels in 3 weeks after the curettage. CONCLUSIONS: Pregnancy rates in a women using OC is reported % 0.1 for the first year. In our review of the english literature we could not find any report of cervical pregnancy in a patient who was taking oral contraceptive. Our patient responded to the conservative therapy completely. It should be kept in mind that cervical pregnancy could occur in a patient who is taking OC regulary. KEY WORDS: Cervical pregnancy, oral contraceptive, management

Poster-MFM&P-077 The incidence of congenital anomalies at defivery during six years period

Akdenlz N, Kale A, Erdemoglu M, Ozcan Y, Yalmkaya A Dicle University Faculty of Medicine Departments of Obstetrics and Gynecology Diyarbakir, Turkey

OBJECTIVES: The aim of this study is to investigate the incidence, anomaly types and clinical properties of the congenital anomalies at delivery between January 1999 to De- cember 2004 years. MATERIALS AND METHODS: We analyzed 417 fetal major congenital anomalies in 9240 pregnant women at delivery retrospectively in our obstetrics clinic. The incidence, anomaly types, delivery types and fetal Apgar scores were evaluated. RESULTS: Total 417 fetal congenital anomalies were detected, and the incidence of anomaly was 4.51%. The neural tube defects were the most common anomalies (40%), and the second was genitourinaryl anomalies (17%). The patients were delivered with vaginal (83%) and cesarean section (17%), and 32% of the fetuses had 0/0 Apgar scores at delivery. CONCLUSIONS: We found that, the incidence of major congenital anomalies were higher than literature. Our clinic is a reference center of the region, therefore the incidence was found higher. KEY WORDS: Major congenital anomalies, Incidence, An- omaly types

Poster-M FM& P-078 Treatment of intrahepatic cholestasis of pregnancy and fetal, maternal outcome

Ozdemir B, Numanoglu N, Usta T, Ortakuz S, Seyhan A, Sidal B Department of Gynecology and Obstetric, Vakif Gureba Research And Education Hospital, Istanbul, Turkey.

OBJECTIVES: Our aim is to compare the efficacy of drug therapy (cholestyramine or ursodeoxycholic acid) for the treatment of intrahepatic cholestasis of pregnancy (ICP) and is to evaluate maternal and fetal outcomes. METHODS: A total of 34 patients of ICP were identified.All patients presented with pruritis. Maternal serum free bile acids and aminotranferases was elevation in all. All pregnancies were >33 week gestational age. Of 34 women enrolled, 28 received ursodeoxychotic acid (UDCA 750 mg/day), 12 received cholestyramine (16 gr/day) until delivery.6 patients did not accept drug therapy. RESULTS: The outcome measures were reduction in the concentration of serum bile acids, aminotransferase,bilirubin levels and clinical symptoms (pruritus).Both therapies improved pruritus. Patients receiving UDCA had a greater impro- vement in the concentration of serum bile acids,aminotransferase,and bilirubin (p<0.02).Pregnancy outcomes were similar in both groups. Patients without therapy had a statistically greater risk of worse fetal outcomes (p<0.05) (fetal distress,preterm delivery, fetal death). CONCLUSIONS: ICP should be managed such as high risk pregnancy.The disease poses little medical risk to the mother but poses significantly risk to the fetus of perinatal mortality, preterm delivery and fetal distress. We recommend UDCA in the management of intrahepatic cholestasis of pregnancy as a first line agent and cholestyramine as a second line agent. KEY WORDS: intrahepatic cholestasis, pregnancy, outcome

Poster-MFM&P-079 Transient Central Diabetes Inspidus In Pregnancy: A Case Report

S.eyhan A, Numanoglu N, Usta T, Ortakuz S, C)ztarhan A, Ozdemlr B, Dogan O Department of obstetric and gynecology, Vakif Gureba Research Hospital, Istanbul, Turkey

OBJECTIVES: Diabetes inspidus(DI) is a rare endocrinopa- thy, and its association with pregnancy is even rarer. In this report we aimed to discuss diagnosis, management and treatment of DI. METHODS: A 32- year-old G3P2 was admitted with severe thirst and polyuria at 24 weeks' gestation. There was no history of DM, cerebrovascular disease or cancer. Her electrolytes and OGTT were normal.Urine specific gravity was 1.005. Serum osmolality was 312 mOsm/I and correspon- ding urinary osmolality was 73 mOsm/I which was suggesti- ve of diabetes inspidus. T1 weighted magnetic resonance images revealed enlargement of the pituitary posterior lobe with absence of hyperintense signal. The patient responded to intranasal DDAVPwith reduction of urinary output and thirst.The patient was diagnosed with gestational diabetes inspidus and discharged on DDAVP 10 micrograms nasally BID. She had spontaneous onset of labor at 40 2/7 weeks

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Maternal Fetal M e d i c i n e - P e r i n a t o l o g y - P o s t e r P r e s e n t a t i o n s

and had successful vaginal delivery. DDAVP was disconti- nued 6 weeks postpartum. CONCLUSIONS: Pregnancy is associated with number of changes predisposing pregnant women to DI, such as decreased thirst threshold, an enhanced degradation of vasopressin by placenta derived vasopressinase, and a decreased renal responsiveness to vasopressin. Administration of DDAVP is the drug of choice and careful monitoring of the patient's fluid balance during and after pregnancy is crucial KEY WORDS: Diabetes Insipidus, pregnancy

Poster-MFM&P-080 Misoprostol for second trimester pregnancy termination in women with prior cesarean delivery

Dilbaz S, Kovalak E.E, Tarcan A, Sariisik B, Sivaslioglu A, Haberal A Ministry of Health Ankara Etlik Matemity and Women's Health Research Training Hospital

OBJECTIVES: Our aim is to evaluate the efficacy of misoprostol for second trimester pregnancy termination in women with at least one previous cesarean delivery. METHODS: Twenty-six pregnant with at least one a previous cesarean delivery and who underwent second trimester (12-20 weeks)termination of pregnancy were included the study. The indications for termination were fetal death (88.5%) or fetal anomalies (11.5%). All patients received 100 Fg misoprostol pc. every 2 hours after an initial dose of 200 #g vaginal misoprostol. Mean gestational age was 14.76 weeks. RESULTS: The mean duration of abortion was 10.8 hours (4-18 hours). The mean misoprostol dose was 656.25 #g (300-1000 #g). One (3.8%) of the patients had placental re- tention and none of the patients had uterine rupture, major bleeding, or a need for transfusion. CONCLUSIONS: Misoprostol appears to be safe and effective in second trimester termination in the patients who had a previous cesarean delivery. Further randomized controlled studies are necessary to investigate the safety and efficacy of this drug in patients who have a uterine scar. KEY WORDS: misoprostol, termination, second trimester

Poster-MFM&P-081 The Tap test and Shake test as alternative to the standard U S rat io in the assesment of fetal lung matur i ty

Cinar E, Tanriverdi HA, Akbulut, V, Sade H, Barut A Karaelmas University Medical School Department of Obstetrics & Gynecology

OBJECTIVES: The aim of this study is to evaluate the Sha- ke test and Tap test results and to compare them with the standard L/S ratio. MATERIALS AND METHODS: 40 patients who delivered between January 2004 and May 2004 were included in the study. Gestational age was determined by the last menstru- ation date and ultrasonographically. Amniotic fluid samples were obtained via vaginal aspiration in patients who had amniotic membrane rupture, and in patients who had intact membranes via transabdominal amniocentesis, amniotomy

or during cesarean section. All of the patients delivered in 12 hours after amniotic fluid sampling. Tap test (on the 2, 5, 10 minutes) and Shake test of amniotic fluid samples were performed manually, and Lecithin/Sphingomyelin (L/S) ratio was determined in the biochemistry laboratory. Shake test and Tap test results were compared to the L/S ratio, as the gold standart and the correlation of these results with L/S ratio was evaluated. Statistical analysis of the data was performed with the McNemar and Chi-square test, a p value <0.05 was accepted as statistically significant. RESULTS: We found that Shake test and Tap test results correlates well with the L/S ratio for assesment of the fetal lung maturity. CONCLUSIONS: Shake test and Tap test are acceptable lung maturity prediction tests. As an alternative to L/S ratio to determine the fetal lung maturity, they might be used easily beside the patient and have additional advantages: They have a lower cost, are less time consuming, and the need for experienced personal is minimal. Key words: Am- niotic fluid, Tap test, Shake test, Lechitin/sphingomyelin ratio, Fetal lung maturity tests, Respiratory distress syndrome KEY WORDS: Amniotic fluid, Tap test, Shake test, Lechitin /sphingomyelin ratio, Fetal lung maturity tests, Respiratory distress syndrome

Poster-MFM&P-082 Effects Of Various Risk Factors For Surgical-Site Complications Following Vaginal Birth With Episiotomy And Cesarean Defivery

Dede A, Ozel M, Genaydin S, Ertas E, Danisman N, Mollamahmutoglu L Department of Perinatoloji, Zekai Tahir Burak Woman Health Education and Researh Hospital, Ankara, Turkey

OBJECTIVES: To detect the factors affecting the healing proccess of the surgical wounds of cesarean incision and episiotomy. METHODS: This was a retrospective, observational cohort study in which the data belong to 50 patients with diagnosed wound complication after cesarean section or vaginal delivery with episiotomy, and the data belong to 50 patients with no wound complication delivered vaginally or by cesarean section in the year 2004 were collected and compared for a variety of factors. RESULTS: No statistically significant difference was found for age, weight, body mass index, parity, gravidity, presence of chronic systemic disease and smoking history between study and control groups. Among patients who delivered vaginally it was detected that in patients with episiotomy complication, the peripartum maternal hemoglobin level was lower and the duration of the labor was longer. Among patients who delivered by cesarean section it was found that in patients with surgical scar complication, the peripartum maternal hemoglobin level was lower, duration of the operation and hospitalization period was longer. CONCLUSIONS: Correction of maternal anemia, shortening the duration of cesarean operation, labor, and hospital stay can help to decrease the frequency of surgical wound complication. KEY WORDS: cesarean incision, episiotomy, wound healing, complication


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Poster -MFM&P-083 Hyperemesis gravidarum in relation to total BhCG, free BhCG, progesteron, estradiol, thyroid hormones and body mass index

Ates U, Seyhan A, Atmaca U, Ortakuz S, Ata B, Akar S, Sidal B Department of Obstetrics and Gynecology, Vakif Gureba Research and Training Hospital, Istabul, TURKEY

OBJECTIVES: Nausea and vomiting are the most common symptoms in early pregnancy and 3% of these experience hyperemesis gravidarum.We evaluated body mass index and the correlation of hormonal parameters of the patients with hyperemesis gravidarum compared with a normal control group. METHODS: 28 patients with hyperemesis and 34 control subjects were included in study. Sera from hyperemesis was compared with that from controls with respect to total i3hCG, Free i3hCG, progesteron, E2, free T3, free T4, and TSH. RESULTS: Maternal age (26,5• and 28,1_+4,8), gravidity (2,7_+1,5 and 2,8___1,4), parity( 1,21_+1,07 and 1,09• gestational ages (9,18• and 9,60-+1,98) and BMI (22,76-+3,31 and 24,34• were not statistically different. Total 8hCG, free T4 and E2 were significantly higher in hyperemesis patients than in the controls.Free 13hCG concentrations were higher in hyperemesis pregnancies, but differences were not statistically significant.TSH levels were significantly lower in the hyperemesis patients. Free T4 levels were decreased after treatment in hyperemesis group.(p=0.01) Free 8hCG correlated positively with free T4 and E2 in hyperemesis group. CONCLUSIONS: 28 patients with hyperemesis and 34 control subjects were included in study. Sera from hyperemesis was compared with that from controls with respect to total 13hCG, Free i3hCG, progesteron, E2, free T3, free T4, and TSH. KEY WORDS: hyperemesis gravidarum, total 13hCG, Free 13hCG, progesteron, E2, free T3, free T4, TSH.

Poster -MFM&P-084 Conjoined twins with thoracoabdominophagus anomaly in the th i rd tr imester

Tanriverdi HA, Akbulut V, Usal D, Cinar E, Barut A Karaelmas University Medical School Department of Obstetrics & Gynecology

Conjoined twinning represents a rare occurrence in about 1% of monochorionic twins with an estimated incidence ran- ging from 1:30,000 to 1:200,000 live births and one in 650- 900 twin deliveries. However the exact prevelance is still unknown. Forty percent to 60% of conjoined twins are reported to be stillborn, and approximately 35% of live births do not expected to survive 24 hours or more. The prognosis for conjoined twins is generally poor. So the diagnosis of conjoined twins at an early stage of pregnancy enables proper counselling of the family and gives the parents the option of termination.In this case report we present a case which is diagnosed as a thoracoabdominophagus anomaly of conjoined twins in the 32rid week of gestation with early membrane rupture at time of admission. Her previous medical, surgical, obstetrical history was unremarkable. Ultrasonographic evaluation of the patient revealed a thoracoabdominopha-

gus anomaly with a single heart and hypoplasic single lung. Magnetic resonance imaging confirmed the sonographic diagnosis of conjoined twinning. The parents were informed about the malformation of the fetuses. A cesarean section was performed because of progressive preterm labour and early membrane rupture. The infants survived only for 18 hours, and died due to circulatory insufficiency. Although detailed counselling of the parents, they accepted neither a se- paration operation nor an autopsy. Conjoined twinning is a very complex anomaly and the optimal time for prenatal diagnosis are the early stages of pregnancy. In the later stages the sensitivity of ultrasonographic diagnosis is lowered, due to the changes of in-utero conditions. Therefore, a detailed sonographic examination during the first visits of twin pregnancies is vital. A brief review of literature is discussed. KEY WORDS: Conjoined twins, Toracoabdominophagus, Ultrasonography, prenatal diagnosis

Poster -MFM&P-085 Placental expression of insulin-like growth factor, fibroblast growth factor and neural cell adhesion molecule in pregnancies complicated with preeclampsia

Vural B 1, (~zkan S 1, Costur p2, Dalcik H 2, Filiz S 2, Y0cesoy 11 1 Department of Obstetrics and Gynecology, Kocaefi University, School of Medicine, Kocaeli, Turkey 2 Department of Histology and Embryology, Kocaefi University, School of Medicine, Kocaeli, Turkey

OBJECTIVES: To investigate placental expression of IGF-I, FGF and N-CAM regarding the pathogenesis of preeclampsia. METHODS: An immunohistochemical analysis using anti- IGF-I, anti-FGF and anti-N-CAM antibodies was conducted on 4% paraformaldehyde-fixed placental tissues of preeclamptic pregnancies (n=14) and controls (n=3). Immuno- staining of amniochorionic membranes and chorionic villi was assessed. RESULTS: IGF-I immunoreactivity was intense in trophoblastic X cells and decidua throughout the amniochorionic membranes of preeclamptic cases while a weak immunostaining was shown in stroma (Hofbauer cells and fibroblasts), capillary endothelium and syncytiotrophoblasts. FGF expression was increased in stroma and syncytiotrophoblasts in preeclampsia. FGF immunostaining of amniochorionic membranes was indifferent from controls. N-CAM immunoreactivity in villi of preeclamptic placentas was promi- nent in Hofbauer cells while a slight immunostaining of capillary endothelium and syncytiotrophoblasts was noted. N- CAM staining was reduced throughout the amniochorionic membranes in preeclampsia. CONCLUSIONS: Multifunctional regulatory cytokines provide adequate trophoblastic invasion which is of vital import- ance regarding the placental anchoring and setting of vas- cular connections with maternal circulation. Disturbed regulation of those molecules is implicated in pathogenesis of preeclampsia. Investigation of regional distribution of IGF-I, FGF and N-CAM at the maternal-fetal interface may esta- blish a better understanding of etiopathogenetic processes of preeclampsia. KEY WORDS: IGF-I, FGF, N-CAM, preeclampsia

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Poster -MFM&P-086 Color doppler examination of fetal an urinary obstructive anomaly

Erdemoglu E 1, Kolusari A~, Sahin HG~, Kamaci M~, Sahin AM 2 1 Department of Obstetrics and Gynecology, YEiz#nc(~ Yil University Facutly of Medicine, Van, Turkey 2Department of Family Medicine, YEIz#ncEI Yil University Faculty of Medicine, Van, Turkey

BACKGROUND: To report a congenital obstructive urinary system anomaly and discuss the use of color Doppler studies in differential diagnosis. CASE: 33 years-old, G6P5, women was admitted to hospital with diagnosis of fetal abdominal mass and anhidramnios at 20 weeks of gestation. Initial examination of the patient by B-mode ultrasonography was in accordance with bladder outlet obstruction and hydronephrosis. However, color Doppler study and documenting umbilical arteries tributing from internal lilac artery which course near to bladder help us make a diagnosis of complete pelvic obstruction on the left and incomplete obstruction on the right. Fetus was considered for fetal surgery and 2 ureterocentesis was done to evalute renal function. Besides, amnioinfusion was performed. Renal function of the fetus has detoriated and the pregnancy was terminated. Pathologic examination of the fetus confirmed the diagnosis made by color Doppler. CONCLUSIONS: Color Doppler examination should be in- corparated to routine examination in fetuses with obstructive urinary anomalies. KEY WORDS: Urinary anomaly, fetus, Doppler study

Poster -MFM&P-087 Placental Expression of Insulin-Like Growth Factor- I, Fibroblast Growth Factor and Neural Cell Adhesion Molecule in Pregnancies Complicated with Intrauterine Growth Retardation

Vural B~, 0zkan S 1 , mas A 2, Dalcik C 3, Dalcik H 2, YQcesoy G ~

Department of Obstetrics and Gynecology, Kocaefi University, School of Medicine, Kocaeli, Turkey 2 Department of Histology and Embryology, Kocaeli University, School of Medicine, Kocaeli, Turkey 3 Department of Anatomy, Kocaeti University, School of Medicine, Kocaeli, Turkey

OBJECTIVES: To investigate the implications of placental IGF-I, FGF and N-CAM expression regarding the pathogenesis of lUGR. METHODS: An immunohistochemical analysis using anti- IGF-I, anti-FGF and anti-N-CAM antibodies was conducted on 4% paraformaldehyde-fixed placental tissues of pregnancies with IUGR (n=12) and the controls (n=3). Immunostai- ning of amniochorionic membranes and chorionic villi was assessed. RESULTS: IGF-I immunoreactivity of the chorionic villi was increased in syncytiotrophoblasts, capillary endothelium and stroma (Hofbauer cells and fibroblasts) in IUGR when compared with the controls. Trophoblastic X cells presented a positive immunostaining throughout the amniochorionic membranes in IUGR. Placental FGF expression was promi- nent in syncytiotrophoblasts, capillary endothelium and stro-

ma in IUGR while the amniochorionic membranes had a similar immunostaining with the controls. IUGR cases had an intense N-CAM immunoreactivity throughout chorionic villi; in syncytiotrophoblasts and stroma. N-CAM immunostaining of amniochorionic membranes in IUGR was weak in vacuo- lated trophoblastic X cells. CONCLUSIONS: Abnormal regulation of growth factors and adhesion molecules serving as modulators of placental function is well-correlated with impaired fetal development. Increased placental expression of IGF-I, FGF and N-CAM may act in an autocrine and/or paracrine manner to restore the impaired trophoblastic proliferation by a positive feed- back mechanism. KEY WORDS: IGF-I, FGF, N-CAM, placenta, IUGR

Poster -MFM&P-088 Clinical and laboratory predictors of fetal loss after f i rs t t r imester threatened abortion

Unlubilgin E 1, Caliskan 5 2, Demir B 1, Dilbaz S ~, Sonmezer M 1, Haberal A~ 1 TCSB Ankara Etlik Maternity and Women's Health Teaching Research Hospital, Ankara, Turkey 2 Department of Obstetrics and Gynecology, Kocaeli University, Kocaeli, Turkey

OBJECTIVES: To evaluate the possible predictors of fetal loss after the diagnosis of threatened abortion with live fetuses in the first trimester. METHODS: Fifty women diagnosed to have threatened abortion and 25 gestational age matched controls were included in the study. Gestational age at diagnosis, vaginal bleeding, abdominal pain, cervical length, crown-rump length, gestational sac volume, localization of the placenta, presence of a decidual hematoma, Doppler measurements of the uterine arteries, Ca-125, B-hCG, estradiol and progesterone levels were included in a logistic regression analysis to predict abortion by 12 weeks and 20 weeks of gestation. RESULTS: Five (6.7%) abortions were observed by 12 weeks of gestation and 12 (16%) abortions occurred by 20 weeks of gestation. Increase in cervical length decreased (OR:0.76, Ch0.57-1,p=0.05) and presence of decidual hematoma increased (OR:12, C1:1.09-131, p=0.04) the risk of abortion by 12 weeks of gestation. Cervical length was the only predictor of abortion by 20 weeks of gestation (OR:0.75, C1:0.62-0.92, p=0.005). A 35mm cut-off value for cervical length has a 41% sensitivity, 85.7% specificity, 35% positive predictive value and 88% negative predictive value. CONCLUSIONS: Uterine cervix is the main side to which all hormones act and can be used to predict probable fetal loss when threatened abortion is diagnosedKey words: threatened abortion, fetal loss, cervical length, predictors KEY WORDS: threatened abortion, fetal loss, cervical length, predictors


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Poster -MFM&P-089 Bilateral ventriculomegaly and agenesis of corpus callosum: case report

Erdem M, Turp A, Gunaydin G, Erdem A Department of Gynecology and Obstetrics, Gazi University, Ankara, Turkey

INTRODUCTION: Corpus callosum is a transvers commis- sure that connects two lateral hemispheres. Agenesis of corpus callosum may be partial or total, congenital or acquired. Multiple anomalies like Dandy Walker Malformation, Chiari Malformation, arachnoid cyst, heterotopy, coloboma, midfacial defects, skeletal anomalies and aquaductal stenosis may co-exist.CASE REPORT: A 28 year-old, G1P0,no remarkable personal or family history, was referred to our prenatal diagnosis unit for suspected anomalies.Fetal bio- metry was consistent with 30 2/7 weeks of gestation. Bilate- ral ventriculomegaly was determined. No other anomalies could be seen. Lateral ventricule diameter measurements were stable during the course of pregnancy. At 38 weeks of gestation a healthy female infant was delivered weighing 3200 g with an Apgar score of 9 and 10 at one and five minutes respectively. Neurologic examination of the newborn was normal. Transfontanel cranial ultrasonography revealed bilateral ventriculomegaly and agenesis of the corpus callo- s u m .

CONCLUSIONS: Agenesis and dysgenesis of corpus callosum is frequently seen. It may be isolated or a part of metabolic or genetic disorders or syndromic with multiple malformations. In this case bilateral ventriculomegaly is accompanied by agenesis of corpus callosum no other metabolic or genetic disorder could be identified. KEY WORDS: bilateral ventriculomegaly, agenesis of corpus callosum

Poster -MFM&P-090 Decision making of genetic amniocentesis

Sade H, Tanriverdi HA, Gezer S, Bayar 0, Barut A Karaelmas University Medical School Department of Obstetrics & Gynecology

OBJECTIVES: To evaluate the genetic amniocentesis applications perfomed for different indications between January 2002 - March 2005 in our department and the decision making process of amnoicentesis is discussed. MATERIAL-METHODS: 130 amniocentesis were included to this study. Advanced mother age (>35 years of age), abnormal tripple test results (cut-off 1/250), a familiy history of a pregnancy with a genetic abnormality and abnormal fetal ultrasonography findings were the inidications. All amniocentesis applications made by abdominal approach with 20- 22 gauge neddle. All karyotype analysis results were discussed with the families within 15 days and according to the result reasonable suggestions were made. RESULTS: One abortion (0.7%) happened in the first day after the amniocentesis. In this patient three punctures had to be performed because of innapproprite scnnang conditions due to morbid obesity of the mother. Amniocentesis was performed in 51 (%37) pregnant with the unique indication of advanced maternal age, and any abnormal karyotype was determined in this group. In 13 pregnant women the indication for amniocentesis was an abnormal ultrasound fin-

ding; 2 of them had an abnormal karyotype result: One of them had 45x0 karyotype, and the other one had a 47XX karyotype. Amniocentesis was perfomed in 52 (40%) pregnant women for abnormal triple test results and an abnormal karyotype was determined in 2 of these patients (One case 47XX, and one case trisomy 16 mozaizism). CONCLUSIONS: The combination of prenatal screening tests seem to have the best results for making the decision of genetic amniocentesis. Key words: Amniocentesis, prenatal diagnosis, ultrasonography KEY WORDS: Amniocentesis, prenatal diagnosis, ultrasonography

Poster-MFM&P-091 Influence of various factors on birthweight

Demir B 1, Demir F 2, Yayla M 1 1 Department of Obstetrics and Gyncology, School of Medicine, Dicle university, Diyarbakir, Turkey 2 Department of Pediatrics, School of Medicine, Dicle university, Diyarbakir, Turkey

OBJECTIVES: The determinants of birthweight were inves- tigatet in 500 pregnant women prospectively. These factors were included socioeconomic, anthropometric, medical and nutritional status. METHODS: This prospective study was performed by face to face talking to each mother using a form including 50 questions priorly prepared. RESULTS: Mean birthweights of the babies were 2923.66 gr. and 2923.10 gr. for boys and girl, respectively. The difference in mean birthweights of males and females were 156 gr. but not statistically significant different between both se- xes. Mother's body weights and height measures were affecting the babies' birth weights positively. In conclusion, the birthweights of babies were affected by maternal age, maternal body weight and height, educational and occupational status of the family, smoking habit in pregnancy, number of birth, mineral and vitamin support during pregnancy, frequency of prenatal care, weight gain in pregnancy, localization of in habitance and nourishment of mothers in pregnancy. CONCLUSIONS: It was concluded that the investigation and management of the factors that could lead to low birt- weight will reduce the perinatal morbidity and mortality. KEY WORDS: pregnancy, birth weight, outcome

Poster -MFM&P-092 Oxytocin infusion in labor: the use of di f ferent diluents on neonatal bilirubin levels.

Api O, Ayg0n E, Kars B, Cengizoglu B, Bulut S, Turan C, Unal O Ob&Gyn, Kartal Education Hospital, Istanbul, Turkey

OBJECTIVES: To investigate the relationship of neonatal bilirubin levels to oxytocin infusion and the diluent used for oxytocin infusion. METHODS: The study was a prospective, randomized study. Thirty patients managed with oxytocin during labor were recruited. These patients were divided into isotonic (Group 1) (n=15) and 5% glucose solutions (Group 2) (n=15). Thirty multiparous patients delivering without oxytocin infusion for-

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med the control group (Group 3). Maternal age, gestational age, labor duration, mode of delivery, birth weight of the babies, total volume of fluid administered until delivery and total oxytocin dose were noted in each case. Sodium and initial bilirubin levels were measured in the cord blood. RESULTS: The difference between study and control groups regarding the rate of hyponatremia, neonatal hyperbilirubinemia and neonatal jaundice was not statistically significant. Cord plasma sodium levels, cord plasma bilirubin levels, hematocrit and blood gas analysis were not statistically different between the groups. CONCLUSIONS: No significant effect of oxytocin infusion was revealed on neonatal hyperbilirubinemia. KEY WORDS: oxytocin infusion, induction of labor, neonatal bilirubin level

Poster -MFM&P-093 An analysis of 421 non-elective cesarean sections: factors associated with hemorrhage

Api 01, Unal 01, Karageyim YK 1, Balcik O ~, Kara ~)1, Dogance U 1, Akil A t, Api M 2

Ob&Gyn, Kartal Education Hospital, Istanbul, Turkey 20b&Gyn, Haseki Hospital, Istanbul, Turkey

OBJECTIVES: To study the risk factors for hemorrhage in non-elective cesarean deliveries. METHODS: The charts of women who underwent Cesarean section during 2003 were reviewed for pre- and postoperative hemoglobin values, demographic data and indication for surgery. RESULTS: There were 2450 total deliveries, 743 (30.3%) being delivered by C/S; 421 of these (56.6%) were non- elective. Mean hemoglobin (Hb) level was 11.70+1.99 g/dl prior to surgery and 11.24+1.99 g/dl after the surgery (p<0.0001). Hemorrhage (a decrease in hemoglobin of 10% or greater) occurred in 72 cases (17.1%). There was a statistical difference between the fetal distress and two prior C/S groups in terms of hemorrhage. Grand multiparous women bled significantly more, irrespective of the indication (p=0.023). Factors having a significant association with hemorrhage were: maternal age in the one prior C/S group, gravidity in the CPD and other groups. CONCLUSIONS: These data stress the possibility of hemorrhage in patients at risk for undergoing non-elective C/S. KEY WORDS: Hemorrhage, cesarean delicery, prevalence

Poster -MFM&P-094 Assessment of perinatal outcomes of adolescent pregnancies between the age of 15-18

Balsak D., Avcl ME, Elveren B., Hanhan M., Kayhan K., Tmar S., Ispahl C. Aegan Maternity and Women Hospital

OBJECTIVES: To anlyse the perinatal outcomes of adolescent pregnancies (Age between 15-18). METHODS: We made retrospective anlysis of 176 adolescent pragnant women (Age between 15-18) who were admitted to the Aegan Maternity and Women's Health Tea- ching Hospital at the date between 1.1.2004-1.1.2005 RESULTS: Out of 11000 pregnant women, %1.6 were adolescent group. %86 of these pregnancies were primipar.An-

emies was detected in %29. Premature delivery was seen in %8. Low birth weight was measured in %15.9. %6.8 of adolescent pregnancies resulted in abortion. Preeclampsia was seen in 9 (%5.1)adolescent pregnants, 8 of them primipar. %69.9 of pregnacies terminated via normal spontan vaginal delivery, %30.1 were terminated by C/S. The most ethiology of C/S were Cephalopelvic disproportion. CONCLUSIONS: The percentage of low birth weight is high but there is no difference at early gestation loss and premature delivery with normal pregnant women (Age between 19- 35), Anemia was detected high than normal pregnant women (age between 19-35). The most of the ethiology of the C/S were cephalopelvic disproportion, it suggest that adolescent pregnant have poor bone pelvis structure. We must be careful to adolsecent pregnant women for anemi and nutriti- on. KEY WORDS: perinatal outcome, adolescent pregnancy, pregnancy complications

Poster -MFM&P-095 Serum selenium levels in preeclamptic and normal pregnancies

M ollamahmutoglu L, GengSr T, Ozdal B, Cavkaytar S, Ozat M, Demirel C, Aksakal O Zekai Tahir Burak Research and Training Hospital, Ankara, Turkey

OBJECTIVES: Possible association between selenium status and occurance of preeclampsia was investigated. METHODS: Blood samples from 15 preeclamptic patients and 15 matched pregnant controls at 32-36 gestational weeks for selenium determination by GTA 96 (graphite tube atomizer) analysis. Clinical characteristics of the women and their infants were recorded. Statistical analysis was made by Wilcoxon signed rank test. RESULTS: Median selenium concentration in the preeclamptic subjects was 52.7 ng/ml (range 41.3-81.4) and 59.8 ng/ml (45.5-99.8) in their matched controls. Although lower selenium levels were detected in the preeclamptic group, this was not statistically significant. Age average was 22.4 in preeclamptic group and 23.2 in control group which was not statistically significant (p>0.05). CONCLUSIONS: Measurement of total intravascular selenium can give more accurate results about the selenium status. So one must consider the total plasma volume in mea- suring the selenium levels in pregnancy. In pre-eclampsia, impaired perfusion decreases the transport and the usage of selenium by placenta. So although serum selenium levels are normal, placental selenium levels may be low. Measure- ment of placental selenium may be more helpful to repre- sent the possible role of selenium in pathogenesis of preeclampsia. KEY WORDS: Preeclampsia, oxidative stress, selenium


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Poster-MFM&P-096 Does high dose betamethasone application make any difference in hellp syndrome recovery?

Caliskan E ~, Unlubilgin E 2, Cakiroglu Y~, Dilbaz B 2, Dilbaz S 2 l Department of Obstetrics and Gynecology, University of Kocaeli, Kocaeli, Turkey 2 TCSB Ankara Etlik Maternity and Womens Health Research Hospital, Ankara, Turkey

OBJECTIVES: To determine the effect of betamethasone on HELLP syndrome outcome. METHODS: A restricted randomized study using 34 weeks cut-off as a block was performed on 65 pregnant women with HELLP syndrome. In group I (n=34) 24 mg betamethasone was applied immediately after the diagnosis of HELLP syndrome before cesarean delivery and repeated 24 hours later. Cesarean delivery was performed in Group II (n=31) immediately after diagnosis. All cases received 6 g MgSO4 bolus followed-by 1.5 g/hour infusion. Trombocyte count and mean arterial pressure was followed-up in the post-partum period. RESULTS: The mean gestational age was 33_+2,5 in Group I and 33,8_+3 in Group II (p=0,8). Mean arterial pressure before and at 4th, 8th, 12th, 16th, 24th hours were similar. The mean platelet count at admission was 106x103+_5x103/mm3 in Group I and 110x103_+7x103/mm3 in Group II (p=0,5). The mean platelet counts were also similar in the two groups at 12th hour after the cesarean delivery. But, the mean platelet count was higher in Group I at 24th hour (103x103_+8x103/mm3) and at 48th hour (118x103_+ 9x103/mm3) after delivery compared to Group II (m24=79x 103_+8x103/mm3 (p=0,03), m48=89x103_+9x103/mm3 (p=0.04)) respectively. CONCLUSIONS: High dose betamethasone application results in earlier recovery of platelet counts in the postpartum period. KEY WORDS: HELLP syndrome, betamethasone, platelet count

Poster-MFM&P-097 Predictive value of insulin like growth factor binding protein-1 in cervical secretion for premature rupture of membranes in preterm labor

Dilbaz S ~ Caliskan E 2, Dilbaz B 1, Ozdas E ~, Filiz T 2, Haberal A~

TCSB Ankara Etlik Maternity and Women 2 Department of Obstetrics and Gynecology, Kocaefi University, Kocaefi, Turkey

OBJECTIVES: To evaluate if IGFBP-1 detection in cervical secretions of pregnant women with preterm labor have a predictive value for premature rupture of the membranes (PROM). METHODS: Seventy-eight women in preterm labor were evaluated for Bishop score, cervical length, amniotic flow, vaginal pH, vaginal infection, and the rapid strip-test of amniotic fluid IGFBP-1 was applied. PROM was diagnosed if fluid pooling in the vagina was observed with pH>7 in the absence of vaginal infection or progressive decrease in amniotic fluid index when positive patient history was present.

RESULTS: The mean gestational age was 34,2+/-1.7 (30- 36) weeks. Forty-four women (56,4%) complained for fluid flow from the vagina. PROM was diagnosed in 34 (43,6%) cases. IGFBP-1 test was positive in 38 (48,7%) cases. The sensitivity of IGFBP-1 test for detection of PROM was 88%, specificity was 81%, positive predictive value was 79%, and negative predictive value was 90%. CONCLUSIONS: Detection of IGFBP-1 in cervical secretions is not better than a good clinical evaluation for the diagnosis of preterm PROM. KEY WORDS: IGFBP-1, Preterm premature rupture of membranes, Prediction

Poster-MFM&P-098 Isolated Mega Cisterna Magna

Asian E~, Tarim E 1, Kilicdag E 1, Haydardedeoglu B 1, Kuscu E 2 1 Baskent University, Medicine Faculty, Department of Obstetrics and Gynecology, Adana, Turkey 2 Baskent University, Medicine Faculty, Department of Obstetrics and Gynecology, Ankara, Turkey

BACKGROUND: Enlarged cisterna magna is an anatomical finding which is almost always accompanied by other abnormalities when encountered in chromosomal aneuploidies, mainly in trisomy 18 or a component of Dandy-Walker malformation. Isolated mega cysterna magna is generally considered as a variant of normal reported in a limited number of studies. Cases: We have encountered 3 isolated cisterna magna enlargements in our routine 20 week-scanning or later follow-up scannings among 1139 pregnancies. Isolated mega cisterna magna was confirmed by computed tomogra- phy in two of the cases, and in one of these two, further investigation was carried out by MRI. The parents of the third case refused to have any radiological examination because the infant was normal appearing. The neuromotor development of the infants was found to be normal at 6, 12 and, 18 months in all three, two and one of the cases respectively. CONCLUSIONS: Our cases support the consideration of isolated mega cisterna magna as a variant of normal. But it should be stressed that the cases should undergo a tho- rough scanning in order to detect any associated abnormality when mega cisterna magna is encountered. Because any additional abnormality most probably connotes a chrosomal abnormality. KEY WORDS: Mega Cisterna Magna, ultrasonography, fetal anomaly, central nervous system

Poster-MFM&P-099 Gastric Cancer In Differential Diagnosis Of Hyperemesis Gravidarum

Asian E 1, Kilicdag E~, Simsek E 1, Bolat F 2, Haydardedeoglu B ~ 1 Baskent University, Medicine Faculty, Department of Obstetrics and Gynecology, Adana, Turkey 2 Baskent University, Medicine Faculty, Department of Pathology, Adana, Turkey

BACKGROUND: Gastric cancer in pregnancy is rare and, portends a grave prognosis probably due to its relatively late diagnosis at an advanced state.

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M a t e r n a l Fetal M e d i c i n e - P e r i n a t o l o g y - Pos te r P r e s e n t a t i o n s

CASE: A 30-year-old multigravida in her 22nd week of gestation was referred to our institution because of nausea, vomiting, heartburn, and epigastric pain resistant to extensive symptomatic therapy. In abdominal ultrasonography a mass lesion adjacent to liver was detected. Gastric carcinoma is diagnosed by biopsy taken by endoscopy. The patient and family decided not to terminate the pregnancy. At 24th week of gestation subtotal gastrectomy and Witzel jejuno- stomy and lymphadenectomy procedures were performed. Histopathology confirmed signet cell type gastric carcinoma. After corticotherapy a 1450 gr weighing baby was delivered by c/s at 29 week and 3 days of gestation with the parents' insistence in order to institute chemotherapy and radiothera- py as soon as possible. The patient is alive and disease free at 36 months postoperatively. CONCLUSIONS: When hyperemesis gravidarum extends beyond second trimester and is resistant to conventional therapy, an upper abdomen ultrasound scanning and/or en- doscopic examination should be performed in order to rule out the probability of a gastric cancer even if it is rarely encountered. KEY WORDS: Gastric Cancer, Hyperemesis Gravidarum, pregnancy, dispepsia

Poster -MFM&P-100 Seroprevalance of Hepatitis and HIV Infections Among Pregnant Women

Ocak S ~, Zeteroglu S 2, Deveci A 3, Gungoren A 2, Borazan E 2, Hakverdi A 2 1 Mustafa Kemal University, Faculty of Medicine, Department of Infection Disease and Clinical Microbiology, Antakya, Turkey 2 Mustafa Kemal University, Faculty of Medicine, Department of Obstetrics and Gynecology, Antakya, Turkey 3 Yuzuncu Yit University, Faculty of Medicine, Department of Infection Disease and Cfinical Microbiology, Van, Turkey

OBJECTIVES: Determination of seroprevalance of hepatitis and HIV infections among pregnant women. METHODS: Pregnant women admitted to obstetric policlincs of 2 state hospitals and 1 university hospital in Hatay for antenatal care controls were enrolled to study. Blood samples took for investigation of hepatitis B surface antigen (HBs Ag), hepatitis B core antigen (HBc Ag), hepatitis B e antigen (Hbe Ag), anti-HBs, anti-HBc and anti-Hbe and anti-hepatitis C virus (anti-HCV) and anti-HIV antibodies by enzyme-linked immonosorbent assay (ELISA). RESULTS: Eight hundred and eleven pregnant women aged between 17 and 42 years old (mean age 28.14 with SD: 5.17 years) were enrolled to study. HBs Ag was detected in 31 (3.82%) pregnant women blood sample. One hundred eighty three (22.56%) women had anti-HBs antibody where as only 59 (7.27%) women had anti-HBc antibody. None of HBs Ag positive women had HBe Ag positivity. All blood samples were non-reactive in terms of anti-HCV and anti-HIV antibodies. CONCLUSIONS: Our region has moderate endemicity in terms of hepatitis B virus infection whereas very low endemicity in terms of hepatitis C and human immunodeficiency virus infections. KEY WORDS: hepatitis C, human immunodeficiency virus, HIV, AIDS, pregnancy

Poster-MFM&P-101 Seropositivity of Rubella, Cytomegalovirus and Toxoplasma in Pregnant Women

Zeteroglu S 1, Ocak S 2, Deveci A 3, Gungoren A1, Andi A 4, Hakverdi A 1 1 Mustafa Kemal University, Faculty of Medicine, Department of Obstetrics and Gynecology, Antakya, Turkey 2 eustafa Kemal University, Faculty of Medicine, Department of Infection Disease and Clinical Microbiology, Antakya, Turkey 3 Yuzuncu Yil University, Faculty of Medicine, Department of Infection Disease and Clinical Microbiology, Van, Turkey 4 Maternity Hospital, Antakya, Turkey

OBJECTIVES: Investigation of rubella, toxoplasma and cytomegalovirus antibodies in pregnant women. METHODS: Pregnant women admitted to hospital for antenatal care controls were enrolled to study. Blood samples investigated for anti-rubella IgG, anti-rubella Ig M, anti-cytomegalovirus (CMV) IgG, anti-CMV IgM, anti-toxoplasma IgG and anti-toxoplasma Ig M antibodies by enzyme-linked immonosorbent assay (ELISA). RESULTS: Nine hundred and fifty four pregnant women aged between 17 and 42 years (28.53_+4.62) participated to study. Anti-toxoplasma IgG antibodies was found in 511 (53.56%) pregnant women whereas anti-toxoplasma Ig M was found only in 6 (0.63%) women. Seropsitivity of CMV was in 948 (99.37%) women in terms of Ig G and in 5 women (0.52%) in terms of Ig M. Anti-rubella Ig G and Ig M were found reactive in 931 (97.59%) and 7 (0.73%) pregnant women, respectively. CONCLUSIONS: Rubella and CMV seropositivity is found at high ratio while Toxoplasma IgG found 53.56% seropositivity. This seropositivity is higher than other studies in our country. KEY WORDS: pregnancy, TORCH infections, rubella, cytomegalovirus, toxoplasma

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Maternal fetal medicine-perinatology