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P113

Does substance abuse increase prematurity and low

birth weight?

K. Khashia1, T. Breslin1, N. Swamy2, J. Patrick1. 1Royal Oldham

Hospital, 2Royal Glamorgan Hospital

Background: Poly substance abuse tends to be common. Substance

abuse can be associated with IUGR, pre-term labour, and low birth

weight of babies. These women do need a lot of social support in

their pregnancy and hence involvement of drug laison midwife is

vital.

Aims:

• To assess obstetric and neonatal outcome of women with

substance abuse;

• To assess whether substance abuse is associated with IUGR, pre-

term labour, and low birth weight of babies;

• To assess if referral was made to the drug liason midwife.

Methodology:

• Patients identified – Euroking maternity database;

• Review of 66 case notes of women with substance abuse in

pregnancy across 3 hospitals in the Penine Acute NHS trust

(Rochdale informary/North Manchester general hospital and

Royal Oldham hospital);

• Time period – 1/1/2006 to 30/06/2007.

Standard:

• All women with substance abuse should be under consultant lead

shared care;

• All women should have growth scan at 28 weeks;

• All women should be referred to drug liaison midwife.

Results: Poly substance abuse was common, with most of them

using cannabis(76%) and methadone use in 20%. 24% were teenage

pregnancies. 23% booked late after 20wks. 83% were under

consultant led shared care and drug laison midwife was involved

in the care of 43%. There was history of smoking in 88% and

alcohol intake in 44%. 14% were subjected to domestic violence.

Prematurity and lowbirth weight were noted in 15%. There were

suspected congenital anomalies in 3%. The caesarean section rate

was 16%.

Conclusion: Consultant led shared care and involvement of a drug

laison midwife to offer support does improve the outcome of a

high risk pregnancy.

P114

Maternal serum placental protein (PP13) as a potential marker

for early pre-eclapsia

X. Ma, B. Chen, X. Xin. Department of Ob/Gyn, Xijing Hospital, Fourth

Military Medical University

Objective: To evaluate first-trimester maternal serum placental

protein 13 as a screening test for preeclampsia (PE).

Methods: In prospective nested case–control studies, PP13 levels

were measured during 1st, 2nd and 3rd trimesters in women who

developed PE vs matched controls.

Results: Placental protein 13 (PP13) is a 32-kd dimer protein

produced only in the placenta which belongs to one of 56 members

in one super family. PP13 is thought to be involved in normal

implantation. As pregnancy progresses the level of pp13 in maternal

serum slowly rises. The PP13 values in women who went to

develop late-onset PE were lower in 1st trimester (6–13) weeks

but ontinuously increased to exceed the level of unaffected women

in the 3rd trimester.

Conclusion: PP13 has been found to be a useful marker at 6–13

weeks of pregnancy for early serum screening to assess the risk to

develop preeclampsia.

P115

Hyperemesis gravidarum and Wernicke’s Syndrome

O. Oviedo Moreno, J. Macedo Pereira, A. Romay Bello, R. Rodriguez

Rabanal, G. Jimenez Alba. Hospital Clınico San Carlos, Madrid

Objectives: Hyperemesis gravidarum is the condition of incoercible

nausea and vomiting in pregnancy, preventig the proper food, with

a low morbidity at present thanks to hydroelectrolitical support.

One of the most feared reversible complication is Wernicke’s

Syndrome, by reduced intake of thiamin and other B vitamins.

Thiamine is a coenzyme in the metabolism of carboydrates. Its

deficit cause decrease in consumption, cerebral glucose metabolism

abnormalities and neural function. It’s a medical emergency, fatal

to 20% of cases. Classic triad is characterized by ophthalmoplegia,

ataxia and confusional disorders.

Methods: We present the case of a 21 years old, primigravida

with multiple episodes of incoercible vomiting and intolerance

to the oral alimentation since sixth week of pregnancy with a

poor response to treatment, complicated peripancreatic reaction

to developments en 12 weeks, ataxia, peripheral polyneuropathy

and confusional disorders in three-month period, visual and

hearing hallucinations, fluid and electrolyte imbalance affecting

heart. Neurological manifestations partially respond to thiamine

administration. Several fetal Growth Intrauterine restriction cause

caesarian section in 36 week. In the postpartum period, patient

moves well and its currently asintomatic.

Results: We must suspected Wernicke encephalopathy in patients

with cronic vomiting and neurological disorders beginning

treatment as soon as possible replacement thiamine.

P116

Role of serum bile acids in diagnosis of intrahepatic cholestasis

of pregnancy and effect of ursodeoxycholic acid therapy on

bile acids and perinatal outcome

R. Mahey, N. Agarwal, A. Kriplani, A. Saraya, P. Garg. All India

Institute of medical Sciences, New Delhi

Objectives: Diagnosis of intrahepatic cholestasis of pregnancy (ICP)

may be difficult by liver function tests i.e. transaminases, alkaline

phosphatase and serum bilirubin levels because these are also

affected in other conditions. We conducted a prospective clinical

trial at All India Institute of Medical Sciences, New Delhi, India

to assess the role of serum bile acids in diagnosis of ICP, effect

of ursodeoxycholic acid (UDCA) therapy on bile acid levels and

perinatal outcome in relation to bile acid levels.

Materials and Methods: Baseline serum bile acids were assessed

in 100 cases, 50 of ICP (group I) and 50 asymptomatic pregnant

women (group II) between 16–36 weeks POG. UDCA was

administered in dose of 300mg thrice daily to group I which

was continued till delivery. Serum bile acids were repeated after

4 weeks of therapy or at time of labour whichever occurred

earlier. Other liver function tests were done at 2 week interval. All

parameters and perinatal outcome of study group were compared

with controlgroup.

Results: The mean serum bile acid levels in study group

were 76.47±39.74m mol/L. and that of control group were

29.18±5.67mmol/L. (p value < 0.001). The severity of itching was

directly correlated with bile acid levels. After 4 weeks therapy

with UDCA the mean serum bile acids were 44.6±15.4m mol/L

(41.6% reduction, p value < 0.001). There was significant reduction