THURSDAY, SEPTEMBER 7 119

P4.11.02 DOPPLER BLOOD FLOW VELOCITY WAVEFORMS IN HYPERTENSIVE PREGNANT WOMEN M.Ivanovski, Dept.OB/GYN, University Hospital, Vodnjanska 17, Skopje 91000, R.Macedonia

Objectives: The aim of the study was to investigate the role of Doppler velocity waveforms changes in the circulation of a.uterina and a. umbilicalis in hypertensive pregnancies for prediction of fetal outcome. Study Methods: Forty- four hypertensive pregnant women were included in this study. Doppler velocimetries were performed during third trimester with Pulsed wave Doppler Toshiba, Sonolayer SSa-250A with 3,75 transabdominal probe. We recorded the resistance index(R1) of Pourcelot of the umbilcal artery and uterine artery. Results: The hypertensive women were divided into four groups based of umbilical artery and uterine artery resistance index (RI): l.(n=9) Normal umbilical and Normal uterine (NuNu); 2.(n=7) Normal umbilical and Abnormal uterine (NuAu); 3.(n=ll) Abnormal umbilical and normal uterine (AuNu); 4.(n=19) Abnormal umbilical and Abnormal uterine (AU&I). Detection of AuAu was connected with higher rate of complications: Gestational age 33+-3,2;Birth weight 1600+-850 g; Cesarean Section for fetal distress 57,9%; SGA 73,6%; NICU>48 h 68,4%; Perinatal mortality 26,3% (p<O,O5) than other tree groups separately. Conclusions: Doppler sonography allows better understanding of the hemodinamic changes associated with hypertensive disorders of pregnancy. Various high risk groups can be classified based on Doppler velocimetry. Doppler velocimetry can guide us in the treatment of these pregnancies and the prevention of high mortality and morbidity in hypertensive patients

P4.11.03 EFFECT OF NIFEDIPINE ON THE MOTILITY OF THE HUMAN UMBILICAL ARTERY IN VITRO A. F Costa, H. GuimarPes, A. Matthes, G. Duarte, S. Cunha. Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirso Preto, University of SBo Paula, 3900 Bandeirantes Ave., Ribeirso Preto, SP, Brazil, 14049-900.

Objectives: To determine the effect of Nifedipine in an vitro study of the tonus of the human umbilical artery. Study Metohods The action of nifedipine and bradykinin on the contractility of the human umbilical artery was studied by a perfusion method. Forty nine human umbilical segments were studied and a vasodilator effect of different nifedipine concentrations was observed compared to infusion of Tyrode alone. Results: Comparison of the results obtained by infusion of Tyrode solution and the results obtained by infusion of Tyrode + Nifedipine at different concentrations showed a vasodilator action of nifedipine on the umbilical artery segments. Conclusions: Pregnant women with arterial hypertension usually present a reduced uterine-placental flow. If in this situation nifedipine had the same effect as observed here in vitro, this drug could have a beneficial effect by reducing the vascular resistance of the umbilical artery, probably facilitating maternal-fetal exchange.

P4.11.04 FETAL INTRAVASCULAR TRANSFUSION CLINICAL REPORT D.Filimonovic. Z.Mikovic, A.Cirovic, A.Hajric, OB/GYN Clinic Beograd, Narodni Front Str.62, Belgrade, Serbia, Yugoslavia, 11000.

Objectives: Evaluation of seven-years expirience in fetal intravascular blood transfusions in immunizied fetus. Study Methods: Statistical analysis of data of 93 pregnant woman vith antieritthrocyte antibodies present in circulation. Indication for fetal transfusions were: absolute:fetal hidrops and decrease of Hct or Hgb less than 95 percentiles for gestation age, and relative: fetus inB2 or C zone(Liley), ascites, fetal anemia detected by cordocentesis and expected decrease of Hct. Results: Acording to accepted criteria, in 14 cases fivt was performed. in general, 26 transfusionqin particular case maximum of 3 transfusions were performed.From 14 pregnancies, 12 heltlly children were born, 1 IFD and 1 terminated pregnancy ( Sy Edvards)

Conclusions: With strice selection and secure tehnical procedure FIVT gives chance to fetuses in cases of confirmed aloimunisation. Althov high risks of FIVT are recognised, bat is a acceptibl in most severe cases of aloimunisationes.

P4.11.05 FOR EARLY DETECTION OF CONSUMmION COAGULOPATHY IN PREECLAMPSIA AND ECLAMPSIA - PLATELET COUNT MAY BE A SUITABLE SCREENING TEST N. Dept. OBIGYN, Dhaka Medical College, Dhaka, Bangledesh.

Objectives: The aim of this study is to find out whether platelet count can be used as a suitbale screening test for early detection of consumption coagulopathy in preeclampsia and eclampsia. Study Methods: This study was undertaken in Dhaka medical College Hospital from February 1997 and October 1998. 130 pregnant women were included in this study among them 50 were severe preeclamptic, 50 were eclamptic and 30 were normal healthy pregnant women. Normal pregnant women were served as control. All of them were at third trimester of their pregnancy. Prothrombin time (pr), Activated partial thromboplastin time (Am), Thrombin time (TT), Plasma fibrinogen level, D-Dimer and platelet count were determined of all the persons. The data obtained were complied and statistical analysis was done. Result: Mean platelet count was significantly lower in preeclampsia and eclampsia group and 37% were thrombocytopenic. Prolonged m, APTT and TT were present in 5%, 3% and 2% cases respectively. Hypofibrinogenaemia was present in 18% cases and D-Dimer was elevated in 16% cases. All the people who had any abnormalities in any of the above test also had thrombocytopenia. One patient developed frank DIC, her platelet count was very low. Conclusions: It can be concluded that platelet count alone can be used as an effective screening test for early detection of consumption coagulopathy in preeclampsia and eclampsia.

P4.11.06 HELLP SYNDROME AND POSTPARTUM CORTICOSTEROIDS F.Varol, Trakya University Medical School, Obstetrics and Gynecology Dept. , Edirnenurkey,, T.Aydm, F.Gucer, T.Yardlm

Objective: To investigate beneficial effects of postpartum corticosteroids on the labour parameters of HELLP syndrome. Study Method: The study group consisted of 8 postpartum patients with HELLP syndrome.The mean gestational age is 33.5 A total dose of 30 mg dexametasone with 3 doses of 10 mg of intravenous dexametasone was given 2 hours apart.Only one corticosteroid regimen was used..Eight patients had laboratory findings of HELLP syndrome before the corticosteroid administiration.The HELLP syndrome is characterized by hemolysiqelevated liver functionqand low platelet counts. The control group consisted of 11 postpartum patients w / HELLP syndrome who were managed without dexamethason. All patients were postpartum, given intravenous fluids and started on magnesium sulphate for 24 hours.Management also included nifedipine for diastotic blood pressure > 105 mm Hg. Mean arterial pressure (MAP) , platelet , liver function tests (serum AST,ALT), lactate dehydrogenase (LDH) were compared before and after dexametasone administiration.Samples for postdexametasone values were evaluated between 6 and 8 hours after corticosteroid regimen. Result: Corticosteroid improve the abnormalities in MAP,mean AST, ALT, LDH and platelet.This shorten the mean hospitalization duration. Conclusion: Consideration should be given to the use of corticosteroid in postpartum patients with HELLP.

P4.11.07 HIGH RISK OR LOW RISK? DO PREGNANT WOMEN CARE? H. Simuson, H. Ashwood-Smith, C. Finye, G. Gondwe, K. Misoya, Safe Motherhood Project, Blantyre, Malawi.

Objectives: Reports from Malawi indicate compliance with obstetric referral advice is deliberately ignored by women identified to be at ‘high risk’. This descriptive study was conducted to determine the compliance rate among high-risk pregnant women and to explore the factors surrounding non-compliance.