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MATERNAL FETAL HEALTH
Prevalence of congenital anomalies in
neonates and associated risk factors in a
Tertiary Care Hospital in Ulaanbaatar,
Mongolia
Jargalsaikhan Badarch,
1
Oyunkhand Enkhtaivan,
1
Tsengel Batsuuri,
1
Dulamsuren Nergui,
1
Oyunomin
Teskhuyag,
1
Budzaya Enkbayar,
1
Amarzaya
lkhagvasuren,
2
Tegshjargal Sereenendorj
1
1
Mongolian National University of Medical
Sciences,
2
Unimed Hospital
Objective: This study was undertaken to determine
the congenital anomalies in live newborns and to
study the associated maternal risk factors.
Method: This hospital-based prospective descriptive
study highlights the prevalence of Congenital Anoma-
lies (CAs) in 1 year among live born neonates deliv-
ered in two Ulaanbaatar city maternity hospitals from
January to December, 2018 (Mongolia). All women
giving birth to viable babies were included. The new-
borns were examined and assessed systematically for
the presence of congenital anomalies. Case ascertain-
ment of congenital anomalies was done through
visual examination, followed by various investiga-
tions. For each case, a detailed antenatal and maternal
history including the age of the mothers, parity or the
history of consanguinity were obtained by reviewing
the maternal and labor ward records.
Data was entered into SPSS 20.0 program and
appropriate statistical analysis was performed. Pro-
portion was calculated and the association was tested
with Chi-square test and Fisher’s exact test. P< 0.05
was considered to be statistically significant.
Results: During the study period, 17 070 newborns were
born in our institution; of which 178 had congenital
anomalies (CAs), making the prevalence 1.05%. One
third of the mothers were aged between 25 and 29 years
(31.5%) with only 5.1% of the mothers were over the age
of 40 years. The prevalence of congenitally anomalies
babies born was 3.9% for mothers <20 years, 16.3% for
20–24 years, 25.3% for 30–34, and 18% for 35–39 years.
However, this difference was not statistically significant.
The predominant CAs in babies involved was cardio-
vascular 19.6% (n= 35) and cleft lip and cleft palate
17.9% (n= 32) musculoskeletal system 16.8% (n=30)
followed by gastro-intestinal (GI) system 10.1% (n=18)
and chromosomal abnormalities 10.1% (n=18). Mode
of delivery was significantly associated with maternal
care due to uterine scar from previous surgery (30.7%).
ThemostofthebabywithCAswasdeliveredat38–41
gestational weeks (69.7%). The main maternal complica-
tion during pregnancy was pregnancy complicated com-
plication (35.5%), mild and moderate pre-eclampsia
(19.2%), severe pre-eclampsia (3.85%), complete placenta
praevia without hemorrhage (3.85%). The most com-
monly happened maternal complications during deliv-
ery were premature rupture of membranes were 15%
(n=11) unspecified as to length of time between rup-
ture and onset of labor 14% (n= 10), delayed delivery
after spontaneous or unspecified rupture of membranes,
10.1% (n= 8) and labor and delivery complicated by
cord around neck with compression.
Conclusion: This hospital-based prospective descriptive
study highlighted the prevalence of congenital anomalies
in 1 year in a two tertiary hospital in Ulaanbaatar city,
Mongolia. Regular antenatal visits and prenatal diagnosis
are recommended for prevention, early intervention and
even planned termination, when needed.
Prevalence of perinatal vertical
transmission of hepatitis anti-HCV
antibody, Amgalan Maternity Hospital,
Mongolia
Jargalsaikhan Badarch,
1
Khonchinkhuu
Mandakhtsetsen,
2
Batsukh Enkhjargal,
2
Oyun-
Erdene Ariunbold,
1
Lkhamnorov Battur,
1
Erdenesuvd Damdinsuren
1
1
Mongolian National University of Medical
Sciences,
2
Public Health Institute
Introduction: In low and middle income countries, hepa-
titis C virus (HCV) is the most common cause of chronic
liver disease in children. Hepatitis C has increasingly
affected women of child-bearing age over the past few
years.
1,2
Perinatal transmission is the leading cause of
infection. Perinatal transmission is confined almost
always to women with detectable HCV ribonucleic acid
25Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
doi:10.1111/jog.14284 J. Obstet. Gynaecol. Res. Vol. 46, No. S1: 25–41, August 2020
(RNA) in the peripheral blood by the polymerase chain
reaction but all children born to women with anti-HCV
should be tested for HCV.
3
Objective: Perinatal exposure to hepatitis C virus anti-HCV
during pregnancy may affect the developing immune sys-
tem in the fetus. We aimed to study the perinatal transmis-
sion of anti HCV in maternal and cord blood.
Methods: Sera from 1034 pregnant mothers were tested
for anti-HCV antibody and HCV RNA. Anti-HCV anti-
body were determined in sera from 1043 non infected
andHCV-infectedmothersandtheircordblood.
The study was conducted at the Obstetrics depart-
ment, Amgalan Maternity Hospital, Ulaanbaatar city,
Mongolia. Between March 2018 and March 2019 a
random sample of 1034 women entering the Obstet-
rics department of the Amgalan Maternity Hospital
were included in the present study. Maternal and
umbilical cord bloods were drawn aseptically and the
serum was stored at −20C until tested.
Results: The anti-HCV levels in pregnant women’s
placental side blood and fetal cord blood were corre-
lated. For those cord blood samples positive for anti-
HCV their maternal blood levels of anti-HCV were at
a high level. Hepatitis anti-HCV antibody was
detected in 29 (2.8%), mothers from 1034 cases. Thus,
the study included 29 positive mothers and their
29 newborns. This was not detected in the umbilical
cord blood of the antigen-negative mothers. Hepatitis
anti-HCV antigen was shown in the umbilical cord
blood of out 12 (41.3%), of 29 newborns whose
mothers were permanent hepatitis antiHCV carriers.
These data indicate that the fetuses of carrier mothers
are exposed to the hepatitis C virus.
Conclusion: Our results also show that when a higher
level of viraemia exists in placental blood, detection
of anti HCV may be found in umbilical blood. These
findings indicate that vertical transmission of anti-
HCV was very high. Thus, exposure to these anti-
HCV may influence the developing immune
responses to natural infections.
References
1. Kushner T, Terrault NA. Hepatitis C in pregnancy: a unique
opportunity to improve the hepatitis C cascade of care. Hepatol
Commun. 2018; 3(1): 20–28. https://doi.org/10.1002/hep4.1282
2. Su GL. Hepatitis C in pregnancy. Curr Gastroenterol Rep. 2005;
7(1): 45–49.
3. Muñoz-Gámez JA, Salmerón J, Ruiz-Extremera
A. Med Clin
(Barc). Hepatitis C during pregnancy, vertical transmission and
new treatment possibilities. 2016; 147(11): 499–505. doi:
10.1016/j.medcli.2016.04.003. Epub 2016 May 18.
Risk factors for adverse outcomes among
teenage pregnancies delivered in a
Tertiary Center from 2007–2016: A
retrospective cohort study
Trinilisa E. Bagalso, MD, Maria Estrella Y.
Flores, MD
Philippine Children’s Medical Center, Quezon
City, Philippines
Background: Adolescents appear to be at increased
risk for adverse pregnancy outcomes, such as low-
birth-weight babies and infant deaths. Whether these
outcomes are the result of biologic immaturity or
sociodemographic factors related to adolescent preg-
nancy remains unclear.
Objectives: We aim to determine the risk factors
for adverse maternal and neonatal outcomes
among adolescent pregnancy and to explore
whether teen pregnancy is an intrinsic risk factor
for adverse outcomes independent of con-
founding factors.
Methods: We performed a retrospective cohort study cov-
ering a period from 2007 to 2016 of 369 nulliparous preg-
nant women of less than 25 years of age involving
239 adolescent (study group) and 130 young adult mothers
(referent), with a singleton birth in a Tertiary Center. Rel-
ative risk for subgroups of this study population was
examined to eliminate the confounding influence of
educational level, adequacy of prenatal care and
weight gain during pregnancy, anemia and exposure
to vices.
Results: After correction of variables, it was seen
that maternal age of 10 to 15 increased the risk for
having neonatal death (RR 4.5, 95% CI 1.1–18),
<32 weeks AOG at birth (RR 5.8, 95% CI 1.7–19.5),
SGA (RR 9.1, 95% CI 1.8–45.1), poor APGAR score
at the 5th minute of life (RR 5.9, 95% CI 1.4–24.9),
fetal congenital anomalies (RR 5.9, 95% CI 2–15.6),
and admission to neonatal ICU (RR 6.4, 95% CI
2.5–16.3). Risks for infant being SGA and admitted
to NICU were 5.25 (95% CI 1.1–24.6) and 3.3 (95%
CI 1.5–7.3) times increased in mothers 16 to17 years
compared to those who were past their teens.
Among the late teens, there was increased likeli-
hood for the same adverse neonatal outcomes as in
the youngest age group, except for preterm birth.
Teen mothers are intrinsically at risk for bacterial
vaginosis, but are comparably less likely to deliver
abdominally.
26 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
Conclusion:A young maternal age conferred an
increased risk of adverse pregnancy outcomes,
where the highest of risk occurring within the youn-
gest of group (15 years and less), that was indepen-
dent of important confounding socio-demographic
factors.
Recommendation:The uniqueness of adolescent mothers
requires a multidisciplinary care in a special unit to opti-
mize perinatal outcomes regardless of her sociodemographic
status.
Key word: teenage pregnancy, preterm birth, small
for gestational age, neonatal death
Violence against women in Bangladesh
Prof Laila Arjumand Banu
Immediate Past President, Obstetrical and
Gynaecological Society of Bangladesh (OGSB) And
Chief Consultant of Obstetrics and Gynaecology,
Lab Aid Specialized Hospital, Dhanmondi, Dhaka
Introduction: Bangladesh is a small south Asian
country - borders India, Myanmar and Bay of Bengal.
Since it gained independence in 1971 Bangladesh’s
economy has been growing about 6% annually but
socially it has room for advancement. Almost 1 in
every 7 maternal deaths is caused by violence.
Material and Methods: Different statistics from gov-
ernment, different non-government organizations,
and development partners have been analyzed.
Discussion: Violence is on the rise - 2981 in 2004
whereas 4563 in 2012 –mainly dowry related vio-
lence. From 2010 to 2012 –Bangladesh police received
10, 962 complaints about violence, but they deter-
mined only 6875 were genuine.13.8% of maternal
death in pregnancy resulting from violence.
Bangladesh Bureau of Statistics (BBS) in 2011 –sam-
ple of 12 600 women - 87% had been abused, 50%
had serious injuries but 1 in 3 women refused to go to
the hospital. Bangladesh Mahila Parishad- a famous
NGO (Jan to Dec 2016) 5616 cases of violence, Rape-
840, gang rape-166, Murder-900, stalking-662, dowry
related murder-558, Suicide-435 and acid burn-38.
Domestic violence-most common. 78% verbal
abuse, 42% physical abuse, 18% threatened with
divorce. WHO multi country study reported that
53.3% in urban and 79.3% in rural area believed that a
man had a right to beat his wife.
Rape is the 2nd most common cause for violence. In
2002 total 1434 cases of rape were reported and 355 were
gang rape and 10% rape followed by murder.
Acid throwing –a heinous act more common in
Bangladesh. 266 acid attack reported over one year—
affects 322 people—183 were women.
Women and child trafficking also alarming in
Bangladesh. Also eve teasing, suicide, dowry related
murder are increasing.
Action - action taken by Government, NGO and
development partner –designated VAW as a priority
area. Few laws are revised for the women’s interest.
UNICEF has an important role, along with govt –to
raise community awareness, shelter for victims, pre-
vention of women and child trafficking.
Conclusion: No improvement practically. State
should take a fresh commitment, to implement the
laws –to the realization of women’s equal right. Effec-
tive legislation and policy implementation is abso-
lutely necessary.
Globally child birth intervention going
overboard
Professor Dr. Rowshon Ara Begum, Ex-President,
OGSB, Vice President-FSSB, Vice President-
GOSB, Vice President-GOESB, Chairman- SRH
(AOFOG)
Holy Family Red Crescent Medical College,
Dhaka, Bangladesh
There are growing concerns about the increase in
rates of commonly used child birth intervention.
Child birth interventions are crucial for preventions
maternal and perinatal morbidity & mortality but
their routine use in healthy women & children leads
to avoidable maternal & neonatal harm & rising
health care cost. Medical technology has led to
improved maternal & perinatal out comes in the last
decades.
The rate of child birth interventions varies both
geographically & over different time periods, even
with within groups of women with identical risk pro-
files and has risen for some interventions & declined
for others.
Primary outcomes are rates of commonly used
child birth interventions- Induction or augmentation
of labor, Episiotomy in vaginal births, caesarian sec-
tion, intra partum antibiotics, epidural and pharmaco-
logical pain relief, and to early to frequently
doing USG.
Our interventions also have implications for indi-
viduals and health system. Facilities that provide
access care may be financially inaccessible to certain
27Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
population. For example, if providers prioritize
patients who are willing to accept additional proce-
dures to speed up delivery.
Facilities that do over interventions often under
perform on indicators of respectful healthcare, such as
providing adequate advice and informed consent and
allowing mothers to give birth with a companion of
their choice.
To improve maternal health, the problems caused
by excessive unnecessary interventions must be
addressed. As more and more low and middle
income countries develop their medical infrastructure,
it is imperative that system be put in place to curb the
medical economic and patient rights consequences
that arrive from excessive interventions.
Comparison of perinatal outcomes of
adolescent and non-adolescent
primigravids admitted in a Tertiary
Government Hospital
Margaret Rose C. Bocaya, MD, Precious DC
Diaz MD
Amang Rodriguez Memorial Medical Center,
Marikina, Philippines
Introduction: The incidence of teenage pregnancy in
the Philippines has only slightly decreased since 2013.
‘Amang’Rodriguez Memorial Medical Center
(ARMMC) currently caters to numerous adolescent
pregnancy admissions and there are no local studies
determining the adverse perinatal outcomes in this age
group.
Objective: To determine the perinatal outcomes
of pregnancy among the primigravid adolescent
group as compared to the non-adolescent (adult)
group admitted in ARMMC from 2017 to 2018.
Materials and Methods: This is an observational, ret-
rospective cohort study comparing two groups of
primigravid women admitted at ARMMC from 2017
to 2018—those in the adolescent age group (less than
or equal to 19 years old) and of the controls, the non-
adolescent age group (20–29 years old) and their
resulting perinatal outcomes.
Results: Among the 1768 cases of primigravid, low-
risk patients identified, 810 cases belonged in the ado-
lescent group and 958 cases were in the adult group. In
the adolescent group, there was a significantly lower
risk of undergoing Caesarean section, lower risk of
major perineal lacerations in vaginal deliveries, and
lower risk of developing hypertensive disorders except
preeclampsia, and a significantly higher risk of preterm
delivery. For neonatal outcomes in the adolescent
group, there was a significantly higher risk of delivering
low birth weight and small for gestational age (SGA)
babies, prematurity at birth, and poor APGAR score at
the 10th minute. The risk for admission at the neonatal
ICU, congenital anomaly, neonatal death and perinatal
death were also higher in the adolescent group.
Conclusion: This study revealed significant differences
in risk of developing perinatal outcomes in the adoles-
cent primigravids as compared to the adult group.
These perinatal outcomes were consistent with many
studies on adolescent pregnancies done globally. This
preliminary local study may serve as a jump-off point
for more research in the adolescent pregnant group.
Pregnancy outcomes following different
types of bariatric surgery: National
cohort study
Katie Cornthwaite, MD, Chetan Prajapati PhD,
Erik Lenguerrand PhD, Natalie Blencowe PhD,
Andrew Johnson MD, Dimitrios Siassakos MD
University of Bristol, North Bristol NHS Trust,
United Kingdom
Introduction: Maternal obesity is associated with
adverse consequences to mothers and babies. Weight
loss is essential to mitigate these risks and is increas-
ingly being achieved with bariatric surgery.
Objective: To assess the impact of type of bariatric
surgery on maternal and perinatal outcomes.
Methodology: Design: National prospective observa-
tional study using UK Obstetric Surveillance System
(UKOSS).
Participants: Pregnant women following gastric
banding (n= 127), gastric bypass (n= 134) and sleeve
gastrectomy (n= 29).
Data collection: November 2011–October 2012 (gas-
tric banding) and April 2014–March 2016 (gastric
bypass and sleeve gastrectomy).
Analysis: Maternal and perinatal outcomes were
compared by type of bariatric surgery using linear
mixed model, modified Poisson regression, general-
ized least square model and Bernard exact test.
Results: Maternal outcomes: Women pregnant with a
gastric band had a higher booking weight than those
pregnant after gastric bypass (P= 0.005) and sleeve
gastrectomy (P= 0.007). Pregnancies after gastric
bypass were associated with an increased risk of
28 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
maternal anemia (bypass vs band: P= 0.002; bypass
vs sleeve: P= 0.04) and surgical complications, such
as internal hernia (bypass vs band: P= 0.03;bypass vs
sleeve: P= 0.06).
Perinatal outcomes: Infants born to mothers after
gastric bypass had a lower birth weight (P< 0.001)
and reduced risk of large for gestational age
(P= 0.006) than those born to mothers with a gastric
band. Risk of preterm birth was higher in babies of
women with a gastric band compared with bypass
(P= 0.04). Risk of small for gestational age and still-
birth were comparable between groups.
Conclusions: This study reveals the divergent impact
of different types of bariatric surgery on pregnancy
outcomes. Higher rates of surgical complications fol-
lowing gastric bypass are particularly concerning.
Abdominal pain during pregnancy after gastric
bypass should be comprehensively investigated
including early surgical assessment. Pregnancies fol-
lowing all types of bariatric surgery should be closely
monitored by a multi-professional team of obstetri-
cians, endocrinologists/bariatric specialists and
dieticians.
A retrospective review of neonatal
outcomes of inborn and outborn preterm
neonatal admissions based on perinatal
profiles at a Tertiary Referral Perinatal
Center in Quezon City from January 2012
to December 2016
Katleen R. Del Prado, MD, Edward
N. Padilla, MD
Philippine Children’s Medical Center, Quezon
City, Philippines
Introduction: Preterm birth is associated with long
term complications, long term health needs that lead
to financial burden to parents and neonatal death.
Limited NICU slots add to the problem among insti-
tutions. Preterm inborn managed appropriately, pre-
term inborns have better outcomes than outborns.
Also, identification of perinatal risk factors early is
important to predict who are at risk to preterm births,
to early facilitate prenatal referral and/or maternal
transport to capable institutions early.
Objective: To compare the neonatal outcomes of
inborn and outborn preterm neonatal admissions at a
Tertiary Referral Perinatal Center in Quezon City
from 2012 to 2016 based on Perinatal Profiles.
Methodology: A cross sectional study through a chart
review was done among preterm neonates admitted
at a Tertiary Referral Perinatal Center in Quezon City
between January 1, 2012 to December 31, 2016. Data
was collected among singleton, non-anomalous neo-
nates with Ballard’s score of 28 to 36 weeks age of
gestation.
Results: Out of 415 preterm neonates, 61.2% were
inborns (254/415) and 38.8% were outborns
(261/415). Among maternal factors, hypertensive dis-
eases, heart disease, diabetes mellitus, preterm pro-
longed rupture of membranes, and infections
occurred more frequently among inborn mothers, but
these factors did not significantly increase the risk of
prolonged NICU stay or neonatal mortality. The out-
born group had more very preterm neonates (28 to
32 weeks) and developed more co-morbities. Neona-
tal co-morbidities increased the duration of NICU
stay but not mortality. Irregular or no prenatal care
significantly increased the risk of neonatal mortality.
Prenatal care by non-obstetrician increases the risk of
prolonged NICU stay and mortality. Among out-
borns, age appropriateness is protective to neonatal
mortality.
Conclusions: Inborns, even those born to mostly
high-risk mothers in our institution, compared to out-
borns who are largely born from low risk mothers,
had better neonatal outcomes in terms of duration of
NICU stay and mortality.
Keywords: Preterm, Inborn, Outborn, Tertiary Perina-
tal Center, Prolonged NICU Stay, Mortality
Implement of post-partum intrauterine
device project in Bangladesh: Strengths
and challenges
Dr. Farhana Dewan, Dr. Jobaida Sultana,
Dr. Alpona Adhikary
Ibn Sina Medical College Hospital, Dhaka,
Bangladesh
Post partum IUD services is institutionalized in
Bangladesh by Obstetrics and Gynecology Society of
Bangladesh (OGSB) in collaboration with FIGO. The
project is ongoing in 6 centers in the country. The
project is running in 3 phases. Phase I from Jan 2015
to Dec 2017; Phase II from Jan 2018 to June 2018 and
Phase III from July to Dec 2019. The objectives of
Phase I & II is to incorporate postpartum IUD ser-
vices as a routine part of antenatal counseling and
delivery room services; to train all health care
29Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
providers on PPIUD and to ensure that health care
providers continue to provide PPIUCD services in
other facilities as well. The objectives of Phase-III is
to continue the PPIUD programme in existing facili-
ties; train Midwifery Faculty on PPIUD services &
train Master Trainers in 9 branches of OGSB on
PPIUD services.
The project is run by a National Coordinator, Deputy
National Coordinator centrally and there are DCO &
Counselors to carry on the activities in the respective
centers. During July-2015 –May 2019, a total number of
2, 14 942 women were counseled to take PPIUD in all
six facilities during ANC visits and during delivery.
Among the counseled women, 20 204 (9.4%) agreed to
take PPIUD as a method of contraception. Among the
agreed women 12 018 PPIUDs were inserted during
this period. 59.5% women during the tenure. Expulsion
rate was 8.8% and removal rate was 2.0%.
Challenges: Challenges in implementation were lack
of woman’s decision making capability, lack of Fam-
ily planning counseling during ANC, lack of doctor
interest for PPIUD counseling, misconceptions regard-
ing IUD & lack of interest of women to come for the
follow-up visit.
During ANC, problems in Counseling were that
doctors are too busy to counsel. In addition women
did not come for regular check up, even they did not
come for any ANC visit but they directly came for
delivery. In some instances consent was given during
ANC but refused during labor.
In labor ward, duty doctor is reluctant regarding
PPIUD, duty doctor is not familiar with PPIUD inser-
tion technique & not enough confident to do the
insertion without senior support.
Conclusion: PPIUD is an indispensable method of
LARC (Long Acting Reversible Contraception). It is
the responsibility of the service providers to make it
popular among the clients and try to address minor
issues to overcome the hurdles.
Long term prognosis of EXIT procedure
for delivering babies with fetal airway
obstruction: Novel insights from a
multicenter retrospective study
Satoshi Dohi, MD, PhD
Department of Obstetrics and Gynecology, Showa
University, Tokyo, Japan
Objective: To describe the long-term prognosis of
babies after EXIT procedure.
Methods: Multicenter retrospective study wherein
primary questionnaires were given out to 174 perinatal
centers to determine incidence of fetal airway obstruc-
tion cases, whether or not EXIT was performed, and
EXIT team members were interviewed.
Results: Thirteen cases were successfully completed
in our study. The average gestational age at delivery
was 35 weeks. The average birth weight was around
2500 grams. Umbilical arterial pH was 7.2. Among
these cases, 9 underwent tracheal intubation, and
4 underwent tracheotomy. The average placental sup-
port time was 14 minutes with a maximum of
54 minutes. The average maternal blood loss was
about 3600 mL. One case with maximal transfusion
was autotransfusion 400 mL plus 8 unit red cells. Six
maternal patients had uterine atony, and one had pul-
monary edema as an operative complication. There
were no maternal deaths via EXIT. On the other hand,
all neonates were born alive just after delivery, and
the infant survival rate at the age of 1.5 years was
84 %, that’s 11 out of 13.
Conclusion: EXIT Procedure has minimal maternal
complications with good outcomes, and is an optimal
strategy for establishing an airway. This procedure
avoids emergency intubation or tracheostomy. EXIT
indication may correlate with fetal lung maturity.
Dutta’s scoring technique for early
detection and management of uterine
atony during emergency LSCS: A
randomized trial
Indranil Dutta, MD, Dilip Kumar Dutta MD
Associate Professor, IQCMC, Durgapur, WB,
India, IQ City Medical College, West Bengal, India
Objective: To analyze the efficacy of Dutta’s score for
early detection and management of uterine atony dur-
ing emergency LSCS and to prevent subsequent post-
partum hemorrhage.
Study methods: This study was undertaken at GICE
at Kalyani, Nadia, WB, India from 1st January 2015 to
31st December 2019. Three hundred cases undergoing
emergency LSCS were selected for randomized trial.
Clinical observations were made after placental expul-
sion for scoring which includes shape and size of
uterus, rugosity, tone, placental localization and time
of placental expulsion. Score of 0, 1, 2 were given on
each observation. Three groups are created depending
on scoring –Group A(130)- 8 to10, Group-B(N-100)-5
to 7 and Group –C(N-70)- <5 for better management.
30 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
Management protocols were formulated in the
three groups for prevention of PPH –.
Group A: Oxytocin 10 U (5 U IM+ 5 U IV 40drops/
min in Ringer Lactate 500 mL).
Group B: Oxytocin 15 U (5 U IM + 10 U IV 40drops/
min in Ringer lactate 500 mL) + methyl ergometrine
(0.25 mg IM) + anterior posterior uterine wall
compression.
Group C: Oxytocin 20 U (5 U IM plus 15 U IV
40drops in Ringer Lactate 500 mL) + methyl
ergometrine (0.5 mg IM) + carboprost (250 mcg IM)
+ lateral followed by anterior posterior uterine wall
compression + compression of isthmus region of
uterus + misoprostol 800 mg per rectal during post-
operative period.
Results: After adopting Dutta’s score and manage-
ment protocols it was interesting to observe that intra
and post-operative blood loss within 2 h were found
to be significantly reduced in group A -69.3%
(<300CC), 84.6%(<200CC) and group B-70%(<300 cc),
72%(<200CC). Intra operative blood loss>500 cc were
also found to be reduced in group A-7.6%, group B-
14%. In group C intra operative blood loss >500 cc
were seen in 47.1% and post-operative −32.9% cases.
Conclusion: Early diagnosis and management of uter-
ine atony during emergency LSCS after adopting
Dutta’s score was found not only to reduce intra and
post-operative blood loss but also was found to main-
tain a satisfactory hemoglobin level and hemody-
namic status.
Keywords: uterine atony, Dutta’s score, PPH, MMR.
Role of colposcopy in unexplained
infertility
Indranil Dutta
Associate Professor, IQCMC, Durgapur, WB,
India
Objective: To know about the role of colposcopy in
diagnosing cervical lesions which maybe responsible
for unexplained infertility.
Introduction: Causes of Infertility- MALE -30%,
FEMALE-30%, UNEXPLAINED–25%, COMBINED-
10%, OTHERS- 5%. BASIC INVESTIGATIONS:-
Semen analysis of husband, USG to see pelvic region,
HSG or Lap Dye Test to see tubal patency, Ovulation
study, Hysteroscopy to uterine cavity abnormality.
PROTOCOLS –A- Proper Counseling, Importance of
hygiene, Detailed discussion on uterine & ovarian –
anatomy and physiology, Explanation of various
option of ART, Importance of safe & unsafe period.
PROTOCOL –BSCHOOL = S = Semen Analysis –
Spermatozoa, C = Colposcopy –Cervix, H = HSG –
Tubal Patency, O = Overview Of Uterus & Ovary By
USG, O = Ovulation Study, L = Lap Dye &
Hysteroscopy.
Method: 1400 patients were randomly selected from a
software based selection. Study was done in GICE
Hospital, Kalyani, and IQCMC, Durgapur. SPSS Soft-
ware was used to find PValue and statistical
analysis.
Results: COLPOSCOPY FINDINGS (N -1400) Jan
18 –Feb 19 = Healthy Cervix = 200, unhealthy cervix
(cervicitis) = 990, erosion = 175, POLYP = 10,
others = 25.
Preliminary Management = Tissue paper after pass-
ing stool, Antibiotic and others drugs to both partner,
Vaginal irrigation, OC pill –3 cycle, Cervical fluid
and sperm for culture and sensitivity.
Pregnancy outcome (N -870) = AFTER COUNSEL-
ING = 220, after hydrotubation = 65, after induction
of ovulation = 335, AIH = 68, AID = 32, preg-
nancy = 720 (82.6%), take home baby = 686 (95.3%)
out of 720, 78.9%) out of 870.
Conclusion: Role of Colposcopy in infertility is very
much significant-till date much research is not done,
It is not only help to diagnose cervical pathology but
also help the husband to have healthy & safe sex,
Additionally it will help to diagnose or exclude cervi-
cal cancer in elderly women opted for ART, IVF &
ET, It should be included to basic parameter for infer-
tility investigations.
Evaluation of gestational weight gain
and its correlation with maternal and
neonatal outcome in women of normal
early pregnancy body mass index
Roli Gautam, MD, Abhilasha Jain MD
Holy Family Hospital, Delhi, India
Introduction: Antenatal care today is an integral part
of health care delivery system in pregnant women.
There are several antenatal factors responsible for
maternal and fetal outcome out of which maternal
weight gain can offer good means of assessing the
wellbeing of the pregnant mother & inference of
her baby.
Hence we proposed to do an observational study to
evaluate the relationship between Gestational weight
gain (as per Institute of Medicine (IOM) guidelines) &
pregnancy outcomes among women with normal BMI
31Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
(in accordance with WHO cut off) who deliver full
term infants at Holy Family Hospital, New Delhi.
Objective: To study effect of gestational weight gain
on maternal & fetal outcome.
Method: It is a prospective observational analytical
study conducted on 300 low risk antenatal women
attending antenatal OPD at Holy Family Hospital,
New Delhi in 1st trimester (up to 12 weeks of ges-
tation) between July 2017–March 2019. Women
were categorized into three groups based on gesta-
tional weight gain relative to IOM guidelines:
Group 1 - weight gain below IOM recommenda-
tion Group 2- weight within IOM recommendation,
Group 3- weight gain above IOM guidelines. Out-
comes were compared between three groups of
women, using gestational weight gain within IOM
guidelines as the reference group.
Results: In our study group, group 1 and group 2 had
statistically significant higher number of antepartum
complications. On comparing the overall, group 3 as
well as group 1 had statistically significant higher
number of intrapartum complications. Group 1 and
3 had significantly higher number of vacuum delivery
and LSCS in comparison to group 2.
Conclusion: We found that guidelines laid down by
IOM (2009) about weight gain during pregnancy are
apt and can be applied to Indian population with nor-
mal early pregnancy BMI.
Introducing the new method: Role of
amnioinfusion using CVP set in the
management of PPROM with
oligohydramnios in pregnancy
Herlambang Herlambang
1*
, Muhammad Alamsyah
Aziz
2
, Amelia Dwi Fitri
3
1
Maternal-fetal Medicine, Department of
Obstetrics and Gynecology, Faculty of Medicine
and Health Science University of Jambi, Raden
Mattaher General Hospital Jambi,
2
Maternal-fetal
Division, Department of Obstetrics and
Gynecology, Faculty Of Medicine University of
Padjajaran, Hasan Sadikin Hospital,
3
Medical
Education Department, Faculty of Medicine and
Health Science University of Jambi
Introduction: Perinatal mortality and morbidity fol-
lowing Preterm Premature Rupture of Membrane
(PPROM) was high. Two variables that were available
at the time of membrane rupture have major
prognostic implications, gestational age at rupture
and residual amount of amniotic fluid.
Objective: Our purpose was to evaluate the role of
amnioinfusion using Central Venous Pressure (CVP)
set following cerclage in the management of PPROM
with oligohydramnios.
Methods: A retrospective study of 60 singleton preg-
nancy who experienced PPROM with oligohydramnios
at 24–26 weeks gestational age and AFI < 2 cm
between May 2015 until December 2018 in Raden
Mattaher General Hospital Jambi. All participants were
given the new procedure, amnioinfusion with CVP set
following cerclage to maintain AFI > 2 cm and
followed until delivery. This procedure was conducted
transabdominally with ultrasonography guidance by
infusing 1500–2000 mL ringer lactate, added with
antibacterial and steroid and maintained for 48 h. We
evaluated the improvement in AFI, gestational age
achieved, delivery method, birth weight and APGAR
score. The differences in AFI improvement were statis-
tically analyzed with Wilcoxon test.
Result: 55 women (91.67%) had AFI >2 cm after 48 h
following this procedure. Mean gestational age at the
time membrane rupture was 25.20 weeks and
achieved 33.57 weeks after the amnioinfusion (deliv-
ery age), 65.45% patients had caesarian section, Mean
AFI before the procedure was 1.65, and achieved 3.76
after the procedure, All patients had AFI increase
(mean 2.034). Mean intrauterine weight was 770.69
gram and mean achieved after delivery was 2123.23
grams. Mean APGAR score was 2.12 at 1 min and
4.8 at 5 min. Wilcoxon statistical analysis test in AFI
increase showed significant difference with sig 0.00.
Conclusion: Amnioinfusion using CVP set following
cerclage significantly increases AFI in PPROM with
oligohydramnios.
Key words: PPROM, oligohydramnios, amnioinfusion
with CVP set, AFI.
Maternal and neonatal outcomes of
women with chronic kidney disease
Romelyn April P. Imperio-Onglao, MD, Luwalhati
Ordillo Lim MD, Cristina Pelaez Crisologo MD,
Coralie D Dimacali MD
Department of Obstetrics and Gynecology,
University of the Philippines - Philippine General
Hospital, Manila, Philippines
Introduction: Chronic Kidney disease affects approxi-
mately 3% of women of childbearing age. Pregnancy
with chronic kidney disease (CKD) is considered high
32 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
risk and leads to poor maternal and fetal outcomes.
Management of pregnant women with CKD remains
challenging due to paucity of clinical studies. More
studies are needed to guide management and
counseling of these patients.
Objective: To describe the profile and identify the
maternal and neonatal outcomes of pregnant CKD
patients admitted at the Philippine General Hospital.
Methodology: A total of 33 pregnancies of patients
with CKD admitted at the Philippine General Hospi-
tal from January 2010 to March 2018 were analyzed.
Cases were identified using Epi Info from the perina-
tology database, ward reports from the Intensive
Maternal Unit conferences and PGH Section of
Nephrology census.
Results: Of the 33 pregnancies, 67% had worsening
hypertension, 24% had worsening renal function, 64%
had preeclampsia, 12% had an abortion and no mor-
talities. Of the 23 livebirths, 70% were preterm while
30% were full term, 39% had low birthweight while
43% had very low birthweight, 74% were appropriate
for gestational age while 26% were small for gesta-
tional age, 24% were delivered by spontaneous vagi-
nal delivery while 50% were delivered by caesarean
section.
Conclusion: Chronic kidney disease is a risk factor for
adverse maternal and neonatal outcomes across all
stages.
Management of hyperglycemia for
women with twin pregnancies and risk
of small-for-date weights: A single-center
13-year study
Yuko Irie, MD, Liangcheng Wang PhD, Isao
Horiuchi PhD, Kenro Chikazawa PhD, Tomoyuki
Kuwata PhD, Kenjiro Takagi PhD
Saitama Medical Center, Jichi Medical University,
Shimiotsuke, Japan
Introduction: The present study aimed to investigate
whether current aggressive management of gesta-
tional diabetes mellitus (GDM) for singleton pregnan-
cies is appropriate for twin pregnancies.
Method: Women with singleton/twin pregnancies
who took the 50-g glucose challenge test (GCT) during
the second trimester for GDM screening during the
study period were evaluated. In our hospital, the 75-g
oral glucose tolerance test (OGTT) is subsequently per-
formed when the 50-g GCT result is positive. GDM was
diagnosed if the 75-g OGTT result was (1) ≥92 mg/dL
before the test, (2) ≥180 mg/dL after 1 h, or
(3) ≥153 mg/dL after 2 h. Patients were asked regarding
short-term hospitalization for GDM management, and
insulin was introduced aggressively if required. The
prevalence of small-for-date (SGA) weight, a consider-
able side effect of overscreening and overtreatment,
was investigated in the two groups.
Result: We enrolled 2065 singleton and 77 twin preg-
nant women who took the 50-g GCT for GDM screen-
ing. No significant differences in maternal age, height,
body weight, body mass index, and gravidity were
found between the two groups. However, a signifi-
cant difference was observed in the diagnostic rate of
GDM (7.99% vs 16.88%, P < 0.05). The twin-pregnant
women had a higher rate of positive results in the
75-g OGTT after 2 h (16.19% vs 36.00%, P < 0.05).
Despite the higher diagnostic rate, aggressive insulin
treatment did not increase the risk of delivery of SGA
infants in twin pregnancy. (OR = 0.5363, 95%CI:
0.1342–1.8317), as observed in singleton pregnancy
(OR = 0.8485, 95%CI: 0.4104–1.5680).
Conclusion: The current management of hyperglyce-
mia is appropriate and effective for GDM screening in
singleton and twin pregnancies.
Maternal and fetal outcomes in
pregnancy with chronic kidney disease
depending on the stages by GFR
Chan-Mi Lim, MD, Suk-Young Kim MD, Eun-
young Woo MD, Sun-young Jung MD, Ryoon-sun
Lee MD
Department of Obstetrics and Gynecology, Gachon
University, Gil Medical Center, Inchon, South
Korea
Introduction: Chronic kidney disease (CKD) is known
as a risk factor of pregnancy increasing miscarriage,
preterm birth, IUGR, and preeclampsia, etc. And
pregnancy may deteriorate the maternal CKD itself.
However, few studies are available regarding on
pregnancy outcomes in women with CKD and the
adverse effect of pregnancy on CKD in Korea.
Objectives: To assess maternal and fetal outcomes in
pregnancy with CKD and effect of pregnancy on
CKD progression according to stage of CKD in Korea.
Methodology/Process: 30 singleton pregnancies with
CKD who were delivered in our institute from 2006
to 2018 were reviewed retrospectively. Cases with
major fetal malformation, history of kidney
33Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
transplantation, or insufficient information were
excluded. Study population was divided into early
(stage1,2) and late(stage 3,4,5) groups according to
glomerular filtration rate (GFR). Maternal demo-
graphic profiles, renal function and perinatal compli-
cations were compared between two groups using
Mann–Whitney U test and Fisher exact test. Changes
of GFR from before conception to after delivery were
analyzed by Wilcoxon signed rank test.
Results/Outcomes: Comorbidity of hypertension
(19.0% vs. 77.8%) and diabetes mellitus(9.5%
vs. 44.4%) were higher in late stage group. Incidence
of preeclampsia(23.8% vs. 77.8%), anemia(28.6%
vs. 77.8%), cesarean section(38.1% vs. 100.0%) and
need for neonatal intensive care unit(33.3% vs. 88.9%)
were increased in late stage significantly. Gestational
age at delivery(38.1wks vs 34.9wks) and birth weight
(2965 g vs 2130 g) in late stage were significantly
lower than early stage. When comparing GFR before
conception and after delivery, there was no significant
difference in early stage whereas significant decrease
in late stage (P= 0.017).
Conclusion: Late stage of CKD is a poor prognostic
factor for pregnancy outcomes. Pregnancy deterio-
rates renal function in late stage of CKD. Close moni-
toring and management are required for pregnant
women with late stage of CKD.
Diagnostic utility of urine gram stain
versus urinalysis in asymptomatic
bacteriuria among pregnant patients
Suzanne C. Lucero, MD, Marie Faith B. Villaruz
MD, Ramela O. Contrevida MD, Geraldine L.
Gubatina MD, Eileen M. Granada MD, Gertrude
Emilie P. Gelito MD
West Visayas State University College of
Medicine, Iloilo City, Philippines
Objective: This study aimed to compare urine Gram
stain and urinalysis using urine culture as gold stan-
dard in the diagnosis of asymptomatic bacteriuria
(ASB) among pregnant patients; determine the sensitiv-
ity, specificity, positive and negative predictive values
as well as compare the likelihood ratios of both tests.
Methods: This was a cross-sectional study conducted
from July to December 2016 involving 220 pregnant
patients on initial prenatal visit at the Out-patient
Department of West Visayas State University Medical
Center (WVSUMC) Department of OB-Gyne. Urinalysis,
Gram stain and culture were performed at the
Bacteriology Section of WVSUMC laboratory. Sensitivity,
specificity, positive predictive values, negative predictive
values and accuracy were computed for both tests in
relation to urine culture. Tocompareforthediagnostic
test characteristics, areas under the curve were generated.
McNemar’s Test was used to compare the superiority of
urine Gram stain over urinalysis. The research proposal
was reviewed and approved by the WVSU Unified Bio-
medical Research Ethics Review Board.
Results: In this study, the prevalence rate of ASB
among pregnant women was 7.7%. It was found that
urine Gram stain is more sensitive (58.82%) in the
diagnosis of bacteriuria in pregnant patients as com-
pared to urinalysis (29.41%). Urinalysis however was
highly specific (94.09%) compared to urine Gram stain
(77.83%) in detecting ASB. The likelihood ratios of
both tests were equally similar in detecting ASB.
Comparing the relative sensitivity of both tests it was
found out that urine Gram stain had a significantly
higher sensitivity than urinalysis (P = 0.03). Urine
Gram stain was more sensitive but less specific than
urinalysis in detecting ASB in pregnant women. How-
ever, based on Area under the Curve (AUC), both
tests were comparable in detection of ASB (P = 0.26).
Conclusion: In this study, urinalysis because of its
high specificity remains to be a good diagnostic tool
for ASB while Urine Gram stain due to its better sen-
sitivity is more effective in detecting the presence of
ASB especially in low resource settings. For patients
with negative urinalysis, we recommend proceeding
to urine gram stain instead of urine culture because of
the 7.7% ASB prevalence.
Keywords:Asymptomatic bacteriuria, pregnancy, uri-
nalysis, urine Gram stain
Performance of a first trimester
preeclampsia screening program and
effectiveness of aspirin in reducing the
development of preeclampsia: A five-year
Philippine experience
Michelle Martin, MD, Zarinah Gonzaga, MD
The Medical City, Ortigas Avenue, Pasig City
Introduction: In this private tertiary institution,
hypertensive disorders occurred in 16–17% of all high
risk pregnancies. In response to the high prevalence
of preeclampsia (PE), a first trimester screening pro-
gram (FTS) was established in 2014.
Objective: This study aims to determine the 5-year
performance of the FTS for PE and assess the
34 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
effectiveness of aspirin administration in reducing the
incidence of PE among women detected at high risk.
Methodology: This was a retrospective cohort study
of all singleton pregnant women who underwent PE
screening between 11 to 13 6/7 weeks’gestation and
delivered in the same hospital between January 2014
to May 2018. The FTS utilized a combination of mater-
nal characteristics, serum levels of placental growth
factor and pregnancy associated plasma protein A and
uterine artery pulsatility indices in the calculation of
maternal risk for early and late onset PE. After deliv-
ery, medical records were searched for the diagnosis
of PE and administration of aspirin therapy. Detection
rates for early-onset and late-onset PE were calculated.
Results: Data from 123 women showed an overall
accuracy of 91.87% and 88.62%, at a false positive
rate of 8% and 7% respectively for early-onset and
late-onset PE. There is insufficient evidence to state
statistically significant difference in the incidence of
PE among high risk women given aspirin therapy
compared with those not given aspirin therapy.
Despite this, the findings demonstrated that PE
occurred in only 14.3% of those high risk mothers
who were given aspirin therapy.
Conclusion: The findings validate that FTS for PE can
identify with high accuracy those women who are
high risk women of developing PE <34 weeks and
<37 weeks’gestation. Our results also highlight the
need for a standardized protocol on aspirin therapy
for PE prevention based on the most current recom-
mendations and guidelines.
Keywords: aspirin; first trimester preeclampsia
screening; mean arterial pressure; uterine artery
pulsatility index; pregnancy associated plasma pro-
tein A; placental growth factor
Pre-pregnancy transabdominal cervical
cerclage in women with recurrent
preterm birth or late miscarriage: A case
series report
An Mai Nguyen, MD, Anh My To MD, Xuyen Thi
Ha Le MD, Trung Thien Ly MD, Minh Ngoc Chau
MD, Vinh Quang Dang MD
Obstetrics and Gynecology Department, My Duc
Hospital, Ho Chi Minh City, Vietnam
Background: In women with history of recurrent pre-
term birth (PTB) or late misscariage and failed vaginal
cerclage, transabdominal cerclage (TAC) procedure
could be used to prevent future PTB. Most published
studies included patients with TAC placement in
early pregnancy with encouraging results. Data on
pre-pregnancy TAC is limited.
Objective: To evaluate the effectiveness of pre-
pregnancy TAC to prevent PTB in women with his-
tory of recurrent PTB/ late miscarriage and failed
vaginal cerclage.
Methods: This was a retrospective, case series study.
Women with recurrent PTB or late miscarriage and
failed vaginal cerclage undergoing pre-pregnancy
TAC from 1/2015 to 5/2019 at My Duc Hospital were
included and followed up until birth. TAC was per-
formed via minimal access surgery, under general
anesthesia, with a nonabsorbable suture (Trustilene 0)
placing high at the level of internal os. Primary out-
come was PTB <34 weeks’gestation. Secondary out-
comes were procedure time, length of hospital stay,
complications and obstetric outcomes after TAC.
Results: Between 1/2015 and 5/2019, 12 women
underwent pre-pregnancy TAC. Five cases reported
pregnancies after TAC, the other 7 patients are plan-
ning for pregnancy. Out of 5 cases reporting pregnan-
cies, there were 2 cases with PTB <34 weeks. Other
obstetric outcomes were shown in Table below. Aver-
age procedure time was 48.3 min, blood loss was
43.3 mL. Average length of hospital stay after the pro-
cedure was 4.7 days.
Conclusion: In women with history of recurrent PTB
or late miscarriage and previously failed vaginal
cerclage, pre-pregnancy TAC could be an option in
prevention of PTB.
Evaluating abnormal fetal
cardiotocogram
J. Oyuntsetseg
1
, O. Altanzul
2
,
Ts. Ankhzaya
2
,N. Bayasgalan
2
, B. Tsengelmaa
2
,
E. Mandkhai
2
,D.Gereltuya
2
, B. Zulaa
2
,
E. Ouynkhand
2
1
Officer in charge of policy and planning, Khuree
Maternity Home, Ulaanbaatar, Consultant, Master
of Medical Sciences, Doctor of Advanced Degree,
2
Obstetrician, Khuree Maternity Home,
Ulaanbaatar,
2
Residency Doctor, ObGyn
Department, NUMS
Goal: To study the correlation between abnormal fetal
cardiotocogram and Apgar score of newborn.
Methodology: A retrospective study was conducted
for 150 delivery records of mothers delivered from
September, 2018 to March, 2019 at Khuree Maternity
35Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
Home, Ulaanbaatar, whose gestational age was above
37 weeks and who had pathologic or suspicious fetal
cardiotocogram. Study tools were developed; data
were collected and coded according to specially
designed questionnaire. Statistical analyses were
processed using SPSS 21.0.
Results: 86 (57.3%) of mothers had suspicious and
64 (42.7%) of them had pathologic fetal cardiotocogram.
Abnormal fetal cardiotocogram and Apgar score of
newbornat1and5minhadstatisticallysignificant cor-
relation (Р= 0.003, Р= 0.029). Abnormal fetal car-
diotocogram and clinical condition of newborn
statistically significant correlation (Р= 0.035).
Conclusion: Abnormal fetal cardiotocogram and
Apgar score of newborn had correlation between
them. Additional analyses such as fetal scalp blood
pH and internal cardiotocography are needed when
we choose mode of delivery on the basis of suspicious
recording.
Keywords: Abnormal fetal cardiotocogram, Apgar
score, clinical condition of newborn.
Prediction of preeclampsia and
intrauterine growth restriction in low-
risk pregnancies in East Avenue Medical
Center using uterine artery Doppler
velocimetry
Shiela Mae D. Putol, MD, Ma. Bernadette R.
Octavio MD
East Avenue Medical Center, Diliman, Quezon
City, Philippines
Objective: The aim of this study is to predict the risk
for the development of adverse pregnancy outcomes
on the basis of mid-trimester uterine artery Doppler
velocimetry. Specifically, it aims to screen the risk of
preeclampsia and intrauterine growth restriction
among low-risk pregnancies.
Methodology: This was a prospective cross-sectional
study for preeclampsia and intrauterine growth
restriction using uterine artery doppler sonography in
low-risk pregnancies carried out at East Avenue Med-
ical Center. All patients with singleton pregnancy
between ages 20–34 years on their 16 to 22 weeks age
of gestation seen at the obstetric outpatient depart-
ment of East Avenue Medical Center were selected. A
minimum of randomly selected 160 patients who sat-
isfied the inclusion/exclusion criteria were required at
95% confidence level and expected precision of 4%, to
obtain an 80% chance of detecting the predictive
value of uterine artery Doppler velocimetry in identi-
fying adverse pregnancy outcomes. The pulsatility
index (PI) for each uterine artery was obtained by
averaging the value of three consecutive uterine
artery blood velocity waveforms. If the mean PI was
more than 1.45, the flow velocity waveforms were
considered abnormal.
Results: Statistical analysis showed that preeclampsia
occurred significantly more commonly in the group
with an abnormal doppler result at 16–22 weeks of ges-
tation, compared to pregnancies with normal doppler
findings. That is 42.9% for abnormal doppler result ver-
sus 7.2% for those with normal doppler findings. How-
ever, none of the 34 evaluated cases developed
intrauterine growth restriction.
Conclusion: Abnormal uterine artery Doppler result
at 16–22 weeks is associated with adverse pregnancy
outcomes. In this study, it was well correlated with
the development of preeclampsia. Hence, uterine
artery Doppler can be used as a useful method for
identifying high-risk pregnancies. Uterine artery
pulsatility index can provide further information for
the prediction of preeclampsia in order to conduct
appropriate clinical interventions to avoid perinatal
morbidity.
A comparative study of the efficacy of
misoprostol administered by oral,
sublingual and vaginal route for
induction of labor at term
Priyankur Roy, MD
Introduction: Induction of labor includes natural,
mechanical, surgical and pharmacological methods.
Objectives: The objectives of this study were to
determine the efficacy and safety of 50 micrograms of
sublingual misoprostol, 50 micrograms of oral miso-
prostol compared with 50 micrograms of vaginal
misoprostol for induction of labor, in women with a
live, term fetus and an unripe cervix.
Methodology: 1200 women, those for labor induction
at term were included in this study. 400 women were
administered misoprostol by either vaginal, sublin-
gual or oral route for maximum of 3 doses in each of
the groups. Fetal heart sound was routinely moni-
tored. Six hours after the last dose, if Bishop’s score
was favorable amniotomy was done and if required
labor was augmented by using oxytocin. Labor was
36 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
monitored using partogram. Bishop’s score was
assessed every 4th hourly. All further monitoring and
interventions was left to the discretion of the treating
obstetrician.
Results: The total number of patients studied was
1200 –equally distributed in all the three groups.
Themeanageofthewomeninthestudywas
25 years and most of the women were
primigravidas. The BMI among the 3 groups were
comparable and the mean gestational age was
39 weeks. The commonest indications for induction
were past dates and prolonged latent phase of
labor.ThemeanBishopscoreatthetimeofinduc-
tion was 3.5 in all the groups. The median number
of doses of misoprostol used was 2. Oxytocin
requirement for augmentation of labor was signifi-
cantly less in women of the oral misoprostol group.
Most women of the oral misoprostol group deliv-
ered by spontaneous vaginal delivery; a statistically
significant difference in the mode of delivery
between the groups was noted. The indication for
which caesarean section was performed was similar
in all the groups. The mean induction to delivery
interval was significantly less in the oral group. The
rate of hyperstimulation was most in the vaginal
group. Meconium stained amniotic fluid was seen
inwomenofallthegroupsbutwastheleastin
women of the oral misoprostol group. 92 neonates
were admitted to the NICU and they were equally
distributed in all the 3 groups.
Conclusion: Oral misoprostol was the most effective
route of administration for induction of labor at the
used dosing schedule as compared to the vaginal or
sublingual routes.
Keywords: Efficacy, Oral, Misoprostol, Safety, Sublin-
gual, Vaginal.
Pregnancy outcome in women with
polycystic ovary syndrome
Haritha Sagili, MD, Amandeep Mann MD, Murali
Subbaiah MD
Jawaharlal Institute of Postgraduate Medical
Education and Research, Pondicherry, India
Introduction: PregnantwomenwithPolycystic
ovary syndrome seem to be prone for adverse
maternal and perinatal outcomes but there is no
conclusive evidence. Indian data evaluating the
pregnancy outcome in women with Polycystic
ovary syndrome is sparse.
Objectives: This study was proposed to evaluate the
pregnancy outcome in women with Polycystic ovary
syndrome.
Methodology: This descriptive study on 135 preg-
nant women with Polycystic ovary syndrome was
carried out in a tertiary care hospital in South India
from January 2016 to October 2017. Data regarding
present pregnancy, Polycystic ovary syndrome and
maternal/ perinatal outcomes was noted in MS
Excel and analyzed using SPSS version 20. Categor-
ical variables studied were parity, various maternal
and perinatal outcomes. Data was expressed as pro-
portions. Continuous variables such as age, weight,
gestational age were expressed as mean SD as
appropriate.
Results: The mean age was 26.8 years, 77% had high
BMI and 88% had history of primary infertility. The
proportion of hypertensive disorders of pregnancy
(17.8%), PROM(18.5%), low APGAR score at 5 min
(13%) was found to be higher, but the proportion of
gestational diabetes(13%), miscarriage(2.2%), preterm
delivery(10.4%), meconium stained liquor, caesarean
delivery(30.4%), low birth weight babies (2%),
macrosomia(0.7%), PPROM(8%), perinatal mortality
(2%), NICU admission(20%) and congenital anomalies
was found to be either similar or lower in pregnant
women with Polycystic ovary syndrome in comparison
to those described in the general pregnant population.
Conclusion: The data in our study throws more light
on the current thinking of the obstetrical problems
faced by mothers with Polycystic ovary syndrome, in
which some of our results support and others refute
several long held beliefs about the risks. Early book-
ing and adequate antenatal care should improve the
obstetric and perinatal outcome in pregnant women
with Polycystic ovary syndrome.
Association of serum C-reactive protein
and selected coagulation marker in
preeclampsia and its impact on
fetomaternal outcome
Shahanaj Sharmin, MD, Shahanara Chowdhury
MD, Didarul Alam MD, Nasreen Banu MD, Shirin
Akter Khanam MD, Fahmida Rashid MD
Chattogram Maa-O-Shishu Hospital Medical
College, Agrabad, Chattogram, Chittagong,
Bangladesh
Objective: To evaluate the association of serum
C-reactive protein and selected coagulation marker
37Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
in preeclampsia and its impact on fetomaternal
outcome.
Methods: It was a case control study and was per-
formed in the Department of Obstetrics and Gyne-
cology, Chittagong Medical College Hospital
(CMCH) and Bangabandhu Memorial Hospital
(BBMH). Study period was 12 months and study
population included women in their third trimester
of pregnancy, both preeclamptic (case group) and
normotensive (control group). Sample size was cal-
culated statistically. Data was recorded in a pre-
tested questionnaire by using available information
and interviews.
Results: We analyzed 150 pregnancies, 50 women
were in the case group, and 100 were from the control
group. The ages were matched and mean age was dis-
tributed evenly (P> 0.05).
Regarding obstetric variables of the study, there
were more primigravid women in case group com-
pared to the control. C-reactive protein concentration
(mg/L) was 3.45 1.71 in normotensive group and
10 6.93 in preeclamptic group, which was signifi-
cantly higher than in control group (P= 0.000). The
mean value of platelet counts was significantly lower
while the mean values of prothrombin time and
APTT were higher in the preeclamptic patient
(P< 0.005). Preeclamptic women delivered at a sig-
nificantly shorter gestational age than normal preg-
nant women. Mean gestational age during delivery
for the case group and control group was 39.02 1.6
and 39.5 0.8 weeks respectively. Regarding mode
of delivery 62% LSCS in case group and 50% LSCS
in control group which was statistically significant
(P= 0.038). Mean SD birth weight in PE
(2.52 0.42 kg) were significantly lower than normal
pregnancies (2.88 0.29 kg). The sensitivity and
specificity of CRP were 68.00% and 98.00% respec-
tively. Multiple regression analysis showed investi-
gated markers (CRP, PLT, PT, APTT) were
significantly correlated between case and control
groups.
Conclusion: Study showed 68% cases CRP raised in
case group whereas in control group it was 2%. Multi-
ple regression analysis showed investigated markers
(CRP, PLT, PT and APTTT) were significantly corre-
lated between case and control group. Coagulation
abnormality leads to adverse fetomaternal outcome in
terms of morbidity and mortality. The birth weight
was found significantly less in those babies with
raised serum CRP. Therefore, CRP may be used as
cost effective investigation to identify the risk of
preeclampsia and to monitor the patient for progres-
sion of severity.
Keywords: Preeclampsia, C-reactive protein, Platelet
count, Prothrombin time, Activated Partial Thrombo-
plastin Time, Pregnancy, Fetomaternal
The correlation between perineal body
length and obstetric perineal laceration
among Filipino Primigravid patients in a
Tertiary Hospital
Iris A. Soria, MD, Kareen N. Reforma MD
Department of Obstetrics and Gynecology,
University of the Philippines - Philippine General
Hospital, Manila, Philippines
Currently, there are conflicting studies on the perineal
body length as an independent risk factor affecting
degree of perineal laceration in Asian and Western
countries.
Objectives: This study aims to establish the correla-
tion of perineal body length and obstetric perineal lac-
erations in primigravid patients. It intends to
establish perineal body length as an independent risk
factor of an obstetric perineal laceration.
Methods: It was a cross-sectional, prospective study of
primigravid patients in active stage of labor admitted at
a tertiary hospital. Inclusion criteria were term, singleton
pregnancies and in vertex presentation. A total of
139 primigravids were recruited and underwent mea-
surement of perineal body length by the resident-physi-
cian. Other delivery characteristics were recorded. Data
were analyzed using Spearman rank-order association
and Fisher’s exact test of association.
Results: Birthweight (P < 0.203) and type of episiot-
omy (P < 0.012) were associated with second, third,
and fourth degree lacerations in primigravid women.
Other maternal, neonatal and surgical factors were
not statistically significant. Moreover, the study pres-
ented that Filipino primigravid has an average peri-
neal body length of 2.7 centimeters. The result of the
study showed that perineal body length has no signif-
icant correlation with the degree of perineal laceration
incurred (P < 0.84).
Conclusion: This is the first study to present norma-
tive data on perineal length for Filipino primigravid
in correlation with outcomes of vaginal deliveries.
Birthweight and type of episiotomy were associated
with higher order lacerations. Moreover, perineal
38 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
body length has no significant correlation with the
degree of vaginal laceration incurred.
Predicting HELLP syndrome in
preeclampsia cases and determining fetal
outcomes
Ali Sungkar, MD, Rima Irwinda, MD, Raymond
Surya, MD
Department of Obstetrics and Gynecology,
Dr. Cipto Mangunkusumo Hospital/ Faculty of
Medicine Universitas Indonesia, Jakarta, Indonesia
Introduction: Hypertensive disorders in pregnancy
(HDP) contributed as one of the leading causes of
maternal and perinatal mortality worldwide. Hemoly-
sis, Elevated Liver enzymes, Low Platelet (HELLP)
syndrome is considered as more severe form of pre-
eclampsia. This study aims to determine parameters
to predict the occurrence of HELLP syndrome, and
perinatal outcomes among preeclampsia patients.
Methods: All preeclampsia without, with severe fea-
tures and HELLP syndrome coming to Dr. Cipto
Mangunkusumo hospital between January 2015 and
December 2017 were recruited into this retrospective
cohort study. A sample size of 329 was expected mini-
mally based on proportion of diseases. The author
conducted bivariate and multivariate analysis to
determine factors predicting the occurrence of HELLP
syndrome among preeclampsia patients. All P-values
were 2-tailed, and the significance level was set to
<0.05. SPSS 21.0 for Windows was used for all
analyses.
Results: There were 5197 deliveries at this tertiary
hospital in Jakarta, 676 of which was complicated by
preeclampsia without or with severe features and
113 patients with HELLP syndrome. Gestational age,
history of hypertension, ureum, and uric acid
≥5.2 mg/dL significantly predicted HELLP syndrome
with area under the curve 84%. Uric acid more than
5.2 mg/dL had the strongest predictors (RR 2.19; 95%
CI 1.06–4.52). Based on data of gestational age at
delivery which lower in HELLP syndrome, it showed
lower median birth weight in HELLP syndrome
(1442.5 grams) compared with preeclampsia (2400
grams).
Conclusion: Gestational age, history of hypertension,
ureum, and uric acid ≥5.2 mg/dL significantly
predicted HELLP syndrome. Baby born from HELLP
syndrome had lower birth weight and prone for mor-
tality due to lower gestational age at delivery.
Keywords: preeclampsia, HELLP syndrome, fetal
outcome, predictor.
Factors affecting compliance to voluntary
HIV screening among pregnant women
seeking prenatal care in the outpatient
Department of a Tertiary Government
Hospital
Victoria May H. Velasco, MD, Analyn Fuentes
Fallarme MD
Department of Obstetrics and Gynecology,
University of the Philippines - Philippine General
Hospital, Manila, Philippines
Background: Prenatal testing for Human Immunode-
ficiency Virus (HIV) is recommended, but not
required, for all pregnant women. Determining the
factors that influence a woman’s willingness to be
screened is crucial in preventing mother to child
transmission (MTCT) of HIV.
Objectives: This study determined the factors that
influence acceptability of HIV testing, calculated the
proportion that agreed to be screened and the propor-
tion that was actually screened.
Methods: A total of 247 women seeking prenatal care
in the outpatient department of Philippine General
Hospital answered a self-administered questionnaire
about HIV, MTCT and HIV testing. The
sociodemographic profiles were analyzed using
descriptive statistics and correlation with willingness
to be screened was determined using multiple logistic
regression analysis. The proportion that actually
underwent screening was calculated.
Results: The respondents were between 20 to 29 year-
old, single, Catholic, unemployed high school gradu-
ates. Awareness about HIV was high (98%), but those
of MTCT (43–60%) and HIV testing (34%) were low.
Most of the participants have heard about HIV from the
television and the Internet. Only a handful learned of it
from the medical community, which is unfortunate,
since this is the main source of prenatal care. Only 47%.
of the respondents were willing to be screened, but
52% were eventually screened, implying that prenatal
care was effective in educating about HIV. Previous
HIV testing and cost were found have a negative
effect on the willingness to be tested during the cur-
rent pregnancy.
Conclusion: The general awareness about HIV was
high, but those of prenatal HIV testing and MTCT
39Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
were low. Previous HIV testing and financial con-
straints were found to discourage against HIV testing.
Even though less than half initially agreed to be
tested, more than half eventually were, implying that
prenatal counseling is an effective method of educat-
ing people about HIV and MTCT.
Effectiveness of prophylactic vaginal
micronized progesterone in prevention of
preterm birth among high risk women
seen at the Tertiary Government Hospital
outpatient department: A randomized
controlled trial
Mae Marecel Villalba, MD, Rose Joy D. Vallega
MD, Maria Jenina M. Soyao MD
Corazon Locsin Montelibano Memorial Regional
Hospital, Bacolod, Philippines
Introduction: Preterm birth is the largest cause of neona-
tal death each year worldwide accounting for 3.1 million.
It accounts for major perinatal morbidity and mortality.
Objectives: To determine the efficacy of prophylactic
vaginal micronized progesterone in preventing pre-
term labor and preterm birth in women with history
of previous preterm birth who are seen at Tertiary
Government Hospital Outpatient Department based
on the maternal and neonatal outcome.
Materials and Methods: A randomized controlled trial
of 40 women with history of preterm birth, abortion or
preterm labor in an outpatient department of a tertiary
hospital who was randomly chosen to a treatment and
observation group. The treatment group was given
200 mg vaginally of prophylactic micronized progester-
one from 28 weeks to 34 weeks age of gestation. Results
were analyzed using mean, standard deviation and t-test.
Results: Prophylactic prenatal administration of vaginal
micronized progesterone significantly prolongs the preg-
nancy to term by mean age of 38 weeks of gestation com-
pare to the observation group of 29 weeks. It also shows
in the neonatal outcome that those given the prophylactic
vaginal micronized progesterone has increased birth
weight with a mean of 3, 200 grams and better APGAR
score which leads to decreased length of NICU stay.
Conclusion: This study showed that the prophylactic
prenatal administration of micronized vaginal micron-
ized progesterone from 28 weeks to 34 weeks age of
gestation is effective in preventing preterm labor and
preterm birth in high risk women, thus prolongs the
pregnancy to term, thus improves APGAR score,
increase birthweight and decrease length of NICU stay.
Preeclampsia in the era of universal
screening and aspirin prophylaxis in
Sarawak: An observational multicentre
study
Hian Yan Voon, MD, Soon Leong Yong MD, Aini
Nabilah Abdul Raub MD, Ming Cheng Chai MD,
Ching Mun Ng MD, Freddie Atuk MD
Sarawak General Hospital, Malaysia
Objective: Screening strategies and aspirin prophy-
laxis for preeclampsia remains heterogeneous
across various states in Malaysia. A state-wide ini-
tiative to screen pregnant women based on the
National Institute of Health and Care Excellence
(NICE) criteria has been in place since 2016. We
aim to review the limitations of this approach, in a
setting where there is no existing first trimester
aneuploidy screening program.
Method: All women who delivered in the six main
district hospitals throughout the state were
reviewed within 24-48 hours postdelivery. Women
with any form of hypertensive disease in pregnancy
were identified, their antenatal records and case
notes were reviewed for presence of preeclampsia,
eclampsia or HELLP syndrome. The definition of
preeclampsia was based on the criteria rec-
ommended by the International Society for the
studyofHypertensioninPregnancy(ISSHP).The
incidence, clinical risk factors, screen negative rate,
onset and severity of preeclampsia were described,
including in women already started on aspirin
antenatally.
Results: A total of 3834 women were reviewed
throughout the study period with 111 (2.89%)
women developing a spectrum of preeclampsia,
eclampsia or HELLP syndrome (sPET). Of these,
three (2.7%) women had HELLP syndrome and
had an average gestation of 32 weeks while four
(3.6%) women had eclampsia, with an average ges-
tation of 37weeks at delivery. Early onset
(<34weeks), preterm (<37weeks) and term sPET
occurred in 20 (18.2%), 48 (43.6%) and 63 (56.4%)
pregnancies respectively.
Screening using NICE criteria failed to identify
more than two-thirds of women who eventually
developed sPET. Despite the reported efficacy of
40 Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
aspirin prophylaxis in preventing preterm PET, 7/34
(20.5%) and 13/34 (38.2%) women still developed
sPET prior to 34 and 37 weeks. All these women were
also taking calcium carbonate after 20 weeks. There
were no difference in gestation at delivery between
women who developed sPET, whether they were on
aspirin or not (36
+2
vs 36
+5
weeks; P=0.513)
Conclusion: Screening by NICE criteria detects only a
third of women who eventually develop preeclamp-
sia. Validated models incorporating maternal charac-
teristics, biophysical profile and uterine arteries
should be considered, although it may involve consid-
erable investment and training. Emphasis should be
placed on appropriate dose, nocturnal intake and
compliance to aspirin to extract its maximum preven-
tive benefit.
Prediction of preterm birth using cervical
length, hsCRP, and fetal
fibronectin (fFN)
Eun-young Woo, Suk-Young Kim, Chan-Mi Lim,
Sun-Young Jung, Sun-Young Jung, Min-Jung Choi
Department Of Obstetrics And Gynecology,
Gachon University, Gil Medical Center, Inchon,
Korea
Introduction Preterm birth (PTB) is a major cause of
neonatal mortality and morbidity and its prediction
and prevention remain a challenge in maternity care.
Currently, many methods can be used to detect PTB.
Objectives: To evaluate the usefulness of various pre-
dictors of PTB, especially combined results such as
fetal fibronectin (fFN), cervical length(CL), hsCRP,
GBS and multiplex PCR at vaginal secretion.
Methodology/Process: Various causes of PTB, total
219 cases were enrolled between July of 2014 and
December of 2018. There were spontaneous pre-
term labor, PPROM, IIOC and short
CL. Incomplete data and delivery for maternal or
fetal indications were excluded. Study population
was divided into 3 groups, less than 28 weeks of
gestation, between 28 and 32 weeks of gestation,
and less than 37 weeks of gestation. CL was mea-
sured by transvaginal sonography, positive result
is <2.0 cm. fFN was obtained by cervical smear,
positive result is ≥50 ng/mL. Maternal characteris-
tics, risk factors of PTB, clinical characteristics and
neonatal outcomes were analyzed using χ
2
test and
CL and hsCRP level were analyzed by multinomial
logistic regression and ROC curve.
Results: Less than 2.0 cm of CL (P= 0.002),
hsCRP ≥0.9 mg/dL (P= 0.004), fFN≥50 ng/mL
(P= 0.03) were associated with shortening gestational
age at birth. And the earlier the birth, the worse the
neonatal outcome. In multinomial logistic regression,
the shorter of CL and the higher values of hsCRP
were associated with the risk of PTB. In ROC curve,
when CL was 1.39 cm, sensitivity and specificity were
62.7% and 62.5%, respectively. When hsCRP was
0.49 mg/dL, sensitivity and specificity were 60.8%
and 59.5%, respectively.
Conclusion: It is somewhat surprising that BV and
GBS were not linked with PTB, but fFN, shortening of
CL, elevation of hsCRP caused by cervical inflamma-
tion carried increased risk of PTB. Therefore, these
useful predictors will continue to play important role
in clinical research for prediction and prevention
of PTB.
41Editorial material and organization © 2020 Japan Society of Obstetrics and Gynaecology. Copyright of individual
abstracts remains with the authors.
Maternal Fetal Health
