Polyhydramnios Research Articles

Outcome of Pregnancies Conceived with Ivf and Icsi Depending on Age Factor

INTRODUCTION: Infertility, a reproductive health condition prevalent among one in every four couples in the developing countries, is a neglected problem.In this era of exponential industrialization and global changes, lifestyle disorders like infertility are on the ri se. It is estimatedthat infertility affects 8 to 12 per cent of couples worldwide. overall IVF pregnancies are often seen as risky mainly due to multiple gestations. However, even singletonART pregnancies are associated with increased incidences of preterm birth, low birth weight, small-for-gestational-age (SGA) infants, and obstetric complications such as preeclampsia, placental abruption, and placenta praevia. While there are many studies that compare pregnancies after assisted reproductive techniques with spontaneously conceived pregnancies, fewer data are available that evaluate the differences between IVF and ICSI-conceived pregnancies. The aim of our study was to compare adversepregnancy outcomes in IVF and ICSI cases and how they vary depending on age factor. METHODS: This retrospective cohort study was conducted at Radhakrishna multispeciality hospital and IVF center, Bangalore during January 2013 to January 2019. A total of 667 of which 434 were IVF and 233 ICSI cases were done. 263 cases were pregnancy positive out of which 149cases underwent conventional IVF and 114 cases underwent ICSI. These cases were divided into three groups depending upon age factor. Outcome variables included maternal parameters: i.e., age; gravity;duration of infertility, pregnancy complications such as abortions, ectopic pregnancy, multiple pregnancies, pregnancy-induced hypertension, preeclampsia, prematurerupture of membranes, gestational diabetes mellitus, IUGR and preterm labour; antepartum hemorrhage and fetal parameters: i.e., gestational age; low and very low birth weight,meconium aspiration syndromeand need for NICU admission. RESULTS: In the study among those who had IVF pregnancy, there was no significant association between causes and Age distribution. however, a greater number of ICSI cases were done for male factor infertility. In IVF group, there was significant difference in Biochemical Pregnancy, Gestational DM, Pre-Term Labour, Oligo Hydramnios and Poly Hydramnios with respect to age distribution. I.e., all the above-mentioned complications were significantly high in mothers in the age group 30 to 40 years compared to other age groups. There was no significant difference in other complications with respect to age distribution. In ICSI group, there was significant difference in Biochemical Pregnancy with respect to age distribution. I.e., Biochemical Pregnancy were significantly high in mothers in the age group 30 to 40 years compared to other age groups. In the study there was significant difference in Preterm birth and NICU admission in IVF group with respect to age distribution. I.e., Preterm birth and NICU admission were highest in the age group 30 to 40 years mother. CONCLUSION: Women who conceived with IVF and ICSI were at higher risk of maternal and perinatal complications particularly with age group 30-40 years. There was significant increase in multiple pregnancies, gestational diabetes and preterm labour and NICU admission in IVF group. Hence with proper diagnosis, stimulation protocol and with single embryo transfer can reduce the risk of multiple birthand further perinatal complications.

Late preterm polyhydramnios and the risk of transient tachypnea of the newborn

Clearance of fetal lung fluid at birth is instrumental in neonatal respiratory outcomes, with decreased fluid clearance related to development of transient tachypnea of the newborn (TTN). The effects of excess fetal lung fluid on neonatal respiratory outcomes in the late preterm (LP) period have yet to be elucidated. We aimed to determine if polyhydramnios (POLY) in LP gestation increases the risk of TTN.

197 Amniotic fluid levels in pregnancies affected by diabetes

While diabetes is recognized as a risk factor for polyhydramnios (PH), the distribution of amniotic fluid levels (AF) among pregnancies affected by diabetes (DM) is inadequately studied in contemporary populations. We sought to compare the distribution of AF levels, as well as rates and severity of PH, between DM and non-DM cohorts. We performed a retrospective cohort study of non-anomalous singleton gestations who had an ultrasound examination (USE) in the 3rd trimester at any of 17 academically affiliated ultrasound units. All USE were performed by RDMS. Pregnancies were separated into those with and without DM (both gestational and pregestational). We computed gestational age specific AFI and DVP centiles for both groups following logarithmic transformation of the AF measurements. Rates of PH, both overall and by gradations of severity were compared between groups for AFI and DVP using logistic regression. PH was defined according to SMFM guidelines. Rates of PH were determined on a per pregnancy basis, and a diagnosis of PH at any gestational age was considered a positive finding. There were 71,893 USE of singleton pregnancies with recorded AFI and DVP. Of these, 8,275 (11.5%) had a fetal anomaly and were excluded. The final study group consisted of 63,618 USE from 28,070 pregnancies. There were 4,225 (15.1%) pregnancies with DM and 23,845 (84.9%) without DM. The AFI and DVP were significantly higher in the diabetic cohort between 28-36 weeks with no significant differences at 37 weeks or greater (Figure 1; DVP not shown). Using AFI, the rate of PH was 10.5% vs 3.8% (OR 2.95; 95% CI 2.62-3.32) for pregnancies with vs without DM, respectively. Using DVP, the rate of PH was 13.9% vs 5.4% (OR 2.84; 95% CI 2.56-3.15). A breakdown by severity, method of measurement, and type of DM is shown in Figure 2. Within our study population, pregnancies affected by DM had increased levels of AF between 28-36 weeks. Rates of polyhydramnios are nearly 3x higher in pregnancies affected by DM and vary by DM classification.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

196 Moderate-severe polyhydramnios: cutoffs for deepest vertical pocket corresponding to amniotic fluid index

SMFM Consult Series (#46) on polyhydramnios (PH) recommends that “antenatal fetal surveillance (AFS) is not required for the sole indication of mild idiopathic” PH. A corollary is that AFS may be considered for moderate-severe (MS) PH. The objective of this study was to determine the cutoff for deepest vertical pocket (DVP) which correlates with amniotic fluid index (AFI) > 30 cm (i.e. MS PH) to guide those who utilize DVP over AFI. This retrospective study of 3rd trimester ultrasounds at 17 academically affiliated units included singletons with AFI and DVP. The study population was randomly divided into testing and validation groups. In the testing group, DVP thresholds correlating with AFI > 30 cm were calculated in two ways: i) a receiver operating curve and Youden’s J statistic (DVP-Youden) and ii) calculation of the DVP percentile that corresponded with an AFI of 30.0 (DVP-Percentile). Using the validation group, test performance was calculated for DVP-SMFM, DVP-Youden, and DVP-Percentile for diagnosis of AFI > 30 cm. From the 71,893 ultrasounds in the study period, the test group was 23,965 (33%) and the validation group 47,928 (67%). MS PH occurred in 286 (1.2%) in test group and 571 (1.2%) in validation group. An AFI of 30 cm corresponded to the 98.9 percentile and with DVP-Percentile, 10 cm. The calculated cutoff for MS PH was 8.0 for DVP-Youden (Figure). Sensitivities of DVP-Youden and DVP-Percentile were significantly higher than DVP-SMFM, but with an increased false positive rate (Table). In the sensitivity analysis, results were similar among pregnancies without diabetes or anomalies. Applying a cutoff of 8.0 cm rather than 12.0 cm increased detection of moderate-severe polyhydramnios to 100% with a false positive rate under 5%. If the SMFM DVP threshold of 12 cm were applied, 75% of the MS PH in the validation group would be missed. For obstetric practices utilizing DVP for amniotic fluid evaluation, identification of a DVP ≥ 8.0 cm should prompt further evaluation with full AFI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Is higher mean platelet volume an additional predictive marker of oligohydramnios and polyhydramnios?

Objectives:
 Amniotic fluid abnormalities are the
 leading cause of fetal morbidity and mortality. The aim of this study
 was to investigate whether prepartum mean platelet volume (MPV) is associated
 with and a predictable marker for oligohydramnios
 (OHA)
 and polyhydramnios (PHA).
 Materials and Methods: In
 this retrospective study, an examination was made of the records of patients
 who were monitored and gave birth at Karabuk Training and Research Hospital
 Gynecology and Obstetrics Clinic in 2014-2015. Patients with isolated OHA and
 PHA were included in the study group and those with normal amnion fluid volume
 (AFV) in the control group.  A record was
 made of age, obstetric and clinical history, smoking, alcohol consumption,
 laboratory test results and ultrasonography reports in the third trimester of
 the pregnancy.Results: A
 total of 284 pregnant women were included in the study. The MPV levels of the
 OHA and PHA groups were significantly higher than those of the normal group
 (p=0.000). There was no significant difference was observed between the OHA and
 PHA groups (p=0.20). MPV>8.4 accurately differentiated AFV (AUC:68.8%, sensitivity:78.6%,
 specificity:59.1%). MPV>8.0 accurately differentiated OHA (AUC:67.1%,
 sensitivity:84.4%, specificity:50.0%). MPV>8.5 accurately
 differentiated PHA (AUC:70.2%,
 sensitivity:79.0%, specificity:61.4%).
 
 
 
 
 
 Conclusion: The result of the current study shows that
 screening MPV has a predictive value for OHA and PHA in pregnancies without
 complications or fetal anomaly.

Diagnosis and prognosis of fetal periventricular pseudocysts

Objective To investigate the diagnosis, clinical outcomes and factors influencing the prognosis of fetal periventricular pseudocysts (PVPC). Methods A retrospective analysis was performed on the results of fetal neurosonography (NSG), cranial magnetic resonance imaging (MRI), chromosome karyotype and neonatal cranial ultrasound of 76 PVPC cases detected by prenatal ultrasound in Peking University First Hospital from May 2014 to October 2018. The accuracy of NSG and cranial MRI in PVPC diagnosis was assessed. Prognosis of PVPC and the influencing factors were evaluated. Statistical analysis was performed using Chi-square test or Fisher's exact test. Results (1) This study involved 51 cases (67.1%) of isolated PVPC and 25 cases (32.9%) of non-isolated PVPC. Among the 25 non-isolated PVPC cases, 15 were complicated by one abnormality and 10 by multiple abnormalities. There were 20 cases with intracranial abnormalities, two with extracranial abnormalities, and three with both intracranial and extracranial abnormalities. (2) Eight out of the 76 pregnancies (10.5%) were terminated and among them, two were isolated PVPC cases, five complicated by determined abnormalities (one case of PVPC complicated with pachygyria and bilateral mild fetal ventriculomegaly, one case of PVPC complicated with pachygyria or agyria and agenesis of corpus callosum, one case of PVPC complicated with arachnoid cyst and vermis dysplasia, one case of PVPC complicated with cortical dysplasia, one case of PVPC complicated with intestinal dilatation) and one by abnormalities of undertermined prognosis (PVPC combined with mild fetal ventriculomegaly and polyhydramnios). A total of 61 neonates (80.3%, 61/76) were born alive and followed up. Seven cases (9.2%, 7/76) were lost to follow-up. (3) As of February 2019, among the 61 followed-up infants, 44 with isolated PVPC and 15 with unclear abnormalities developed well. The other two with determined intracranial abnormalities were diagnosed as having cystic lesions in the brain parenchyma. One of them died of respiratory failure two days after birth and the other suffered from chromosomal disease (13.23 Mb deletion in region q24.3q31.2 of chromosome 2) with mental retardation and delayed growth and development. (4) A total of 44 (57.9%, 44/76) neonates received cranial ultrasound after birth and confirmed the diagnosis of PVPC, among which 11 (25.0%, 11/44) were missed or misdiagnosed in prenatal MRI. Conclusions PVPC may have many comorbidities, particularly intracranial abnormalities, which are closely related to the prognosis. A thorough prenatal ultrasound examination is necessary for fetal PVPC, especially NSG. Isolated PVPC usually has a good outcome. However, PVPC complicated by cystic lesions in the brain parenchyma may be associated with chromosomal abnormalities, hence fetal chromosome examination is required. Key words: Lateral ventricles; Central nervous system cysts; Ultrasonography, prenatal; Prognosis

Clinical research of Huangqi-Sijunzi decoction combined with conventional western medicine for gestational diabetes mellitus

Objective To evaluate the efficacy of Huangqi-Sijunzi decoction combined with conventional western medicine in treatment of gestational diabetes mellitus(GDM). Methods A total of 103 patients with GDM who met the inclusion criteria were randomly divided into control group and treatment group (52 in each group). The control group was treated with GDM standardized treatment, and the treatment group was added Huangqi-Sijunzi decoction on the basis of the control group. Both groups were treated for 14 days. The ELISA was used to detect serum CRP and adiponectin, and Mg2+ was detected by automatic biochemical analyzer. Pregnancy outcome observed and recorded, and the adverse reaction was recorded. Results After the treatment, the levels of FPG, 2 hPG and HbAlc in the treatment group were significantly lower than those in the control group (t=7.352, 17.962, 9.713, P<0.01); and the level of CRP in the treatment group was significantly lower than that in the control group. While the Mg2+ and adiponectin were significantly higher than those in the control group (t=9.275, 4.206, 6.021, P<0.01). After the treatment, the incidence of abortion, fetal macrosomia, cesarean section and polyhydramnios in the treatment group were significantly lower than that in the control group (χ2=5.358, 7.262, 3.992, 6.116, P<0.05). Conclusions The Huangqi-Sijunzi decoction combined with conventional western medicine can improve the blood sugar level of GDM patients, reduce the incidence of adverse pregnancy outcomes, and improve the clinical efficacy. Key words: Diabetes, gestational; Huangqi-Sijunzi decoction; Adiponectin; Pregnancy outcome; Drug-related side effects and adverse reactions

Prenatal ultrasonic manifestations and prognostic analysis of 17q12 microdeletion syndrome

Objective To summarize and analyze the prenatal ultrasonic manifestations of 17q12 microdeletion syndrome, so as to provide help for prenatal diagnosis. Methods It carried out a retrospective analysis of 21 cases of 17q12 microdeletion syndrome prenatally confirmed by chromosomal microarray analysis(CMA) in the third affiliated hospital of Zhengzhou University from 2015.01 to 2018.05. Prenatal ultrasound findings were collected. A close follow-up was given for the cases. Results Of the 21 fetus, 20 cases were presented with bilateral hyperechogenic kidneys, and 1 case showed duodenal obstruction. There were 4 cases accompanied with polyhydramnios, 8 cases with mild polyhydramnio, and 9 cases with normal amniotic fluid index. Parents of 6 fetus underwent chromosomal examination, of which 2 cases were inherited from the mother and 4 cases had new chromosomal mutations; Seven cases had a family history of diabetes and 3 cases had a family history of kidney disease; Twelve cases performed induced labor, 2 cases lost follow-up and 1 case was unborn. Six cases were born, of the 6 cases, 1 case associated with mild dysmorphic facial features, and 1 case associated with bilateral renal cysts. Conclusions 17q12 microdeletion syndrome has specific prenatal ultrasound characteristics, while echogenic kidneys are of great value in the diagnosis of 17q12 microdeletion syndrome prenatally. Key words: Ultrasonography, prenatal; 17q12 microdeletion syndrome; Kidney; Chromosomal microarray analysis; Prognosis

899: Microarray in 562 pregnancies with polyhydramnios – do the degree and week of diagnosis matter?

899: Microarray in 562 pregnancies with polyhydramnios – do the degree and week of diagnosis matter?

Effect of community nutrition management in tertiary prevention of gestational diabetes mellitus

Objective To establish the community sustainable nutrition management path of patients with gestational diabetes mellitus (GDM) and explore the effect in the tertiary prevention of GDM. Methods The number of pregnant women who delivered in the Jiangdong district of Ningbo city during January 2013 to December 2016 was 1 028. 512 patients with GDM who delivered were enrolled in control group and 516 patients in study group. Prevalence rate of GDM, blood glucose , glycosylated hemoglobin (HbA1c), weight gain during pregnancy, pregnancy outcomes, satisfaction rate of blood glucose control were compared between two groups. Data was analyzed by SPSS 13.0 statistical software. Results Prevalence rate of GDM in study group was 7.69%, lower than control group11.1%. Fasting blood glucose (FPG), 1 hour blood glucose (1 h PG), macrosomia, low birth weight in study group were better than control group. Fetal distress, Intrauterine infection, Hydramnios, Amniotic fluid embolism, Placental abruption, pregnancy weight gain were similar in two groups. Conclusions The sustainable nutrition management path of the community has good effect in the tertiary prevention of gestational diabetes mellitus. Key words: Community health services; Nutrition therapy; Diabetes, gestational/TH; Tertiary prevention

Early outcome of surgical intervention of esophageal atresia and tracheo-esophageal fistula in erbil pediatric surgical center

Background: Esophageal atresia (EA) and treacheo-esophageal fistula occur in 1 out of every 3500 live births. Children born with EA have a higher incidence of prematurity than the general population EA. The treatment of EA and tracheo-esophageal fistula, although still a challenge, represents one of the true successes of newborn surgery. Objective: The aim of this study cases with EA and/or tracheo-esophageal fistula in Rapareen pediatric surgery center, Erbil, Iraq, regarding management, and early outcome. Materials and Methods: Fifty-three neonates were enrolled in this study from October 2011 to September 2015. Preoperative investigations included chest X-ray, ultrasound of the abdomen, and echocardiography. All patients were resuscitated before surgical intervention. Statistical Package for the Social Sciences version 20 was used for data analysis. Results: Out of 53 cases, 21 survived and 32 died. Thirty patients were male and 23 were female (male-to-female ratio 1.3:1). Twelve were premature and 41 term babies. The most common type was EA and distal fistula in 47 cases, pure atresia in 5 cases, and EA with both distal and proximal fistula in one case. Presenting features were excessive salivation in all cases, failure to pass nasogastric tube in 98.1%, cyanosis in 69.8%, and chocking in 37.7%. Prenatal history of polyhydramnios was present in 67.9%. Eighteen cases had associated anomalies, most of them were cardiac. Conclusion: EA with distal tracheo-esophageal fistula is the most common type of anomaly. Early diagnosis, weight, maturity, and associated anomalies are the most important factors that affect the outcome. Postoperative respiratory care is necessary, especially for those who have a preoperative chest infection.

Perinatal outcome analysis of different glycosylated hemoglobin levels in gestational diabetes mellitus

Objective To study and analyze the perinatal outcomes of different glycosylated hemoglobin levels in gestational diabetes mellitus (DM). Methods 53 pregnant women diagnosed gestational diabetes in our hospital were selected as the observation group, and 53 pregnant women without gestational diabetes were selected as the control group.The two groups were followed up to terminate pregnancy.The glycosylated hemoglobin level was detected by HPLC.The postpartum hemorrhage, pregnancy induced hypertension syndrome and urinary tract infection and other complications were compared between the two groups.And the premature delivery, polyhydramnios, fetal macrosomia, intrauterine distress, premature rupture of membranes and other adverse pregnancy outcomes were compared between the two groups.According to the different HbA1c levels in the observation group, they were divided into group A (HbA1c 7%), the incidences of adverse pregnancy outcome were compared among four groups. Results The incidence rates of postpartum hemorrhage, pregnancy induced hypertension and urinary system infection of the observation group (18.86%, 13.21%, 11.32%) were higher than those of the control group (3.77%, 1.89%, 3.77%), the differences were statistically significant (χ2=11.356, 9.179, 4.085, all P<0.05). The incidence rates of premature delivery, polyhydramnios, fetal macrosomia, intrauterine distress, premature rupture of membranes of the observation group (9.43%, 9.43%, 11.32%, 13.21%, 15.09%) were higher than those of the control group (1.89%, 1.89%, 1.89%, 3.77%, 5.66%), the differences were significant (χ2=5.323, 5.323, 7.207, 5.735, 4.781, all P<0.05). The higher the level of glycosylated hemoglobin, the higher the incidence rates of adverse pregnancy outcomes, such as premature delivery, polyhydramnios, fetal macrosomia, fetal distress.And the incidence rate of premature rupture of membranes had no significant correlation with glycated hemoglobin levels (r=0.955, P<0.05). Conclusion Glycosylated hemoglobin as an important index of gestational diabetes, its change has great influence on the outcome of pregnancy, HbA1c level higher, adverse pregnancy outcomes and the high incidence of clinical pregnancy, should strengthen the HbA1c test, in order to take timely and effective measures to reduce the incidence of adverse pregnancy outcomes and ensure the safety of mother and child. Key words: Gestational diabetes mellitus; Glycosylated hemoglobin; Perinatal outcome

Microwave ablation for selective feticide in complicated monochorionic twin pregnancies

Objective To evaluate the feasibility, safety and short-term fetal outcome of ultrasound-guided percutaneous microwave ablation for selective feticide in complicated monochorionic twin pregnancies. Methods Twenty-two patients who underwent microwave ablation for selective fetal reduction in Peking University Third Hospital between July 2015 and June 2016 were retrospectively studied. Surgical complications, fetal outcomes and neural development at age of 60 days were recorded. One-way ANOVA, Mann-Whitney U test, Chi-square or Fisher's exact test was used for statistical analysis. Results Indications of the 22 patients for selective feticide included five cases of twin pregnancy with one anomalous fetus, five cases of severe twin-twin transfusion syndrome (TTTS), three cases of twin reserved arterial perfusion (TRAP) and nine cases of selective intrauterine growth restriction (sIUGR). All surgeries were successful under regional anesthesia. Four pregnancies (18.2%, 4/22) ended in miscarriage following surgery, three of which were caused by intrauterine fetal death (13.6%, 3/22) and one by premature rupture of membranes before 26 weeks of gestation (4.5%, 1/22). Totally, 18 babies were born alive at an average gestational age of (35.5±4.2) weeks (26~40 weeks+2) and with an average birth weight of (2 380±778) g (800~3 430 g), and four of them were preterm infants less than 32 weeks of gestation. Except for one extremely low birth weight infant, whose gestational age was 26 weeks at birth and birth weight was 800 g, died two days after birth, 17 infants were discharged alive, giving an neonatal survival rate of 17/18. The total fetal survival rate was 77.3% (17/22). Polyhydramnios, placenta location, and position of the fetus being aborted showed no significant effect on miscarriage or fetal survival rate (all P>0.05). No severe maternal complications occurred. No brain injuries were detected by imaging examination in 17 infants who were followed up to 60 days of age. Conclusions Ultrasound-guided percutaneous microwave ablation can be used for selective feticide in complicated monochorionic twin pregnancies. Further studies are needed to evaluate its effects on long-term fetal outcome. Key words: Pregnancy reduction, multifetal; Pregnancy, twin; Surgical procedures, elective; Ablation techniques; Microwaves

Study of risk factors of abruption placenta in Al.wahda teaching hospital, Aden

The aim of this study is to determine the prevalence and associated risk factors of abruption placenta in Al-Wahda Teaching Hospital in Aden Governorate, from 1st of November 2011to 30th of November 2012. A case control study was performed for 33 of abruption placenta cases with 165 control cases, conducted at the Department of Obstetrics and Gynecology, Al-Wahda Teaching Hospital. Out of 6765 deliveries included in the study period, 33 (4.88%) were complicated by placental abruption. Most complications occurred were urgent and in need of massive blood transfusion. The most frequent complication were Postpartum hemorrhage (51.52%), cesarean section (42.43%), hemorrhagic shock (18.18%), hysterectomy (12.12%), renal failure (6.06%), pulmonary embolism (3.03%), and congestive cardiac failure (3.03%). There was one maternal mortality case in the period of study from abruption placenta. Women aged more than 35 were more likely for experiencing abruption placenta, while grand multipara ( &gt; 5 children) were at higher risk for abruption placenta. Gestational age &lt; 37 weeks increased the risk by eight folds. The risk of abruption placenta increased by six folds in hypertensive patients, as well as those with previous history of abruption and previous abortion. Poly hydramnios and abdominal trauma increased the risk of abruption placenta by two folds. he fetal outcomewas characterized by low body weight &lt;2500 gram seen in 20 cases (60.6%), low APGAR score at 5th min&lt;7 was seen in 4 cases (21.05%), and stillbirth rate in 14 cases (42.42%).

Clinical and laboratory study of infants and children with Bartter syndrome attending Alexandria University Children’s Hospital (10 years experience)

Background Bartter syndrome (BS) is a group of inherited, salt-losing tubulopathies presenting as metabolic alkalosis with normotensive hyperreninemia and hyperaldosteronism. It is a consequence of abnormal function of the kidneys, which become unable to properly regulate the volume and composition of body fluids because of defective reabsorption of NaCl in loop of Henle. A first consequence of the tubular defect in BS is polyuria, which is responsible for particular complications of pregnancy − that is, polyhydramnios and premature delivery. Low potassium levels in the blood may result from overactivity of the renin–angiotensin II–aldosterone hormone system that is essential in controlling blood pressure. To date, at least five genes have been linked to BS, and they characterize five types of BS. Aim The aim of this work is to study the clinical and laboratory data of infants and children with BS attending Alexandria University Children’s Hospital during a 10-year period (January 2004–December 2013). Participants and methods A retrospective analysis of children diagnosed with BS attending Alexandria University Children’s Hospital during a 10-year period (January 2004–December 2013) was carried out. On the basis of the clinical, biochemical features, and ultrasonographic findings, 20 children were diagnosed with BS. Their demographic, clinical, biochemical, and hormonal profiles were analyzed. Follow-up data and outcomes were recorded. Results The majority of cases had perinatal history of polyhydraminos. All cases had high urinary chloride in spot urine analysis. The mainstay of treatment in BS is potassium supplementation and indomethacin. Correction of hypokalemia and hyperprostaglandinemia are mandatory for improving the symptoms (vomiting, polyuria) and chronic sequalae such as FTT and growth retardation. Conclusions According to this study, BS should be suspected in any child with a history of failure to thrive and metabolic alkalosis. Early diagnosis and treatment with NSAIDs are life-saving.

104: Transient isolated polyhydramnios - is it even an entity?

104: Transient isolated polyhydramnios - is it even an entity?

Effects of individualized medical nutrition therapy on metabolism index and pregnancy outcome of patients with GDM during pregnancy and lactation periods

Objective To investigate the effects of individualized medical nutrition therapy (IMNT) on the nutrition metabolism index and pregnancy outcome in gestational diabetic mellitus (GDM) patients during pregnancy and lactation periods. Methods Totally 98 female patients diagnosed with GDM from the Second Hospital of Hebei Medical University were selected from June 2014 to September 2015 and divided into the study group and the control group according to the principles of randomization. 51 patients in the study group received intervention of IMNT during pregnancy and lactation periods. 47 patients in the control group received traditional oral nutritional intervention model. The purpose was to observe the changes of biochemical indicators among different periods and pregnancy outcomes between two groups at the 3rd and 6th month after intervention. Results The metabolism index including fasting blood glucose (FBG), postprandial blood glucose (PBG), HbA1c, Ca2+ , CHOL, TG, TP, and ALB of the study group were significantly better than that of the control group (P<0.05). The incidence rate of pregnancy-induced hypertension syndrome, polyhydramnios and other complications, and the Cesarean delivery rate was also significantly lower in the study group than those in the control group (P<0.05). Macrosomia, hypoglycemia, asphyxia, high blood bilirubin, fetal distress, premature birth rate, and the neonatal Apgar score ratio after postpartum in the study group were significantly better than the control group (P<0.05). The average weight gain among the pregnant women, the postpartum maternal weight, and the neonatal average birth weight of the study group were significantly lower than that of the control group (P<0.05). Conclusions IMNT can ensure good pregnancy outcome, and help to effectively control nutrition metabolic indices; It is a safe and important non-drug intervention to ensure the safety of mothers and their fetus. Key words: Diabetes, gestational; Pregnancy outcome; Individualized medical nutrition therapy; Metabolism index

Study on the ultrasonic imaging characteristics of the twin reversed arterial perfusion sequence-hemiacardius

Objective To explore the ultrasonic characteristics of the twin reversed arterial perfusion (TRAP) sequence-hemiacardius. Methods A retrospective analysis of the clinical data and ultrasonic characteristics of 9 cases with the TRAP was made, which were compared with the pathlogical result after delivery. Results The prenatal ultrasonic imaging characteristics showed: The vestigial heart′s pulsating was seen in all the hemiacardius twin′s thoracic cavity, and the Doppler spectrum in it went up and down.It was noted that the heart rate was slower in the better (multicavity) development of the heart and faster in the poor development (pipe type and single cavity) of the heart. Nine hemiacardius twin had hydroderma and cystic hygroma. The head, spine, abdominal organs (both kindenys and intestines) of all the 9 cases were hypogenetic. The diaphragm was present in 7 cases; lower limbs was present in 8 cases, single leg was seen in one case; upper limbs was present in 7 cases. Seven cases of the pump twin suffered from the cardiac insufficiency. Polyhydramnios were seen in 5 cases. Prognosis of the 9 cases of the TRAP pump twin: the cessation of blood flow spontaneous was seen in one case, the pump twin was survived and delivered at term. Eight cases were demise(2 cases with intrauterine demise, 5 cases induced labor with cardiac insufficiency, 1 case died from polyhydramnios after premature birth). Conclusions The pump twin of the TRAP hemiacardiacs have a poor prognosis with the nautural course, and are easy to suffer from the cardiac insufficiency in utero. The ultrasonography can diagnose the TRAP hemiacardius accurately, which can be used to guide the clinical doctors to choose a reasonable timing to take intrauterine treatment, that will effectively improve the survival rate of the pump twin. Key words: Ultrasonography; Twin reversed arterial perfusion sequence; Hemiacardius; Acardiac

The influence of high quality nursing intervention on patients with gestational diabetes and the situation of neonatal neurobehavioral development

Objective To explore the application of high quality nursing intervention on patients with gestational diabetes and the situation of neonatal neurobehavioral development. Methods A total of 92 patients with gestational diabetes in our hospital from October 2012 to May 2014 were randomly selected and were divided into observation group and control group according to their orders of admission, 46 cases in each group.The observation group were given the high-quality nursing intervention, while the control group were given routine nursing intervention.The glycemic control, pregnancy outcomes (including three aspects: natural childbirth, postpartum hemorrhage and polyhydramnios) and neurobehavioral development of newborn patients (including capacity, active muscle tone, passive muscle tone, primitive reflexes, general state and the overall scores) were observed, and patients' satisfaction of the two groups were investigated. Results The glycemic control of the pregnant women of the observation group was superior than that of the control group, and the difference was statistical significant(P 0.05 ). The newborn's neurobehavioral development of the observation group was better than that of the control group, and the degree of satisfation of the observation group was significantly higher than that of the control group, and the difference was statistically significant(P<0.05). Conclusion The clinical effect of the high quality nursing intervention for patients with gestational diabetes is obvious, and it has a positive and significant role for the newborn neurobehavioral development, which is worth a further promotion and application. Key words: High quality nursing intervention; Gestational diabetes; Newborns; Neurobehavioral development

P21.06: Polyhydramnios in isolated oral cleft pregnancies: incidence and outcome in a retrospective study

P21.06: Polyhydramnios in isolated oral cleft pregnancies: incidence and outcome in a retrospective study