Human cytomegalovirus (HCMV) is the most common congenital infection. HCMV strains display genetic variability in different regions. Distribution of HCMV genotypes in the population of congenitally infected newborns from Central Poland and viral load in newborns' blood is described and discussed. HCMV isolates were analysed by sequencing at three sites on the genome: the UL144 tumour necrosis factor-alpha (TNFα)-like receptor gene, the US28 beta-chemokine receptor gene and the UL55 envelope glycoprotein B (gB) gene. The newborns' blood was examined for HCMV DNA with a nested (UL144, UL55) or heminested (US28) polymerase chain reaction, and the genotypes were determined by sequence analysis. HCMV DNA was detectable in 25 out of 55 examined newborns born by HCMV-infected mothers (45.5%). The blood viral load in mother-infant pairs was determined. Most of the newborns had identical virus genotype, gB2 (96%), UL144 B1 (88%) and US28 A2 (84%). These genotypes were detected in all newborns with asymptomatic congenital infection. The occurrence of UL144 B1 or US28 A2 genotypes in the babies examined was significant in comparison to other genotypes (p=0.0002 and p=0.040 respectively). There was no association between specific gB subtypes in all patients groups (p=0.463). There was no correlation between HCMV genotypes and the outcome.

The purpose of this investigation was to describe a distribution of cytomegalovirus (CMV) single and multiple genotypes among infected pregnant women, their fetuses, and newborns coming from Central Poland, as well as congenital cytomegaly outcome. The study involved 278 CMV-seropositive pregnant women, of whom 192 were tested for viral DNAemia. Human cytomegalovirus (HCMV) genotyping was performed for 18 of 34 pregnant women carrying the viral DNA and for 12 of their 15 offspring with confirmed HCMV infections. Anti-HCMV antibodies levels were assessed by chemiluminescence immunoassay (CLIA) and enzyme-linked fluorescence assay (ELFA) tests. Viral DNA loads and genotypes were determined by real-time polymerase chain reaction (PCR) assays for the UL55 gene. In the pregnant women, we identified HCMV gB1, gB2, gB3, and gB4 genotypes. Single gB2, gB3, or gB4 genotypes were observed in 14 (77.8 %) women, while multiple gB1–gB2 or gB2–gB3 genotypes were observed in four (22.2 %). Maternal HCMV genotypes determined the genotypes identified in their fetuses and newborns (p ≤ 0.050). Half of them were infected with single HCMV gB1, gB2, or gB3 genotypes and the other half with multiple gB1–gB2 or gB2–gB3 genotypes. Single and multiple genotypes were observed in both asymptomatic and symptomatic congenital cytomegaly, although no gB3 genotype was identified among asymptomatic cases. In Central Poland, infections with single and multiple HCMV strains occur in pregnant women, as well as in their fetuses and neonates, with both asymptomatic and symptomatic infections. HCMV infections identified in mothers seem to be associated with the viral genotypes in their children.

Carcinoma of the Bartholin's gland is very rare, comprises below 2% of Bartholin's gland lesions and adenoid cystic carcinoma (ADC) is one of the most uncommon variants and accounts for 10-15% of Bartholin's gland malignancies. There is no consensus on treatment of ADC of the Bartholin's gland: reported cases were treated with local excision or vulvectomy with or without lymphadenectomy followed or not by radiotherapy. The survival of patients varies significantly, so we present a case of interdisciplinary treatment of ADC resulting in 15 years’ survival. The patient was initially treated with local excision, but the margins were not clear. Then vulvectomy, inguinal lymphadenectomy and adjuvant brachytherapy were performed resulting in 7 years free of the disease. Relapses were excised by abdominoperineal amputation of the rectum and distal part of the vagina with sigmoideostomy, excisions of local recurrences in vagina and metastasectomy of isolated lung metastases. The patient died manifesting multiple lung metastases 15 years after the initial diagnosis. Based on our experience and world literature, in cases of adenoid cystic carcinoma of the Bartholin's gland, vulvectomy with or without lymphadenectomy should be considered as a treatment of choice and in patients with positive margin, surgery should be extended by adjuvant radiotherapy.

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Oral communication abstractsMethods: This was a prospective observational cohort study of 1435 women presenting to an early pregnancy unit. Prior to TVS women completed a detailed menstrual, prior obstetric and demographic questionnaire, a visual analogue score (VAS) for pain and pictorial assessment of blood loss (score 0-4). The main outcome measure was pregnancy viability at 11-14 weeks. Results: At 11-14 weeks 885 (61.7%) of pregnancies were viable with the remainder confirmed to have failed. The odds ratio for viability was 0.81 (95%CI 0.75-0.88) for age > 35 years, 0.21 (CI 0.16-0.28) for any bleeding, 0.75 (CI0.58-0.98) for any pain, 3.52 (CI2.48-4.99) for women requesting dating and 2.39 (CI1.17-4.86) for women with anxiety. VAS, prior obstetric history and ethnicity were not significant. Multivariate analysis showed age had no effect < 35 years but that the odds of a viable outcome dropped by 21.3% with each year of age thereafter. Bleeding score was highly significant with odds of viability dropping by 62.3% for each increase in score. Period-type pain in isolation was associated with 3x higher odds of viability but in the presence of bleeding was associated with 89% decrease in odds. A mathematical model gave an area under the curve of 0. 736 (0.689-0.783 Objective: Antenatal ultrasound is a powerful tool in obstetric care, but is still not available in many developing countries. One of the reasons for this is the lack of qualified ultrasonographers. Although several training programs for local healthworkers have started, quality assessment has not been reported. We present a study of quality assurance of locally trained sonographers in a refugee camp on the Thai Burmese border. Methods: 349 women were scanned for standard fetal biometry measurements (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL)). All measurements were obtained twice by examiner 1 (to assess intra observer variability) and once by examiner 2 (to assess inter observer variability), resulting in 12 measurements per woman (i.e., 3 sets of 4 measurements). Each examiner was blinded to their own results and to the results of the other examiner. Results: The intraclass correlation coefficient (ICC) for all four parameters was greater than 0.99 for all ultrasonographers (range 0.996 to 0.998). For the inter observer variability we found that 95% of measurements by the second sonographer could be expected to be between 0.93 to 1.07 times the measurement by the first sonographer, with the highest error in the abdominal circumference measurements. In the second trimester the differences were within 1 week. Plots and figures will be shown during the meeting. Conclusions: This study demonstrates that locally trained health workers are able to perform and reproduce basic fetal biometry (BPD, HC, AC and FL) satisfactorily and comparable to other published quality assurance studies of expert sonographers. Objectives: The goal was to evaluate the relationship between CMV DNA load in maternal and ...