BackgroundPatients with gynecologic cancer have a high risk of venous thromboembolism (VTE) like patients with other cancers. However, there is little information on risk factors for VTE during gynecologic surgery and no uniform preventive strategy. Our objectives were to identify risk factors for perioperative VTE in gynecologic patients and establish methods for prevention.MethodsWe analyzed 1,232 patients who underwent surgery at the Department of Obstetrics and Gynecology of St. Marianna University School of Medicine between January 2005 and June 2008. We investigated (1) risk factors for preoperative VTE, (2) use of an inferior vena cava (IVC) filter, and (3) risk factors for postoperative VTE.ResultsThere were 39 confirmed cases of perioperative VTE (3.17%), including 25 patients with preoperative VTE and 14 with postoperative VTE. Thirty-two patients had cancer and seven patients had benign diseases. Twenty-two of the 32 cancer patients (68.7%) had preoperative VTE, while postoperative VTE occurred in 10 cancer patients. Multivariate analysis indicated that ovarian cancer, tumor diameter ≥10 cm, and previous of VTE were independent risk factors for preoperative VTE. Among ovarian cancer patients, multivariate analysis showed that an age ≥50 years, the presence of heart disease, clear cell adenocarcinoma, and tumor diameter ≥20 cm were independent risk factors for preoperative VTE. The factors significantly related to preoperative VTE in patients with benign disease included previous VTE, age ≥55 years, tumor diameter ≥20 cm, and a history of allergic-immunologic disease. Thirteen of the 25 patients (52%) with preoperative VTE had an IVC filter inserted preoperatively. Postoperative screening (interview and D-dimer measurement) revealed VTE in 14/1,232 patients (1.14%). Multivariate analysis indicated that cancer surgery, a history of allergic-immunologic disease, and blood transfusion ≥2,000 ml were independent risk factors for postoperative VTE.ConclusionsPerioperative VTE is often fatal and preventive measures should be taken in the gynecologic field, especially when patients have the risk factors identified in this study. Since VTE is often present before surgery, preoperative screening is important and use of an IVC filter should be considered.

Key Clinical MessageWe describe a case of prenatal diagnosis of a pharyngeal cyst as a pyriform sinus fistula on the findings of ultrasonography and magnetic resonance imaging.

Peripartum cardiomyopathy is a rare but potentially life-threatening condition. The current definition of peripartum cardiomyopathy only includes patients with systolic dysfunction. We describe a 25-year-old nulligravid patient with heart failure, i.e. left ventricular diastolic dysfunction with preserved systolic dysfunction during the third trimester of pregnancy. She complained of dyspnea and was referred to our hospital at 31 weeks of gestation. The patient met the clinical criteria for peripartum cardiomyopathy with the exception of systolic dysfunction. Brain-type natriuretic peptide levels peaked at 1447 pg/dL. The patient responded to therapy for heart failure and showed resolution of her diastolic dysfunction by 1 month postpartum. The case demonstrated the important role of diastolic dysfunction in peripartum heart failure and the possibility of clarifying the pathophysiology of peripartum cardiomyopathy by evaluating diastolic function. Further investigations are needed to provide evidence regarding the clinical role of diastolic dysfunction in peripartum heart failure.

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Objectives: Ovarian hyper stimulation syndrome (OHSS) is the most severe iatrogenic complication of ovulation induction. It has been suggested that OHSS might carry an increased risk of obstetric complication once the pregnancy is established. The aim of this meta-analysis was to explore the association between OHSS and adverse obstetric outcome. Methods: This review was performed according to a protocol designed to PRISM guidelines. Event rate was calculated for all the studies included in the analysis while risk ratio and risk difference were calculated compared to pregnancies conceived with assisted reproduction techniques (ART) but not affected by OHSS. Quality assessment of studies was also performed. Between-study heterogeneity was explored using the I2 statistic, and fixed or random effect models were used accordingly. The outcomes observed were pre-eclampsia (PE), gestational diabetes mellitus (GDM), small for gestational age (SGA), preterm delivery (PTD) and thromboembolic events. Results: A total of 1738 articles were identified during the search and a total of 9 studies (2859 patients) were included in the systematic review and meta-analysis. The rates of PE, GDM and thromboembolic events were 9.6% (95% CI 6.9-13.3), 6.2% (95% CI 3.4-11.1) and 3.0% (95% CI 0.9-9.9), respectively, with no significant difference between OHSS cases and controls. The rates of SGA and PTD were 38.9% (95% CI 28.6-50.4) and 30.0% (95% CI 21.7-39.8). Both these complications were seen significantly more often in OHSS cases compared to controls: RR: 1.59 (95% CI 1.15-2.22) and RR: 1.25 (95% CI 1.17-1.34), respectively. Conclusions: OHSS is associated with an increased risk of both SGA and PTD compared to ART pregnancies uncomplicated by OHSS. OC09.02What is the significance of an intertwin size discrepancy in the first trimester of IVF pregnancies? We hypothesized that twin pregnancies which demonstrate larger size discrepancies would be associated with a number of outcomes: 'vanishing twin', increased risk of prematurity and preterm delivery. Methods: Prospective study of women with live first trimester DCDA twin pregnancies following IVF All women underwent TVUS when the CRL of both twins was measured. The intertwin size discrepancy was determined by subtracting the smaller twin from the larger twin and dividing by the larger twin. Pregnancy outcomes: final order of pregnancy, gestational age and weight at delivery were noted. The t-test and univariate analysis were used. * This presentation is eligible for the Young Investigator award (to be presented in the closing session).Results: 242 DCDA twin pregnancies were included. First trimester measurements were made between 6+0 and 12+6 wks. 184 pregnancies continued as twins (76%), 39 reduced to a singleton pregnancy (16%), 19 pregnancies miscarried (7.9%). The mean GA of delivery was 34+1 (±5.23d), with 100 pregnancies (41.3%) delivering at term (37-41 wks); 123 (51.4%) delivering preterm (24-37 wks) and 19 (7.9%) miscarriages (<24wks). There were 6 neonatal deaths.There was ...