Porphyrias are very rare and easily overlooked diseases in pregnancy. Among these eight known metabolic disorders, acute intermittent porphyria (AIP) is the most common and most severe type. An enzymatic alteration in the haem biosynthesis pathway causes liver overproduction of neurotoxic toxic metabolites, which cause attacks of acute neurovisceral symptoms, severe abdominal pain and/or skin lesions. Women with AIP can sometimes develop their first acute attack during pregnancy, and because the symptoms are unspecific, the diagnosis is difficult to obtain and often missed. However, prompt diagnosis of AIP during pregnancy is crucial as treatment can significantly improve the pregnancy outcome. The backbone of the therapy is food rich with carbohydrates, complemented by 20% glucose infusion and adequate pain control. We present a case of previously undiagnosed AIP in a 34-year primigravida, whose treatment was especially challenging due to co-existing gestational diabetes mellitus and problems with the central venous catheter.

Introduction: According to the published data, a combination of mifepristone and misoprostol is recommended in literature for labour induction in the second and third pregnancy trimester after a foeticide due to a fetal malformation or intrauterine fetal death and for abortion induction in the first pregnancy weeks. At our department we perform foeticide by applying Fentanyl and Xylocaine into the fetal heart. Since the intraamnial input is applied in this procedure, we also perform labour induction by intraamnial prostaglandin application. During the first weeks of pregnancy we performs abortion induction with mifepristone and misoprostol. Through the analysis of our own data, we aimed at establishing in what time fetal expulsion occurs after abortion induction with mifepristone and misoprostol compared to labour induction through intraamnial prostaglandin application. Methods: The retrospective study included all women on whom abortion or labour induction was performed between 2010 and 2015 due to fetal malformations established by means of ultrasound. The first group included all participants in the 16th-24th week of pregnancy or with the fetus weight under 500 g determined through ultrasound where the abortion induction was performed with mifepristone and misoprostol according to the following protocol: mifepristone 200 mg orally, followed 36-48 h later by misoprostol 800 g vaginally, then misoprostol 400 m orally, 3hourly, to a maximum of four further doses. The second group included women after the 24th week of pregnancy or with the fetus weight above 500 g determined through ultrasound. Labour induction were performed through intraamnial 1000 g prostaglandin application. We compared the time at which the fetal expulsion occurred after the beginning of induction in the first group with the same time in the second group. Results and conclusions: Based on the data from literature, the best abortion or labour induction method is the application of mifepristone and misoprostol regardless of the duration of pregnancy. The aim of our research was to establish whether the cases when a foeticide needs to be performed and therefore intraamnial input is already being used it also makes sense to apply prostaglandins in order to commence induction at the same time. Compared to the protocol with mifepristone and misoprostol we benefit from extra time since it is recommended to wait 36-48 h after mifepristone application before misoprostol application is continued. Based on the data from literature, the time to fetal expulsion in case of induced abortions or labours is proportional to the duration of pregnancy. With our research, we aimed to prove that in the group with the labour induction by means of intraamnial prostaglandin application despite being further into the pregnancy, the time to fetal expulsion is shorter due to the 36-48-h-long break in the mifepristone and misoprostol protocol.

Objectives: Evaluation of the fetal blood flow of pregnant women in stress. Methods: With the help of self-report scale of Spilberger the pregnant women between 24-38 weeks were divided into control and base groups. Control group: 20 women with normal gestation course without history of emotional problems and low state and trait anxiety scores; base group: 50 pregnant with/without history of emotional problems and high level of scores. Doppler evaluation of the fetal umbilical artery (UA), middle cerebral artery (MCA), descending aorta (DA) with measurement of pulsatility index (PI) and systolo-diastolic (S/D) ratio were performed. Umbilical-cerebral ratio (PI UA/PI MCA) were calculated. Measurement of maternal and fetal heart rate, maternal systolic and diastolic arterial blood pressure were performed. Results: In the base group we revealed high level of trait anxiety in all women, in 38% of cases high level of state anxiety. The comparative analysis of umbilical artery and descending aorta PI in both groups revealed increase of PI in base group from 1,07 ± 0,02 to 1,24 ± 0,03 (p < 0,05) and from 1,94 ± 0,02 to 2,02 ± 0,02(p < 0,05) respectively, decrease PI in MCA from 1,97 ± 0,02 to 1,90 ± 0,03(p < 0,05). Increase of S/D ratio in UA and umbilical-cerebral ratio in base group from 2,85 ± 0,07 to 3,27 ± 0,11(p < 0,05) and 0,54 ± 0,01 to 0,60 ± 0,02 (p < 0,05) was observed respectively. Conclusion: In pregnant women undergoing psychoemotional stress with high level of state and trait anxiety there is increase in resistance of fetal umbilical artery and descending aorta, increase in umbilical-cerebral ratio, indicating the compensatory centralization of fetal blood flow and improving blood supply to the brain. P15.20Torsion of the umbilical cord diagnosed prenatally L. Haakova, A. Mechurova, L. Krofta Institute for the Care of Mother and Child, Praha4, Czech RepublicUmbilical cord torsion is an uncommon cause of intrauterine fetal demise, usually not diagnosed antenatally but upon pathological examination. An extremely large number of twists in the cord can cause torsion, leading to compromized fetal status.We present a case of a 31-year old gravida 1, referred to the hospital toward the end of her pregnancy, as is standard practice. Upon her first visit, her fetal CTG tracing was not fully satisfactory, so repeated CTG testing was performed, followed by an ultrasound scan. At a gestational age of 37 + 0 weeks, the fetus was appropriate for size, there was marked polyhydramnios, and there was an abnormal finding in the umbilical cord Doppler tracings, showing an atypical waveform with notching in the section of the umbilical cord close to the fetal head, which appeared to be a tangled and hypercoiled section of umbilical cord, with a normal Doppler waveform and pulsatility index in the free loop of the cord. MCA Doppler showed a decreased pulsatility index. There were normal fetal movements despite the pathological Doppler flow characteristics.Following the ultrasound examination, the patient was sent to the labo...

Aim: To compare the perinatal outcome and delivery intervals after the induction of labour with the Prostin vaginal tablet versus the Propess vaginal system in pregnant women with term-PROM. Design: One centre paralleled randomised controlled trial with a computer-generated table to allocate treatments. Setting: University Medical Centre in Slovenia. Participants: A total of 205 singleton healthy pregnant women with term-PROM. Intervention: Induction of labour with the Propess vaginal system (intervention group) versus Prostin tablets (control group). Main outcomes: The rate of failed inductions, complications in labour, time intervals between the PROM, induction, the beginning of the active phase, and delivery. Results: A total of 104 patients received Prostin, and 101 patients received Propess. Induction failure rates in the Prostin and the Propess groups were 8/104 (7.7%) and 5/101 (5.0%), respectively (p = 0.80). Delivery abnormalities were uncommon and comparable across the groups. The rates of caesarean sections in the Prostin and Propess groups were 4/96 (4.2%) and 6/96 (6.3%), respectively. The delivery intervals were comparable across the groups. Conclusions: In term-PROM pregnancies, the Propess vaginal system is a safe and effective option for inducing labour.

Background: To analyze the mode of delivery and the outcome of a trial of labor in women with one prior caesarean birth. Methods: We extracted from the national database our hospital’s information on women with a prior caesarean section from January 2014 to July 2019. They were then divided into groups that either opted for a trial of labor or repeat caesarean section. We further focused on the trial of labor group and divided them in two subgroups of either a vaginal delivery or repeat caesarean section. Results: 796 women with one prior caesarean section were identified and 201 (25.3%) opted for a trial of labor. Successful vaginal delivery was achieved in 84.1% of women that opted for a trial of labor. Women pregnant for the third time or greater delivered vaginally at a higher rate (24.3% vs 10.7%). More women who had labor induced with a Foley catheter ended in caesarean section (8.1% vs 17.9%). There was one uterine rupture without further complications. Failed trial of labor was caused by the lack of persistence (14.3%) and arrest of labor (50.0%). Conclusion: Improved counselling is needed for those women who choose a trial of labor. The rate of successful vaginal delivery following a trail of labor is high, but could be improved with more conservative management during the first stage of labor.