Abstract: Journal of Obstetrics and Gynaecology ResearchVolume 43, Issue S1 p. 56-82 Supplement ArticleFree Access Maternal Medicine First published: 09 June 2017 https://doi.org/10.1111/jog.13388Citations: 1 Correspondence: Run-mei MA, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Kunming Medical University, Yunnan Province, 650053, PRC. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat 0006 Clinical features of preeclampsia superimposed on chronic hypertension with or without proteinuria Sayuri Nakanishi, Shigeru Aoki, Ami Nagashima and Kazuo Seki Yokohama City Medical Center, Yokohama, Japan Introduction: In 2014, the International Society for the Study of Hypertension in Pregnancy (ISSHP) revised the definition of preeclampsia(PE). However, there is no report on the incidence of PE superimposed on chronic hypertension without proteinuria, which is not mentioned in the conventional diagnostic criteria, as well as pregnancy outcomes. Objective: We aimed to evaluate the validity of the diagnostic criteria for PE superimposed on chronic hypertension without requiring proteinuria. Methodology: This retrospective study included 142 women with essential hypertension diagnosed at ≤20 weeks of gestation, managed at a tertiary center. They were divided into three groups (non-PE group; PE with proteinuria group; and PE without proteinuria group) to compare pregnancy outcomes. The non-PE group was further divided into two subgroups (controlled and uncontrolled hypertension subgroups) Results: There were 87 women in the non-PE group, 47 in the PE with proteinuria group, and 8 in the PE without proteinuria group. Median gestational age at delivery was 38.7 weeks in the non-PE group, 30.4 in the PE with proteinuria group, and 28.4 in the PE without proteinuria group. In three of the eight women in the PE without proteinuria group, the condition fulfilling the diagnostic criteria was liver involvement (complicated by thrombocytopenia in one woman). Although the remaining five women had uteroplacental dysfunction, the validity of their PE diagnosis was questionable because their blood pressure was well controlled throughout pregnancy. The 87 women in the non-PE group were divided into a controlled hypertension subgroup of 75 women and uncontrolled hypertension subgroup of 12. In the uncontrolled HT subgroup, the pregnancy outcomes were significantly poorer than those in the controlled HT subgroup. Conclusion: Although exclusion of proteinuria from the essential diagnostic criteria for PE superimposed on chronic hypertension is valid, the criteria might need to include uncontrolled hypertension instead of uteroplacental dysfunction. 0020 Maternal magnesium sulfate treatment and infant outcomes Ting-Chun Lai and Chi-Yuan Liao Mennonite Christian Hospital, Hualien, Taiwan Introduction: To prevent risk of the sometimes fatal complications of preeclampsia, magnesium sulfate is the recommended drug of choice for both prevention and treatment of eclampsia. Risk to infants from maternal magnesium sulfate exposure remains unclear, however, as earlier studies found an association with increased admission to neonatal intensive care and special care units, while more recent studies have found no associated risk of intensive resuscitation and other adverse neonatal outcomes. Objectives: Our study aims to elucidate the association between maternal magnesium sulfate exposure and neonatal risk. Methodology: This 12-year retrospective cohort included women diagnosed with preeclampsia who delivered at >=37 weeks' gestation. Women who received treatment with magnesium sulfate were categorized into the exposure group and all others into the non-exposure group. The primary outcomes investigated were neonatal intensive care unit admission and special care unit admission; the secondary outcomes were neonatal adverse effects. We used multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CIs). Results: No differences in 5-minute Apgar and muscle tone scores were found between infants exposed to magnesium sulfate and those unexposed. One-minute Apgar and muscle tone scores were lower in the MgSO4-exposed neonates, although the observed difference did not reach statistical significance. The neonate SCBU admission rate was significantly higher in the exposed group (OR=5.02, 95%CI: 1.98-12.70), whereas no difference in the NICU (OR=3.90, 95%CI: 0.49-30.99) admission rates was found. Additionally, the rate of delayed adaptation was higher in the MgSO4-exposed neonates, but again the difference was not statistically significant. Conclusion: In conclusion, no significant association was observed between maternal exposure to magnesium sulfate for prevention and treatment of eclampsia and severe adverse effects on neonates. However, exposure to magnesium sulfate might increase the neonate delayed adaptation rate and the admission rate to the special care baby unit. 0024 The diagnostic and therapeutic challenge of managing hemophagocytic lymphohistiocytosis during pregnancy Meng Lu, Lan Qi and Yinyan He Shanghai First Aid Center of Maternal Near Miss affiliated with Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe clinical syndrome associated with poor prognosis. It is rarely described during pregnancy and may be mistaken for other pregnancy-related disorders such as HELLP syndrome, due to the shortage of characteristic clinical manifestation. Furthermore, management appears to be complicated and inconsistent in the limited reported cases. Case: We report two HLH cases during pregnancy, with the similar presentations (persistent fever, bicytopenia, liver dysfunction) but of different outcomes. The first case describes a 24-year-old woman who developed Salmonella and herpes zoster virus-induced HLH combined with autoimmune hemolytic anemia (AIHA). Although her clinical course was inconsistent and refractory, we administered IVIGs in addition to high-dose methylprednisolone after delivery, which finally resulted in a favorable outcome. Our second case involves a 22-year-old women, given the diagnosis of NK-T cell lymphoma-associated HLH. After a cesarean section, her general condition rapidly worsened and all active treatment failed to induce any improvement. Methods: We summarize the characteristics of 16 reported HLH cases during pregnancy to date, including associated factors, major clinical findings, treatments, and outcomes. We discuss the role of pregnancy in HLH and the merits of different therapies. Results: HLH should be suspected when encountering unexplained fever and cytopenia during pregnancy, and a careful diagnostic work-up should be performed subsequently. Corticosteroids may be a first-line treatment for HLH during pregnancy, meanwhile high-dose IVIGs, cyclosporine A and cytotoxic drugs are other therapeutic options. In refractory cases, timely termination of the pregnancy should be considered and may induce improvement. Conclusion: Early diagnosis, by recognizing signs and symptoms, and appropriate treatment of HLH during pregnancy is critical for achieving a better outcome. 0025 Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy - a randomized control trial Khushboo Srivastav, Shailaja Chhetri Shrestha, Ajay Agrawal and G.P. Rauniar B.P Koirala Institute of Health Sciences, Dharan, Nepal Introduction: Anemia in pregnancy is a significant public health problem. Globally, the prevalence of anemia in pregnancy is 55.9 %. Objectives: The aim of this study was to compare the efficacy and safety of intravenous iron with oral iron in the treatment of iron deficiency anemia of pregnancy. Methods: A randomized experimental study was conducted at BPKIHS, Dharan in 2014-15 involving 70 pregnant women between 16 -34 weeks period of gestation with iron deficiency anemia with hemoglobin level between 7-10 g/dl or ferritin level < 15μg/L . In the intravenous group (IV group), the iron dose was calculated from the following formula: Weight before pregnancy (kg) x (12 g/dl – Actual hb[g/dl]) x 0.24 + 500 mg. The oral group (PO group) received 100 mg of elemental iron thrice a day for 6 weeks. Hemoglobin was reviewed at baseline, 2, 4, and 6 weeks. Serum ferritin level was measured at baseline and 6 weeks. Side effects seen in each group were evaluated. Mann-Whitney test and Chi-square test were applied. Results: The change in hemoglobin and serum ferritin levels from baseline was significantly higher in the intravenous group than the oral group at each measurement (P<0.05). At the end of 2 weeks hemoglobin increased in IV group from 8.56 to 9.42 g/dl( 10.62%) while in PO group it increased from 9.13 to 9.72 g/dl( 6.53%). At the end of 6weeks, in IV group hemoglobin increased by 33.87% compared to 16.48% in PO .Similarly, the increase in serum ferritin levels after 6 weeks was significantly more in IV group than oral group .1/3rd of the patient in oral group experienced gastrointestinal side effects while in IV group side effects mainly consisted of local irritation. Conclusion: Intravenous iron elevates hemoglobin and restores iron stores faster than oral iron, with no severe adverse reactions. 0031 Incidence and risk factors for postpartum hemorrhage among transvaginal deliveries at a tertiary perinatal medical facility in Japan. Tatsuya Fukami, Maki Goto, Haruhiko Kondo, Fuyuki Eguchi and Hiroshi Tsujioka ASO Iizuka Hospital, Iizuka, Fukuoka, Japan Postpartum hemorrhage (PPH) remains a leading cause of maternal death worldwide, and it is important to understand the relative contributions of different risk factors. We assessed the incidence of these am Objective-Postpartum hemorrhage (PPH) remains a leading cause of maternal death worldwide, and it is important to understand the relative contributions of different risk factors. We assessed the incidence of these among cases of transvaginal delivery. Between June 2013 and July 2016, a prospective cohort study was conducted at a tertiary perinatal medical facility in Japan. Women were administered a questionnaire to ascertain risk factors for PPH, defined as a blood loss of 1,000 ml or more assessed using a calibrated under-buttocks drape and collection vessel at childbirth. We analyzed 1,068 transvaginal deliveries of singleton pregnancies. The incidence of PPH was 8.7%, and of severe PPH (1,500 ml blood loss or more) was 2.1%. Risk factors for postpartum hemorrhage among the deliveries were: fetal macrosomia (over 4000 g); pregnancy-induced hypertension; pregnancy generated by assisted reproductive technology; severe vaginal or perineal lacerations; and weight gain over 15 kg during pregnancy. Such high weight gain significantly increased the incidence of PPH compared with women showing less than 10 kg weight gain during pregnancy. Monitoring these identified risk factors could enable extra vigilance during labor, and preparedness for managing PPH in all women giving birth. 0039 Impact of gestational weight gain on perinatal outcomes by pre-pregnancy maternal body mass index. Emi Adachi, Shinjiro Tominari, Yoshimitsu Takahashi and Takeo Nakayama Kyoto University School of Public Health, Kyoto City, Kyoto, Japan Objective: To investigate the impact of gestational weight gain (GWG) on perinatal outcomes, including low birth weight (LBW), small for gestational age (SGA) and large for gestational age (LGA) infant births, according to pre-pregnancy maternal body mass index (BMI) in a Japanese population. Methods: This retrospective cohort study analyzed singleton term pregnancies (n=118,543) in a nationwide perinatal database developed by the Japan Society of Obstetrics and Gynecology using multivariate logistic regression analysis in order to determine how GWG was associated with LBW, SGA, and LGA infant births according to pre-pregnancy maternal BMI. BMI was used to categorize underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (>30). Odds ratios were obtained by adjusting for maternal age, GWG, gestational age, parity, smoking during pregnancy, alcohol consumption during pregnancy, obstetrical complications such as gestational anemia, placenta abruption, pregnancy induced hypertension, gestational diabetes mellitus, diabetes mellitus in pregnancy, polyhydramnios, and oligohydramnios. Results: The percentages of women who were underweight, normal weight, overweight, and obese before pregnancy were 17.2, 71.3, 8.3, and 3.2%, respectively, with median GWG of 10.4, 10.2, 8.0, and 5.3 kg, respectively. Among 118,543 infants, 9,745 (8.2%) were LBW, 9,602 (8.1%) were SGA, and 11,636 (9.8%) were LGA. The adjusted odds ratios for LBW and SGA infant births in underweight, normal weight, and overweight categories decreased with increasing GWG and BMI. A U-shape association was observed for the obese category. The adjusted odds ratio for LGA infant births increased with increasing GWG, regardless of BMI category. Conclusion: GWG was associated with LBW, SGA, and LGA infant births, particularly among women who were underweight before pregnancy. In order to prevent LBW, SGA, and LGA infant births, women expecting a child could benefit by ensuring that their pre-pregnancy body weight is within a normal range, and by controlling appropriate weight gain during pregnancy. 0043 Sleep changes during pregnancy in mice Haruna Komiya1,2, Chika Miyoshi2, Hiromi Hamada1, Toyomi Satoh1, Hiromasa Funato2 and Masashi Yanagisawa2 1Department of Obstetrics and Gynecology, Faculty of Medicine, Tsukuba University, Tsukuba, Japan; 2International Institute for Integrative Sleep Medicine(WPI-IIIS), Tsukuba University, Tsukuba, Japan Aim: Although it is known that sleep disturbance occurs due to the physiological and hormonal changes during human pregnancy, there have been few studies on sleep/wakefulness behaviors in pregnant mice. Since mice are used as research models for human health and diseases, it is crucial to elucidate how sleep/wakefulness behaviors in mice change as the pregnancy progresses. Method: At the age of 8-12 weeks, C57/BL6N female mice were subjected to implant electroencephalographic (EEG)/electromyography (EMG) electrodes under anesthesia of isoflurane. After recovery from the surgery, EEG/EMG was recorded for 4 consecutive days for basal sleep/wakefulness. Then, the female mice were mated with a male mouse. The male mouse was removed from the cage when a vaginal plug was confirmed. The plug positive day was designated as pregnant day 0 (PD0). EEG/EMG was recorded again from PD0 and continued until the delivery, usually at PD18. Results: NREM sleep time increased as pregnancy progressed. NREM sleep increase was mainly observed in the dark phase, active period of mice. Delta power during NREM sleep, an index of sleep depth, increased significantly during pregnancy. Total REM sleep time was constant during pregnancy, but the duration of REM sleep episode shortened with pregnancy progression. The power spectrum analysis revealed that delta wave during wakefulness was enhanced in the late pregnancy. Conclusion: We showed that the NREM sleep amount increased with the progression of pregnancy. Increased delta power during NREM sleep suggests that sleep demand increases during pregnancy. REM sleep time was constant but fragmented as gestational age advanced. Our observation in sleep/wakefulness behaviors during pregnancy in mice may provide a basis for future studies on health and disease during pregnancy. 0055 Uterine artery Doppler velocimetry as a predictor for pregnancy induced hypertension in pregnant women with borderline high blood pressure before 20 weeks gestation Seung Woo Yang, Soo Hyun Cho, In Sook Sohn, Han Sung Kwon and Han Sung Hwang Konkuk University Medical Center, Seoul, Republic of Korea Objective: The aim of this study is to investigate the sequential changes of blood pressure measured throughout pregnancy, and the significance of uterine artery Doppler velocimetry as a predictor for pregnancy induced hypertension (PIH) in pregnant women with borderline high blood pressure (BHBP) before 20 weeks gestation. Methods: A total of 2039 nulliparous women who delivered in our institution were included in this study. Maternal blood pressure was measured from brachial artery in a sitting position on every visit to the hospital. The BHBP was defined between upper 2 standard deviation of the mean and 106.7 mmHg (140/90 mmHg) in mean arterial pressure. PIH included gestational hypertension and preeclampsia. Uterine artery Doppler velocimetry was performed between 20 and 24 weeks gestation. Results: The sequential patterns of blood pressure measured in a sitting position were similar to that in left lateral recumbent. Of the 2039 women, 223 women were measured to have BHBP at least once before 20 weeks gestation and 149 were diagnosed as PIH (61 preeclampsia and 88 gestational hypertension). Among BHBP group, 4 women had 4 times or more BHBP, 24 had 3 times, 106 had 2 times, 89 had 1 time. Of the 134 women who had 2 or more BHBP, 31 were later diagnosed with PIH (22.1%). When two or more BHBP history was combined with abnormal uterine artery Doppler, the odds ratio of PIH was further increased. The combination of two or more BHBP history, and abnormal uterine artery Doppler velocimetry to predict PIH in BHBP group showed sensitivity, specificity, positive and negative predictive values of 62.6%, 69.1%, 81.1%, and 69.5%, respectively (OR 2.9; 95% CI 1.1-4.1). Conclusions: Uterine artery Doppler ultrasound examination during second trimester could be used as a predictor for PIH in pregnant women with BHBP before 20 weeks gestation. 0063 The perinatal outcomes of pregnant women with heart disease in Okayama University Hospital and towards the future Jota Maki1, Yuji Hiramatu1, Hisashi Masuyama1 and Teiji Akagi2 1Department of Obstetrics and Gynecology, Okayama University Graduate School Of Medicine, Okayama, Japan; 2Department of Cardiovascular Surgery, Okayama University, Okayama, Japan Purpose: The number of pregnant women with adult congenital heart disease (ACHD) has been increased due to the improving prognosis of ACHD. Management of these patients has become an important problem in Obstetrics. Materials: We analyzed the outcome 72 cases of pregnant women with ACHD treated in our hospital during 2004 to 2016. Results: Sixty-eight patients were in NYHA classification I degrees, four patients were after Fontan surgery, and four patients were in II degrees. Cesarean section was performed in 20 cases (27.5%) were (emergency 13 cases) including 7 cases due to the internal maternal adaptation. Thirty-one of 52 patients (60%) underwent a painless vaginal delivery under epidural anesthesia. The amount of postpartum bleeding increased in proportion to the deterioration of cardiac function. Obstetrics complication is equal to a general pregnant women. Newborn complication is equal to a high-level case of facilities, and the number of the newborn who has with CHD was a little more.The emergent Cesarean sections were performed one of the post Fontan surgery and HOCM (NYHA II) within 29 weeks of pregnancy in order to avoid outbreak of the clinical condition of the pregnant woman and the fetus. Result of almost pregnancies with ACHD had uneventful course. And it was possible to vaginal delivery, and enough to be managed of labor and delivery in high-level facilities. Discussion: For the management of pregnant women with severe heart disease, it is very important for gynecologists, pediatricians, and circulatory physicians to collaborate and work in a team at the higher medical center. We also experienced many cases of pregnant women after Fontan surgery, which is very risky, so we also report the results. 0079 Postpartum seizure with posterior reversible leukoencephalopathy syndrome: a case report Emiciel Alta Gigante and Pilar Lagman-Dy St. Luke's Medical Center, Quezon City, The Philippines Postpartum seizure in a hypertensive mother more or less equates to a complex diagnostic and therapeutic process, more so if it presents with associated behavioural changes in rare occasions. When seizure occurs in patients with preeclampsia, one of the initial assessments is eclampsia. However, more than eclampsia, there is a conglomeration of different disease entities which may even overlap with each other. Presented in this case is a 31 year old G1P1, known to have preeclampsia, who delivered by primary cesarean section due to non-reassuring fetal heart rate pattern at 29 weeks age of gestation to a live preterm girl, small for gestational age. On day 4 after delivery, she had sudden onset of lip-smacking, generalized tonic-clonic seizures associated with aggressive mood, visual disturbances and disorganized speech. The following day, after stabilization of the patient's status, she was apparently well without residual deficits. This case is clinically suggestive of the posterior reversible leukoencephalopathy syndrome (PRES), which on neuroimaging shows vasogenic edema of the white matter in the posterior parietal and occipital lobes of the brain. Even if it is becoming more popular, the incidence is still uncertain. The diagnosis is both clinical and neuroradiologic as described earlier. However, treatment is still controversial but includes blood pressure control as one of the major goals. Diagnosis and management of postpartum seizure in a hypertensive patient entails an exhaustive list of procedures and considerations. Seizures in postpartum hypertensive patients associated with behavioral changes and resolving spontaneously in a few days may be part of the PRES syndrome, coupled with neurologic findings of cerebral edema on brain imaging. Recognizing this disease entity may help one in directing the management of these patients. 0096 Obstetric intensive care unit (ICU) admission evaluation: experiences in a tertiary care hospital Tanjila Karim Chittagong Medical College & Hospital, Chittagong, Bangladesh Introduction: Pregnancy, delivery and puerperium can be complicated by severe maternal morbidity with potential catastrophic consequences necessitating intensive care unit (ICU) admission. Objectives: 1. To review pregnant patients up to 6 weeks postpartum who needs ICU admission to identify the demographic characteristics, indication for admission, procedure performed, cause of transfer to ICU, intervention required, outcome, duration of ICU stay & to determine the conditions associated with maternal mortality. 2. To emphasize importance of establishing an obstetric ICU in our setting. Method: This cross sectional study was conducted in the Department of OB-GYN of Chittagong Medical College Hospital, Bangladesh from 1st Jan’ 2014 to 30th June’ 2016. Pregnant patients up to 6 weeks postpartum admitted in Dept. of OB-GYN & subsequently shifted to ICU were included. Result: Total obstetric patient 47941 & 124 transferred to ICU. The mean age 27.41 years [Range : 17 – 47 years ]. Rural resident 69.35% (n=86). 54.84% (n=68) of middle class. Multi gravida/para 70.16 % (n=87). Antenatal 69.35% (n=86). 48.39% (n=60) received irregular antenatal care. Hypertensive disorder of pregnancy - most frequent obstetric indication for ICU admission which was 41.13% (n=51) [eclampsia: 26.61% (n=33); PE:13.71% (n=17); HEELP:0.81% (n=1)]. Obstetric hemorrhage stood second position which was 31.45% (n=39) [Rupture uterus 12.10% (n=15); APH due to placental cause 8.87% (n=11); PPH 6.45% (n=8); ectopic pregnancy 3.23% (n=4); molar pregnancy 0.81% (n=1)]. Obstructed labour & sepsis in 3rd & 4th position which included 9.68% (n=12) & 6.45% (n=8). Others 11.29% (n=14). 50% (n=62) transferred for both respiratory failure & hemodynamic instability, 41.94% (n=52) for respiratory failure, 7.26% (n=9) for hemodynamic instability. 41.94% (n=52) fully recovered. Majority 33.87% (n=42) stayed in ICU for 1 day [range:1-45 days]. Conclusion : Appropriate primary health care, efficient referral system & multidisciplinary approach including ICU is essential for management of these critical patients & to reduce of maternal mortality & morbidity. 0097 Posterior reversible encephalopathy syndrome (PRES) in postpartum woman: a case report Tanjila Karim and Fahmida Rashid Chittagong Medical College & Hospital, Chittagong, Bangladesh Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is a serious clinico-radiological condition of multiple etiologies. Pregnancy, labour and puerperium can be complicated by this rare entity. This syndrome presents with a variety of features like headache, vomiting, visual disturbance, seizure, altered mental status associated with characteristics imaging findings. Radiological findings are thought to be due to vasogenic oedema, predominantly in posterior cerebral hemisphere. Still the exact pathophysiology is not clear. Objectives: To identify socio-demographic factor, clinical presentation, radiological findings, management and outcome of a patient presenting with PRES at tertiary care hospital. Method: This case report was observed in the Dept. of OB-GYN of Chittagong Medical College Hospital, Bangladesh in 2016. Description: Here we are reporting a case of postpartum PRES who presented to Dept. of OB-GYN with headache and convulsion/ seizure at 14th POD following LSCS. She was a lady of 25 years, multipara, belonged to low socioeconomic condition and came from rural area. The provisional diagnosis of postpartum PRES was made and confirmed on the basis of MR findings. Clinical improvement with complete resolution without any neurological deficit was observed with multidisciplinary timely care. Conclusion: Though PRES is a rare condition, obstetrician should be aware of this clinically frightening, under-diagnosed condition. Because this entity is potentially reversible on prompt recognition and early appropriate intervention which will improve the prognosis and can reduce morbidity and mortality. 0098 Eclampsia – flash of lightening: still an issue of concern Tanjila Karim and Tanjina Sultana Chittagong Medical College & Hospital, Chittagong, Bangladesh Introduction: Eclampsia is a life threatening obstetric emergency and one of the leading cause of maternal mortality and morbidity. Objectives: To study the socio-demographic profile and feto-maternal outcome of eclampsia patient in a tertiary care hospital. Method: This cross sectional study was conducted in the Dept. of OB-GYN of Chittagong Medical College Hospital, Bangladesh from 1st Jan'2016 to 30th June'2016. 143 patients who were diagnosed as eclampsia in dept. of OB-GYN were included in this study. Result: Total obstetric patients were 9507 & eclampsia patients were 216. We included 143 in our study.72.73% (n=104) were of 20-30 years of age followed by 20.98% (n=30) of <20 years. Rural resident were 80.42% (n=115). All were housewives. Maximum 25.87% (n=37) got primary education. Regarding husband's occupation, day labourer stood first which is 24.48% (n=35). 55.24% (n=79) had monthly income BDT 5000-10000. 66.43% (n=95) were admitted with antepartum eclampsia whereas 28.67% (n=41) postpartum, 3.50% (n=5) intrapartum and 1.40% (n=2) with both. Among antepartum, 52.94% (n=54) were at term. 66.43% (n=95) were on irregular ANC. Local health facility referred 70.63% (n=101) patients. 60.14% (n=86) arrived within 6 hours of convulsion. Distance was the main contributing factor for delay in transfer. 55.94% (n=80) presents >3 episodes of seizure. 60.14% (n=86) were unconscious. 68.53% (n=98) had systolic BP >140 mm of Hg and 73.43% (n=105) had diastolic BP >90 mm of Hg. Both loading and maintenance dose of magnesium sulfate were given in 78.32% (n=112). BP was controlled. 68.63% (n=70) pregnancy were terminated by LSCS. 80.39% (n=82) neonates were alive. 97.90% (n=140) fully recovered. ICU support was required in 3.50% (n=5). 19.58% (n=28) needed transfusion. 27.97% (n=40) stayed at hospital for 7 days. Conclusion: Awareness among rural women, appropriate ANC, early identification of pre-eclampsia, efficient referral system & multidisciplinary approach including ICU is essential for management of these critical patients. 0103 Clinical significance of ultrasonic placental grading during third trimester in hypertensive disorders in pregnancy Atima Bharti1 and Anubha Vidyarthi2 1Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India; 2Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India Introduction: Hypertension is one of the most common complications in pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. Placenta is an important foetal organ which is an intermediate link between foetus and mother. Owing to delicate and important nature of the placenta, it is sometimes referred to as “mirror of the perinatal period which has not been sufficiently polished” [1]. Placenta being a foetal organ shows the same stress and strain, to which the foetus is exposed. Any disease affecting mother and foetus has a great impact on placenta. Wellbeing of foetus is affected by many factors but healthy placenta is the single most important determinant in producing a healthy baby. Foetal outcome is directly related to the maturation of placenta. Compromised placental perfusion from uterine vasospasm, a major culprit