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Results: There were 63853 childbirths in period of 15 years. Abruptio placentae occurred in 465 (0,737) D cases. In 38 cases or 8,6% abruptio placentae were associated with severe form of EPH Gestosis what mean that frequency rate is 11 time greater than in other pregnancies. Deliveries in 52,5% of cases with abruptio placentae and gestosis was finished with SC. 129 (28,01%) fetuses were dead before admitting in hospital. The mean age of the patient with this condition was 28,2 years. Conclusion: The analysis of data on our material is in conformity with results of other authors. Prognosis for mother and newborn depends on establishing diagnosis on time and appropriate therapy of EPH Gestosis. The severe forms of EPH Gestosis with abruptio placentae demanded urgent finishing of delivery and very often expose to danger life of mother and caused the dead of fetus.

P3.12.02 ACTIVITY OF LACTIC DEHYDROGENASE (LDH), CREATINE KINASE (CK) AND GAMMA-GLUTAMYLOTRANSFERASE (yGT) IN THE COURSE OF INTRAHEPATIC CHOLESTASIS IN PREGNANCY K. Czaikowski, R. Smolarszyk, .I. Wojcicka-Jagodzinska, P. Piekarski, E. Romejko, .I. Teliga, A. Malinowska, K. Dragowska, The 2”d Dept. OBIGYN, Warsaw Medical School, Warsaw, Poland.

Objectives: The activity of LDH, CK and yGT in blood serum of women with intrahepatic cholestasis in pregnancy was investigated. Diagnosis of intrahepatic cholestasis was based on anamnesis, clinical examination and laboratory tests. Study Methods: 41 women with intra hepatic cholestasis (the study group) and 30 healthy women (the control group) entered the study. All women were in the third trimester of pregnancy. The prevalence rate of intrahepatic cholestasis in pregnancy in our Department is 1%. All women of the study group presented an intensive pruritis and had negative hepatitis B antigen. The also presented negative results of laboratory tests. Clinical examination and anamnesis concerning other hepatitis. Results: There was no significant difference in mean gestational age between study and control group (35.1e2.8 Vs 36.Oe3.0 weeks). The results of biochemical tests in study Vs control group: (1) total bilirubin 33.3e18.8 Vs 8.55e3.4 microMol& p<O.OOl, (2) direct bilirubin 25.6e14.2 Vs 1.7* 1.7 microMoVL; p<O.OOl, (3) indirect bilirubin 7.7e2.22 Vs 8.55e3.4 microMol/L,NS, (4) alkaline phosphatase (AP) 168.4e61.2 Vs 96.8* 14.9 IU/L;

p<O.OOl, (5) heat-stable AP 99.8e38.7 Vs 64.1e20.9 IU/L; p<O.OOl, (6) bile acid 28.6e20.0 Vs 4.5e1.5 microMol& p<O.OOl, (7) AlAT 158elOO Vs 5*3 IU/L; p<O.OOl, (8) AspAT 97*31 Vs 8*3 IU/L, p<O.OOl, (9) de Ritis ratio AspATiAlAT 0.61*0.31 Vs 1.6eO.4; p<O.OOl, (10) total protein 61.8e5.6 Vs 66.Oe6.0 G/L; p<O.OOl, (11) albumine 45Oe34.8 Vs 484.Oe37.7 microMoVL, p<O.OOl, (12) FE++ 26.Oe3.8 Vs 12.71e2.15 microMoVL, p<O.OOl, (13) total cholesterol 8.81e1.87 Vs 6.68e1.04 mMoVL; p<O.OOl, (14) total LDL 6.8Oe1.57 Vs 4.80*0.81 G/L; p<O.OOl, (15) LDH 211*48 Vs 134*33 UI/L; p<O.OOl, (16) CK 51.0*33 Vs 45*14UI/L; NS, (17) G-GT 49*22 Vs 23*8 UI/L; p<O.OOl. Conclusions: An increase of LDH is related to the significant impairment of hepatocytes. An increase of yGT confirms the retention of bile in intrahepatic ducts. CK does not present prognostic value in intrahepatic cholestasis in pregnancy.

P3.12.03 HELLP SYNDROME - ASYNTOMATIC GESTOSIS, EXORDIUM IN PUERPERIUM, EVOLUTION IN CID M.G. Mazza, D. Galea, G. Masciari, Dept. OBIGYN, General Hospital, Crotone, Italy.

This syndrome can occur, as in our case, also in the course of asyntomatic gestosis in the early hours of puerperium growing in cid in a second time. Clinic Case: M.G. arrives at our observation at 3gth week. At her arrival: the objective general and ostetric and urinic exams were normal, P.A. 120180, HCI 39.6, MCV 89.5; MCH 30.5; MCHC 34.1; PLT 179/10^3/ul. The birth was done in the same day of the arrival. Soon

after the birth occurred in a spontaneous way after about 6 hours from the entrance the hospital, (alive and vital fetus, 3470 gr. P.A. 130190) the clinic conditions showed a quick worsening with presence of abdominal bar ache of the arterial pressure with ipertensive crisis (180/110), subsequent eclamptic crisis with alterations of the following indexes of laboratory: a quick and drastic reduction of HCI (36.2) MCV (93.3) MCH (32.9) MCH (35.2); emoglobinuria, fragments of granular cylinders; a quick reduction of the pyastrinic count (33/103/u1); a strong increasing of the whole bilirubyna (4.05 mg/dl);an alteration of epatic enzymes with a strong increasing of GOT, Gm, CK, LDH levels; iperuricemia; rightness of the emocoagulative tests. Moved into the intensive therapy, the following day remarkable emocoagulative alterations appeared (HCI 33.2; MCV 87.9; MCH 31.4; MCHC 35.7; PLT 21/103/ul) becoming later cid (antitrombina III A 43.88%; antiplasmina 33.58%; product of phybrogen degradation>40 pml). Considerations: The H.S. according to us, can occur then the birth evolving in cid quickly, disegrecing with the data of literature where such a syndrome occurs in the course of the gestosyc pregnancy and it improves quickly after the birth. In our case the H.S. occurs in the hours following the birth matching to a worse of the symptoms of the gestosy, occurring the H.S. as essential element putting in evidence a gestosic syndrome up to then asyntomatic. The mother prognosis in spite of the seriousness of the clinic situations through which it occurred, is good, with a constant clinic improvement in the weeks following the birth.

P3.12.04 HYSTERECTOMY IN THE OBSTETRIC PRACTICE FOR THE PERIOD 1993-1998 N.D. Grueva, Dept. OBIGYN, The District Hospital, Rouse, Bulgaria.

The Cesarean hysterectomy and the hysterectomy after vaginal delivery together with their indications, complications and the outcome for the mothers are observed during the period 1993-1998. The most common indications for Cesarean hysterectomy are: infected uterus, hemorrhage, myoma and cancer of the uterine cervix (80%). The hemorrhage and the rupture of the uterus (75%) are the main indications of hysterectomy after vaginal delivery. We had three fatal outcomes after hysterectomy following vaginal delivery. The authors recommend the organ-preserving approach. For the first time successful Cesarean hysterectomy was performed by Eduardo Porro - 1876. Together with the hysterectomy after vaginal delivery, it is the most severe intervention, done in the surgical obstetric practice for the benefit of the mother. Materials and Methods: The hysterectomies were done over a period of five years in the dep. of obstetrics and gynecology in the District Hospital of Rouse. During that period we had 10 010 deliveries. Cesarean section was done on 550 cases. We did 10 hysterectomies 7 Cesarean and 3 after vaginal delivery. The indications that led to hysterectomy were divided into 6 groups: l.lnfected uterus 2.Primary hemorrhage 3.Secondary hemorrhage 4.Myoma of the uterus 5.Cancer of the uterine cervix 6.Rupture of the uterus We have studied the severe complications after the hysterectomy and the outcome of the mothers. Results: The rate of the hysterectomies over the studied period is. The rate of the Cesarean hysterectomies is.. The rate of the hysterectomies after vaginal delivery is.. Groups Of Indications For Hysterectomy In The Obstetric Practice 1993-1998