Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239

Netherlands, 3 Obstetrics and Gynecology, UMCU, Utrecht, Netherlands) Introduction: Women with a pregnancy complicated by preeclampsia, intra-uterine growth restriction and/or gestational diabetes are at increased risk of future cardiovascular and metabolic disease. Lifestyle intervention may help these women to effectively lower these risks. Objectives: To test if offering lifestyle intervention after a complicated pregnancy significantly reduces weight (primary objective) and/or other cardiovascular and metabolic risk factors (secondary objective). Methods: The Pro-Active study (Postpartum Rotterdam Appraisal of Cardiovascular health and Tailored Intervention) is a feasibility study to develop and evaluate a postpartum lifestyle intervention program. In a prospective casecontrol setting we tested the effect of the lifestyle intervention. Women were included between April 2007 and August 2009. They were eligible if 18 years old at time of inclusion, being able to understand and speak the Dutch language and not having pre-existing conditions that could interfere with the lifestyle intervention. Cases were offered lifestyle intervention by a trained counsellor between 6 and 10 months postpartum. During 3 private sessions, mainly exercise and fat-intake and to some extend smoking habits were discussed and aims were made to improve lifestyle. Controls did not receive these sessions, but were not restricted to improve lifestyle on their own. Anthropometric and laboratory measurements were taken at 6 and 10 months postpartum and again at 13 months postpartum to test for durability of the effects. Results: During our study 1121 women gave birth after a complicated pregnancy. Four hundred and ninety Women were eligible for the study of which 240 women (49%) gave informed consent to participate. 56 Women (23%) were lostto-follow-up, leaving 186 women for the analysis. Between 6 and 13 months postpartum weight was significantly reduced in cases compared to controls by 2.1 kg (95% > CI 0.4–3.7), resulting in a 0.7 kg/m2 (0.1–1.3) lower BMI. Also systolic blood pressure (5.0 mmHg (0.3–9.7)), waist circumference (4.6 cm (2.6–6.6)) and waist-to-hip ratio (0.03 (0.01–0.04)) were significantly improved in cases compared to controls. Heart rate, hip circumference and total cholesterol were significantly improved within cases, but not compared to controls. Diastolic blood pressure and fasting glucose were not improved. Conclusion: Lifestyle intervention after complicated pregnancy may be effective in lowering weight and improving other cardiovascular and metabolic risk factors. It suggests that now is prudent and justified to start a large-scale randomised controlled trial to validate our results.

Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.032

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OS032. Pharmacotherapy for pre-eclampsia in low and middle income countries: An analysis of essential medicines lists (EMLS) S. Lalani 1,*, T. Firoz 1, L.A. Magee 2,3,4, R. Lowe 5, D. Sawchuck 3,6, B. Payne 6, R. Gordon 6, M. Vidler 6, P. von Dadelszen and Community Level Intervention for Preeclampsia (CLIP) Working Group 6,7 (1 Faculty of Medicine, 2 Clinical Professor of Medicine, 3 Child and Family Research Institute, 4 Obstetric Medicine, Children’s and Women’s Hospital and Health Centre, Vancouver, Canada, 5 Maternal and Child Health Integrated Program, Washington, D.C., United States, 6 Obstetrics and Gynaecology, University of British Columbia, 7 Maternal Fetal Medicine-Obstetrics and Gynaecology, Children’s and Women’s Health Centre of BC, Vancouver, Canada) Introduction: Pre-eclampsia is the second leading cause of maternal mortality in low and middle income countries (LMIC). Pharmacological management of pre-eclampsia has five major components including antihypertensive therapy for severe and non-severe hypertension, magnesium sulphate for prevention or treatment of eclampsia, treatment of preeclampsia-related end-organ complications, antenatal corticosteroids for acceleration of fetal pulmonary maturity given iatrogenic preterm delivery for maternal and/or fetal indications, and labour induction for such indicated deliveries. Essential medicines are defined by the World Health Organization (WHO) as ‘‘drugs that satisfy the health care needs of the majority of the population’’. Essential Medicines Lists (EMLs) detail these essential medicines within an individual country and support the argument that the medication should be routinely available. Objectives: To determine how many drugs required for comprehensive pre-eclampsia management are listed in national EMLs of LMIC. Methods: We conducted a descriptive analysis of relevant drug prevalence on identified EMLs. We searched for the national EMLs of the 144 LMIC identified by the World Bank. EMLs were collected by broad based internet searches and in collaboration with the WHO. The EMLs were surveyed for therapies for the different aspects of pre-eclampsia management: hypertension (nonsevere and severe with oral or parenteral agents), eclampsia, pre-eclampsia complications (e.g., pulmonary oedema, thrombosis), preterm birth, and labour induction. Results: EMLs were located and reviewed for 58(40.3%) of LMIC. One or more parenteral antihypertensive agents were listed in 51(87.9%) EMLs. The most common agents were: hydralazine (67.2%), verapamil (58.6%), propranolol (39.7%) and sodium nitroprusside (37.9%); parenteral labetalol was listed by only 19.0% of EMLs. The most prevalent oral antihypertensive therapies listed were: nifedipine (96.6%, usually 10 or 20 mg intermediate-acting tablets), methyldopa (94.8%), propranolol (89.7%), and atenolol (87.9%). Captopril, enalapril, hydrochlorothiazide and spironolactone were commonly listed. Magnesium sulphate for prevention and management of eclampsia was present in 86.2% of EMLs (and its antidote, calcium gluconate in 82.8%). To manage complications of pre-eclampsia, oral frusemide was listed in 94.8% of EMLs and parenteral heparin in 91.4%. Most EMLs

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Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 175–239

listed parenteral dexamethasone (91.4%) for acceleration of fetal pulmonary maturity and oxytocin (98.3%) or a prostanoid (usually misoprostol, 39.7%) for labour induction. Conclusion: EMLs of LMIC provide comprehensive coverage of all aspects of recommended pre-eclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country.

Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.033

OS033. Correlates of maternal health outcomes associated with a low-cost intervention in secondary facilities across Kano state, Nigeria J. Tukur 1,*, B. Ahonsi 2, I. Salisu 2, A.B. Oginni 2, E. Okereke 2 (1 Obsterics and Gynaecology, Bayero University, Kano, Nigeria, 2 Population Council, Abuja, Nigeria) Introduction: Nigeria has one of the highest rates of maternal mortality in the world. Eclampsia is a major contributor to the deaths especially in Northern Nigeria where the culture of teenage marriage is common. Kano is the state with the highest population in Nigeria. Despite its effectiveness, magnesium sulphate was been used to treat eclampsia and severe preclampsia in only one of 35 general hospitals inthe state as at 2007. Objectives: In 2008, magnesium sulphate was introduced in 10 General Hospitals in Kano state of Northern Nigeria in a Population Council project funded by the MacArthur Foundation. The aim of the study was to determine if the maternal outcomes improved. Methods: Doctors and midwives from the 10 hospitals were trained on the use of magnesium sulphate. The trained health workers later conducted step down trainings at their health facilities. Magnesium sulphate, treatment protocol, patella hammer and calcium gluconate were then supplied to the hospitals. Data was collected through structured data forms. The data was analysed using SPSS. Results: Within a year of the project, 1045 patients with severe preeclampsia and eclampsia were treated. The case fatality rate for severe preeclampsia and eclampsia fell from 20.9% (95% CI 18.7–23.2) recorded before the project to 2.3% (95%CI 1.5–3.5) after the project. The perinatal mortality rate in those that received magnesium sulphate was 12.3% (CI 10.4–14.5) while the 5 min APGAR score for 72.9% of the babies was 7 or more. Conclusion: Training of health workers on updated evidence based interventions and providing an enabling environment for their practice are key components to the attainment of the Millennium Development Goals in developing countries.

Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.034

OS034. Magnesium sulfate for prevention of eclampsia: Are intramuscular and intravenous regimens equivalent? T. Easterling 1,*, D. Salinger 2, S. Mundle 3, A. Regi 4, H. Bracken 5, B. Winikoff 5, P. Vicini 2 (1 Ob-Gyn, Seattle, United States, 2 University of Washington, Seattle, United States, 3 Ob-Gyn, Government Medical College, Nagpur, India, 4 Christian Medical College, Vellore, India, 5 Genuity Health Projects, New York, United States) Introduction: Magnesium sulfate is the agent of choice for the treatment and prevention of eclampsia. Optimal loading and maintenance dosing has not been determined. Objectives: To compare the pharmacokinetic parameters if IM vs. IV magnesium sulfate. Methods: A pharmacokinetic study was performed as part of a randomized trial that enrolled 300 women comparing IM and IV regimens of magnesium dosing in two low resource sites in India. Data from 258 enrolled women were analyzed in the pharmacokinetic study. Due to infrastructure available at the sites, a single sample was drawn per subject with the expectation of utilizing samples in a pooled data analysis. Results: Magnesium clearance was estimated via pharmacokinetic modeling to be 48.1 dL/h, volume of distribution 156 dL and IM bioavailability 86.2%. The IM regimen produced higher initial serum concentrations, consistent with a substantially larger loading dose. At steady state, Mg concentrations in the IM and IV Groups were comparable. With either regimen, a substantial number of subjects would be expected to have serum concentrations lower than those generally expected to be therapeutic. Conclusion: A larger loading dose for the IV regimen should be considered. Where feasible, individualized higher doses of magnesium sulfate would yield a greater number of treated women with clinically effective magnesium concentrations.

Disclosure of interest None declared. doi:10.1016/j.preghy.2012.04.035

OS035. Blood pressure measurement by health professionals, comparison with American Heart Association Technique F. Sahbaeiroy 1,*, M. Pourzadi 2, M. Mohammad Hasani 1, N. Khatibi 1, S. Esmailpour 1 (1 Faculty of Nursing and Midwifery, Islamic Azad University, Tehran Medical Branch, Iran, 2 Khatam Hospital, Tehran, Iran)

OS032. Pharmacotherapy for pre-eclampsia in low and middle income countries: An analysis of essential medicines lists (EMLS).

Pre-eclampsia is the second leading cause of maternal mortality in low and middle income countries (LMIC). Pharmacological management of pre-eclampsia...
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