AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 46 African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | Abstracts AFJOG ABSTRACTS conducted at study enrolment Additionally, placental histopathological analysis was conducted in a subset of participants representing both cohorts. Results: A total of 66 study participants were recruited, 36 in the EoPET cohort and 30 with SARS-CoV2. At enrolment there were no significant differences in age, gravidity, parity, substance use or medical co-morbidity between the SARS- CoV2 and EoPET cohorts. Although there was no significant difference in the gestational age at enrolment, the gestational age at delivery was significantly different between EoPET (median 33 weeks, IQR 31 - 34) and SARS-CoV2 (median 38 weeks, IQR 36 - 39) (p<0.0001). Median sFlt-1 concentrations were not significantly different between the two cohorts, 3726.5 pg/ml (IQR, 2228 – 14,258) EoPET compared to 3295 pg/ml (IQR, 2157 – 4923) with SARS-CoV2. However, the median PlGF levels were significantly lower in the EoPET cohort 26.6 pg/ml (IQR, 18.1 – 57.4), compared to those with SARS-CoV2 140 pg/ml (IQR, 61.9 – 354.5). This difference translated to significantly higher sFlt-1/PlGF ratio in the EoPET 109.4 (45.7 - 310.1) compared to 30.3 (6.8 - 70.7) to the SARS-CoV2 cohort (p=0.0002). Plasma NT-proBNP levels were significantly elevated in the EoPET group (median,IQR) 116.9 (25.5 - 259.8) compared to those with SARS-CoV2 50.1 (13.7 - 143.4) (p<0.0001). Similarly, levels of Troponin T were higher in the EoPET compared to SARS-CoV2 cohort, median (IQR) 5.6 (4.6 – 11.8) and 4.6 (3.7 – 7.1) respectively (p=0.041). We report no difference in plasma CK-MB levels between the two cohorts. Placental histopathological analysis was conducted in 39 placentae, 26 EoPET and 13 SARS- CoV2. Apart from smaller placentae in the EoPET cohort, median placental weights 223.4g (IQR 160 - 291) and 376g (IQR 350.7 - 383) in the SARS-CoV2 group (p<0.0001), there were no differences in other placental parameters (fetal-placental weight ratio or placental thickness) or histopathological findings. The lower placental weights in EoPET are likely associated with earlier gestational age at delivery in this cohort. Conclusion: Despite similar underlying mechanisms, the sFlt- 1/PlGF ratio was higher in patients with EoPET compared to those with SARS-CoV2, likely a reflection of underlying placental dysfunction in those with EoPET. The higher ratio in EoPET was through lower expression of PlGF than elevated sFlt-1 levels – a curious finding given prevailing dogma in pathophysiological understanding. Further, elevated NT -proBNP and Troponin T in patients with EoPET may have a role in distinguishing those with preeclampsia and cardiac morbidity. ABSTRACTTITLE: 501: Recent developments in cervical cancer treatment: SHAPE & INTERLACE trials AUTHORS: Prof Greta Dreyer gretadreyer@mweb.co.za Greta Dreyer 1 1 Gynaecologic Oncology Unit, Department Obstetrics & Gynaecology, University of Pretoria and Steve Biko Academic Hospital Background: First results of two recent international studies regarding management of cervical cancer are summarised and contextually interpreted. Methods: SHAPE-trial, randomised early cancers (<2cm, <10mm invading, no nodal involvement on imaging) to either simple or radical hysterectomy and lymph node assessment via open or laparoscopic approach in 130 centres (mostly in Western Europe, Canada and South Korea). INTERLACE-trial, randomised 500 locally advanced cervical cancer patients to standard chemoradiation (CRT) with/ without 6-weeks induction chemotherapy (IC) (carboplat/ paclitaxel) in 32 centres (5 countries). Waiting time after IC was one week; radiation quality was excellent. Results: SHAPE-trial reports that non-radical hysterectomy had pelvic recurrence rates “non-inferior” to radical hysterectomy (3.1% vs 2.9%), but recurrence (4.3% vs. 2.9%), extra-pelvic recurrence (2.0% vs. 0.6%) and death from cervical cancer (4/350 vs. 1/350) were higher after simple hysterectomy [median follow-up 4.5years]. INTERLACE confirms feasibility of IC before CRT, with 85%+ treatment completion, and grade 3+ adverse events in 48% (CRT) vs 59% (IC/CRT). For the IC/CRT arm, oncological outcomes were improved for PFS (73% vs. 64%) and OS (80% vs.72%) [median follow-up 5.3years], due to less distant relapse (12% vs. 20%); local relapse only 16% (both arms). Discussion: SHAPE-trial results are invalid for HIV- positive women, grade-3 adenocarcinoma, LVI+, Black/“developing nation”-participants as these were all severely underrepresented; therefore less radical surgery has limited local applicability. Oncological outcomes were overall inferior to the open arm of LACC-trial, and similar to the laparoscopy arm, also reporting unexplained extra-pelvic recurrences. Study data is immature and surgical approach related to outcomes remains undisclosed. INTERLACE-trial included stage IIB(70%), node negative (57%) women; HIV-undisclosed. Such low-risk patients are scarce in our context, where we experience reduced chemo- tolerability, frequent treatment interruptions and poor completion related to kidney function impairment, anaemia, etc. Excellent oncological outcomes reflect the study-group and state-of-the-art treatment. Conclusion: SHAPE: Surgery of reduced radicality (and minimally invasive surgeries) even in very early stage patients, should be done with utmost caution, careful patient selection and sufficient counselling. INTERLACE: Induction chemotherapy before CRT is feasible in selected patients, and may reduce early distant relapse. Optimal (chemo)radiation plus brachytherapy is first priority for local control. ABSTRACTTITLE: 502: Addressing stillbirths in South Africa: Early detection using Umbiflow AUTHORS: Dr Tsakane Hlongwane tsakane.hlongwane@up.ac.za Tsakane Hlongwane 1