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pressure sores, respiratory embarrassment, autonomic dysreflexia and thromboembolism. 1.5 patients had a normal vaginal delivery, 7 had an assisted vaginal delivery and 8 patients had caesarean sections, of these four were for breech presentation. This gave a caesarean section rate of 26%. There was 1 maternal mortality. Neonatal outcome was good. Conclusions : A successful pregnancy outcome is possible in paraplegic and tetraplegic patients within a shared framework of community, spinal unit and Hospital maternity unit. Vaginal Delivery is appropriate unless there are obstetric indications for caesarean section.

FC5.08.02 THE RELATION OF BREECH PRESENTATION AT TERM TO EPILEPSY IN CHILDHOOD L.Krebs. J.Langhoff-Roes, Rigshospitalet, Copenhagen University Hospital, Department of Obstetrics, 4031, Copenhagen, DK, Denmark, DK-2100.

Objectives: The aim of the study was to examine the relation between presentation at birth and epilepsy in childhood, and to identify risk factors for epilepsy in nonmalformed, singleton term infants delivered in breech presentation. Study Methods: Information from the National Patient Register on all infants born between 1980 and 1994 hospitalized with epilepsy were linked to the National Birth Register. Singleton infants with epilepsy delivered at term without malformations were identified (n=7.514). For each case delivered in breech presentation (n=290), two subsequent deliveries of nonmalformed, singleton infants delivered at term at the same hospital were selected as controls (n= 580). Results: Breech presentation was associated with a significantly higher risk of epilepsy than other presentations (1.1% vs. 0.9%; (OR 1.14; CI 95% 1.0-1.3). Breech presentation infants with epilepsy were more often SGA (small for gestational age) but did not differ regarding low Apgar score or mode of delivery, when compared to those without epilepsy. Conclusions: The risk of epilepsy in breech infants is not related to intrapartum events but to growth restriction in pregnancy.

FC5.08.03 HYPERMOBILITY AND PERIPARTUM PELVIC PAIN SYNDROME IN PREGNANT SOUTH AFRICAN WOMEN P.W.J. Dept. OB/GYN, King Fahad National Guard Hospital, Riyadh, Saudi Arabia.

Objectives: To determine the incidence and correlation of joint hypermobility (HM) and peripartum pelvic pain (PPPP) in a homogenous pregnant South African population. Study Methods: A cross-sectional study among Cape Colored pregnant women. Joint mobility was measured by Beighton score; PPPP with a specially developed PPPP score. Results: Using the Beighton scores with a cut-off point of HM zz 5/9, only 4.9% of the 509 pregnant women were hypermobile. Hyperextension of the elbow was the largest contributor to HM (35.4%). No correlation of HM with the incidence of PPPP was established. Only 20 very mild cases of PPPP were recorded. Back pain increased significantly during pregnancy to a mean of 38%. Right-handedness occurred in 95.9%. No significant relation was found between HM and the non-dominant side. Conclusions: Hypermobility in pregnant Cape Colored women was surprisingly low (4.9%) with a decrease with age, but no increase during pregnancy. Peripartum pelvic pain is virtually absent and has no correlation with joint laxity. Back pain increased during pregnancy to a mean of 38%. Right-handedness was high (96%) in comparison with the worldwide figure of 85%. No correlation was found between the dominant body side and hypermobility.

FC5.08.04 COMPLICATED FALCIPARUM MALARIA DURING PREGNANCY Anita Sharma, K.D.J. & K.M. Hospital & Research Centre, Baradari Crossing, Morar, Gwalior-474006 (M.P.) India

Objectives: Aim of the study was to highlight the clinical courses of severe malaria in gravid patients which constitutes a grave risk to the life of the mother and the foetus.

Study Methods: 148 patients having Falciparum malaria admitted in the wards & ICU of K.D.J. & K.M. Hospital, Gwalior were included in this perspective study. Result: In the present study out of 148 patients admitted with complicated falciparum malaria, 74 were pregnant & the same were non pregnant cases. Multiple complications were seen in 40 pregnant & 25 non-pregnant cases. 28 pregnant patients & 12 non-pregnant cases had cerebral malaria level of sensorium was more fluctuating among the former group and they also had prolonged mean recovery time. Acute renal failure was observed is 16 pregnant & 5 non-pregnant patients. Respiratory complications along with ARDS was seen in 9 pregnant & 3 non-pregnant cases. Intravascular haemolysis was also more pronounced among the pregnant cases. Hypoglycemia at the time of admission & during therapy was seen in 14 pregnant & 6 non pregnant cases. Anemia during pregnancy was very common among these cases. The degree of anemia observed during acute state of malaria is multi-factorial. Foetas loss occurred in 20 cases either in the form of abortion, IUD or premature delivery. Maternal mortality was high among pregnant patients. Deaths occurred in 19 pregnant & 6 non pregnant cases. Conclusions: Clinical courses of falciporum malaria among pregnant patients is disastrous. The incidence of multiple complications on is high in gravid patients. The maternal and neonatal mortality is high in spite of aggressive and multidisciplinary therapy so, the prophylaxis should be given a high priority in order to overcome this challenging problem.

FC5.08.05 RUPTURE OF SPLENIC ARTERY ANEURYSM IN A PREGNANT PATIENT WITH PORTAL HYPERTENSION S. Chaichian, A. Akbarian, F. Arjomand, R. Alaghehbandan, Dept. OB/GYN, Azad Islamic University of Medical Sciences, Zarghande Street, Shariati Avenue, Tehran, Iran

Objectives: Spontaneous rupture of splenic artery aneurysm during pregnancy is a rare event with catastrophic consequences. The risk of rupture, generally given as 3% to 5%, rises in pregnancy up to over 20%, with a 70% maternal and 95% fetal mortality rate. Review of the literature reveals more than 100 cases of ruptured splenic artery aneurysms in pregnancy have been reported, with however, only 13 cases with maternal and fetal survival. This paper describes a case of splenic artery aneurysm rupture during pregnancy reporting survival of mother. Study Methods: Case report. Results: A 27.year-old primigravid woman at 31 weeks’ gestation was admitted because of acute severe epigastric pain, nausea, and vomiting. Physical examination showed that she was in a state of hypovolemic preshock with abdominal tenderness in the epigastric and left upper quadrant on palpation. From the obstetrical point of view, there had been no bleeding and no uterine contractions but fetal heart rate showed severe bradycardia. She immediately underwent an emergency laparatomy and then splenic artery aneurysm was resected with splenectomy but unfortunately fetus did not survive. This allowed her to recover without complications, however, further evaluation revealed esophageal varices due to portal hypertension. After two years, she is pregnant again and in good general condition. Conclusions: Treatment is recommended for all patients who are symptomatic, pregnant women who are identified to have a splenic artery aneurysm, and women of childbearing age. It is also recommended to screen patients with portal hypertension for before conception and, if present, to treat electively.

FC5.08.06 AN INTERVENTION STUDY TO REDUCE ADVERSE PREGNANCY OUTCOMES DUE TO SYPHILIS IN MOZAMBIQUE N.B. Osman, K. Challis, E. Folgosa, M. Cotiro, S. BergstrBm, Dept. OB/GYN, Eduardo Mondlane University, Central Hospital, Maputo, Mozambique.

Objectives: To create an alternative screening approach among pregnant women in order to reduce adverse pregnancy outcomes due to syphilis in Mozambique.