- Email: [email protected]
I298 MVA FOR OUTPATIENT MISCARRIAGE MANAGEMENT
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Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
especially in low-resource countries where 88 percent of cervical cancer deaths occur. New alternatives to Pap smear are needed to overcome the challenges associated with screening programmes. HPV DNA testing has emerged as a sensitive, objective, and reproducible method to identify women at high risk for cervical cancer. The careHPV™ Test (careHPV™) has been developed for usage in low-resource settings as a simple and accurate HPV DNA test. The technology was tested and compared to other tests in field sites in India, Uganda, China, and Nicaragua, where around 28,000 women were enrolled and screened with Pap smear, VIA, and careHPV™. In addition to a cervical sample collected by the provider, women were offered the option of self-collecting a vaginal sample before the pelvic evaluation was completed. The results show that the highest sensitivity rate was obtained by careHPV™ testing in provider-collected cervical samples. The sensitivity of careHPV™ in self-collected vaginal samples was better than Pap smear and VIA. Self-collection of vaginal samples was accepted by more than 80 percent of women in all the study sites. In conclusion, it is possible to perform high quality HPV DNA testing in low-resource areas, and the use of self-collected specimens opens the opportunity for performing discrete sample collection at the community level. Only women with a positive HPV test would need to be evaluated in the health centers. This approach could potentially increase the coverage of screening without overwhelming the capacity of the health system.
include an element of transgenerational inheritance, independent of genetic predisposition. Thus it is suggested that exposure to the metabolic influences of maternal obesity in fetal life may directly influence the risk of obesity in the child. Investigations in mother-child cohorts certainly suggest that maternal obesity during gestation is an independent determinant of obesity risk in the child and a reportedly greater influence of maternal versus paternal BMI argues against an important influence of genetic inheritance. Most recently, several publications have uniformly described that excessive gestational weight gain (by USA Institute of Medicine criteria) is a determinant of offspring obesity. However, causation is difficult to prove, even following adjustment for known confounders such as maternal smoking, breast feeding duration, childhood sleep patterns, physical activity and diet. Lifestyle or pharmacological intervention clinical trials in obese pregnant women designed to improve pregnancy outcome and/ or reduce gestational weight gain provide, through childhood followup, an exciting opportunity to test this theory, sometimes known as the ‘fetal overnutrition hypothesis’. Ongoing studies, including trials in Australia and the UK, are prospectively designed to assess the relative roles of gestational and postnatal determinants of childhood obesity and thereby to evaluate whether maternal obesity/gestational weight gain, through persistent influences on the fetus may contribute to the global epidemic of childhood obesity.
I296 DEVELOPMENTAL PROGRAMMING IN DIABETES AND OBESITY
Reference(s) Gillman M and Poston L (eds). Maternal Obesity. Cambridge University Press; 2012.
L. Poston The adverse pregnancy outcomes associated with maternal obesity and gestational diabetes present an increasing clinical problem globally. The focus of this talk will be on the potential for longer term effects on the metabolic health of the child. Many motherchild cohort studies have proposed an independent association between maternal obesity and the risk of obesity and diabetes in the child and similar relationships are frequently reported between maternal diabetes (both Type 1 and Type 2/GDM) and the susceptibility to diabetes and obesity in the child. However, residual confounding is difficult to avoid in observational studies and causality remains difficult to prove. Animal models have provided much needed insight into ‘programming’ of diabetes and obesity. Experimentally induced diabetes in rodents is associated with persistent pancreatic b cell secretory dysfunction in the offspring, abnormal insulin signaling in insulin-sensitive tissues and altered development of the hypothalamus which has been linked to development of obesity in adult life. Maternal diet-induced obesity in several different animal species gives rise to metabolic and cardiovascular dysfunction in the offspring which also develop characteristics of non-alcoholic fatty liver disease. Prospective studies in children born to obese and diabetic mothers who have participated in intervention trials in pregnancy are underway, and these have the capacity to address these intriguing concepts of the transgenerational influence of maternal obesity and diabetes. Reference(s) Gillman M and Poston L (eds). Maternal Obesity. Cambridge University Press; 2012. Poston L. Intergenerational transmission of insulin resistance and type 2 diabetes. Prog Biophys Mol Biol. 2011; 106: 315–22.
I297 DEVELOPMENTAL ORIGINS OF OBESITY L. Poston The dramatic increase in obesity rates worldwide is associated with changes in diet and physical activity, but this rapid escalation could
I298 MVA FOR OUTPATIENT MISCARRIAGE MANAGEMENT S. Prager. University of Washington in the Department of Obstetrics and Gynecology, USA Many areas of the world still consider dilation and curettage (D&C) for miscarriage to be a surgery requiring an operating room and anesthesia. In contrast, D&C can often be safely performed in an outpatient setting using a Manual Vacuum Aspirator (MVA). I will discuss briefly some of the advantages of MVA over D&C in the operating room for miscarriage management, including more timely care, better continuity of care, pain management and shorter recovery times. I299 EVIDENCE-BASED APPLICATION OF 3D/4D ULTRASOUND IN FETAL MEDICINE: OVERVIEW F. Prefumo Three- and four-dimensional ultrasound have gained a wide popularity in the fields of prenatal diagnosis and fetal medicine. A Pubmed search using the terms “fetal or prenatal” and “three-dimensional” ultrasound lists more than 1,500 publications. However, the large majority of this contributions has a low level of evidence, being mostly represented by case reports or uncontrollled case series. It is difficult to compare the results of 3D/4D ultrasound to 2D for a number of reasons: both techniques are operatordependent; standardizing the diagnostic approach with 3D/4D ultrasound is not easy; 3D/4D ultrasound techniques are in rapid evolution from the point of view of hardware and software facilities; the additional contribution of 3D/4D ultrasound is likely to be variable depending on the indication for the ultrasound scan (screening vs. targeted) and on the different anatomical districts investigated. Two of the most promising fields for 3D/4D ultrasound application are the in the investigation of the fetal heart and central nervous system.
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
especially in low-resource countries where 88 percent of cervical cancer deaths occur. New alternatives to Pap smear are needed to overcome the challenges associated with screening programmes. HPV DNA testing has emerged as a sensitive, objective, and reproducible method to identify women at high risk for cervical cancer. The careHPV™ Test (careHPV™) has been developed for usage in low-resource settings as a simple and accurate HPV DNA test. The technology was tested and compared to other tests in field sites in India, Uganda, China, and Nicaragua, where around 28,000 women were enrolled and screened with Pap smear, VIA, and careHPV™. In addition to a cervical sample collected by the provider, women were offered the option of self-collecting a vaginal sample before the pelvic evaluation was completed. The results show that the highest sensitivity rate was obtained by careHPV™ testing in provider-collected cervical samples. The sensitivity of careHPV™ in self-collected vaginal samples was better than Pap smear and VIA. Self-collection of vaginal samples was accepted by more than 80 percent of women in all the study sites. In conclusion, it is possible to perform high quality HPV DNA testing in low-resource areas, and the use of self-collected specimens opens the opportunity for performing discrete sample collection at the community level. Only women with a positive HPV test would need to be evaluated in the health centers. This approach could potentially increase the coverage of screening without overwhelming the capacity of the health system.
include an element of transgenerational inheritance, independent of genetic predisposition. Thus it is suggested that exposure to the metabolic influences of maternal obesity in fetal life may directly influence the risk of obesity in the child. Investigations in mother-child cohorts certainly suggest that maternal obesity during gestation is an independent determinant of obesity risk in the child and a reportedly greater influence of maternal versus paternal BMI argues against an important influence of genetic inheritance. Most recently, several publications have uniformly described that excessive gestational weight gain (by USA Institute of Medicine criteria) is a determinant of offspring obesity. However, causation is difficult to prove, even following adjustment for known confounders such as maternal smoking, breast feeding duration, childhood sleep patterns, physical activity and diet. Lifestyle or pharmacological intervention clinical trials in obese pregnant women designed to improve pregnancy outcome and/ or reduce gestational weight gain provide, through childhood followup, an exciting opportunity to test this theory, sometimes known as the ‘fetal overnutrition hypothesis’. Ongoing studies, including trials in Australia and the UK, are prospectively designed to assess the relative roles of gestational and postnatal determinants of childhood obesity and thereby to evaluate whether maternal obesity/gestational weight gain, through persistent influences on the fetus may contribute to the global epidemic of childhood obesity.
I296 DEVELOPMENTAL PROGRAMMING IN DIABETES AND OBESITY
Reference(s) Gillman M and Poston L (eds). Maternal Obesity. Cambridge University Press; 2012.
L. Poston The adverse pregnancy outcomes associated with maternal obesity and gestational diabetes present an increasing clinical problem globally. The focus of this talk will be on the potential for longer term effects on the metabolic health of the child. Many motherchild cohort studies have proposed an independent association between maternal obesity and the risk of obesity and diabetes in the child and similar relationships are frequently reported between maternal diabetes (both Type 1 and Type 2/GDM) and the susceptibility to diabetes and obesity in the child. However, residual confounding is difficult to avoid in observational studies and causality remains difficult to prove. Animal models have provided much needed insight into ‘programming’ of diabetes and obesity. Experimentally induced diabetes in rodents is associated with persistent pancreatic b cell secretory dysfunction in the offspring, abnormal insulin signaling in insulin-sensitive tissues and altered development of the hypothalamus which has been linked to development of obesity in adult life. Maternal diet-induced obesity in several different animal species gives rise to metabolic and cardiovascular dysfunction in the offspring which also develop characteristics of non-alcoholic fatty liver disease. Prospective studies in children born to obese and diabetic mothers who have participated in intervention trials in pregnancy are underway, and these have the capacity to address these intriguing concepts of the transgenerational influence of maternal obesity and diabetes. Reference(s) Gillman M and Poston L (eds). Maternal Obesity. Cambridge University Press; 2012. Poston L. Intergenerational transmission of insulin resistance and type 2 diabetes. Prog Biophys Mol Biol. 2011; 106: 315–22.
I297 DEVELOPMENTAL ORIGINS OF OBESITY L. Poston The dramatic increase in obesity rates worldwide is associated with changes in diet and physical activity, but this rapid escalation could
I298 MVA FOR OUTPATIENT MISCARRIAGE MANAGEMENT S. Prager. University of Washington in the Department of Obstetrics and Gynecology, USA Many areas of the world still consider dilation and curettage (D&C) for miscarriage to be a surgery requiring an operating room and anesthesia. In contrast, D&C can often be safely performed in an outpatient setting using a Manual Vacuum Aspirator (MVA). I will discuss briefly some of the advantages of MVA over D&C in the operating room for miscarriage management, including more timely care, better continuity of care, pain management and shorter recovery times. I299 EVIDENCE-BASED APPLICATION OF 3D/4D ULTRASOUND IN FETAL MEDICINE: OVERVIEW F. Prefumo Three- and four-dimensional ultrasound have gained a wide popularity in the fields of prenatal diagnosis and fetal medicine. A Pubmed search using the terms “fetal or prenatal” and “three-dimensional” ultrasound lists more than 1,500 publications. However, the large majority of this contributions has a low level of evidence, being mostly represented by case reports or uncontrollled case series. It is difficult to compare the results of 3D/4D ultrasound to 2D for a number of reasons: both techniques are operatordependent; standardizing the diagnostic approach with 3D/4D ultrasound is not easy; 3D/4D ultrasound techniques are in rapid evolution from the point of view of hardware and software facilities; the additional contribution of 3D/4D ultrasound is likely to be variable depending on the indication for the ultrasound scan (screening vs. targeted) and on the different anatomical districts investigated. Two of the most promising fields for 3D/4D ultrasound application are the in the investigation of the fetal heart and central nervous system.