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I362 Research insights into the pathophysiology of pelvic pain – implications for diagnosis and treatment
S90
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
demonstrated rates of 22/1000 amongst black children in Soweto. All these communities far exceeded previous FAS prevalence figures recorded in Europe and the United States where 0.1–12 per 1000 children were estimated to have FASD. Risk Factors: Common to the South African populations studied, mothers at risk of having a child with FASD were found to have poor socio-economic circumstances (R200/week), limited education (<8 years schooling), low BMI (Body Mass Indices) (<22), and low religiosity and to be cigarette smokers (>60%), binge-drinkers (>60 g of absolute alcohol/occasion), and frequently were infected with tuberculosis or HIV/AIDS virus. There was some indication of a genetic predilection for FASD when enzyme/polymorphisms of alcohol metabolism were studied. Prevention: Rates of FASD have been dramatically reduced by brief motivational interventions during pregnancy, and an intensive holistic prevention campaign in the highest-prevalence population in the Northern Cape Province reduced the rates from 119 to 48 per 1000 of the population.
which is most commonly used for managing ectopic pregnancy; however addition of Mifeprestone or Potassium Hydroxide may in specific cases be considered part of the treatment regimen. Different treatment regimens don’t necessarily result in a difference in outcome, however complications, side effects and the influence on the patient’s life should be considered before making a decision. Fertility rates following medical treatment are similar to that following surgery. In the developed world, ectopic pregnancies usually present early. Unfortunately this is not the case in the developing world where patients tend to present after tubal rupture which leaves no room for medical management. Patients should be educated so that this phenomenon can be reversed in favour of less serious unruptured ectopic pregnancies which will not only decrease morbidity and mortality but also the cost associated of management.
I362 Research insights into the pathophysiology of pelvic pain – implications for diagnosis and treatment
M. Westgren. Fetal Medicine, Karolinska Institutet, Stockholm, Sweden
U. Wesselmann. Dept. of Anesthesiology, Division of Pain Treatment, University of Alabama at Birmingham, Birmingham, AL, USA Objective/Background: Chronic gynecological pain is a common and debilitating problem. The clinical presentation is often considered to be a diagnostic dilemma, since many urological, gastrointestinal and gynecological disorders appear to cause or are associated with chronic pelvic pain. Pelvic pain disorders in women were estimated in 1996 to cost almost 3 billion dollars U.S. annually due to medical expenditures and lost wages. This lecture will highlight recent basic science and clinical studies that will lead to new insights into the pathophysiological mechanisms of chronic gynecological pain and to improved treatment avenues. Methods: Studies in a rat model of inflammatory uterine pain will be reported. These studies serve as a model to identify spinal cord pathways that are involved in pain from the reproductive organs. Psychophysical studies in healthy volunteers and women suffering from pelvic and urogenital pain syndromes will be considered to assess alterations in pain modulatory mechanisms. Results: (1) Results of the animal studies demonstrate that a noxious stimulus to one area of the reproductive tract influences the reactivity to subsequent stimulation of another area of the reproductive tract, whose sensory innervation projects to adjacent spinal cord segments. (2) Results of the psychophysical studies in women with chronic pelvic pain show distinct alterations in sensory processing. Conclusions: These basic science and clinical studies suggest that there are specific alterations in pain modulatory mechanisms in women suffering from chronic pelvic pain. The viscero-visceral and viscero-somatic interactions observed in these studies may account for the co-morbidities observed in a subgroup of these patients. Supported by NIH grants DK066641 (NIDDK), HD39699 (NICHD) and the Office of Research for Women’s Health. I363 Medical management of ectopic pregnancy P.H. Wessels The incidence of ectopic pregnancy is increasing which is most probably the result of better diagnostic tools as well as assisted reproductive technologies being utilised more often. It accounts for 2% of all first trimester pregnancies and 6% of all pregnancy related deaths in the United States. Early diagnosis may lead to successful management without surgical intervention. Management of ectopic pregnancies include conservative management, medical treatment and surgery. Medical treatment is commonly practiced and Methotrexate is recognised as the drug
I364 Stem cell research: where are we today
The complexity of reproductive stem biology is immense, and involves many fields in medicine. The present presentation will focus on fetal stem cell biology in regard to normal fetal development, chimerism and fetal therapy. New data on microchimerism and the interaction between mother and fetus will be presented. Finally, the presentation will include a review on the present state of fetal stem cell therapy and reproductive regenerative medicine. I365 Management of endometrial cancer in developing countries S. Wilailak Endometrial cancer is among top-three gynecologic cancers in the world. Being the most common gynecologic cancer in developed countries, it is usually the second or third in less developed world. Meanwhile, the incidence of endometrial cancer in developing countries is increasing, and there is still no means of effective screening available for endometrial cancer. With regard to the treatment of endometrial cancer, after FIGO changed clinical staging to surgical staging in 1988, surgery has become first-line therapy, either alone or followed by adjuvant radiotherapy or chemotherapy depending on the extent of the disease, according to the standard guidelines. However, developing countries have limited resources in terms of gynecologic oncologist, instruments or equipment for radiological imaging and radiotherapy as well as financial support. These factors could compromise the maximum ability of management for the best treatment and outcome. Fortunately, due to its early manifestation of the bleeding symptom, the majority of endometrial cancer is detected in early stage which would need surgery at the level generalists could perform. Hence, using available tools such as ultrasonography to stratify the patients into low or high-risk group as to allocate proper resources for the best outcome might be a solution to the problem encountered by developing countries. Also, effective use of available personnel or treatment would help raise the level of the outcome. Finally, a model management for endometrial cancer in the context of developing countries will be presented. I366 Practical advice to organise local training C. Winter The North Bristol NHS Trust (UK) ‘in house’, multi-professional, obstetric emergencies training day was first introduced in 2000. It runs bi-monthly, accommodating all medical and midwifery staff. Annual attendance is mandatory and is monitored via midwifery supervision and medical staff appraisals.
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
demonstrated rates of 22/1000 amongst black children in Soweto. All these communities far exceeded previous FAS prevalence figures recorded in Europe and the United States where 0.1–12 per 1000 children were estimated to have FASD. Risk Factors: Common to the South African populations studied, mothers at risk of having a child with FASD were found to have poor socio-economic circumstances (R200/week), limited education (<8 years schooling), low BMI (Body Mass Indices) (<22), and low religiosity and to be cigarette smokers (>60%), binge-drinkers (>60 g of absolute alcohol/occasion), and frequently were infected with tuberculosis or HIV/AIDS virus. There was some indication of a genetic predilection for FASD when enzyme/polymorphisms of alcohol metabolism were studied. Prevention: Rates of FASD have been dramatically reduced by brief motivational interventions during pregnancy, and an intensive holistic prevention campaign in the highest-prevalence population in the Northern Cape Province reduced the rates from 119 to 48 per 1000 of the population.
which is most commonly used for managing ectopic pregnancy; however addition of Mifeprestone or Potassium Hydroxide may in specific cases be considered part of the treatment regimen. Different treatment regimens don’t necessarily result in a difference in outcome, however complications, side effects and the influence on the patient’s life should be considered before making a decision. Fertility rates following medical treatment are similar to that following surgery. In the developed world, ectopic pregnancies usually present early. Unfortunately this is not the case in the developing world where patients tend to present after tubal rupture which leaves no room for medical management. Patients should be educated so that this phenomenon can be reversed in favour of less serious unruptured ectopic pregnancies which will not only decrease morbidity and mortality but also the cost associated of management.
I362 Research insights into the pathophysiology of pelvic pain – implications for diagnosis and treatment
M. Westgren. Fetal Medicine, Karolinska Institutet, Stockholm, Sweden
U. Wesselmann. Dept. of Anesthesiology, Division of Pain Treatment, University of Alabama at Birmingham, Birmingham, AL, USA Objective/Background: Chronic gynecological pain is a common and debilitating problem. The clinical presentation is often considered to be a diagnostic dilemma, since many urological, gastrointestinal and gynecological disorders appear to cause or are associated with chronic pelvic pain. Pelvic pain disorders in women were estimated in 1996 to cost almost 3 billion dollars U.S. annually due to medical expenditures and lost wages. This lecture will highlight recent basic science and clinical studies that will lead to new insights into the pathophysiological mechanisms of chronic gynecological pain and to improved treatment avenues. Methods: Studies in a rat model of inflammatory uterine pain will be reported. These studies serve as a model to identify spinal cord pathways that are involved in pain from the reproductive organs. Psychophysical studies in healthy volunteers and women suffering from pelvic and urogenital pain syndromes will be considered to assess alterations in pain modulatory mechanisms. Results: (1) Results of the animal studies demonstrate that a noxious stimulus to one area of the reproductive tract influences the reactivity to subsequent stimulation of another area of the reproductive tract, whose sensory innervation projects to adjacent spinal cord segments. (2) Results of the psychophysical studies in women with chronic pelvic pain show distinct alterations in sensory processing. Conclusions: These basic science and clinical studies suggest that there are specific alterations in pain modulatory mechanisms in women suffering from chronic pelvic pain. The viscero-visceral and viscero-somatic interactions observed in these studies may account for the co-morbidities observed in a subgroup of these patients. Supported by NIH grants DK066641 (NIDDK), HD39699 (NICHD) and the Office of Research for Women’s Health. I363 Medical management of ectopic pregnancy P.H. Wessels The incidence of ectopic pregnancy is increasing which is most probably the result of better diagnostic tools as well as assisted reproductive technologies being utilised more often. It accounts for 2% of all first trimester pregnancies and 6% of all pregnancy related deaths in the United States. Early diagnosis may lead to successful management without surgical intervention. Management of ectopic pregnancies include conservative management, medical treatment and surgery. Medical treatment is commonly practiced and Methotrexate is recognised as the drug
I364 Stem cell research: where are we today
The complexity of reproductive stem biology is immense, and involves many fields in medicine. The present presentation will focus on fetal stem cell biology in regard to normal fetal development, chimerism and fetal therapy. New data on microchimerism and the interaction between mother and fetus will be presented. Finally, the presentation will include a review on the present state of fetal stem cell therapy and reproductive regenerative medicine. I365 Management of endometrial cancer in developing countries S. Wilailak Endometrial cancer is among top-three gynecologic cancers in the world. Being the most common gynecologic cancer in developed countries, it is usually the second or third in less developed world. Meanwhile, the incidence of endometrial cancer in developing countries is increasing, and there is still no means of effective screening available for endometrial cancer. With regard to the treatment of endometrial cancer, after FIGO changed clinical staging to surgical staging in 1988, surgery has become first-line therapy, either alone or followed by adjuvant radiotherapy or chemotherapy depending on the extent of the disease, according to the standard guidelines. However, developing countries have limited resources in terms of gynecologic oncologist, instruments or equipment for radiological imaging and radiotherapy as well as financial support. These factors could compromise the maximum ability of management for the best treatment and outcome. Fortunately, due to its early manifestation of the bleeding symptom, the majority of endometrial cancer is detected in early stage which would need surgery at the level generalists could perform. Hence, using available tools such as ultrasonography to stratify the patients into low or high-risk group as to allocate proper resources for the best outcome might be a solution to the problem encountered by developing countries. Also, effective use of available personnel or treatment would help raise the level of the outcome. Finally, a model management for endometrial cancer in the context of developing countries will be presented. I366 Practical advice to organise local training C. Winter The North Bristol NHS Trust (UK) ‘in house’, multi-professional, obstetric emergencies training day was first introduced in 2000. It runs bi-monthly, accommodating all medical and midwifery staff. Annual attendance is mandatory and is monitored via midwifery supervision and medical staff appraisals.