- Email: [email protected]
O269 Multiple pregnancies: risks and outcome
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
instrumental delivery & birth trauma were excluded. 100 patients were received either oxytocin or methergine immediately after delivery, & 100 patients were received misoprostol 400 mg either buccal (50 patients) or rectal (50 patients) immediately after delivery, both groups were around the same parity, around 70% of the patient were ≤p4 & 30% were >p4. In group (1) oxytocin group 21 patient develop P.P.H & 4 patient need blood transfusion. In group (2) misoprostol group, 6 patients develop P.P.H after misoprostol And given piton ± methergine in this category the birth weight of the baby >4 kg One of them receive 1 unit blood transfusion & one of them post partum evacuation done because of retained placental tissue. All these patients were >85 kg weight & there age between 25–34 years. In misoprostol group (group 2) 2 patient developed diarrhea & 3patient developed vomiting as drug side effect. There’s no significant difference in the effect &side effect of misoprostol which given either rectally or buccal, but buccal is more accepted by the patient. There’s no significant difference in days of hospital stay between the two groups. Results of our study show that: There’s significant Reduction of p.p.H & the need of blood transfusion when misoprostol used instead of oxytocin or methergine as an active management of 3rd stage of labour. In conclusion, P.p.H witch occur with misoprostol could be related to the patient weight & to the baby birth weight. O266 From Kuala Lumpur (2006) to Cape Town (2009), novasure impedance controlled endometrial ablation – Three-year follow up
S169
O267 Ultrasonographic evaluation of lower uterine segment thickness in pregnant women with previous cesarean section D. Elmoghazy. Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Egypt Objective: To evaluate the lower uterine segment thickness in pregnant women with previous cesarean section by ultrasonography in comparison to those with previous normal vaginal delivery, and to determine a critical thickness above which safe vaginal delivery is predictable. Methods: A prospective observational study of 100 antenatal women with previous cesarean delivery and 50 controls was carried out. Transabdominal and transvaginal ultrasonography were used in both groups to evaluate lower uterine segment thickness. The obstetric outcome in patients with successful vaginal birth and intraoperative findings in women undergoing cesarean delivery were correlated with lower segment thickness. Results: The overall vaginal birth after cesarean section (VBAC) was 68%, the incidence of dehiscence was 28%, and there were no uterine ruptures. There was an 86% correlation between transabdominal ultrasonography with magnification and transvaginal ultrasonography. The critical cutoff value for safe lower segment thickness, derived from the receiver operator characteristic curve, was 2.5 mm. Conclusion: Ultrasonographic evaluation permits better assessment of the risk of scar complication intrapartum, and could allow for safer management of delivery.
A. Elmardi1 , M. Hamza, S. Furara, F. Khan, I. Gallos, A. Yagoub. 1 Obstetrics and Gynaecology department, Stafford General Hospital, Stafford, UK
O268 Hepatitis B virus and Hepatitis C virus in pregnant Sudanese women
Objectives: – To assess the safety, efficacy and patient satisfaction after the procedure in women with menorrhagia secondary to dysfunctional uterine bleeding – To compare our current results (bigger sample size and longer duration post treatment) to initial results presented at Kuala Lumpur in 2006. Materials and Methods: Note: The numbers into brackets represent our initial figures presented at Kuala Lumpur (KL) in 2006. A pilot study was used at our hospital with 199 (KL, 50) premenopausal women with menorrhagia secondary to dysfunctional uterine bleeding. Approval was sought from the Patient Advisory and Liaisons Services (PALS) and data was analyzed using postal questionnaires, Pictorial Blood loss assessment chart diary pre and post treatment, and individual patient case notes. Results: Out of the total of 199 patients who received the treatment, data was analyzed in 171 (KL, 50 and 40 respectively). The mean postoperative period following the study was of 18 months (KL, 6 months). Treatment time averaged 94 seconds (KL, 93 seconds). None of the patients had intraoperative complications (KL, same). 93.6% reported reduction in their periods and 61% reported complete amenorrhoea (KL, 95% and 80% respectively). 58% (KL, 75%) reported improvement in dysmenorrhoea. 85% (KL, 95%) were satisfied with the results. Conclusions: Novasure provides a safe, effective and rapid treatment option for menorrhagia and potentially avoids major surgery. It has a short intraoperative time and can be performed at anytime during menstrual cycle without the need for endometrial pretreatment. Results of our study are comparable to the figures quoted by the manufacturers. These observations are very valuable during preoperative counseling of patients undergoing novasure endometrial ablation. Hysterectomy was avoided in 95.53%.
R. Elsheikh, A. Daak, M. Elsheikh, M. Karsany, I. Adam Background: The epidemiology of viral hepatitis during pregnancy is essential for health planners and programme managers. While much data exist concerning viral hepatatis during pregnancy in many African countries, no proper published data are available in Sudan. Aim: The study aimed to investigate the sero-prevalance and the possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among antenatal care attendants in central Sudan. Methods: During 3 months from March-June 2006, sera were collected from pregnant women at Omdurman Maternaty Hospital in Sudan and they were tested for markers of hepatitis B virus (HBVsAg) and anti-HCV. Results: HBVsAg was detected in 41 (5.6%) out of of 728 women, Anti-HCV was detected in 3 (0.6%) out of 423 women, all of them were not aware of their condition. Age, parity, gestational age, residence, history of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HBVsAg sero-positivity. Conclusion: Thus 5.6% of pregnant women were positive for HBVsAg irrespective of their age, parity and sociodemographic characteristics. There was low prevalance of Anti-HCV. O269 Multiple pregnancies: risks and outcome O. Elsraiti, F. Essadi, M. Elmehashi, E. Bakosh Objective: Data of multiple pregnancies to be analysed in comparison to other studies and to find out whether maternal and perinatal mortality and neonatal morbidity are influenced by mode of delivery. Methods: We reviewed medical records of all women with multiple pregnancies who delivered in Misurata Teaching Hospital during a period of one year (1/6/2007–31/5/2008). Data analysed using chisquare test and P-value considered to be significant if <0.05. Results: Total number of deliveries was (7736). The number of multiple delivers was (130), twins (121), triplet (7) & quadriplet
S170
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
(2). The incidence of twin pregnancy was 15.6/1000 delivers which is going in agreement of many studies, in-spite of ART and infertility management have increased the incidence of multiple pregnancies. Most cases of multiple pregnancies occurred before 35 years, probably the marriage age still younger than other countries. Most of primigravidae with multiple pregnancies delivered by cesarean section (72.2%), (P < 0.05). Para1-Para5 patients with twins showed significant increase in number of normal vaginal deliveries. Most cases of twin pregnancies delivered after 37 weeks (63%), only (37%) were preterm. No significant differences in maternal morbidity, mortality and morbidity in the neonates between cesarean sections & vaginal birth apart from risk of blood transfusion. All cases of multiple pregnancies with IUFD delivered vaginally. Conclusions: No significant differences in maternal & perinatal mortality and neonatal morbidity were found between twins born by cesarean sections and those born vaginally. O270 Applicable precautions for prevention of cervical stump carcinoma: An Egyptian experience M. Emam. Ob & gyn Objective: To pinpoint our experience on performing subtotal hysterectomy (SH) by performing certain simple and applicable precautions, for prevention the development of stump cervical carcinoma, as in Egypt; we are facing a problem of two paradox arms: un established screening programme for precancerous cervical lesions in one arm & increased practice of (SH) in the other arm. Methods: Prospectively, we apply certain precautions on performing 46 (SH) in last ten years in Mansoura university hospital in Egypt; utilizing visual inspection of cervix by acetic acid (VIA) preoperatively. Ablation of endocervical columnar epithelium and transformation zone intraoperatively. Lastly follow up, utilizing cervical screening recommendations postoperatively. On the other hand, a retrospective evaluation of 23 cases of stump carcinoma was done, where SH were done without precautions. Results: The prospective evaluation of 46 cases of (SH), where the precautions mentioned were applied, no report of any case of stump carcinoma till now. On the other hand the retrospective evaluation of cases with stump carcinoma showed that, no precautions were taken before performing SH. Conclusions: Morbidity and mortality from stump cervical carcinoma can be minimized by adherence to the recommended preoperative, intraoperative and postoperative precautions especially in localities without well established screening programmes for cervical precancerous lesions. O271 A study of the relationship between visually estimated blood loss during delivery and post partum hematocrit change E. Enabudoso, E. Gharoro. Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, P.M.B 1111, Benin City, Nigeria Introduction: Estimation of blood loss following delivery is an essential part of obstetric practice. Visual estimation of blood loss and postpartum hematocrit change are two commonly used methods of estimating blood loss following delivery. There is the need to study the relationship between both methods to aid standardization. Objective: To assess the average blood loss using visual estimation and the average change in postpartum hematocrit following vaginal delivery and to study any relationship between both. Materials and Methods: A prospective study involving 152 parturients who had vaginal delivery and in whom the blood loss at delivery was visually estimated, and an intrapartum and 48 hour postpartum hematocrit evaluation was done. Results: The average visually estimated blood loss following vaginal delivery was 317±197.5 mls with a primary postpartum hemorrhage
rate of 7.8% and over 60% of the parturients had minimal visual estimated blood loss of <200 mls. The average hematocrit change following vaginal delivery was 0.74±3.99% with 53.29% of parturients having either no change or an increased postpartum hematocrit. An increase in average blood loss was associated with a progressive change in hematocrit values from positive to negative and there was a statistically significant negative correlation between both variables – Spearman’s correlation coefficient was −0.549 with a P value <0.01. Conclusion: There is a negative, significant but non-linear correlation between visually estimated blood loss following vaginal delivery and postpartum hematocrit change. Other factors are also believed to affect the relationship. There is need for further research to determine factors that affect this relationship. Recommendations: Parturients who are dehydrated should be closely monitored especially in the immediate postpartum period as they could develop anaemia even in the face of visually estimated normal blood loss following delivery. Also, there is need for training of accocheurs to improve the accuracy of visual estimation of blood loss. Larger studies also need to be conducted to help review the necessity or otherwise of routine hematocrit evaluation following visual delivery. O272 Effects of simulation-based and traditional education on midwifery students’ skill in pelvic examinations F. Erfanian, T. Khadivzadeh Background: The Simulation Based Education (SBE) is useful in overcoming the practical and ethical tensions of practicing with living patients. Pelvic examination is un-pleasure both for the women being examined and the inexperience students. Aim: This study was conducted to determine the effect of SBE on midwifery students’ skill and learning experiences. Methods: In this randomized controlled trial, 56 midwifery students participated in two educational programs about pelvic examinations. Study group received SBE including standard patients and practice on models, add to methods administered for control group. The students’ performance evaluated through a simulationbased assessment using validated detailed checklists. Results: Students in SBE group had significantly better performance in pelvic examinations (p = 0.001) and rated their perceived ability higher (p = 0.000) compare to other group. Students reported SBE provide rapid feedback, help in 3D imaging of technique, led to better learning and faster recall of learned issues without anxiety of harm or discomfort for patients, and possibility of repeating as needed. Conclusion: The results suggest that SBE is a highly effective in enhancement of midwifery students’ skill in pelvic examinations and provide an enjoyable educational experience. The use of SBE in enhancement of special clinical skills must be considered and assessed. O273 Jejunum segment use for vaginal reconstruction: clinical experience in twenty-two patients 2 3 ¨ Ozkan ¨ M. Erman Akar1 , O. , T. Colak ¸ , N. Kayacan4 . 1 Akdeniz University Department of Obstetrics and Gynecology, 2 Department of Plastic Surgery, 3 Department of General Surgery, 4 Department of Anaesthesiology and Reanimation Twenty-two patients with absence of the vagina underwent vaginal reconstruction using the jejunal segment transfer technique. The flap was salvaged with venous anastomosis revision. The overall flap success rate was thus 100%. No urinary tract or gastrointestinal system complication was observed in any case, nor any stenosis of vaginal introitus. The average follow-up period was 14.5 months (ranges between 4 to 38 months). Both the depth and diameter of the neovagina were satisfactory postoperatively. After the
instrumental delivery & birth trauma were excluded. 100 patients were received either oxytocin or methergine immediately after delivery, & 100 patients were received misoprostol 400 mg either buccal (50 patients) or rectal (50 patients) immediately after delivery, both groups were around the same parity, around 70% of the patient were ≤p4 & 30% were >p4. In group (1) oxytocin group 21 patient develop P.P.H & 4 patient need blood transfusion. In group (2) misoprostol group, 6 patients develop P.P.H after misoprostol And given piton ± methergine in this category the birth weight of the baby >4 kg One of them receive 1 unit blood transfusion & one of them post partum evacuation done because of retained placental tissue. All these patients were >85 kg weight & there age between 25–34 years. In misoprostol group (group 2) 2 patient developed diarrhea & 3patient developed vomiting as drug side effect. There’s no significant difference in the effect &side effect of misoprostol which given either rectally or buccal, but buccal is more accepted by the patient. There’s no significant difference in days of hospital stay between the two groups. Results of our study show that: There’s significant Reduction of p.p.H & the need of blood transfusion when misoprostol used instead of oxytocin or methergine as an active management of 3rd stage of labour. In conclusion, P.p.H witch occur with misoprostol could be related to the patient weight & to the baby birth weight. O266 From Kuala Lumpur (2006) to Cape Town (2009), novasure impedance controlled endometrial ablation – Three-year follow up
S169
O267 Ultrasonographic evaluation of lower uterine segment thickness in pregnant women with previous cesarean section D. Elmoghazy. Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University, Egypt Objective: To evaluate the lower uterine segment thickness in pregnant women with previous cesarean section by ultrasonography in comparison to those with previous normal vaginal delivery, and to determine a critical thickness above which safe vaginal delivery is predictable. Methods: A prospective observational study of 100 antenatal women with previous cesarean delivery and 50 controls was carried out. Transabdominal and transvaginal ultrasonography were used in both groups to evaluate lower uterine segment thickness. The obstetric outcome in patients with successful vaginal birth and intraoperative findings in women undergoing cesarean delivery were correlated with lower segment thickness. Results: The overall vaginal birth after cesarean section (VBAC) was 68%, the incidence of dehiscence was 28%, and there were no uterine ruptures. There was an 86% correlation between transabdominal ultrasonography with magnification and transvaginal ultrasonography. The critical cutoff value for safe lower segment thickness, derived from the receiver operator characteristic curve, was 2.5 mm. Conclusion: Ultrasonographic evaluation permits better assessment of the risk of scar complication intrapartum, and could allow for safer management of delivery.
A. Elmardi1 , M. Hamza, S. Furara, F. Khan, I. Gallos, A. Yagoub. 1 Obstetrics and Gynaecology department, Stafford General Hospital, Stafford, UK
O268 Hepatitis B virus and Hepatitis C virus in pregnant Sudanese women
Objectives: – To assess the safety, efficacy and patient satisfaction after the procedure in women with menorrhagia secondary to dysfunctional uterine bleeding – To compare our current results (bigger sample size and longer duration post treatment) to initial results presented at Kuala Lumpur in 2006. Materials and Methods: Note: The numbers into brackets represent our initial figures presented at Kuala Lumpur (KL) in 2006. A pilot study was used at our hospital with 199 (KL, 50) premenopausal women with menorrhagia secondary to dysfunctional uterine bleeding. Approval was sought from the Patient Advisory and Liaisons Services (PALS) and data was analyzed using postal questionnaires, Pictorial Blood loss assessment chart diary pre and post treatment, and individual patient case notes. Results: Out of the total of 199 patients who received the treatment, data was analyzed in 171 (KL, 50 and 40 respectively). The mean postoperative period following the study was of 18 months (KL, 6 months). Treatment time averaged 94 seconds (KL, 93 seconds). None of the patients had intraoperative complications (KL, same). 93.6% reported reduction in their periods and 61% reported complete amenorrhoea (KL, 95% and 80% respectively). 58% (KL, 75%) reported improvement in dysmenorrhoea. 85% (KL, 95%) were satisfied with the results. Conclusions: Novasure provides a safe, effective and rapid treatment option for menorrhagia and potentially avoids major surgery. It has a short intraoperative time and can be performed at anytime during menstrual cycle without the need for endometrial pretreatment. Results of our study are comparable to the figures quoted by the manufacturers. These observations are very valuable during preoperative counseling of patients undergoing novasure endometrial ablation. Hysterectomy was avoided in 95.53%.
R. Elsheikh, A. Daak, M. Elsheikh, M. Karsany, I. Adam Background: The epidemiology of viral hepatitis during pregnancy is essential for health planners and programme managers. While much data exist concerning viral hepatatis during pregnancy in many African countries, no proper published data are available in Sudan. Aim: The study aimed to investigate the sero-prevalance and the possible risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) among antenatal care attendants in central Sudan. Methods: During 3 months from March-June 2006, sera were collected from pregnant women at Omdurman Maternaty Hospital in Sudan and they were tested for markers of hepatitis B virus (HBVsAg) and anti-HCV. Results: HBVsAg was detected in 41 (5.6%) out of of 728 women, Anti-HCV was detected in 3 (0.6%) out of 423 women, all of them were not aware of their condition. Age, parity, gestational age, residence, history of blood transfusion, dental manipulations, tattooing and circumcision did not contribute significantly to increased HBVsAg sero-positivity. Conclusion: Thus 5.6% of pregnant women were positive for HBVsAg irrespective of their age, parity and sociodemographic characteristics. There was low prevalance of Anti-HCV. O269 Multiple pregnancies: risks and outcome O. Elsraiti, F. Essadi, M. Elmehashi, E. Bakosh Objective: Data of multiple pregnancies to be analysed in comparison to other studies and to find out whether maternal and perinatal mortality and neonatal morbidity are influenced by mode of delivery. Methods: We reviewed medical records of all women with multiple pregnancies who delivered in Misurata Teaching Hospital during a period of one year (1/6/2007–31/5/2008). Data analysed using chisquare test and P-value considered to be significant if <0.05. Results: Total number of deliveries was (7736). The number of multiple delivers was (130), twins (121), triplet (7) & quadriplet
S170
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
(2). The incidence of twin pregnancy was 15.6/1000 delivers which is going in agreement of many studies, in-spite of ART and infertility management have increased the incidence of multiple pregnancies. Most cases of multiple pregnancies occurred before 35 years, probably the marriage age still younger than other countries. Most of primigravidae with multiple pregnancies delivered by cesarean section (72.2%), (P < 0.05). Para1-Para5 patients with twins showed significant increase in number of normal vaginal deliveries. Most cases of twin pregnancies delivered after 37 weeks (63%), only (37%) were preterm. No significant differences in maternal morbidity, mortality and morbidity in the neonates between cesarean sections & vaginal birth apart from risk of blood transfusion. All cases of multiple pregnancies with IUFD delivered vaginally. Conclusions: No significant differences in maternal & perinatal mortality and neonatal morbidity were found between twins born by cesarean sections and those born vaginally. O270 Applicable precautions for prevention of cervical stump carcinoma: An Egyptian experience M. Emam. Ob & gyn Objective: To pinpoint our experience on performing subtotal hysterectomy (SH) by performing certain simple and applicable precautions, for prevention the development of stump cervical carcinoma, as in Egypt; we are facing a problem of two paradox arms: un established screening programme for precancerous cervical lesions in one arm & increased practice of (SH) in the other arm. Methods: Prospectively, we apply certain precautions on performing 46 (SH) in last ten years in Mansoura university hospital in Egypt; utilizing visual inspection of cervix by acetic acid (VIA) preoperatively. Ablation of endocervical columnar epithelium and transformation zone intraoperatively. Lastly follow up, utilizing cervical screening recommendations postoperatively. On the other hand, a retrospective evaluation of 23 cases of stump carcinoma was done, where SH were done without precautions. Results: The prospective evaluation of 46 cases of (SH), where the precautions mentioned were applied, no report of any case of stump carcinoma till now. On the other hand the retrospective evaluation of cases with stump carcinoma showed that, no precautions were taken before performing SH. Conclusions: Morbidity and mortality from stump cervical carcinoma can be minimized by adherence to the recommended preoperative, intraoperative and postoperative precautions especially in localities without well established screening programmes for cervical precancerous lesions. O271 A study of the relationship between visually estimated blood loss during delivery and post partum hematocrit change E. Enabudoso, E. Gharoro. Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, P.M.B 1111, Benin City, Nigeria Introduction: Estimation of blood loss following delivery is an essential part of obstetric practice. Visual estimation of blood loss and postpartum hematocrit change are two commonly used methods of estimating blood loss following delivery. There is the need to study the relationship between both methods to aid standardization. Objective: To assess the average blood loss using visual estimation and the average change in postpartum hematocrit following vaginal delivery and to study any relationship between both. Materials and Methods: A prospective study involving 152 parturients who had vaginal delivery and in whom the blood loss at delivery was visually estimated, and an intrapartum and 48 hour postpartum hematocrit evaluation was done. Results: The average visually estimated blood loss following vaginal delivery was 317±197.5 mls with a primary postpartum hemorrhage
rate of 7.8% and over 60% of the parturients had minimal visual estimated blood loss of <200 mls. The average hematocrit change following vaginal delivery was 0.74±3.99% with 53.29% of parturients having either no change or an increased postpartum hematocrit. An increase in average blood loss was associated with a progressive change in hematocrit values from positive to negative and there was a statistically significant negative correlation between both variables – Spearman’s correlation coefficient was −0.549 with a P value <0.01. Conclusion: There is a negative, significant but non-linear correlation between visually estimated blood loss following vaginal delivery and postpartum hematocrit change. Other factors are also believed to affect the relationship. There is need for further research to determine factors that affect this relationship. Recommendations: Parturients who are dehydrated should be closely monitored especially in the immediate postpartum period as they could develop anaemia even in the face of visually estimated normal blood loss following delivery. Also, there is need for training of accocheurs to improve the accuracy of visual estimation of blood loss. Larger studies also need to be conducted to help review the necessity or otherwise of routine hematocrit evaluation following visual delivery. O272 Effects of simulation-based and traditional education on midwifery students’ skill in pelvic examinations F. Erfanian, T. Khadivzadeh Background: The Simulation Based Education (SBE) is useful in overcoming the practical and ethical tensions of practicing with living patients. Pelvic examination is un-pleasure both for the women being examined and the inexperience students. Aim: This study was conducted to determine the effect of SBE on midwifery students’ skill and learning experiences. Methods: In this randomized controlled trial, 56 midwifery students participated in two educational programs about pelvic examinations. Study group received SBE including standard patients and practice on models, add to methods administered for control group. The students’ performance evaluated through a simulationbased assessment using validated detailed checklists. Results: Students in SBE group had significantly better performance in pelvic examinations (p = 0.001) and rated their perceived ability higher (p = 0.000) compare to other group. Students reported SBE provide rapid feedback, help in 3D imaging of technique, led to better learning and faster recall of learned issues without anxiety of harm or discomfort for patients, and possibility of repeating as needed. Conclusion: The results suggest that SBE is a highly effective in enhancement of midwifery students’ skill in pelvic examinations and provide an enjoyable educational experience. The use of SBE in enhancement of special clinical skills must be considered and assessed. O273 Jejunum segment use for vaginal reconstruction: clinical experience in twenty-two patients 2 3 ¨ Ozkan ¨ M. Erman Akar1 , O. , T. Colak ¸ , N. Kayacan4 . 1 Akdeniz University Department of Obstetrics and Gynecology, 2 Department of Plastic Surgery, 3 Department of General Surgery, 4 Department of Anaesthesiology and Reanimation Twenty-two patients with absence of the vagina underwent vaginal reconstruction using the jejunal segment transfer technique. The flap was salvaged with venous anastomosis revision. The overall flap success rate was thus 100%. No urinary tract or gastrointestinal system complication was observed in any case, nor any stenosis of vaginal introitus. The average follow-up period was 14.5 months (ranges between 4 to 38 months). Both the depth and diameter of the neovagina were satisfactory postoperatively. After the