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O882 Ruptured renal artery aneurysm during pregnancy, a clinical dilemma
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
were analysed using data in Cancer Registry: 482 (94.5%) were alive, 17 (3.5%) dead and 11 (2%) not registered. One death occurred 3 years after diagnosis of stage IA2 MIC in cervical cone and after final treatment, hysterectomy and lymphadenectomy (LD). Recurrent disease appeared in the unremoved ovary and Fallopian tube. Causes of death in 10 patients were malignant neoplasms of gastrointestinal tract (5), breast (1), and other not neoplastic diseases (4). In 37 years old patient stage IA2 CC was diagnosed in cervical cone. Hysterectomy was advised but not accepted. One year after conisation recurrent disease in stage IB appeared and was treated with radical hysterectomy and LD. Patient is alive and free of CC. Conclusions: The radicality in treatment of cervical cancer has diminished and today almost 70% of all cases even stage IA2 has been treated only with conisation. When stage IA1/A2 CC were treated with conservative surgical approach (conisation) very low risk of recurrence (0.35%), lymph node disease (0.35%), or death caused by cancer (0.17%) was found in our study. Based on our experience, conservative management of MIC is safe when exact evaluation of tumor extension and surgical margins of the cone are assured. O881 Cervical cytology screening as part of antenatal care in pregnant women L. Snyman, K. Minnaar. Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria Background: Cervical carcinoma remains an important disease. It is the most common gynaecological malignancy in South Africa, where an effective screening program has not been implemented. Pregnancy offers an opportunity for cervical cancer screening as the majority of local pregnant women attend ante natal clinics. HIV infection increases the risk for cervical pre-malignant lesions and cancer. Objective: To assess the prevalence of abnormal cervical smears in a pregnant population and to compare HIV infected and non-infected women. Setting: Kalafong Hospital in Atteridgeville, Pretoria, South Africa. Methods: A comparative cross-sectional study. Patients were recruited from the antenatal clinic for cervical smear testing. ASCUS, LGSIL, HGSIL and AGUS lesions were regarded as abnormal. The prevalence of cervical abnormalities and cytological evidence of HPV infection were compared between HIV positive and HIV negative women. Results: Results for 355 patients were analysed. The mean age is 30 years. Forty five abnormal smears (12.67%) with SIL or ASCUS lesions were reported. Hundred and thirty three patients were HIV positive (37%). Thirty five patients (26.3%) in the HIV positive group had abnormal smears. Ten patients (4.5%) in the HIV negative group had abnormal smears (p = 0.000). Fifty two (39%) patients in the HIV positive group had HPV infection on the smear. There were 17 (13%) patients in the HIV infected group with HSIL on their smears, while only 3 (1.4%) patients in the HIV negative group had HSIL smears (p = 0.0000, OR 10.69; 95% CI 3.07–37.26). The abnormal smear rate was not statistically significant in women younger than 30 compared to those 30 years and older. The findings in this study differs quite dramatically from an audit performed in the same unit in 1993/4, and also show that the National screening policy is inadequate HIV positive patients, as it will miss 48% patients with abnormal smears. Conclusion: Screening for cervical abnormalities in pregnant patients yielded a high prevalence of cervical premalignant lesions in HIV infected women, and should be part of routine ante natal care in HIV infected women. The National screening policy should be adapted to accommodate all HIV infected women.
O882 Ruptured renal artery aneurysm during pregnancy, a clinical dilemma K. Soliman1 , Y. Shawky1 , M. Abbas1 , M. Ammary2 , A. Shaaban3 . 1 Obstetrics Gynecology Department, Maternity and Children Hospital, Buraidah, Qassim, Saudi Arabia, 2 General Surgery Department, King Fahd Specialist Hospital, Buraidah, Qassim, Saudi Arabia, 3 Urology Department, King Fahd Specialist Hospital, Buraidah, Qassim, Saudi Arabia Background: Rupture of a renal artery aneurysm (RAA) during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. Case presentation: We present here a case report of total avulsion of solitary kidney secondary to rupture of RAA in a pregnant patient with congenital absence of the contralateral kidney. The main indication for nephrectomy was severely damaged kidney. Diagnosis was made during operation and both mother and fetus were saved. There are no previous reports of an intact renal artery aneurysm diagnosed either antepartum or postpartum. Conclusion: The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. This case was unusual because it occurred in a solitary kidney, during the third trimester of pregnancy. O883 Incontinence in the Sudan; Magnitude of the problem N. Soliman1 , A. Elmardi, H. Abuzeid. 1 Ribat University Hospital Introduction: 4% of Africa’s population (40 million) reside in Sudan. Females comprises almost 50% of them. Assuming international figures of an average of 20% for prevalence of urinary incontinence leaves us with a potential of 8 million women in sudan affected. Figures are frightening and so is the disability that this problem of incontinence could leave our women with from simple embarrassment to complete social detachment. Objectives: The purpose of this study was to determine the prevalence of urinary and fecal incontinence among sudanese women and to study their knowledge, practice and attitude along with the impact it has on their quality of lives. Methodology: 535 women attending gynaecological outpatient clinics in Khartoum over a 4 week period were consented to fill a structured questionnaire. The prevalence of Urinary Incontinence among Sudanese women was found to be 19.6% of which 39% was Stress incontinence, 24.8% was Urge incontinence and 36.2% Mixed Incontinence.17.1% of women sought medical advice while 82.9% did not. The reasons for not seeking medical advice were multifactorial, 11% of them being embarrassed. A negative impact on the women’s lives was evident. Conclusion: This study confirms that urinary incontinence is quite common amongst Sudanese women. The attitudes towards the disease are unsurprisingly similar to the western literature. The authors hope that addressing the objectives of this study would encourage young researchers within the African continent to look into this disease area and contribute with studies to advance the management of incontinence with technologies appropriate to the developing countries.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
were analysed using data in Cancer Registry: 482 (94.5%) were alive, 17 (3.5%) dead and 11 (2%) not registered. One death occurred 3 years after diagnosis of stage IA2 MIC in cervical cone and after final treatment, hysterectomy and lymphadenectomy (LD). Recurrent disease appeared in the unremoved ovary and Fallopian tube. Causes of death in 10 patients were malignant neoplasms of gastrointestinal tract (5), breast (1), and other not neoplastic diseases (4). In 37 years old patient stage IA2 CC was diagnosed in cervical cone. Hysterectomy was advised but not accepted. One year after conisation recurrent disease in stage IB appeared and was treated with radical hysterectomy and LD. Patient is alive and free of CC. Conclusions: The radicality in treatment of cervical cancer has diminished and today almost 70% of all cases even stage IA2 has been treated only with conisation. When stage IA1/A2 CC were treated with conservative surgical approach (conisation) very low risk of recurrence (0.35%), lymph node disease (0.35%), or death caused by cancer (0.17%) was found in our study. Based on our experience, conservative management of MIC is safe when exact evaluation of tumor extension and surgical margins of the cone are assured. O881 Cervical cytology screening as part of antenatal care in pregnant women L. Snyman, K. Minnaar. Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, University of Pretoria Background: Cervical carcinoma remains an important disease. It is the most common gynaecological malignancy in South Africa, where an effective screening program has not been implemented. Pregnancy offers an opportunity for cervical cancer screening as the majority of local pregnant women attend ante natal clinics. HIV infection increases the risk for cervical pre-malignant lesions and cancer. Objective: To assess the prevalence of abnormal cervical smears in a pregnant population and to compare HIV infected and non-infected women. Setting: Kalafong Hospital in Atteridgeville, Pretoria, South Africa. Methods: A comparative cross-sectional study. Patients were recruited from the antenatal clinic for cervical smear testing. ASCUS, LGSIL, HGSIL and AGUS lesions were regarded as abnormal. The prevalence of cervical abnormalities and cytological evidence of HPV infection were compared between HIV positive and HIV negative women. Results: Results for 355 patients were analysed. The mean age is 30 years. Forty five abnormal smears (12.67%) with SIL or ASCUS lesions were reported. Hundred and thirty three patients were HIV positive (37%). Thirty five patients (26.3%) in the HIV positive group had abnormal smears. Ten patients (4.5%) in the HIV negative group had abnormal smears (p = 0.000). Fifty two (39%) patients in the HIV positive group had HPV infection on the smear. There were 17 (13%) patients in the HIV infected group with HSIL on their smears, while only 3 (1.4%) patients in the HIV negative group had HSIL smears (p = 0.0000, OR 10.69; 95% CI 3.07–37.26). The abnormal smear rate was not statistically significant in women younger than 30 compared to those 30 years and older. The findings in this study differs quite dramatically from an audit performed in the same unit in 1993/4, and also show that the National screening policy is inadequate HIV positive patients, as it will miss 48% patients with abnormal smears. Conclusion: Screening for cervical abnormalities in pregnant patients yielded a high prevalence of cervical premalignant lesions in HIV infected women, and should be part of routine ante natal care in HIV infected women. The National screening policy should be adapted to accommodate all HIV infected women.
O882 Ruptured renal artery aneurysm during pregnancy, a clinical dilemma K. Soliman1 , Y. Shawky1 , M. Abbas1 , M. Ammary2 , A. Shaaban3 . 1 Obstetrics Gynecology Department, Maternity and Children Hospital, Buraidah, Qassim, Saudi Arabia, 2 General Surgery Department, King Fahd Specialist Hospital, Buraidah, Qassim, Saudi Arabia, 3 Urology Department, King Fahd Specialist Hospital, Buraidah, Qassim, Saudi Arabia Background: Rupture of a renal artery aneurysm (RAA) during pregnancy is a rare event, with a high mortality rate for both mother and fetus. Increased blood flow and intra-abdominal pressure, and vascular changes secondary to increased steroid production are postulated as contributory to the increased risk of rupture during pregnancy. Case presentation: We present here a case report of total avulsion of solitary kidney secondary to rupture of RAA in a pregnant patient with congenital absence of the contralateral kidney. The main indication for nephrectomy was severely damaged kidney. Diagnosis was made during operation and both mother and fetus were saved. There are no previous reports of an intact renal artery aneurysm diagnosed either antepartum or postpartum. Conclusion: The possibility of a ruptured RAA should be considered in pregnant women with evidence of retroperitoneal hemorrhage. This case was unusual because it occurred in a solitary kidney, during the third trimester of pregnancy. O883 Incontinence in the Sudan; Magnitude of the problem N. Soliman1 , A. Elmardi, H. Abuzeid. 1 Ribat University Hospital Introduction: 4% of Africa’s population (40 million) reside in Sudan. Females comprises almost 50% of them. Assuming international figures of an average of 20% for prevalence of urinary incontinence leaves us with a potential of 8 million women in sudan affected. Figures are frightening and so is the disability that this problem of incontinence could leave our women with from simple embarrassment to complete social detachment. Objectives: The purpose of this study was to determine the prevalence of urinary and fecal incontinence among sudanese women and to study their knowledge, practice and attitude along with the impact it has on their quality of lives. Methodology: 535 women attending gynaecological outpatient clinics in Khartoum over a 4 week period were consented to fill a structured questionnaire. The prevalence of Urinary Incontinence among Sudanese women was found to be 19.6% of which 39% was Stress incontinence, 24.8% was Urge incontinence and 36.2% Mixed Incontinence.17.1% of women sought medical advice while 82.9% did not. The reasons for not seeking medical advice were multifactorial, 11% of them being embarrassed. A negative impact on the women’s lives was evident. Conclusion: This study confirms that urinary incontinence is quite common amongst Sudanese women. The attitudes towards the disease are unsurprisingly similar to the western literature. The authors hope that addressing the objectives of this study would encourage young researchers within the African continent to look into this disease area and contribute with studies to advance the management of incontinence with technologies appropriate to the developing countries.