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I105 USING MVA IN SECOND TRIMESTER ABORTION
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Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
cancer treatment, concurrent chemotherapy and radiotherapy were proposed for stage II, III and metastatic pelvic nodes stage I. Prospective and multicentric studies were necessary to identify the good way of treatment. I102 CAN WOMEN INTENDING LATE MOTHERHOOD TAKE PREVENTIVE MEASURES? J.W. Dudenhausen. Weill Cornell Medical College, Sidra Medical and Research Center, Qatar Foundation, Doha, State of Qatar Objectives: In the industrialized world, the mean age at which mothers give birth to their first child has increased. The purpose of this lecture is to review the available evidence in order to optimize preconception care in women who have postponed childbearing to the later years of the reproductive life cycle. Methods: Review of literature. Results: There is a paucity of evidence and rigorous studies to advise mothers on the potential interventions for optimizing pregnancy outcome. Conclusions: Evidence-based guidelines for advising women who postponed childbearing are scant, and further research in this important area is urgently needed. I103 DELAYED CORD CLAMPING L. Duley If the umbilical cord is not clamped immediately at birth, blood flow (‘placental transfusion’) usually continues for a few minutes. The volume and duration of placental transfusion are influenced by how hard the placenta is squeezed by the uterus after birth of the baby, how far the baby is held below or above the placenta during this time, and how long before the cord is clamped. For a term infant, placental transfusion is around 80–100 ml. Within a few hours, the additional plasma is lost to the circulation, leaving a high red cell mass which is quickly broken down and the iron stored. Reducing placental transfusion by immediate cord clamping deprives the infant of 20–30 mg/kg of iron, sufficient for his/her needs for around 3 months. The physiology of placental transfusion for preterm births is less well understood. For term births, placental transfusion reduces iron deficiency in early childhood, but whether this translates into improved neurodevelopmental outcome for the children remains unclear. For preterm births, data from small trials suggest that neonatal morbidity may be reduced but there are no data on outcome in childhood. To provide reliable evidence to guide clinical care requires large randomised trials, with follow up to assess neurodevelopment of the children. Systematic reviews of randomised trials comparing alternative policies for timing of cord clamping, and other strategies to influence placental transfusion, for term and preterm births will be presented, and the implications for clinical practice, health policy and research discussed. I104 COMPUTERISED TRAINING, LABOUR AND BIRTH O. Dupuis In 1969, Faro and Windle showed that periods of anoxia exceeding 10 minutes induced irreversible cerebral injury in monkeys [1]. Therefore in case of bradycardia decision to delivery interval is vital for the neonate. New tools, like color code can help to decrease decision to delivery interval [2]. Nevertheless comparing with performing a cesarean section we have shown that performing a forceps delivery allow a significantly shorter decision to delivery interval: The mean interval going from 29 minutes in case of cesarean section to 15 minutes in case of forceps deliveries [3]. In 2005, more than 190,000 infants were delivered by instrumental deliveries in the USA [4].
Unfortunately a survey of residents has shown that only 57% were trained with vacuum deliveries [5] and that only 58% felt competent to perform forceps deliveries [6]. Traditional training is limited by several constraints. Spatial ones involve the operators who only have limited visual access to the pelvic canal and time constraints whenever delivery occur in an emergency setting. European safety rules who prevent obstetricians working after on call duty has also decreased the time allocated for training. Finally increased litigation rate makes real time training frightening. Using a birthsimulator [7], we have recently shown that performing 70 forceps deliveries was probably needed in order to become a skilled operator [8]. Actual rate of instrumental deliveries will not allow residents to perform such a number of forceps deliveries. Simulation training allow to reach such a level. During this lecture we will discuss advantages and limits of simulation to increase obstetrical safety. Reference(s) [1] Faro MD, Windle WF. Transneuronal degeneration in brain of monkeys asphyxiated at birth. Exp Neurol 1969; 24: 38–53. [2] Dupuis O et al. Red, Orange and green caesarean sections: a new communication tool for on call obstetricians. Eur J Obstet Gynecol Reprod Biol;2008; 140: 206–11. [3] Dupuis O et al. Decision to deliver interval for forceps delivery and cesarean section: 137 extractions for abnormal FHR during labor. J Gynecol Obstet Biol Reprod. 2005; 34(8): 789–94. [4] Martin JA et al. Births: final data for 2005. Natl Vital Stat Rep 2007; 56: 1–103. [5] Bofill JA et al. Opertaive vaginal delivery. A survey of fellows of ACOG. Obstet Gynecol 1996; 88: 1007–10. [6] Powell J et al Vacuum and forceps training in residency:experience and self reported competency. J Perinatol 2007; 27(6): 343–6. [7] Dupuis O et al. A new obstetric forceps for the training of junior doctors: a comparison of the spatial dispersion of forceps blade trajectories between junior and senior obstetricians. Am J Obstet Gynecol 2006; 194: 1524–31. Video available within the AJOG paper. [8] Dupuis O et al. Does forceps training on a Birth simulator allow obstetrician to improve forceps blade placement? Eur J Obstet Gynecol Reprod Biol 2011; 159(2): 305–9.
I105 USING MVA IN SECOND TRIMESTER ABORTION A. Edelman. Obstetrics and Gynecology, Co-Director of the Oregon Family Planning Fellowship, Graduate Faculty in the Master in Public Health Program at Oregon Health & Science University (OHSU), and Collaborative Scientist at the Oregon National Primate Research Center, USA This presentation will discuss the use of MVA for second trimester surgical abortions (dilation and evacuation) and for treatment of retained placenta following second trimester medical abortions. In an effort to increase the availability of safe second trimester care, Ipas has introduced the use of MVA for second trimester abortion care in several low resource settings including Vietnam, Cambodia, Ethiopia, and Nepal. Ipas’s experience has demonstrated that the MVA can be easily and safely substituted in place of electric vacuum aspiration or even sharp curettage. I106 DID HYSTEROSCOPY CHANGE GYNECOLOGICAL PRACTICE? M.M.F. Elhao. ob and gyn, Ain Shams University, Cairo, Egypt Since the recent revival of hysteroscopy and the advance in hysteroscopic surgery many gynecologists learned the technique, however not all of them have mastered it. Many endoscopists have changed their pactice and altered their managements including their patients consultations, and prognostic decisions. These aspect are presented and discussed in a comprehensive way about an experience of almost 35 years with hysteroscopy.
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
cancer treatment, concurrent chemotherapy and radiotherapy were proposed for stage II, III and metastatic pelvic nodes stage I. Prospective and multicentric studies were necessary to identify the good way of treatment. I102 CAN WOMEN INTENDING LATE MOTHERHOOD TAKE PREVENTIVE MEASURES? J.W. Dudenhausen. Weill Cornell Medical College, Sidra Medical and Research Center, Qatar Foundation, Doha, State of Qatar Objectives: In the industrialized world, the mean age at which mothers give birth to their first child has increased. The purpose of this lecture is to review the available evidence in order to optimize preconception care in women who have postponed childbearing to the later years of the reproductive life cycle. Methods: Review of literature. Results: There is a paucity of evidence and rigorous studies to advise mothers on the potential interventions for optimizing pregnancy outcome. Conclusions: Evidence-based guidelines for advising women who postponed childbearing are scant, and further research in this important area is urgently needed. I103 DELAYED CORD CLAMPING L. Duley If the umbilical cord is not clamped immediately at birth, blood flow (‘placental transfusion’) usually continues for a few minutes. The volume and duration of placental transfusion are influenced by how hard the placenta is squeezed by the uterus after birth of the baby, how far the baby is held below or above the placenta during this time, and how long before the cord is clamped. For a term infant, placental transfusion is around 80–100 ml. Within a few hours, the additional plasma is lost to the circulation, leaving a high red cell mass which is quickly broken down and the iron stored. Reducing placental transfusion by immediate cord clamping deprives the infant of 20–30 mg/kg of iron, sufficient for his/her needs for around 3 months. The physiology of placental transfusion for preterm births is less well understood. For term births, placental transfusion reduces iron deficiency in early childhood, but whether this translates into improved neurodevelopmental outcome for the children remains unclear. For preterm births, data from small trials suggest that neonatal morbidity may be reduced but there are no data on outcome in childhood. To provide reliable evidence to guide clinical care requires large randomised trials, with follow up to assess neurodevelopment of the children. Systematic reviews of randomised trials comparing alternative policies for timing of cord clamping, and other strategies to influence placental transfusion, for term and preterm births will be presented, and the implications for clinical practice, health policy and research discussed. I104 COMPUTERISED TRAINING, LABOUR AND BIRTH O. Dupuis In 1969, Faro and Windle showed that periods of anoxia exceeding 10 minutes induced irreversible cerebral injury in monkeys [1]. Therefore in case of bradycardia decision to delivery interval is vital for the neonate. New tools, like color code can help to decrease decision to delivery interval [2]. Nevertheless comparing with performing a cesarean section we have shown that performing a forceps delivery allow a significantly shorter decision to delivery interval: The mean interval going from 29 minutes in case of cesarean section to 15 minutes in case of forceps deliveries [3]. In 2005, more than 190,000 infants were delivered by instrumental deliveries in the USA [4].
Unfortunately a survey of residents has shown that only 57% were trained with vacuum deliveries [5] and that only 58% felt competent to perform forceps deliveries [6]. Traditional training is limited by several constraints. Spatial ones involve the operators who only have limited visual access to the pelvic canal and time constraints whenever delivery occur in an emergency setting. European safety rules who prevent obstetricians working after on call duty has also decreased the time allocated for training. Finally increased litigation rate makes real time training frightening. Using a birthsimulator [7], we have recently shown that performing 70 forceps deliveries was probably needed in order to become a skilled operator [8]. Actual rate of instrumental deliveries will not allow residents to perform such a number of forceps deliveries. Simulation training allow to reach such a level. During this lecture we will discuss advantages and limits of simulation to increase obstetrical safety. Reference(s) [1] Faro MD, Windle WF. Transneuronal degeneration in brain of monkeys asphyxiated at birth. Exp Neurol 1969; 24: 38–53. [2] Dupuis O et al. Red, Orange and green caesarean sections: a new communication tool for on call obstetricians. Eur J Obstet Gynecol Reprod Biol;2008; 140: 206–11. [3] Dupuis O et al. Decision to deliver interval for forceps delivery and cesarean section: 137 extractions for abnormal FHR during labor. J Gynecol Obstet Biol Reprod. 2005; 34(8): 789–94. [4] Martin JA et al. Births: final data for 2005. Natl Vital Stat Rep 2007; 56: 1–103. [5] Bofill JA et al. Opertaive vaginal delivery. A survey of fellows of ACOG. Obstet Gynecol 1996; 88: 1007–10. [6] Powell J et al Vacuum and forceps training in residency:experience and self reported competency. J Perinatol 2007; 27(6): 343–6. [7] Dupuis O et al. A new obstetric forceps for the training of junior doctors: a comparison of the spatial dispersion of forceps blade trajectories between junior and senior obstetricians. Am J Obstet Gynecol 2006; 194: 1524–31. Video available within the AJOG paper. [8] Dupuis O et al. Does forceps training on a Birth simulator allow obstetrician to improve forceps blade placement? Eur J Obstet Gynecol Reprod Biol 2011; 159(2): 305–9.
I105 USING MVA IN SECOND TRIMESTER ABORTION A. Edelman. Obstetrics and Gynecology, Co-Director of the Oregon Family Planning Fellowship, Graduate Faculty in the Master in Public Health Program at Oregon Health & Science University (OHSU), and Collaborative Scientist at the Oregon National Primate Research Center, USA This presentation will discuss the use of MVA for second trimester surgical abortions (dilation and evacuation) and for treatment of retained placenta following second trimester medical abortions. In an effort to increase the availability of safe second trimester care, Ipas has introduced the use of MVA for second trimester abortion care in several low resource settings including Vietnam, Cambodia, Ethiopia, and Nepal. Ipas’s experience has demonstrated that the MVA can be easily and safely substituted in place of electric vacuum aspiration or even sharp curettage. I106 DID HYSTEROSCOPY CHANGE GYNECOLOGICAL PRACTICE? M.M.F. Elhao. ob and gyn, Ain Shams University, Cairo, Egypt Since the recent revival of hysteroscopy and the advance in hysteroscopic surgery many gynecologists learned the technique, however not all of them have mastered it. Many endoscopists have changed their pactice and altered their managements including their patients consultations, and prognostic decisions. These aspect are presented and discussed in a comprehensive way about an experience of almost 35 years with hysteroscopy.