- Email: [email protected]
I117 CLIENT INTERVIEW AND BIMANUAL EXAMINATION USING NO TECHNOLOGY TO ASSESS OUTCOME OF MEDICAL ABORTION
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
baseline and after 3, 6, 12 and 24 months after surgery. Patients experiencing recurrence/progression of disease were withdrawn from final evaluation. Anova for repeated measures was used to analyze scoring changes over time and to identify predictors of poor QoL scores. Results: Between February 2007 and April 2011, 105 ECC and 122 LACC patients were enrolled in the study. During the follow-up period recurrence of disease was observed in 10 ECC, and 41 LACC patients, respectively. There was no difference in the baseline scores for any of the assessed items between ECC and LACC. In ECC, we showed a substantially significant improvement of symptoms experience (SE) at 3 months from surgery compared to baseline (3months 7.3±1.9, Vs Baseline 10.8±1.8; p = 0.002) which persisted up to 24 months (24-months 6.2±1.9). As expected, menopause (MS at 3-months 25.4±3.2, Vs Baseline 11.5±2.3; p = 0.004) and lymphedema-associated symptoms (LY at 3-months 17.1±2.0, Vs Baseline 13.0±2.1; p = 0.014) showed a significant deterioration after 3 months from surgery compared to baseline which persisted even after 2-year of observation. Finally, 24 months after surgery we observed a significant improvement of scores for body-image (BI at 24-months 7.9±1.5, Vs Baseline 14.4±2.1; p = 0.020) and sexual-activity (SXA at 24-months 30.1±2.6, Vs Baseline 16.2±2.4; p = 0.001) compared to baseline. Focusing on emotional distress, anxiety scores significantly recovered after 2-year of observation (A at 24-months 5.3±0.3, Vs Baseline 8.1±0.4; p = 0.001), no changes over-time were observed for depression levels. As far as LACC patients is concerned, an early recovery (within 3 months) which persisted over-time was observed for C30, SE, BI and A items. Moreover, a significant improvement of SXA scores was observed after 2-year of observation compared to baseline (SXA at 24-months 14.7±2.5, Vs Baseline 8.6±1.6; p = 0.008). On the other hand, an early deterioration, without long-term recovery was documented for MS and LY associated symptoms. In multivariate analysis: post-operative complications (p = 0.032) and low education level (p = 0.010) were identified as predictors of poor LY scores in LACC, whereas living status alone (p = 0.002) was the only independent predictor of poor A scores in LACC. No other clinicopathological factors retained predictive power. Conclusions: A long-term recovery has been observed at 24 months assessment for the vast majority of QOL and HADS items (C30, SE, BI, SXA, A). On the other hand, LY and MS symptoms were the most disabling treatment-related sequelae resulting negatively affected even after 24 months from surgery. Socio-demographic features such as living status and education level emerged as independent predictive factors of poor LY and A scores in LACC, suggesting that unmet needs should be adequately addressed in the next future in these specific cohorts of patients. I115 UPDATING FAMILY PLANNING INFORMATION THROUGH STANDARDIZED TRAINING MATERIALS M. Festin Introduction: The Training Resource Package for Family Planning is a new key resource for trainors, supervisors, and program managers of family planning and reproductive health. Description of development of the tool: The FP TRP is based on the evidenced based guidance materials for family planning, including the Family Planning Global handbook for providers, the Medical eligibility criteria for contraceptive use, and the Selected practices recommendations for contraceptive use. These materials form part of the WHO cornerstones of family planning guidance, which are regularly being updated with the latest high quality evidence. Components of the tool: The TRP will be a web-based resource and includes components and tools for designing, implementing, and evaluating training on family planning methods. Modules are designed to have a model session plan with prepared instructional materials which are meant to be adapted and modified according
S189
to the setting, objective of the training, and target audience, which may include clinical specialists or community lay health workers. Modules will include specific contraceptive methods, such as the combined oral contraceptives, hormonal injectables, implants, condoms, IUDs, sterization, and skills on informed choice counselling. The presentation will focus on the content and evidence base of the modules. Results and Recommendations: These modules have been field tested and updated based on the feedback, which have generally shown favourable acceptability for use. The availability of these modules will facilitate training on the updated evidence based materials of more providers of family planning services. I116 INCONTINENCE AFTER PROLAPSE SURGERY T. Fink, L. Hartmann, G. Hoffmann. Department of Urogynecology, St Josefs-Hospital, Wiesbaden, Germany Objective: Whether concomitant pelvic organ prolapse repair and surgery for urinary incontinence should be performed at the same time is widely debated. It is known that a background prevalence of occult stress urinary incontinence may be as high as 80% and up to 40% de novo stress urinary incontinence (SUI) is reported after urogenital prolapse surgery. This analysis will review the recommendations for treatment in one or two stages based on current literature. Methods: A computerized bibliographic enquiry on Pubmed using the keywords “pelvic organ prolapse, stress urinary incontinence, colposuspension, de novo incontinence, TVT, pelvic floor surgery”, from January 2009 until February 2012. Prospective and retrospective studies were enrolled and analyzed. Results: The incidence of SUI following vaginal prolapse repair was 42% in a 2 years follow up (AL-Mandeel et al.). In a randomized controlled trial the group with abdominal prolapse surgery and concomitant Burch colposuspension showed an almost 30% rate of post operative incontinence in long time follow up when compared to 16 de novo cases of SUI in the only prolapse repair group (Costantini et al.). Discussion: The majority of patients with occult stress urinary incontinence do not develop urinary incontinence after prolapse surgery. If all women with organ prolapse had concomitant incontinence surgery there would be problems with overtreatment and issues of cost efficacy to be considered in many patients. Conclusion: The majority of patients do not develop a de novo SUI after prolpase surgery. So routinely incontinence surgery at the time of prolapse surgery should not be recommended. I117 CLIENT INTERVIEW AND BIMANUAL EXAMINATION USING NO TECHNOLOGY TO ASSESS OUTCOME OF MEDICAL ABORTION M. Fjerstad. WomanCare Global and Ipas Particularly in low-resource settings, medical abortion is being provided successfully by various cadres of providers using no technology. Providers use clinical skills only: interview with the woman and bimanual examination. Ultrasound is not available or used in routine provision of medical abortion. We will discuss medical abortion provision in Ethiopia and Nepal where medical abortion is provided in urban areas and rural health outposts. Medical abortion results in the same high success rates and low complication profile seen in high-resource settings. Research is underway in Nepal and Africa to assess whether a woman herself, or a community health worker, can: (1) determine eligibility for medical abortion and (2) assess success following medical abortion.
baseline and after 3, 6, 12 and 24 months after surgery. Patients experiencing recurrence/progression of disease were withdrawn from final evaluation. Anova for repeated measures was used to analyze scoring changes over time and to identify predictors of poor QoL scores. Results: Between February 2007 and April 2011, 105 ECC and 122 LACC patients were enrolled in the study. During the follow-up period recurrence of disease was observed in 10 ECC, and 41 LACC patients, respectively. There was no difference in the baseline scores for any of the assessed items between ECC and LACC. In ECC, we showed a substantially significant improvement of symptoms experience (SE) at 3 months from surgery compared to baseline (3months 7.3±1.9, Vs Baseline 10.8±1.8; p = 0.002) which persisted up to 24 months (24-months 6.2±1.9). As expected, menopause (MS at 3-months 25.4±3.2, Vs Baseline 11.5±2.3; p = 0.004) and lymphedema-associated symptoms (LY at 3-months 17.1±2.0, Vs Baseline 13.0±2.1; p = 0.014) showed a significant deterioration after 3 months from surgery compared to baseline which persisted even after 2-year of observation. Finally, 24 months after surgery we observed a significant improvement of scores for body-image (BI at 24-months 7.9±1.5, Vs Baseline 14.4±2.1; p = 0.020) and sexual-activity (SXA at 24-months 30.1±2.6, Vs Baseline 16.2±2.4; p = 0.001) compared to baseline. Focusing on emotional distress, anxiety scores significantly recovered after 2-year of observation (A at 24-months 5.3±0.3, Vs Baseline 8.1±0.4; p = 0.001), no changes over-time were observed for depression levels. As far as LACC patients is concerned, an early recovery (within 3 months) which persisted over-time was observed for C30, SE, BI and A items. Moreover, a significant improvement of SXA scores was observed after 2-year of observation compared to baseline (SXA at 24-months 14.7±2.5, Vs Baseline 8.6±1.6; p = 0.008). On the other hand, an early deterioration, without long-term recovery was documented for MS and LY associated symptoms. In multivariate analysis: post-operative complications (p = 0.032) and low education level (p = 0.010) were identified as predictors of poor LY scores in LACC, whereas living status alone (p = 0.002) was the only independent predictor of poor A scores in LACC. No other clinicopathological factors retained predictive power. Conclusions: A long-term recovery has been observed at 24 months assessment for the vast majority of QOL and HADS items (C30, SE, BI, SXA, A). On the other hand, LY and MS symptoms were the most disabling treatment-related sequelae resulting negatively affected even after 24 months from surgery. Socio-demographic features such as living status and education level emerged as independent predictive factors of poor LY and A scores in LACC, suggesting that unmet needs should be adequately addressed in the next future in these specific cohorts of patients. I115 UPDATING FAMILY PLANNING INFORMATION THROUGH STANDARDIZED TRAINING MATERIALS M. Festin Introduction: The Training Resource Package for Family Planning is a new key resource for trainors, supervisors, and program managers of family planning and reproductive health. Description of development of the tool: The FP TRP is based on the evidenced based guidance materials for family planning, including the Family Planning Global handbook for providers, the Medical eligibility criteria for contraceptive use, and the Selected practices recommendations for contraceptive use. These materials form part of the WHO cornerstones of family planning guidance, which are regularly being updated with the latest high quality evidence. Components of the tool: The TRP will be a web-based resource and includes components and tools for designing, implementing, and evaluating training on family planning methods. Modules are designed to have a model session plan with prepared instructional materials which are meant to be adapted and modified according
S189
to the setting, objective of the training, and target audience, which may include clinical specialists or community lay health workers. Modules will include specific contraceptive methods, such as the combined oral contraceptives, hormonal injectables, implants, condoms, IUDs, sterization, and skills on informed choice counselling. The presentation will focus on the content and evidence base of the modules. Results and Recommendations: These modules have been field tested and updated based on the feedback, which have generally shown favourable acceptability for use. The availability of these modules will facilitate training on the updated evidence based materials of more providers of family planning services. I116 INCONTINENCE AFTER PROLAPSE SURGERY T. Fink, L. Hartmann, G. Hoffmann. Department of Urogynecology, St Josefs-Hospital, Wiesbaden, Germany Objective: Whether concomitant pelvic organ prolapse repair and surgery for urinary incontinence should be performed at the same time is widely debated. It is known that a background prevalence of occult stress urinary incontinence may be as high as 80% and up to 40% de novo stress urinary incontinence (SUI) is reported after urogenital prolapse surgery. This analysis will review the recommendations for treatment in one or two stages based on current literature. Methods: A computerized bibliographic enquiry on Pubmed using the keywords “pelvic organ prolapse, stress urinary incontinence, colposuspension, de novo incontinence, TVT, pelvic floor surgery”, from January 2009 until February 2012. Prospective and retrospective studies were enrolled and analyzed. Results: The incidence of SUI following vaginal prolapse repair was 42% in a 2 years follow up (AL-Mandeel et al.). In a randomized controlled trial the group with abdominal prolapse surgery and concomitant Burch colposuspension showed an almost 30% rate of post operative incontinence in long time follow up when compared to 16 de novo cases of SUI in the only prolapse repair group (Costantini et al.). Discussion: The majority of patients with occult stress urinary incontinence do not develop urinary incontinence after prolapse surgery. If all women with organ prolapse had concomitant incontinence surgery there would be problems with overtreatment and issues of cost efficacy to be considered in many patients. Conclusion: The majority of patients do not develop a de novo SUI after prolpase surgery. So routinely incontinence surgery at the time of prolapse surgery should not be recommended. I117 CLIENT INTERVIEW AND BIMANUAL EXAMINATION USING NO TECHNOLOGY TO ASSESS OUTCOME OF MEDICAL ABORTION M. Fjerstad. WomanCare Global and Ipas Particularly in low-resource settings, medical abortion is being provided successfully by various cadres of providers using no technology. Providers use clinical skills only: interview with the woman and bimanual examination. Ultrasound is not available or used in routine provision of medical abortion. We will discuss medical abortion provision in Ethiopia and Nepal where medical abortion is provided in urban areas and rural health outposts. Medical abortion results in the same high success rates and low complication profile seen in high-resource settings. Research is underway in Nepal and Africa to assess whether a woman herself, or a community health worker, can: (1) determine eligibility for medical abortion and (2) assess success following medical abortion.