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I126 Safety and efficacy of consecutive use of the LNG-IUS – confirmed by a new study
Invited presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S1–S92
Consideration should be given to changing the cut-off score for low risk from 6 to 5. I123 Redressing and halting coerced sterilisation of women and girls living with HIV and AIDS J. Gatsi Mallet, T.E. Crone, E. Slattery. International Community of Women Living with HIV and AIDS, Windhoek, Namibia, ATHENA Network, Windhoek, Namibia, Centre for Reproductive Rights, Windhoek, Namibia Issues: HIV positive women from around the world have cited that coerced sterilisation is a significant and routine reproductive rights violations that they are facing. HIV positive women in South Africa have reported that they must consent to sterilisation when they seek nevirapine to protect their unborn infants from HIV during labour. Human Rights Watch has documented involuntary sterilisation among HIV positive women in the Dominican Republic. In spite of broad anecdotal evidence of coercive sterilisation of HIV positive women occurring in Africa, Asia, Europe and Latin America, there has been little systematic documentation of the practice as a human rights violation and even less has been done to address it. Description: In order to begin to define the extent of this human rights violation for HIV positive women, a pilot survey and documentation project is under way in Namibia. The Namibia Women’s Health Network and ICW have convened the Young Women’s Dialogue with young HIV positive women to begin to assess the extent of coerced sterilisation. Further, the Namibia Women’s Health Network is undertaking a national survey and documentation project of this human rights violation with support from global partners. Lessons learned: Findings from key informant interviews and media outreach show that coercive sterilisation of HIV positive women is regularly occurring when HIV positive women access health care services during pregnancy, such as caesarean section. Next steps: Redressing and halting coerced sterilisation must be a cornerstone of efforts to advance the sexual and reproductive rights of HIV positive women. The Namibian Women’s Health Network is partnering with regional and global entities to raise the visibility of this rights violation and to work within the health care system and human rights accountability mechanisms to halt the practice. Country of Research: Namibia I124 Cervical intraepithelial neoplasia (CIN2+) management: post treatment complications C. Gay, A. Grisey. Department of Obstetrics Gynecology, Belfort Hospital, France CIN 2–3 is a preinvasive stage of squamous cell carcinoma uterine cervix. Several standard methods are commonly used for CIN+2 treatment with an equally successful at eradicating CIN and preventing invasive cervical cancer: excision by conisation (cold knife, laser, LEEP ou LLEETZ) or by ablation: laser, cryotherapy. These methods follow a commun goal: to destroy the transformation zone while preserving a good mechanic and secretive cervical function. They present similarly morbidity. However, post-operative complications can outcome and are divided into two groups: – immediate complications (peroperative and immediate postoperative): haemorragiae, pelvic pain, local infection, exceptionnal bowel injury. – late complications: • Cervical stenosis: depending on the excision method (cold knife essentially), the age of the patient (after menopause), the cone depth and hemorragic complication before and after the operation. This stenosis may induce dysmenorrhoea, infertility and unsatisfaction for follow-up (squamocolumnar
S31
junction toward the endocervical canal decreasing satisfactory colposcopy rates) • Obstetrical outcomes with an increased risk of: preterm delivery, lowbirth weight, preterm spontaneous rupture of membranes (pPROM), cesarian section rates, perinatal morbidity and neonatal intensive care unit (NIUC) admission. • Residual and recurrent lesions: free resection margin is not an optimal prognostic criterior for no recurrence. However, incomplete initial excision of CIN exposes women to a substantial risk of high grade post treatment disease (risk factor for recurrence increased with age, more frequent after menopause). Each item will be developed and discussed, according to the most recent international studies. I125 Misoprostol: pharmacokinetics K. Gemzell-Danielsson, P.C. Ho, O.S. Tang. Dept. of Woman and Child Health, Div. of Obstetrics and Gynecology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden Misoprostol, a synthetic prostaglandin E1 analogue, is commonly used for medical abortion, cervical priming, the management of miscarriage, induction of labor and the management of postpartum hemorrhage. Thus, misoprostol is a very versatile drug in obstetrics and gynecology. Knowledge of the pharmacokinetic profiles is very important for designing regimens for various applications. Misoprostol can be given orally, vaginally, sublingually, buccally or rectally. Studies of misoprostol’s pharmacokinetics and effects on uterine activity have demonstrated the properties of the drug after various routes of administration. These studies can help to discover the optimal dose and route of administration of misoprostol for individual clinical applications. Misoprostol is a safe drug but serious complications and teratogenicity can occur with unsupervised use. I126 Safety and efficacy of consecutive use of the LNG-IUS – confirmed by a new study K. Gemzell-Danielsson. Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden The levonorgestrel-releasing intrauterine system (LNG-IUS) is highly effective with a Pearl index of 0.2 at 1 year and a cumulative failure rate of 0.7 at 5 years. Due to the increasing popularity and the high user satisfaction of this method, an increasing number of women opt for a replacement of LNG-IUS after completing the first 5-year segment. A prospective multicenter trial evaluated bleeding patterns, removal and insertion procedures, and user satisfaction in 204 women opting to continue with a second LNG-IUS immediately after removal of the first IUS. The study showed that both removal and insertion of the LNG-IUS was considered easy in the majority of patients and was well tolerated. No pain or mild pain was reported by 88.7% of subjects during removal and by 61.7% during insertion. The median number of bleeding-only days was 0 in all reference periods except for the reference period immediately after insertion of the 2nd LNG-IUS; the number of spotting-only days varied between 3 and 6 per 90-day reference period. No pregnancies and no perforations were reported. The most frequently reported adverse events included headache (9.3%), sinusitis (5.9%), influenza and upper abdominal pain (4.9%). In comparison with the first LNGIUS, uterine bleeding diminished further during the first year of use of the second LNG-IUS.
Consideration should be given to changing the cut-off score for low risk from 6 to 5. I123 Redressing and halting coerced sterilisation of women and girls living with HIV and AIDS J. Gatsi Mallet, T.E. Crone, E. Slattery. International Community of Women Living with HIV and AIDS, Windhoek, Namibia, ATHENA Network, Windhoek, Namibia, Centre for Reproductive Rights, Windhoek, Namibia Issues: HIV positive women from around the world have cited that coerced sterilisation is a significant and routine reproductive rights violations that they are facing. HIV positive women in South Africa have reported that they must consent to sterilisation when they seek nevirapine to protect their unborn infants from HIV during labour. Human Rights Watch has documented involuntary sterilisation among HIV positive women in the Dominican Republic. In spite of broad anecdotal evidence of coercive sterilisation of HIV positive women occurring in Africa, Asia, Europe and Latin America, there has been little systematic documentation of the practice as a human rights violation and even less has been done to address it. Description: In order to begin to define the extent of this human rights violation for HIV positive women, a pilot survey and documentation project is under way in Namibia. The Namibia Women’s Health Network and ICW have convened the Young Women’s Dialogue with young HIV positive women to begin to assess the extent of coerced sterilisation. Further, the Namibia Women’s Health Network is undertaking a national survey and documentation project of this human rights violation with support from global partners. Lessons learned: Findings from key informant interviews and media outreach show that coercive sterilisation of HIV positive women is regularly occurring when HIV positive women access health care services during pregnancy, such as caesarean section. Next steps: Redressing and halting coerced sterilisation must be a cornerstone of efforts to advance the sexual and reproductive rights of HIV positive women. The Namibian Women’s Health Network is partnering with regional and global entities to raise the visibility of this rights violation and to work within the health care system and human rights accountability mechanisms to halt the practice. Country of Research: Namibia I124 Cervical intraepithelial neoplasia (CIN2+) management: post treatment complications C. Gay, A. Grisey. Department of Obstetrics Gynecology, Belfort Hospital, France CIN 2–3 is a preinvasive stage of squamous cell carcinoma uterine cervix. Several standard methods are commonly used for CIN+2 treatment with an equally successful at eradicating CIN and preventing invasive cervical cancer: excision by conisation (cold knife, laser, LEEP ou LLEETZ) or by ablation: laser, cryotherapy. These methods follow a commun goal: to destroy the transformation zone while preserving a good mechanic and secretive cervical function. They present similarly morbidity. However, post-operative complications can outcome and are divided into two groups: – immediate complications (peroperative and immediate postoperative): haemorragiae, pelvic pain, local infection, exceptionnal bowel injury. – late complications: • Cervical stenosis: depending on the excision method (cold knife essentially), the age of the patient (after menopause), the cone depth and hemorragic complication before and after the operation. This stenosis may induce dysmenorrhoea, infertility and unsatisfaction for follow-up (squamocolumnar
S31
junction toward the endocervical canal decreasing satisfactory colposcopy rates) • Obstetrical outcomes with an increased risk of: preterm delivery, lowbirth weight, preterm spontaneous rupture of membranes (pPROM), cesarian section rates, perinatal morbidity and neonatal intensive care unit (NIUC) admission. • Residual and recurrent lesions: free resection margin is not an optimal prognostic criterior for no recurrence. However, incomplete initial excision of CIN exposes women to a substantial risk of high grade post treatment disease (risk factor for recurrence increased with age, more frequent after menopause). Each item will be developed and discussed, according to the most recent international studies. I125 Misoprostol: pharmacokinetics K. Gemzell-Danielsson, P.C. Ho, O.S. Tang. Dept. of Woman and Child Health, Div. of Obstetrics and Gynecology, Karolinska Institutet/Karolinska University Hospital, Stockholm, Sweden Misoprostol, a synthetic prostaglandin E1 analogue, is commonly used for medical abortion, cervical priming, the management of miscarriage, induction of labor and the management of postpartum hemorrhage. Thus, misoprostol is a very versatile drug in obstetrics and gynecology. Knowledge of the pharmacokinetic profiles is very important for designing regimens for various applications. Misoprostol can be given orally, vaginally, sublingually, buccally or rectally. Studies of misoprostol’s pharmacokinetics and effects on uterine activity have demonstrated the properties of the drug after various routes of administration. These studies can help to discover the optimal dose and route of administration of misoprostol for individual clinical applications. Misoprostol is a safe drug but serious complications and teratogenicity can occur with unsupervised use. I126 Safety and efficacy of consecutive use of the LNG-IUS – confirmed by a new study K. Gemzell-Danielsson. Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden The levonorgestrel-releasing intrauterine system (LNG-IUS) is highly effective with a Pearl index of 0.2 at 1 year and a cumulative failure rate of 0.7 at 5 years. Due to the increasing popularity and the high user satisfaction of this method, an increasing number of women opt for a replacement of LNG-IUS after completing the first 5-year segment. A prospective multicenter trial evaluated bleeding patterns, removal and insertion procedures, and user satisfaction in 204 women opting to continue with a second LNG-IUS immediately after removal of the first IUS. The study showed that both removal and insertion of the LNG-IUS was considered easy in the majority of patients and was well tolerated. No pain or mild pain was reported by 88.7% of subjects during removal and by 61.7% during insertion. The median number of bleeding-only days was 0 in all reference periods except for the reference period immediately after insertion of the 2nd LNG-IUS; the number of spotting-only days varied between 3 and 6 per 90-day reference period. No pregnancies and no perforations were reported. The most frequently reported adverse events included headache (9.3%), sinusitis (5.9%), influenza and upper abdominal pain (4.9%). In comparison with the first LNGIUS, uterine bleeding diminished further during the first year of use of the second LNG-IUS.