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I189 PELVIC ORGAN PROLAPSE SURGERY IN WOMEN – INTRODUCTION
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Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
the community about maternal and child health to avail skilled care during pregnancy and labour, and by training of skilled and traditional birth attendants, both at the community as well as facility level to carry out preventive antenatal, intra-partum and postnatal care & to improve referral pathways. The proposed upgrading of 3 health facilities was as follows: Taluka Mirpur Sakro: 1. Sheikh Zayed Medical Centre (Mirpur Sakro) – For comprehensive EmOC 2. RHC Gharo – For Basic EmOC 3. BHU Ghariwah – For ante & postnatal & newborn care & emergency referrals Major Interventions – I: Community mobilization & Awareness to increase demand for RH services. Major Interventions – II: Training of Birth Attendants and Community Health Workers (LHWs). Major Interventions – III: Upgrading 3 Healthcare Facilities: • Essential obstetric care in 1 BHU (Gariwah) • Basic EmONC in RHC (Gharo) • Comprehensive EmONC in one Taluka Hospital (SZMC) Progress was monitored regularly alongside activities & quarterly reports were submitted to FIGO. At the end of the project, a systematic comprehensive evaluation was undertaken to assess impact. This was a Case Control Design using Mixed Methods. The Quantitative Component consisted of Household Surveys, Health Facility Audit & Client Exit Interview. This was augmented with Focus Group Discussions & Quality of Care Observation. Control areas were selected in the same district, Thatta which were being served by the existing government & private facilities. 1750 women were interviewed in each arm. In this Multi stage Cluster Design, households were selected right down to the Union Council level. An equal number of interviews in each quadrant were conducted from each starting point with an interval of 3 or 5 households. If there were more than one family living in one household the “Kish Grid” method was used to select the one woman who had delivered during the last 3 years Results: After analysis of results of various components (Household survey, health facility assessment & focus groups), it was found that health care services provided to women & children were greater in the interventions health facilities but still need improvement. The distribution of Iron, Folic Acid & Calcium were also higher in the intervention health facilities. Intervention clusters had, Higher ANC provision, Lower complications during pregnancy & delivery, Lower SB & PNMR. Ratio of deliveries conducted by SBAs (Physician, Nurse, LHV) in the intervention area was 65% & in 50% in the control area. Conclusion: Reduction of maternal & perinatal mortality is possible. It does not cost much money. What is required is the will to make it possible. No such effort is likely to succeed without acquiring the trust & ownership of the community itself. This is made possible by creating awareness & the motivation to access care. This has to be coupled with functional reliable health facilities & dedicated service providers. I189 PELVIC ORGAN PROLAPSE SURGERY IN WOMEN – INTRODUCTION M. Koyama. Dept of OB/GYN, Osaka City University Medical School, Japan Pelvic floor disorders such as pelvic organ prolapse (POP) and urinary incontinence (UI) are common disorders, with approximately 11% of all women requiring at least one corrective surgical procedure. Pelvic Floor Medicine (urogynecology) and Reconstructive Surgery should offer cutting-edge diagnostic and treatment options for women with complex pelvic floor disorders such as urinary incontinence, overactive bladder syndromes, pelvic organ prolapse, voiding and defecatory dysfunction, fecal incontinence and fistulas.
In April 2010 the FIGO Executive Committee requested an Action Plan whose objective is to delineate guidelines based in international opinion leader’s opinions around the world. The initial objective the Action Plan was to analyze the different Pelvic Floor Reconstructive Treatments according to the personal interpretation and qualified in relation with the grades of evidence and levels of recommendation. The second step was to make a recommendation for the current state, according to the Working Group judgment, of the recommendations of the committee related to the procedures based on their experience and analysis of the levels of evidence and bibliographic recommendations. Working Group met in Rome in January 2012 with the objective to present a draft of what would be the presentation in the session granted to the Working Group by FIGO for FIGO Rome 2012. In this way we had time to finish the recommendations of the proper surgery for anterior, posterior and apical compartment vagina including vaginal vault prolapse. I190 MANAGEMENT OF MALE INFERTILITY T. Kruger Infertility in a couple is defined as the inability to achieve conception after one year of unprotected intercourse. The male factor plays a role in 40% of infertility cases. The basic principles of handling a male factor is to take a good history in the male and female as well as a thorough examination of both as this can often reveal a simple solution to the problem. One must also follow the principle of correcting all female factors if there is a male factor involved. Furthermore this talk will look at the male factor using available international evidence. The basic semen analysis (WHO 2010) and its interpretation will be covered. Sperm functional assays (SFA) and the implications of an abnormal SFA will also be discussed. Different treatment modalities will be reflected on with a final discussion on sperm selection and the role of ICSI (intracytoplasmic sperm injection) and intra-cytoplasmic morphology selected sperm injection (IMSI) in certain male factor problems. I191 ONLY ART IN THE TREATMENT OF MALE INFERTILITY? W. Kuczynski Epidemiological studies of infertility clearly indicate that semen abnormalities are the commonest diagnostic abnormality. Although male infertility has been associated with many clinical conditions (hypogonadism, varicocele, genital tract infections, etc.) most of the diagnostic categories are described as idiopathic oligozoospermia with no understanding of the causes of this disability. The efforts undertaken to develop an effective empirical treament for this group of men have so far been unsuccessful. Treatment with gonadothropins, GnRH analogues, androgens, anti-estrogens, growth-hormone, glucocorticsteroids, aromatase inhibitors and many others have been prooved to be ineffective in improving pregnancy rates. Intrauterine insemination, with or without ovulation induction is ineffective in male infertility. Advancess in assisted reproductive technologies, partcularly ICSI, revolutionized the menagement of male infertility by bypassing the most of the natural requirements for successfull fertilisation. ICSI enables genetic paternity with few or even single spermatozoon obtained from ejaculate or testicular tissue. Despite high efficacy in achieving pregnancy, assisted reproductive techniques are invasive, costly and not free from maternal and fetal risks. They highlights the ethical and legal concerns. With the achievements in the understanding physiology of reproduction and particularly novel genomic, and post-receptor events related to spermatogenesis, some possibilities of development of the new therapies have appeared. They could lead to the improvements of the gamete quality at least for some groups of
Invited presentations and presentations by organisations and societies / International Journal of Gynecology & Obstetrics 119S3 (2012) S161–S260
the community about maternal and child health to avail skilled care during pregnancy and labour, and by training of skilled and traditional birth attendants, both at the community as well as facility level to carry out preventive antenatal, intra-partum and postnatal care & to improve referral pathways. The proposed upgrading of 3 health facilities was as follows: Taluka Mirpur Sakro: 1. Sheikh Zayed Medical Centre (Mirpur Sakro) – For comprehensive EmOC 2. RHC Gharo – For Basic EmOC 3. BHU Ghariwah – For ante & postnatal & newborn care & emergency referrals Major Interventions – I: Community mobilization & Awareness to increase demand for RH services. Major Interventions – II: Training of Birth Attendants and Community Health Workers (LHWs). Major Interventions – III: Upgrading 3 Healthcare Facilities: • Essential obstetric care in 1 BHU (Gariwah) • Basic EmONC in RHC (Gharo) • Comprehensive EmONC in one Taluka Hospital (SZMC) Progress was monitored regularly alongside activities & quarterly reports were submitted to FIGO. At the end of the project, a systematic comprehensive evaluation was undertaken to assess impact. This was a Case Control Design using Mixed Methods. The Quantitative Component consisted of Household Surveys, Health Facility Audit & Client Exit Interview. This was augmented with Focus Group Discussions & Quality of Care Observation. Control areas were selected in the same district, Thatta which were being served by the existing government & private facilities. 1750 women were interviewed in each arm. In this Multi stage Cluster Design, households were selected right down to the Union Council level. An equal number of interviews in each quadrant were conducted from each starting point with an interval of 3 or 5 households. If there were more than one family living in one household the “Kish Grid” method was used to select the one woman who had delivered during the last 3 years Results: After analysis of results of various components (Household survey, health facility assessment & focus groups), it was found that health care services provided to women & children were greater in the interventions health facilities but still need improvement. The distribution of Iron, Folic Acid & Calcium were also higher in the intervention health facilities. Intervention clusters had, Higher ANC provision, Lower complications during pregnancy & delivery, Lower SB & PNMR. Ratio of deliveries conducted by SBAs (Physician, Nurse, LHV) in the intervention area was 65% & in 50% in the control area. Conclusion: Reduction of maternal & perinatal mortality is possible. It does not cost much money. What is required is the will to make it possible. No such effort is likely to succeed without acquiring the trust & ownership of the community itself. This is made possible by creating awareness & the motivation to access care. This has to be coupled with functional reliable health facilities & dedicated service providers. I189 PELVIC ORGAN PROLAPSE SURGERY IN WOMEN – INTRODUCTION M. Koyama. Dept of OB/GYN, Osaka City University Medical School, Japan Pelvic floor disorders such as pelvic organ prolapse (POP) and urinary incontinence (UI) are common disorders, with approximately 11% of all women requiring at least one corrective surgical procedure. Pelvic Floor Medicine (urogynecology) and Reconstructive Surgery should offer cutting-edge diagnostic and treatment options for women with complex pelvic floor disorders such as urinary incontinence, overactive bladder syndromes, pelvic organ prolapse, voiding and defecatory dysfunction, fecal incontinence and fistulas.
In April 2010 the FIGO Executive Committee requested an Action Plan whose objective is to delineate guidelines based in international opinion leader’s opinions around the world. The initial objective the Action Plan was to analyze the different Pelvic Floor Reconstructive Treatments according to the personal interpretation and qualified in relation with the grades of evidence and levels of recommendation. The second step was to make a recommendation for the current state, according to the Working Group judgment, of the recommendations of the committee related to the procedures based on their experience and analysis of the levels of evidence and bibliographic recommendations. Working Group met in Rome in January 2012 with the objective to present a draft of what would be the presentation in the session granted to the Working Group by FIGO for FIGO Rome 2012. In this way we had time to finish the recommendations of the proper surgery for anterior, posterior and apical compartment vagina including vaginal vault prolapse. I190 MANAGEMENT OF MALE INFERTILITY T. Kruger Infertility in a couple is defined as the inability to achieve conception after one year of unprotected intercourse. The male factor plays a role in 40% of infertility cases. The basic principles of handling a male factor is to take a good history in the male and female as well as a thorough examination of both as this can often reveal a simple solution to the problem. One must also follow the principle of correcting all female factors if there is a male factor involved. Furthermore this talk will look at the male factor using available international evidence. The basic semen analysis (WHO 2010) and its interpretation will be covered. Sperm functional assays (SFA) and the implications of an abnormal SFA will also be discussed. Different treatment modalities will be reflected on with a final discussion on sperm selection and the role of ICSI (intracytoplasmic sperm injection) and intra-cytoplasmic morphology selected sperm injection (IMSI) in certain male factor problems. I191 ONLY ART IN THE TREATMENT OF MALE INFERTILITY? W. Kuczynski Epidemiological studies of infertility clearly indicate that semen abnormalities are the commonest diagnostic abnormality. Although male infertility has been associated with many clinical conditions (hypogonadism, varicocele, genital tract infections, etc.) most of the diagnostic categories are described as idiopathic oligozoospermia with no understanding of the causes of this disability. The efforts undertaken to develop an effective empirical treament for this group of men have so far been unsuccessful. Treatment with gonadothropins, GnRH analogues, androgens, anti-estrogens, growth-hormone, glucocorticsteroids, aromatase inhibitors and many others have been prooved to be ineffective in improving pregnancy rates. Intrauterine insemination, with or without ovulation induction is ineffective in male infertility. Advancess in assisted reproductive technologies, partcularly ICSI, revolutionized the menagement of male infertility by bypassing the most of the natural requirements for successfull fertilisation. ICSI enables genetic paternity with few or even single spermatozoon obtained from ejaculate or testicular tissue. Despite high efficacy in achieving pregnancy, assisted reproductive techniques are invasive, costly and not free from maternal and fetal risks. They highlights the ethical and legal concerns. With the achievements in the understanding physiology of reproduction and particularly novel genomic, and post-receptor events related to spermatogenesis, some possibilities of development of the new therapies have appeared. They could lead to the improvements of the gamete quality at least for some groups of