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M522 PRECONCEPTION CARE: ATTITUDE IN PATIENTS WITH REPEATED SPONTANEOUS ABORTIONS. RESULTS FROM A NATIONAL SURVEY
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Results: In the case control-study, comparison of 94 untreated with 31 treated celiac women indicated that the relative risk of abortion was 8.90 times higher (95% confidence limits: 1.19/66.3), the relative risk of low birth weight baby was 5.84 times higher (90% confidence limits: 1.07/31.9). Abortion and low birth weight of baby did not significantly relate to the severity of celiac disese among untreated women. In the before-after study, 12 pregnant celiac women in either treated or untreated condition were compared. Results indicated that the gluten-free diet reduced the relative risk of abortion by 9.18 times (95% confidence limits: 1.05/79.9), reduced the number of low birth weight babies from 29.4% down to zero (p < 0.05). Conclusions: Both case-control and before-after studies indicated that threatened abortion and premature delivery did not significantly relate to treatment of celiac disease. The high incidence of abortion, and of low birth weight babies is effectively corrected by gluten-free diet in women with celiac disease. M521 HOW INFORMED IS CONSENT TO FETAL ANOMALY SCANS? A. Smith1 , G. Stoddart2 . 1 North Bristol Trust, Bristol, United Kingdom; 2 Weston Area Health Trust, Weston-Super-Mare, United Kingdom Objectives: To establish whether women having mid-trimester fetal anomaly scans at a district hospital in the UK had given informed consent to their mid-trimester anomaly scan, using the UK Fetal Anomaly Screening Programme guidelines. To instigate changes in the trust to improve and assess the quality of information given to women. Materials: Women attending for their anomaly scan, over a twoweek period, were given a questionnaire on the purpose and information received about the scan. Methods: Following data analysis, the midwives were informed of the need for clarity around consent and the maternity notes were changed in order to record that the information had been given. Subsequently data was collected and analysed for a second two week period. Results: There were 39 respondents for the first questionnaire, 23 for the second. Both revealed only 61% of patients were aware that the mid-trimester scan was optional. Anomaly identification was the primary aim, for 72% of initial respondents and 61% following intervention. Following intervention 95% of women were aware that anomalies might be identified, but only 87% prior to the changes. Initially 46% understood about receiving the results and 48% in the second questionnaire. Only 54% and 52% respectively understood about the need for a repeat scan if the results were unclear. In the first group 95% of women remembered receiving a screening test information brochure, but only 82% in the second group. Conclusions: Despite interventions to improve the quality of information being given to patients, women were not clear about their choice in having the scan. In both questionnaires, women did not understand the aim of the scan. Women were not clear that results may be inconclusive and that a repeat scan or referral may be necessary. In this population, women lack clarity about their mid-trimester scan, despite receiving written information from their midwives. They attend scans because it is the norm rather than necessarily understanding their purpose. This problem may be most distressing for women in whom anomalies are suspected. There remains a necessity to answer the question as to whether women are receiving the correct information at the correct time in their pregnancy or if they are being given too much information to reasonably understand. The root cause of this problem needs to be assessed and addressed, to ensure we providing an effective service to our patients.
S699
M522 PRECONCEPTION CARE: ATTITUDE IN PATIENTS WITH REPEATED SPONTANEOUS ABORTIONS. RESULTS FROM A NATIONAL SURVEY E. Fabre1 , J.C. Melchor2 , M. Casellas3 , J.A. Espinosa4 , J.A. Garc´ıa5 Hernandez ´ , T. Mart´ınez-Astorquiza2 , D. Oros ´ 1 , A. Perales7 , M. Ramirez-Pineda6 , B. Serra8 , For the CREAS Study Group. 1 Lozano Blesa Hospital, Zaragoza, Spain; 2 Cruces Hospital, Vizcaya, Spain; 3 Valle de Hebr´ on Hospital, Barcelona, Spain; 4 Quir´ on Hospital, Madrid, Spain; 5 Materno-Infantil Hospital, Las Palmas de Gran Canaria, Spain; 6 Virgen Macarena Hospital, Sevilla, Spain; 7 La Fe Hospital, Valencia, Spain; 8 Dexeus Hospital, Barcelona, Spain Objectives: Detect which type of training is necessary for obstetricians and gynaecologists in maternal-foetal medicine. Provide information and training to help their daily practice. Materials: A national survey was carried out in Spain in 2011. The multiple-choice questionnaire was distributed among obstetricians and gynaecologists practicing in public and/or private clinics throughout Spain. Methods: Participants answered several questions; the key question was regarding prenatal care in women with repeated spontaneous abortions. This particular question of interest was: What would your attitude be if a non-pregnant woman with repetitive miscarriages comes to your practice wanting to become pregnant?. Results: The total study population was 966 obstetricians and gynaecologists (378 men and 588 women). They were asked to choose one or more multiple-choice answers. There were 1.452 total responses. Conclusions: Contemporary practice patterns for preconception care in patients with repeated miscarriages are described. Such surveys may be useful in defining standards of care in maternalfoetal medicine. Results suggest that reported practice patterns vary widely in the areas that were surveyed and are not always consistent with the published literature. Acknowledgements: We are grateful to all the clinicians who participated in the inquiry. Funding for this research was provided by Merck, SL – Spain. Option
n (%)*
I would refer the woman to an infertility office I would carry out repeated miscarriage studies in my office I would not carry out the study, but would recommend acetylsalicylic acid from the first trimester of gestation I would begin the study of recurrent miscarriages only after three miscarriages I would recommend prophylaxis with periconceptional folates and iodine Other
284 (19.6) 606 (41.7) 17 (1.2) 145 (10.0) 372 (25.6) 28 (1.9)
*Of the total number of responses.
M523 UTERUS LABOR ACTIVITY AND INTRAUTERINE FETUS MONITORING DURING THE CHILDBIRTH PROCESS OF PREGNANT WOMEN WITH PREECLAMPSIA L. Didenko1 , O. Butkova1 , A. Kolomiytseva1 . 1 Institute of Pediatrics, Obstetrics and Gynecology NAMN Ukraine, Kyiv, Ukraine Objectives: To reduce the incidence of maternal and perinatal complications of parturient women. Materials: 161 parturient women were examined in the dynamics of delivery. All the parturient women are divided into three groups: 1-st group – 80 women with second grade preeclampsia that received an antenatal preparation complex and intensive anaesthetization during the delivery; 2-nd group – 55 women with second grade preeclampsia that got delivered in accordance with the Protocol of the Ukrainian Ministry of Health; 3-d group – 30 women that were healthy (under control). The developed antenatal preparation complex included: dosed physical exercises on a bicycle ergometer with power of 50 watt
Results: In the case control-study, comparison of 94 untreated with 31 treated celiac women indicated that the relative risk of abortion was 8.90 times higher (95% confidence limits: 1.19/66.3), the relative risk of low birth weight baby was 5.84 times higher (90% confidence limits: 1.07/31.9). Abortion and low birth weight of baby did not significantly relate to the severity of celiac disese among untreated women. In the before-after study, 12 pregnant celiac women in either treated or untreated condition were compared. Results indicated that the gluten-free diet reduced the relative risk of abortion by 9.18 times (95% confidence limits: 1.05/79.9), reduced the number of low birth weight babies from 29.4% down to zero (p < 0.05). Conclusions: Both case-control and before-after studies indicated that threatened abortion and premature delivery did not significantly relate to treatment of celiac disease. The high incidence of abortion, and of low birth weight babies is effectively corrected by gluten-free diet in women with celiac disease. M521 HOW INFORMED IS CONSENT TO FETAL ANOMALY SCANS? A. Smith1 , G. Stoddart2 . 1 North Bristol Trust, Bristol, United Kingdom; 2 Weston Area Health Trust, Weston-Super-Mare, United Kingdom Objectives: To establish whether women having mid-trimester fetal anomaly scans at a district hospital in the UK had given informed consent to their mid-trimester anomaly scan, using the UK Fetal Anomaly Screening Programme guidelines. To instigate changes in the trust to improve and assess the quality of information given to women. Materials: Women attending for their anomaly scan, over a twoweek period, were given a questionnaire on the purpose and information received about the scan. Methods: Following data analysis, the midwives were informed of the need for clarity around consent and the maternity notes were changed in order to record that the information had been given. Subsequently data was collected and analysed for a second two week period. Results: There were 39 respondents for the first questionnaire, 23 for the second. Both revealed only 61% of patients were aware that the mid-trimester scan was optional. Anomaly identification was the primary aim, for 72% of initial respondents and 61% following intervention. Following intervention 95% of women were aware that anomalies might be identified, but only 87% prior to the changes. Initially 46% understood about receiving the results and 48% in the second questionnaire. Only 54% and 52% respectively understood about the need for a repeat scan if the results were unclear. In the first group 95% of women remembered receiving a screening test information brochure, but only 82% in the second group. Conclusions: Despite interventions to improve the quality of information being given to patients, women were not clear about their choice in having the scan. In both questionnaires, women did not understand the aim of the scan. Women were not clear that results may be inconclusive and that a repeat scan or referral may be necessary. In this population, women lack clarity about their mid-trimester scan, despite receiving written information from their midwives. They attend scans because it is the norm rather than necessarily understanding their purpose. This problem may be most distressing for women in whom anomalies are suspected. There remains a necessity to answer the question as to whether women are receiving the correct information at the correct time in their pregnancy or if they are being given too much information to reasonably understand. The root cause of this problem needs to be assessed and addressed, to ensure we providing an effective service to our patients.
S699
M522 PRECONCEPTION CARE: ATTITUDE IN PATIENTS WITH REPEATED SPONTANEOUS ABORTIONS. RESULTS FROM A NATIONAL SURVEY E. Fabre1 , J.C. Melchor2 , M. Casellas3 , J.A. Espinosa4 , J.A. Garc´ıa5 Hernandez ´ , T. Mart´ınez-Astorquiza2 , D. Oros ´ 1 , A. Perales7 , M. Ramirez-Pineda6 , B. Serra8 , For the CREAS Study Group. 1 Lozano Blesa Hospital, Zaragoza, Spain; 2 Cruces Hospital, Vizcaya, Spain; 3 Valle de Hebr´ on Hospital, Barcelona, Spain; 4 Quir´ on Hospital, Madrid, Spain; 5 Materno-Infantil Hospital, Las Palmas de Gran Canaria, Spain; 6 Virgen Macarena Hospital, Sevilla, Spain; 7 La Fe Hospital, Valencia, Spain; 8 Dexeus Hospital, Barcelona, Spain Objectives: Detect which type of training is necessary for obstetricians and gynaecologists in maternal-foetal medicine. Provide information and training to help their daily practice. Materials: A national survey was carried out in Spain in 2011. The multiple-choice questionnaire was distributed among obstetricians and gynaecologists practicing in public and/or private clinics throughout Spain. Methods: Participants answered several questions; the key question was regarding prenatal care in women with repeated spontaneous abortions. This particular question of interest was: What would your attitude be if a non-pregnant woman with repetitive miscarriages comes to your practice wanting to become pregnant?. Results: The total study population was 966 obstetricians and gynaecologists (378 men and 588 women). They were asked to choose one or more multiple-choice answers. There were 1.452 total responses. Conclusions: Contemporary practice patterns for preconception care in patients with repeated miscarriages are described. Such surveys may be useful in defining standards of care in maternalfoetal medicine. Results suggest that reported practice patterns vary widely in the areas that were surveyed and are not always consistent with the published literature. Acknowledgements: We are grateful to all the clinicians who participated in the inquiry. Funding for this research was provided by Merck, SL – Spain. Option
n (%)*
I would refer the woman to an infertility office I would carry out repeated miscarriage studies in my office I would not carry out the study, but would recommend acetylsalicylic acid from the first trimester of gestation I would begin the study of recurrent miscarriages only after three miscarriages I would recommend prophylaxis with periconceptional folates and iodine Other
284 (19.6) 606 (41.7) 17 (1.2) 145 (10.0) 372 (25.6) 28 (1.9)
*Of the total number of responses.
M523 UTERUS LABOR ACTIVITY AND INTRAUTERINE FETUS MONITORING DURING THE CHILDBIRTH PROCESS OF PREGNANT WOMEN WITH PREECLAMPSIA L. Didenko1 , O. Butkova1 , A. Kolomiytseva1 . 1 Institute of Pediatrics, Obstetrics and Gynecology NAMN Ukraine, Kyiv, Ukraine Objectives: To reduce the incidence of maternal and perinatal complications of parturient women. Materials: 161 parturient women were examined in the dynamics of delivery. All the parturient women are divided into three groups: 1-st group – 80 women with second grade preeclampsia that received an antenatal preparation complex and intensive anaesthetization during the delivery; 2-nd group – 55 women with second grade preeclampsia that got delivered in accordance with the Protocol of the Ukrainian Ministry of Health; 3-d group – 30 women that were healthy (under control). The developed antenatal preparation complex included: dosed physical exercises on a bicycle ergometer with power of 50 watt