- Email: [email protected]
O-GYN-MD-027 Influence of Diet on Fibroids and Endometriosis, Analysis of the National Health and Nutrition Examination Survey
ABSTRACTS
- O-OBS-JM-062 ........................................................................... OBSTETRICAL OUTCOMES OF PATIENTS WITH HIV IN PREGNANCY: A POPULATION BASED COHORT K. Arab Jewish General Hospital, McGill University, 3755 Cote St-Catherine, Montreal, QC, H3S 1Y9, Canada N. Czuzoj-Shulman, H. Abenhaim Objectives: The study objective was to examine obstetrical outcomes of pregnancy among human immunodeficiency virus positive (HIV+) patients. Study Methods: A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003-2011). Pregnant HIV+ women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical outcomes. Results: Among 7,772,999 births over the 9-year study period, 1,997 were in HIV+ women, resulting in an incidence of 25.7/100,000 births. An increasing trend in incidence was observed over study period. HIV+ patients had greater frequency of pre-existing diabetes and chronic hypertension, and more use of cigarettes, drugs and alcohol during pregnancy (p< 0.001). Upon adjustment for baseline characteristics, HIV+ patients had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.37, 95% CI 1.16-1.63), urinary tract infections (OR 3.01, 95% CI 2.43.79), and gestational hypertension (OR 0.67, 95% CI 0.49-0.92). Delivery and postpartum complications, specifically, cesarean delivery (OR 3.17, 95% CI 2.88-3.49), postpartum sepsis (OR 8.43, 95% CI 5.71-12.46), venous thromboembolism (OR 2.23, 95% CI 1.47-3.37), blood transfusions (OR 3.11, 95% CI 2.53-3.83), and postpartum depression (OR 2.21, 95% CI 1.78-2.75) were also more common in HIV+ patients. Neonates born to these mothers were at higher risk of prematurity (OR 1.62, 95% CI 1.43-1.83) and intrauterine fetal demise (OR 1.72, 95% CI 1.17-2.52). Maternal mortality was also elevated (OR 10.71, 95% CI 5.22-21.96). Conclusion: Pregnancy in HIV+ patients is associated with adverse maternal and fetal morbidities.
- O-OBS-JM-021 ........................................................................... NEURODEVELOPMENTAL OUTCOMES OF INFANTS AT 2 YEARS OF AGE FOLLOWING ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) RELATIVE TO NATURAL CONCEPTION: FINDINGS FROM THE PROSPECTIVE, LONGITUDINAL, COHORT “3D-STUDY” J. Balayla Université de Montréal, 2900, boul. Édouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada W. Fraser, O. Sheehy, J. Seguin, J. Trasler, P. Monnier, G. Muckle, A. Bérard Objectives: Using standardized and validated tools designed to appraise the neurodevelopmental outcomes of infants, the objective of the present study was to compare the cognitive, language, and motor development of 2-year old infants following assisted reproductive technologies (ART) relative to natural conception. Study Methods: The “3D-Study” is a prospective, longitudinal cohort carried out from 2010-2014 by the “Integrated Research Network in Perinatology of Quebec and Eastern Ontario (IRNPQEO)”. The Bayley-III Scale of Infant Development, and the MacArthur-Bates Communicative Development Inventories were used to measure cognitive, language, and motor neurodevelopmental outcomes in infants at 2 years of age. Adjusted linear regression models were then used to evaluate the overall effect of ART techniques on these
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outcomes, using natural conception as the reference. Adjusted estimates for specific ART techniques were also calculated. Results: Neurodevelopmental outcomes were compared between 210 infants born after ART to 2,154 infants born after natural conception. After adjusting for relevant confounders, infants born after ART showed no difference in cognitive development [b1coefficient (SE) ¼ -0.02(1.0), p¼0.9872], motor function [b1(SE) ¼ -0.71(1.1), p¼0.5317] or language skills [b1(SE) ¼ +0.92(2.4), p¼0.7016]. No significant differences were observed when comparing independent ART techniques, including ovarian stimulation, intra-uterine insemination, in-vitro fertilization, intracytoplasmic sperm injection, and in-vitro maturation (p¼0.1940). Conclusion: In this prospective cohort study, using standardized tools to measure neurodevelopmental outcomes, infants born after ART appear to have similar cognitive, motor, and language skills at 2 years of age than infants born following natural conception. These findings may be useful in the clinical counselling of patients undergoing ART.
- O-OBS-MFM-MD-114 .............................................................. THE ROLE OF CERVICAL LENGTH IN TRIPLETS COMPARED WITH TWINS J. Barrett Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada H. Rosen, N. Melamed, O. Nevo, H. Freeman, R. Okby, P. Glanc Objectives: Mid-trimester Sonographic cervical length (CL) has been shown to predict preterm birth (PTB) in singleton and twins. Data regarding predictive value of CL in triplets is limited. Aim was to assess the predictive accuracy of CL in triplet pregnancies Study Methods: Retrospective study of women with triplets and twins followed in a tertiary referral center and underwent serial sonographic measurement of CL between 16 and 32 weeks. The change in CL along gestation in triplets was compared to that observed in twins. The predictive accuracy of CL was determined at 4 time periods along gestation: 18-20 (period 1), 21-24 (period 2), 25-27 (period 3) and 28-32 (period 4) weeks. Results: 1) Overall 442 CL measurements were available from 86 women with triplet pregnancies. 2) The rate of CL shortening was faster in triplets compared with twins (Figure 1A), as well as among triplets that delivered before 34, 32 or 30 weeks compared with those who did not (Figures 1B, 1C and 1D). 3) The correlation between CL and gestational age at delivery was highest during periods 3 and 4 (r¼0.570.58) compared with periods 1 and 2 (r¼0.19 and 0.34, respectively, p<0.001). 4) CL at 18-20 weeks (period 1) was not predictive of PTB. 5) CL a 25 weeks (periods 3 and 4) had the highest predictive value for PTB, with a PPV of 78-87% and NPV of 54-68%. Conclusion: Sonographic CL in triplet pregnancies is predictive of PTB only when performed after 20weeks gestation, and has the greatest predictive value at >¼25 weeks
- O-GYN-MD-027 ........................................................................ INFLUENCE OF DIET ON FIBROIDS AND ENDOMETRIOSIS, ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY O. Bougie The University of Ottawa and the Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada I. Chen, S. Singh Objectives: To determine the association between dietary habits and presence of endometriosis and fibroids.
ABSTRACTS
Study Methods: Data was collected from the National Health and Nutrition Examination Survey (NHANES) survey, administered in the US from 1999 to 2005. Diagnosis of endometriosis and fibroids were self-reported. Nutrition data was gathered based on daily food frequency questionnaires. Macronutrient intake variables (total energy, fat, protein, fiber, and carbohydrate) were distributed in quartiles for the analysis. Multinominal logistic regression analyses was performed to assess the relationship nutritional intake and diagnosis of endometriosis or fibroids, adjusted for age, BMI, race, OCP use, smoking, and gravidity status. Results: Complete case analysis was available for 4, 153 in the database. There were 288 (prevalence 6.93%) women who reported a diagnosis of endometriosis and 522 (prevalence 12.57%)reported a diagnosis of fibroids. Upon analysis of nutritional trends, increased consumption of fiber was associated with a decreased odds of endometriosis, with OR 0.63 (95%CI: 0.43-0.92 quartile 4 compared to quartile 1. Increased consumption of fat was associated with increased odds of fibroids, with OR 1.39 (95% CI 1.02-1.91) for quartile 2, OR 1.57 (95%CI 1.15-2.13) for quartile 3 and OR 1.39 (95%CI 1.03 -1.89) for quartile 4 compared to quartile 1, respectively. Conclusion: Our study suggests a link between dietary habits and presence of two common gynecological, hormone dependent conditions e endometriosis and fibroids. In particular, we suggest that the relationship between fat intake and fibroids should be further explored.
- V-GYN-MD-035 ......................................................................... LAPAROSCOPIC OVARIAN TRANSPOSITION O. Bougie The University of Ottawa and the Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada C. Rajakumar, S. Singh Video Summary: Ovarian transposition may be offered to young women planning to undergo pelvic radiation and at risk of loosing ovarian function. With appropriate preoperative planning, up to 80% of women are able to maintain their ovarian function following this pelvic radiotherapy. The laparoscopic approach offers patients expedited recovery, allowing them to focus on their cancer treatment. In this video, we review the key aspects of patient selection and preoperative counseling for this procedure. We present a case demonstrating the technique of laparoscopic ovarian transposition in a step-wise fashion.
- O-OBS-MD-093 ......................................................................... HOSPITAL VERSUS HOME CARE FOR PREGNANT WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES: A RETROSPECTIVE COHORT STUDY J. Burrows University of British Columbia and Fraser Health Authority, 9750 140th Street, Surrey, BC, V3T 0G9, Canada L. Palmer, K. Grabowska, H. Rowe, E. Billing, A. Metcalfe Objectives: To evaluate the influence of in-hospital management compared to at-home nursing care on maternal and newborn outcomes for women with preterm premature rupture of membranes (PPROM) presenting prior to 34 weeks gestation. Study Methods: A retrospective cohort study was conducted over five years, using data from the British Columbia Perinatal Data Registry and Canadian Institute for Health Information, and supplemented with chart review. Inclusion criteria were women with PPROM 23-34 weeks, stable in hospital for a minimum of 72 hours, and met eligibility criteria for antepartum care at home (ACAH). This study used a sample size of convenience. Two primary outcomes were compared: a composite of maternal morbidity; and a composite of
neonatal morbidity and mortality. The study also examined secondary outcomes, including PPROM latency, mode of delivery, and health resource utilization. Results: The study included 176 women, 87 who received ACAH and 89 who were managed in hospital. There were no differences in the composite maternal outcome (adjusted OR¼0.64; 95%CI 0.35e1.17; p¼0.14) or in composite neonatal outcome (adjusted OR¼0.63; 95%CI 0.31e1.30; p¼0.21) comparing management in hospital and care at home. Maternal and neonatal length of stay were significantly less in the ACAH group (p<0.05). Conclusion: Maternal and newborn outcomes were similar for women with PPROM who met specific eligibility criteria and received ACAH compared to those who met the same criteria and were managed in hospital. Reduced resource utilization with ACAH could result in substantial cost savings with no difference in clinical outcomes.
- O-GYN-UROGYN-MD-037 ................................................... FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY IN CANADA: A SURVEY OF OBSTETRICIANGYNAECOLOGISTS AND UROLOGISTS M. Coroneos University of Toronto, Department of Obstetrics and Gynecology, 123 Edward Street, Toronto, Ontario, M5G 1E2, Canada C. McDermott, E. Shore Objectives: To assess the current status of Female Pelvic Medicine and Reconstructive Surgery (FPMRS) in Canada, including attitudes, level of training, practice patterns and access to care among Canadian obstetrician-gynaecologists (OB/GYNs) and urologists. Study Methods: Electronic surveys were distributed to 737 OB/GYNs through the Society of Obstetricians and Gynaecologists of Canada and to 489 urologists through the Canadian Urological Association. Results: Complete responses were collected from 301 (41%) OB/GYNs and 39 (8%) urologists. Of OB/GYN respondents, 57% were generalists (GEN) and 22% completed FPMRS fellowship training (FPMRS-GYN). OB/GYN generalists were less likely than FPMRS gynaecologists to report comfort with POP-Q assessment, performance of cystoscopy, treatment of mesh complications, and management of overactive bladder (OAB). Urologists were less likely than FPMRS gynaecologists to report comfort completing a POP-Q assessment, performing pessary fittings and treating mesh complications, but more likely to report comfort managing OAB. FPMRS gynaecologists were more likely than other providers to report high volumes (>20 cases in past year) of vaginal hysterectomy, as well as incontinence and prolapse procedures. OB/ GYN generalists and urologists frequently cited lack of formal training in residency as a barrier to performing FPMRS procedures. FPMRS gynaecologists reported a lack of operating room facilities and personnel. Overall, 76% of respondents felt FPMRS should be a credentialed Canadian subspecialty (92% FPMRS-GYN, 69% GEN). Conclusion: OB/GYN generalists reported low case volumes and cited inadequate training in residency as a barrier to surgically managing pelvic floor disorders. The majority of respondents felt that FPMRS should be a credentialed subspecialty.
- O-OBS/GYN-S-080 .................................................................. USING A NEEDS-BASED APPROACH TO IDENTIFY PREDICTORS OF MATERNAL AND NEWBORN HEALTH CARE NEEDS TO INFORM HEALTH HUMAN RESOURCES (HHR) PLANNING A. Elliott Rose Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada G.T. Murphy, D. Gass, J. Gilbert, M. Aston
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- O-OBS-JM-062 ........................................................................... OBSTETRICAL OUTCOMES OF PATIENTS WITH HIV IN PREGNANCY: A POPULATION BASED COHORT K. Arab Jewish General Hospital, McGill University, 3755 Cote St-Catherine, Montreal, QC, H3S 1Y9, Canada N. Czuzoj-Shulman, H. Abenhaim Objectives: The study objective was to examine obstetrical outcomes of pregnancy among human immunodeficiency virus positive (HIV+) patients. Study Methods: A population-based cohort study was conducted using the Nationwide Inpatient Sample database (2003-2011). Pregnant HIV+ women were identified and compared to pregnant women without HIV. Multivariate logistic regression was used to estimate the adjusted effect of HIV status on obstetrical outcomes. Results: Among 7,772,999 births over the 9-year study period, 1,997 were in HIV+ women, resulting in an incidence of 25.7/100,000 births. An increasing trend in incidence was observed over study period. HIV+ patients had greater frequency of pre-existing diabetes and chronic hypertension, and more use of cigarettes, drugs and alcohol during pregnancy (p< 0.001). Upon adjustment for baseline characteristics, HIV+ patients had greater likelihood of antenatal complications: preterm premature rupture of membranes (OR 1.37, 95% CI 1.16-1.63), urinary tract infections (OR 3.01, 95% CI 2.43.79), and gestational hypertension (OR 0.67, 95% CI 0.49-0.92). Delivery and postpartum complications, specifically, cesarean delivery (OR 3.17, 95% CI 2.88-3.49), postpartum sepsis (OR 8.43, 95% CI 5.71-12.46), venous thromboembolism (OR 2.23, 95% CI 1.47-3.37), blood transfusions (OR 3.11, 95% CI 2.53-3.83), and postpartum depression (OR 2.21, 95% CI 1.78-2.75) were also more common in HIV+ patients. Neonates born to these mothers were at higher risk of prematurity (OR 1.62, 95% CI 1.43-1.83) and intrauterine fetal demise (OR 1.72, 95% CI 1.17-2.52). Maternal mortality was also elevated (OR 10.71, 95% CI 5.22-21.96). Conclusion: Pregnancy in HIV+ patients is associated with adverse maternal and fetal morbidities.
- O-OBS-JM-021 ........................................................................... NEURODEVELOPMENTAL OUTCOMES OF INFANTS AT 2 YEARS OF AGE FOLLOWING ASSISTED REPRODUCTIVE TECHNOLOGIES (ART) RELATIVE TO NATURAL CONCEPTION: FINDINGS FROM THE PROSPECTIVE, LONGITUDINAL, COHORT “3D-STUDY” J. Balayla Université de Montréal, 2900, boul. Édouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada W. Fraser, O. Sheehy, J. Seguin, J. Trasler, P. Monnier, G. Muckle, A. Bérard Objectives: Using standardized and validated tools designed to appraise the neurodevelopmental outcomes of infants, the objective of the present study was to compare the cognitive, language, and motor development of 2-year old infants following assisted reproductive technologies (ART) relative to natural conception. Study Methods: The “3D-Study” is a prospective, longitudinal cohort carried out from 2010-2014 by the “Integrated Research Network in Perinatology of Quebec and Eastern Ontario (IRNPQEO)”. The Bayley-III Scale of Infant Development, and the MacArthur-Bates Communicative Development Inventories were used to measure cognitive, language, and motor neurodevelopmental outcomes in infants at 2 years of age. Adjusted linear regression models were then used to evaluate the overall effect of ART techniques on these
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outcomes, using natural conception as the reference. Adjusted estimates for specific ART techniques were also calculated. Results: Neurodevelopmental outcomes were compared between 210 infants born after ART to 2,154 infants born after natural conception. After adjusting for relevant confounders, infants born after ART showed no difference in cognitive development [b1coefficient (SE) ¼ -0.02(1.0), p¼0.9872], motor function [b1(SE) ¼ -0.71(1.1), p¼0.5317] or language skills [b1(SE) ¼ +0.92(2.4), p¼0.7016]. No significant differences were observed when comparing independent ART techniques, including ovarian stimulation, intra-uterine insemination, in-vitro fertilization, intracytoplasmic sperm injection, and in-vitro maturation (p¼0.1940). Conclusion: In this prospective cohort study, using standardized tools to measure neurodevelopmental outcomes, infants born after ART appear to have similar cognitive, motor, and language skills at 2 years of age than infants born following natural conception. These findings may be useful in the clinical counselling of patients undergoing ART.
- O-OBS-MFM-MD-114 .............................................................. THE ROLE OF CERVICAL LENGTH IN TRIPLETS COMPARED WITH TWINS J. Barrett Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada H. Rosen, N. Melamed, O. Nevo, H. Freeman, R. Okby, P. Glanc Objectives: Mid-trimester Sonographic cervical length (CL) has been shown to predict preterm birth (PTB) in singleton and twins. Data regarding predictive value of CL in triplets is limited. Aim was to assess the predictive accuracy of CL in triplet pregnancies Study Methods: Retrospective study of women with triplets and twins followed in a tertiary referral center and underwent serial sonographic measurement of CL between 16 and 32 weeks. The change in CL along gestation in triplets was compared to that observed in twins. The predictive accuracy of CL was determined at 4 time periods along gestation: 18-20 (period 1), 21-24 (period 2), 25-27 (period 3) and 28-32 (period 4) weeks. Results: 1) Overall 442 CL measurements were available from 86 women with triplet pregnancies. 2) The rate of CL shortening was faster in triplets compared with twins (Figure 1A), as well as among triplets that delivered before 34, 32 or 30 weeks compared with those who did not (Figures 1B, 1C and 1D). 3) The correlation between CL and gestational age at delivery was highest during periods 3 and 4 (r¼0.570.58) compared with periods 1 and 2 (r¼0.19 and 0.34, respectively, p<0.001). 4) CL at 18-20 weeks (period 1) was not predictive of PTB. 5) CL a 25 weeks (periods 3 and 4) had the highest predictive value for PTB, with a PPV of 78-87% and NPV of 54-68%. Conclusion: Sonographic CL in triplet pregnancies is predictive of PTB only when performed after 20weeks gestation, and has the greatest predictive value at >¼25 weeks
- O-GYN-MD-027 ........................................................................ INFLUENCE OF DIET ON FIBROIDS AND ENDOMETRIOSIS, ANALYSIS OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY O. Bougie The University of Ottawa and the Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada I. Chen, S. Singh Objectives: To determine the association between dietary habits and presence of endometriosis and fibroids.
ABSTRACTS
Study Methods: Data was collected from the National Health and Nutrition Examination Survey (NHANES) survey, administered in the US from 1999 to 2005. Diagnosis of endometriosis and fibroids were self-reported. Nutrition data was gathered based on daily food frequency questionnaires. Macronutrient intake variables (total energy, fat, protein, fiber, and carbohydrate) were distributed in quartiles for the analysis. Multinominal logistic regression analyses was performed to assess the relationship nutritional intake and diagnosis of endometriosis or fibroids, adjusted for age, BMI, race, OCP use, smoking, and gravidity status. Results: Complete case analysis was available for 4, 153 in the database. There were 288 (prevalence 6.93%) women who reported a diagnosis of endometriosis and 522 (prevalence 12.57%)reported a diagnosis of fibroids. Upon analysis of nutritional trends, increased consumption of fiber was associated with a decreased odds of endometriosis, with OR 0.63 (95%CI: 0.43-0.92 quartile 4 compared to quartile 1. Increased consumption of fat was associated with increased odds of fibroids, with OR 1.39 (95% CI 1.02-1.91) for quartile 2, OR 1.57 (95%CI 1.15-2.13) for quartile 3 and OR 1.39 (95%CI 1.03 -1.89) for quartile 4 compared to quartile 1, respectively. Conclusion: Our study suggests a link between dietary habits and presence of two common gynecological, hormone dependent conditions e endometriosis and fibroids. In particular, we suggest that the relationship between fat intake and fibroids should be further explored.
- V-GYN-MD-035 ......................................................................... LAPAROSCOPIC OVARIAN TRANSPOSITION O. Bougie The University of Ottawa and the Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada C. Rajakumar, S. Singh Video Summary: Ovarian transposition may be offered to young women planning to undergo pelvic radiation and at risk of loosing ovarian function. With appropriate preoperative planning, up to 80% of women are able to maintain their ovarian function following this pelvic radiotherapy. The laparoscopic approach offers patients expedited recovery, allowing them to focus on their cancer treatment. In this video, we review the key aspects of patient selection and preoperative counseling for this procedure. We present a case demonstrating the technique of laparoscopic ovarian transposition in a step-wise fashion.
- O-OBS-MD-093 ......................................................................... HOSPITAL VERSUS HOME CARE FOR PREGNANT WOMEN WITH PRETERM PREMATURE RUPTURE OF MEMBRANES: A RETROSPECTIVE COHORT STUDY J. Burrows University of British Columbia and Fraser Health Authority, 9750 140th Street, Surrey, BC, V3T 0G9, Canada L. Palmer, K. Grabowska, H. Rowe, E. Billing, A. Metcalfe Objectives: To evaluate the influence of in-hospital management compared to at-home nursing care on maternal and newborn outcomes for women with preterm premature rupture of membranes (PPROM) presenting prior to 34 weeks gestation. Study Methods: A retrospective cohort study was conducted over five years, using data from the British Columbia Perinatal Data Registry and Canadian Institute for Health Information, and supplemented with chart review. Inclusion criteria were women with PPROM 23-34 weeks, stable in hospital for a minimum of 72 hours, and met eligibility criteria for antepartum care at home (ACAH). This study used a sample size of convenience. Two primary outcomes were compared: a composite of maternal morbidity; and a composite of
neonatal morbidity and mortality. The study also examined secondary outcomes, including PPROM latency, mode of delivery, and health resource utilization. Results: The study included 176 women, 87 who received ACAH and 89 who were managed in hospital. There were no differences in the composite maternal outcome (adjusted OR¼0.64; 95%CI 0.35e1.17; p¼0.14) or in composite neonatal outcome (adjusted OR¼0.63; 95%CI 0.31e1.30; p¼0.21) comparing management in hospital and care at home. Maternal and neonatal length of stay were significantly less in the ACAH group (p<0.05). Conclusion: Maternal and newborn outcomes were similar for women with PPROM who met specific eligibility criteria and received ACAH compared to those who met the same criteria and were managed in hospital. Reduced resource utilization with ACAH could result in substantial cost savings with no difference in clinical outcomes.
- O-GYN-UROGYN-MD-037 ................................................... FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY IN CANADA: A SURVEY OF OBSTETRICIANGYNAECOLOGISTS AND UROLOGISTS M. Coroneos University of Toronto, Department of Obstetrics and Gynecology, 123 Edward Street, Toronto, Ontario, M5G 1E2, Canada C. McDermott, E. Shore Objectives: To assess the current status of Female Pelvic Medicine and Reconstructive Surgery (FPMRS) in Canada, including attitudes, level of training, practice patterns and access to care among Canadian obstetrician-gynaecologists (OB/GYNs) and urologists. Study Methods: Electronic surveys were distributed to 737 OB/GYNs through the Society of Obstetricians and Gynaecologists of Canada and to 489 urologists through the Canadian Urological Association. Results: Complete responses were collected from 301 (41%) OB/GYNs and 39 (8%) urologists. Of OB/GYN respondents, 57% were generalists (GEN) and 22% completed FPMRS fellowship training (FPMRS-GYN). OB/GYN generalists were less likely than FPMRS gynaecologists to report comfort with POP-Q assessment, performance of cystoscopy, treatment of mesh complications, and management of overactive bladder (OAB). Urologists were less likely than FPMRS gynaecologists to report comfort completing a POP-Q assessment, performing pessary fittings and treating mesh complications, but more likely to report comfort managing OAB. FPMRS gynaecologists were more likely than other providers to report high volumes (>20 cases in past year) of vaginal hysterectomy, as well as incontinence and prolapse procedures. OB/ GYN generalists and urologists frequently cited lack of formal training in residency as a barrier to performing FPMRS procedures. FPMRS gynaecologists reported a lack of operating room facilities and personnel. Overall, 76% of respondents felt FPMRS should be a credentialed Canadian subspecialty (92% FPMRS-GYN, 69% GEN). Conclusion: OB/GYN generalists reported low case volumes and cited inadequate training in residency as a barrier to surgically managing pelvic floor disorders. The majority of respondents felt that FPMRS should be a credentialed subspecialty.
- O-OBS/GYN-S-080 .................................................................. USING A NEEDS-BASED APPROACH TO IDENTIFY PREDICTORS OF MATERNAL AND NEWBORN HEALTH CARE NEEDS TO INFORM HEALTH HUMAN RESOURCES (HHR) PLANNING A. Elliott Rose Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada G.T. Murphy, D. Gass, J. Gilbert, M. Aston
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