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O-GYN-UROGYN-MD-037 Female Pelvic Medicine and Reconstructive Surgery in Canada: A Survey of Obstetrician-Gynaecologists and Urologists
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
MAY JOGC MAI 2016
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485
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
MAY JOGC MAI 2016
l
485