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O028 REVIEW OF MANAGEMENT IN WOMEN WITH ABNORMAL SMEARS REFERRED TO COLPOSCOPY LESS THAN 25 YEARS
S270
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
significance (ASC-US) and atypical squamous cells of undetermined significance but high grade changes cannot be ruled out (ASCUS-H.) We looked at the outcomes of women referred with ASCUS-H smears in our colposcopy unit since March 2011 to September 2011. Materials: A retrospective review of the colposcopy data-base and clinical records was performed. Methods: Data was entered and analysed using microsoft EXCEL. Results: A total of 1163 women were referred to colposcopy during the study period. 62 had ASCUS-H. The majority (70%) of these women were reviewed within eight weeks of referral. Colposcopic impression was high grade lesion in 33% of cases (21/62). Subsequent smears were HSIL in 24% (15/62) of cases of which 73% (11/15) were CIN3. 21 case (33%) had a histologically proven diagnosis of CIN3. 29 women (46%) were treated with LLETZ with a histology subsequently showing high grade lesions (CIN2–3) in 24% and a mixture of HSIL and LSIL (CIN1,2,3) in 55% of cases. Histology revealed micro-invasive cancer in two cases. 10 women were postmenopausal with a histological diagnosis of CIN1–2 in 60%. This might reflect the low threshold in treating this category of patients and adoption of a ‘see and treat’ approach in most cases. Conclusions: The prevalence of high grade cervical intraepithelial lesions among those referred with ASCUS-H is high. This supports the need for urgent referral as per high grade smears recommendation. It remains interesting to determine the role of HPV-DNA test in the triage and further management of these cases particularly in post-menopausal women. O026 VALUES CLARIFICATION AS AN INTEGRAL COMPONENT OF ABORTION SERVICE DELIVERY IN PAKISTAN S. Ahsan Pal5,6,7 , N. Shah3 , S. Sohani4 , A. Mazhar2 , E. Pearson1 , K.L. Turner1 . 1 Ipas, Chapel Hill, NC, United States; 2 Ipas Pakistan, Karachi, Pakistan; 3 Department of Gynecology & Obstetrics, Dow Medical College and Civil Hospital, Karachi, Pakistan; 4 Aahung, Karachi, Pakistan; 5 OMI Hospital, Karachi, Pakistan; 6 National Committee for Maternal and Neonatal Health, Karachi, Pakistan; 7 Executive Member Association for Mothers and Newborns, Executive Member Society of Obstetricians and Gynecologists of Pakistan, Karachi, Pakistan Objectives: Abortion is legal in Pakistan to save a woman’s life and provide necessary treatment; an estimated 890,000 induced abortions occur each year. To address barriers to abortion service provision resulting from misinformation, stigma and negative attitudes and help providers appropriately separate personal beliefs from professional responsibilities, Ipas implemented a series of locally adapted values clarification and attitude transformation (VCAT) workshops. Materials: Initially, Ipas and its local VCAT partner, the Association for Mothers and Newborns (AMAN) reached senior obstetrician/ gynecologists and faculty primarily from teaching hospitals where Ipas’ lead local partner, the National Committee for Maternal and Neonatal Health (NCMNH) was providing clinical training on manual vacuum aspiration (MVA) and misoprostol for postabortion care. As a result, there was demand for additional VCAT workshops for staff of reproductive health organizations and all Ipas clinical trainees, including midlevel providers. A total of 303 providers participated in 17 workshops conducted between 2009 and 2011. Methods: Pre- and post-workshop surveys were administered to all participants to assess changes in knowledge and attitudes, using scores computed on a scale of 0 to 100. Pre-and post-workshop scores were compared using Wilcoxon matched-pairs signed-rank test. Results: Among 303 participants, there was evidence of significant improvement in abortion knowledge and attitudes between the pre- and post-test. Median knowledge score increased from 40
at pre-test to 60 at post-test (p < 0.001), while median attitude score increased from 68 at pre-test to 74 at post-test (p < 0.001). Qualitatively, workshop participants reported greater comfort with abortion after learning about unsafe abortion prevalence and the abortion law and discussing the intersection of Islam and abortion in relation to professional responsibilities. Partners have reported increases in service provision, which they attribute to VCAT workshops. Demand for VCAT has increased as participants recommend the workshop to colleagues, and medical school faculty express interest in conducting VCAT with their students. Conclusions: VCAT workshops have been an integral component of abortion service delivery in Pakistan, as they have complemented clinical training by improving providers’ knowledge and attitudes about and comfort with abortion. O027 METFORMIN: A SAFE ALTERNATIVE TO INSULIN THERAPY IN GESTATIONAL DIABETES J. Ainuddin1 . 1 Gynae Obstetrics, Dow university of health sciences, Karachi, Sindh, Pakistan Objectives: To assess the efficacy of Metformin treatment in gestational diabetes pregnancies compared with insulin treatment. Materials: Human subjects, Pregnant patients having a diagnosis of GDM, Metformin tablets and human isulen. Methods: Interventional study, Randomized clinical trial A total of 150 patients with gestational diabetes between 20–35 weeks of gestation were selected for pharmacological treatment using metformin or insulin during the study period form 20–12–08 till 20–12–10 from Antenatal OPD after screaning with 75grams OGTT. The primary outcomes were neonatal morbidity and fetal macrosomia. Secondary outcome measures were glycaemic control and treatment acceptability including cost benefit. Results: Patients on metformin and insulin were matched in age, parity, BMI and gestational age at study entry. Mean birth weight did not differ in both groups but fetal macrosomia was less in metformin group than in insulin group 18.67% V/S 10. 65% P < 0.05. Neonatal morbidity and NICU admissions were less in metformin group. 40% pts required supplemental insulin with metformin for tight glycaemic control. Conclusions: Metformin is a safe and effective alternative to insulin in gestational diabetes. Metformin treatment resulted in less fetal macrosomia and fewer NICU admissions and neonatal morbidity with advantages of cheap oral therapy in our resource poor setting O028 REVIEW OF MANAGEMENT IN WOMEN WITH ABNORMAL SMEARS REFERRED TO COLPOSCOPY LESS THAN 25 YEARS P. Ajaya Maharajan1 , K. Nakade2 . 1 John Radcliffe Hospital, Milton Keynes, United Kingdom; 2 Milton Keynes Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom Objectives: The BSCCP recommends that women under the age of 25 should be sent their first invitation at 24.5 years. Recently published research and experience from the cervical screening programme have shown that screening women under the age of 25 may do more harm than good. Almost one in six cervical cytology samples taken in this age group are abnormal. Much of this prevalent low grade disease would resolve spontaneously if screening were started at a later age. Our study was to detect the occurrence of low and high grade disease in this group of women and to assess the way they were managed. Materials: It is a retrospective Audit. Total number over a period of 3 years were 300 patients. Our pilot study data analysed 50 patients between Jan-Aug 2009. Methods: Retrospective analysis. Results: Only 2/50 had documented indication for smear like postcoital bleeding and ectropion. 16% was between 15–20years and rest 84% were between 21–25years of age. 56% was nulliparous
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
and rest were multiparous. 46% used OCP followed by 16% using POP as contraception. 50% had moderate dyskaryosis and 42% had severe dyskaryosis followed by BNC 4% and Mild dyskaryosis(4%) in the referral smear. Of the 46 who had high grade disease on smear 41were felt to be high grade on initial assessment, 1 had colposcopic assessment as normal cervix, 4 had assessment low grade but biopsy upgrading them into high grade lesions. Of this high grade group 21/41 had LLETZ in their 1st visit, 18/41 had biopsy and 2/41 had colposcopic assessment only. 5/46 of the high grade on biopsy was managed conservatively. 32% were smokers. Conclusions: Our study concluded that there were more occurrence of high grade disease in this cohort of patients. It is crucial to have guidance and protocols to guide clinicians to treat them if a high grade abnormality is detected. Although conservative management is an available option it unclear as how frequent and they need to be monitored. There need to be more stringent guidelines in the management of these women if we detect high grade abnormality. Multidisciplinary input is crucial in their management and proper follow up is needed to detect any further changes. O029 NEGATIVE LAPAROSCOPY FOR ECTOPIC: ANYTHING TO LEARN? P. Ajaya Maharajan1 , J. Elliot2 , E. Jwarah2 . 1 John Radcliffe Hospital, Milton Keynes, United Kingdom; 2 Milton Keynes Hospital NHS Trust, Milton Keynes, Buckinghamshire, United Kingdom Objectives: It has been said that ultrasound technology and the use of transvaginal ultrasound scan has taken the guesswork out of ectopic pregnancies diagnosis. Some have even gone as far to say laparoscopy, the traditional the gold standard in diagnosis of ectopic pregnancies should not be used in modern management. Our question: can anything be learned to reduce negative diagnostic laparoscopy for ectopic pregnancy? Materials: Retrospective analysis. Methods: This was a retrospect observational study. All emergency diagnostic laparoscopy for ectopic pregnancy between the period of October 2008 and September 2010 at MKGH were reviewed and those with negative findings were analysed in detail. Results: 52% (n = 38) of emergency diagnostic laparoscopy for suspected ectopic were negative for ectopic pregnancy. 15 notes were accessible for detailed analysis. Only 20% (3) of those with negative laparoscopy had associated risk factors for ectopic pregnancy. 43% (7) had suboptimal rise in Beta HCG prior to laparoscopy. 93% (14) had suspicious ultrasound finding of either adenexa mass or empty uterus or free fluid. On follow up, 10 (66.6%) went on to have viable intrauterine pregnancy and 5 (33.3%) had ERPC at time of laparoscopy. The main indicator for laparoscopy was patient’s symptom (66%), followed by suboptimal rise in Beta HCG (53%) and ultrasound findings (53%). Conclusions: Our findings, despite ultrasound sensitivity and probabilistic rules, diagnostic laparoscopy as a diagnostic method for ectopic pregnancy is still yet to be rendered obsolete. O030 COMPLICATED UNSAFE ABORTION IN A NIGERIAN TEACHING HOSPITAL: PATTERN OF MORBIDITY AND MORTALITY F.M. Akinlusi2 , K. Rabiu1 , N. Adewunmi1 , O. Imosemi2 , S. Badmus1 . 1 Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; 2 Lagos State Health Service Commission, Department of Obstetrics and Gynaecology, Ibeju-Lekki General Hospital, Akodo, Lagos, Nigeria Objectives: To describe the socio-demographic characteristics of patients with complicated unsafe abortion, pattern of presentation, management and magnitude of the problem. Materials: This was a retrospective descriptive study of all the 231 patients admitted with complications from unsafe abortion at the Obstetrics and Gynaecological unit of the Lagos State University Teaching Hospital, Ikeja, Nigeria between January 1st 2003 and December 31st 2007.
S271
Methods: The case records were retrieved and reviewed for relevant data such as age, marital and educational status, contraceptive useage, method used, abortion provider, clinical presentation, management and complications. Data obtained were analysed using Epi Info 3.5 statistical software (2008) version of the Centre for Disease Control and Prevention, Atlanta,USA. Categorical data were presented as frequencies and percentages. Numerical data were analysed using means Results: The mean age of the patients was 25.2 years (SD = 6.5) with a range of 16–48 years. Twenty nine percent were teenagers, 57% nulliparous and 51% single. The mean gestational age at termination was 12.3weeks (SD = 5.5) with a range of 5–26 weeks. Abdominal pain, fever and vaginal bleeding occurred most commonly in 62%, 54% and 53% of the cases respectively. Anaemia (55%) and retained products of conception (47%) were the most common complications with 47% having surgical evacuation of retained products. During the study period there were 15,067 deliveries. The complicated unsafe abortion ratio was 1.53 per 100 births. There were 39 abortion related deaths giving a case fatality ratio of 16.9 and contributing 9.9% of all 392 maternal deaths during the period. Sepsis accounted for 80% of mortalities. Conclusions: Mortality remains high from unsafe abortion with sepsis being the leading cause of death. Strategies must focus on patient-friendly post abortal care in our society with restrictive abortion law. O031 CERVICAL CANCER SCREENING AMONG HIV POSITIVE WOMEN: EXPERIENCE FROM A TERTIARY CARE HIV CLINIC IN NIGERIA B.O. Akinwunmi1 , O. Adesina2 , O.A. Awolude3 , O. Morhason-Bello4 , C. Okolo5 , S. Oladokun6 , I. Adewole7 . 1 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 2 Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, Ibadan., Oyo State, Nigeria, Nigeria; 3 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 4 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 5 DEPT. OF PATHOLOGY, UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 6 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 7 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria Objectives: The objective is to see pattern of CIN precursor lesions among HIV patients both on ARV therapy and those not yet on HAART. To see the effect of treatment. To observe the relationships between risk factors for Cervical cancer and the Pap smear results obtained among these HIV patients in our facility. Materials: A four page forty stem questionaire with informations on biosocial characteristics sexual history, reproductive history, previous gynaecological investigations, HIV history and others was administered to five hundred and five registered women with HIV at the University College Hospital, Ibadan. Methods: Pap smear screening was conducted for 505 consented women attending the ARV clinic at the University College Hospital Ibadan for 2 years. Cervical smears were fixed using Safertex spray and stained with Papanicolaou dye. The cytological results were analysed with some biosocial variables of subjects using SPSS 15.0 software. The level of significance was 95% confidence level. Results: Five hundred and five PLWHA women had Pap smear between 2009 and 2011. The mean age was 36.76±8.46 years with mean age of marriage being 23.33± 4.44 years. About 43.37% had at least secondary education and 10.80% had no formal education with 45% in polygamy. The mean duration of HIV diagnosis was 24 months with 57.02 % being on HAART for average of 24 months and 1.9% being on HAART for about 60 months. The range of abnormal results from Low Grade squamous epithelia lesions to the high grade Squamous epithelia lesions varied between 9.5% among those
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
significance (ASC-US) and atypical squamous cells of undetermined significance but high grade changes cannot be ruled out (ASCUS-H.) We looked at the outcomes of women referred with ASCUS-H smears in our colposcopy unit since March 2011 to September 2011. Materials: A retrospective review of the colposcopy data-base and clinical records was performed. Methods: Data was entered and analysed using microsoft EXCEL. Results: A total of 1163 women were referred to colposcopy during the study period. 62 had ASCUS-H. The majority (70%) of these women were reviewed within eight weeks of referral. Colposcopic impression was high grade lesion in 33% of cases (21/62). Subsequent smears were HSIL in 24% (15/62) of cases of which 73% (11/15) were CIN3. 21 case (33%) had a histologically proven diagnosis of CIN3. 29 women (46%) were treated with LLETZ with a histology subsequently showing high grade lesions (CIN2–3) in 24% and a mixture of HSIL and LSIL (CIN1,2,3) in 55% of cases. Histology revealed micro-invasive cancer in two cases. 10 women were postmenopausal with a histological diagnosis of CIN1–2 in 60%. This might reflect the low threshold in treating this category of patients and adoption of a ‘see and treat’ approach in most cases. Conclusions: The prevalence of high grade cervical intraepithelial lesions among those referred with ASCUS-H is high. This supports the need for urgent referral as per high grade smears recommendation. It remains interesting to determine the role of HPV-DNA test in the triage and further management of these cases particularly in post-menopausal women. O026 VALUES CLARIFICATION AS AN INTEGRAL COMPONENT OF ABORTION SERVICE DELIVERY IN PAKISTAN S. Ahsan Pal5,6,7 , N. Shah3 , S. Sohani4 , A. Mazhar2 , E. Pearson1 , K.L. Turner1 . 1 Ipas, Chapel Hill, NC, United States; 2 Ipas Pakistan, Karachi, Pakistan; 3 Department of Gynecology & Obstetrics, Dow Medical College and Civil Hospital, Karachi, Pakistan; 4 Aahung, Karachi, Pakistan; 5 OMI Hospital, Karachi, Pakistan; 6 National Committee for Maternal and Neonatal Health, Karachi, Pakistan; 7 Executive Member Association for Mothers and Newborns, Executive Member Society of Obstetricians and Gynecologists of Pakistan, Karachi, Pakistan Objectives: Abortion is legal in Pakistan to save a woman’s life and provide necessary treatment; an estimated 890,000 induced abortions occur each year. To address barriers to abortion service provision resulting from misinformation, stigma and negative attitudes and help providers appropriately separate personal beliefs from professional responsibilities, Ipas implemented a series of locally adapted values clarification and attitude transformation (VCAT) workshops. Materials: Initially, Ipas and its local VCAT partner, the Association for Mothers and Newborns (AMAN) reached senior obstetrician/ gynecologists and faculty primarily from teaching hospitals where Ipas’ lead local partner, the National Committee for Maternal and Neonatal Health (NCMNH) was providing clinical training on manual vacuum aspiration (MVA) and misoprostol for postabortion care. As a result, there was demand for additional VCAT workshops for staff of reproductive health organizations and all Ipas clinical trainees, including midlevel providers. A total of 303 providers participated in 17 workshops conducted between 2009 and 2011. Methods: Pre- and post-workshop surveys were administered to all participants to assess changes in knowledge and attitudes, using scores computed on a scale of 0 to 100. Pre-and post-workshop scores were compared using Wilcoxon matched-pairs signed-rank test. Results: Among 303 participants, there was evidence of significant improvement in abortion knowledge and attitudes between the pre- and post-test. Median knowledge score increased from 40
at pre-test to 60 at post-test (p < 0.001), while median attitude score increased from 68 at pre-test to 74 at post-test (p < 0.001). Qualitatively, workshop participants reported greater comfort with abortion after learning about unsafe abortion prevalence and the abortion law and discussing the intersection of Islam and abortion in relation to professional responsibilities. Partners have reported increases in service provision, which they attribute to VCAT workshops. Demand for VCAT has increased as participants recommend the workshop to colleagues, and medical school faculty express interest in conducting VCAT with their students. Conclusions: VCAT workshops have been an integral component of abortion service delivery in Pakistan, as they have complemented clinical training by improving providers’ knowledge and attitudes about and comfort with abortion. O027 METFORMIN: A SAFE ALTERNATIVE TO INSULIN THERAPY IN GESTATIONAL DIABETES J. Ainuddin1 . 1 Gynae Obstetrics, Dow university of health sciences, Karachi, Sindh, Pakistan Objectives: To assess the efficacy of Metformin treatment in gestational diabetes pregnancies compared with insulin treatment. Materials: Human subjects, Pregnant patients having a diagnosis of GDM, Metformin tablets and human isulen. Methods: Interventional study, Randomized clinical trial A total of 150 patients with gestational diabetes between 20–35 weeks of gestation were selected for pharmacological treatment using metformin or insulin during the study period form 20–12–08 till 20–12–10 from Antenatal OPD after screaning with 75grams OGTT. The primary outcomes were neonatal morbidity and fetal macrosomia. Secondary outcome measures were glycaemic control and treatment acceptability including cost benefit. Results: Patients on metformin and insulin were matched in age, parity, BMI and gestational age at study entry. Mean birth weight did not differ in both groups but fetal macrosomia was less in metformin group than in insulin group 18.67% V/S 10. 65% P < 0.05. Neonatal morbidity and NICU admissions were less in metformin group. 40% pts required supplemental insulin with metformin for tight glycaemic control. Conclusions: Metformin is a safe and effective alternative to insulin in gestational diabetes. Metformin treatment resulted in less fetal macrosomia and fewer NICU admissions and neonatal morbidity with advantages of cheap oral therapy in our resource poor setting O028 REVIEW OF MANAGEMENT IN WOMEN WITH ABNORMAL SMEARS REFERRED TO COLPOSCOPY LESS THAN 25 YEARS P. Ajaya Maharajan1 , K. Nakade2 . 1 John Radcliffe Hospital, Milton Keynes, United Kingdom; 2 Milton Keynes Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom Objectives: The BSCCP recommends that women under the age of 25 should be sent their first invitation at 24.5 years. Recently published research and experience from the cervical screening programme have shown that screening women under the age of 25 may do more harm than good. Almost one in six cervical cytology samples taken in this age group are abnormal. Much of this prevalent low grade disease would resolve spontaneously if screening were started at a later age. Our study was to detect the occurrence of low and high grade disease in this group of women and to assess the way they were managed. Materials: It is a retrospective Audit. Total number over a period of 3 years were 300 patients. Our pilot study data analysed 50 patients between Jan-Aug 2009. Methods: Retrospective analysis. Results: Only 2/50 had documented indication for smear like postcoital bleeding and ectropion. 16% was between 15–20years and rest 84% were between 21–25years of age. 56% was nulliparous
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
and rest were multiparous. 46% used OCP followed by 16% using POP as contraception. 50% had moderate dyskaryosis and 42% had severe dyskaryosis followed by BNC 4% and Mild dyskaryosis(4%) in the referral smear. Of the 46 who had high grade disease on smear 41were felt to be high grade on initial assessment, 1 had colposcopic assessment as normal cervix, 4 had assessment low grade but biopsy upgrading them into high grade lesions. Of this high grade group 21/41 had LLETZ in their 1st visit, 18/41 had biopsy and 2/41 had colposcopic assessment only. 5/46 of the high grade on biopsy was managed conservatively. 32% were smokers. Conclusions: Our study concluded that there were more occurrence of high grade disease in this cohort of patients. It is crucial to have guidance and protocols to guide clinicians to treat them if a high grade abnormality is detected. Although conservative management is an available option it unclear as how frequent and they need to be monitored. There need to be more stringent guidelines in the management of these women if we detect high grade abnormality. Multidisciplinary input is crucial in their management and proper follow up is needed to detect any further changes. O029 NEGATIVE LAPAROSCOPY FOR ECTOPIC: ANYTHING TO LEARN? P. Ajaya Maharajan1 , J. Elliot2 , E. Jwarah2 . 1 John Radcliffe Hospital, Milton Keynes, United Kingdom; 2 Milton Keynes Hospital NHS Trust, Milton Keynes, Buckinghamshire, United Kingdom Objectives: It has been said that ultrasound technology and the use of transvaginal ultrasound scan has taken the guesswork out of ectopic pregnancies diagnosis. Some have even gone as far to say laparoscopy, the traditional the gold standard in diagnosis of ectopic pregnancies should not be used in modern management. Our question: can anything be learned to reduce negative diagnostic laparoscopy for ectopic pregnancy? Materials: Retrospective analysis. Methods: This was a retrospect observational study. All emergency diagnostic laparoscopy for ectopic pregnancy between the period of October 2008 and September 2010 at MKGH were reviewed and those with negative findings were analysed in detail. Results: 52% (n = 38) of emergency diagnostic laparoscopy for suspected ectopic were negative for ectopic pregnancy. 15 notes were accessible for detailed analysis. Only 20% (3) of those with negative laparoscopy had associated risk factors for ectopic pregnancy. 43% (7) had suboptimal rise in Beta HCG prior to laparoscopy. 93% (14) had suspicious ultrasound finding of either adenexa mass or empty uterus or free fluid. On follow up, 10 (66.6%) went on to have viable intrauterine pregnancy and 5 (33.3%) had ERPC at time of laparoscopy. The main indicator for laparoscopy was patient’s symptom (66%), followed by suboptimal rise in Beta HCG (53%) and ultrasound findings (53%). Conclusions: Our findings, despite ultrasound sensitivity and probabilistic rules, diagnostic laparoscopy as a diagnostic method for ectopic pregnancy is still yet to be rendered obsolete. O030 COMPLICATED UNSAFE ABORTION IN A NIGERIAN TEACHING HOSPITAL: PATTERN OF MORBIDITY AND MORTALITY F.M. Akinlusi2 , K. Rabiu1 , N. Adewunmi1 , O. Imosemi2 , S. Badmus1 . 1 Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria; 2 Lagos State Health Service Commission, Department of Obstetrics and Gynaecology, Ibeju-Lekki General Hospital, Akodo, Lagos, Nigeria Objectives: To describe the socio-demographic characteristics of patients with complicated unsafe abortion, pattern of presentation, management and magnitude of the problem. Materials: This was a retrospective descriptive study of all the 231 patients admitted with complications from unsafe abortion at the Obstetrics and Gynaecological unit of the Lagos State University Teaching Hospital, Ikeja, Nigeria between January 1st 2003 and December 31st 2007.
S271
Methods: The case records were retrieved and reviewed for relevant data such as age, marital and educational status, contraceptive useage, method used, abortion provider, clinical presentation, management and complications. Data obtained were analysed using Epi Info 3.5 statistical software (2008) version of the Centre for Disease Control and Prevention, Atlanta,USA. Categorical data were presented as frequencies and percentages. Numerical data were analysed using means Results: The mean age of the patients was 25.2 years (SD = 6.5) with a range of 16–48 years. Twenty nine percent were teenagers, 57% nulliparous and 51% single. The mean gestational age at termination was 12.3weeks (SD = 5.5) with a range of 5–26 weeks. Abdominal pain, fever and vaginal bleeding occurred most commonly in 62%, 54% and 53% of the cases respectively. Anaemia (55%) and retained products of conception (47%) were the most common complications with 47% having surgical evacuation of retained products. During the study period there were 15,067 deliveries. The complicated unsafe abortion ratio was 1.53 per 100 births. There were 39 abortion related deaths giving a case fatality ratio of 16.9 and contributing 9.9% of all 392 maternal deaths during the period. Sepsis accounted for 80% of mortalities. Conclusions: Mortality remains high from unsafe abortion with sepsis being the leading cause of death. Strategies must focus on patient-friendly post abortal care in our society with restrictive abortion law. O031 CERVICAL CANCER SCREENING AMONG HIV POSITIVE WOMEN: EXPERIENCE FROM A TERTIARY CARE HIV CLINIC IN NIGERIA B.O. Akinwunmi1 , O. Adesina2 , O.A. Awolude3 , O. Morhason-Bello4 , C. Okolo5 , S. Oladokun6 , I. Adewole7 . 1 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 2 Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria, Ibadan., Oyo State, Nigeria, Nigeria; 3 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 4 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 5 DEPT. OF PATHOLOGY, UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 6 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria; 7 PEPFAR-APIN CLINIC /UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA, Ibadan, Oyo State, Nigeria Objectives: The objective is to see pattern of CIN precursor lesions among HIV patients both on ARV therapy and those not yet on HAART. To see the effect of treatment. To observe the relationships between risk factors for Cervical cancer and the Pap smear results obtained among these HIV patients in our facility. Materials: A four page forty stem questionaire with informations on biosocial characteristics sexual history, reproductive history, previous gynaecological investigations, HIV history and others was administered to five hundred and five registered women with HIV at the University College Hospital, Ibadan. Methods: Pap smear screening was conducted for 505 consented women attending the ARV clinic at the University College Hospital Ibadan for 2 years. Cervical smears were fixed using Safertex spray and stained with Papanicolaou dye. The cytological results were analysed with some biosocial variables of subjects using SPSS 15.0 software. The level of significance was 95% confidence level. Results: Five hundred and five PLWHA women had Pap smear between 2009 and 2011. The mean age was 36.76±8.46 years with mean age of marriage being 23.33± 4.44 years. About 43.37% had at least secondary education and 10.80% had no formal education with 45% in polygamy. The mean duration of HIV diagnosis was 24 months with 57.02 % being on HAART for average of 24 months and 1.9% being on HAART for about 60 months. The range of abnormal results from Low Grade squamous epithelia lesions to the high grade Squamous epithelia lesions varied between 9.5% among those