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O065 ROLE OF CHROMOHYSTEROSCOPY IN RECURRENT MISCARRIAGES
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Results: Time required to suture was significantly lower in groups operated with bidirectional suture than in groups with traditional suture either for TLH or LM (p < 0.001). No significant difference was observed in the operative time between the study groups. The degree of surgical difficulty was significantly lower in Quill group than in the other groups. Biomechanical tests showed that maximum force was similar for 2–0 Monocryl and 0-Quill respectively (p = non significant). Conclusions: use of barbed suture reduces time required to repair vaginal cuff during TLH and uterine wall defect during LM. Biomechanical strength of the sutures is comparable. O065 ROLE OF CHROMOHYSTEROSCOPY IN RECURRENT MISCARRIAGES S. Arora1 , Y.M. Mala1 , R. Tripathi1 . 1 Obstetrics & Gynaecology, Maulana Azad Medical College, New Delhi, New Delhi, India Objectives: To evaluate the role of chromohysteroscopy in diagnosing endometrial pathology in patients with recurrent miscarriages. Materials: A prospective study was conducted on women with history of recurrent miscarriages attending gynecology department of Maulana Azad Medical College, New Delhi, India. Sixty five women with history of two or more consecutive miscarriages occurring during the first 20 weeks of gestation were included in the study. Women diagnosed to have diabetes, hypothyroidism and anti phospholipid antibody syndrome were excluded from the study. Methods: In all subjects transvaginal ultrasonography, hysterosalpingography, hysteroscopy and chromohysteroscopy were performed. Chromo hysteroscopy was performed by injecting methylene blue dye and observed for either a diffuse or focal staining pattern of the uterine cavity. Hysteroscopic guided endometrial biopsies were taken from both stained and unstained areas and sent for histo-pathological examination. Results: Out of 65, only 50 patients could be investigated completely. Most of the patients (54%) had two previous miscarriages, 40% had three and 6% had four or more miscarriages. Chromohysteroscopy resulted in diffuse light blue staining of endometrium in 46% and focal dark blue staining in 54% of cases. In patients with diffuse light blue staining endometrial biopsy showed inflammatory changes in 21.7% and a normal proliferative endometrium in 78.3%. In patients who had focal staining, biopsy from the stained areas showed inflammation in 74% of cases, compared to only 15% from unstained areas. The sensitivity, specificity, positive and negative predictive value in diagnosing inflammation from dark stained areas in focal staining pattern were 74%, 85%, 83.3% and 76.6% respectively. The association between stained areas and the presence of inflammation on histopathology was found to be significant (p < 0.001). Conclusions: Office hysteroscopy is a safe and acceptable modality to evaluate the uterine causes of recurrent miscarriages. Chromohysteroscopy can be used to identify the abnormal areas of endometrium. Biopsy from the dark stained areas can help in detecting cases of endometritis which may be a cause of unexplained abortions. O066 BREAST CANCER IN YOUNG PATIENTS D. Arteiro1 , S. Costa2 , S. Soares4 , C. Fernandes3 , A. Correia1 , A. Magalh˜aes2 , F. Osorio ´ 2 , J.L. Fougo2 . 1 Servico ¸ de Ginecologia e Obstetr´ıcia, Centro Hospitalar de S˜ ao Jo˜ ao, Porto, Porto, Portugal; 2 Centro de Mama, Centro Hospitalar de S˜ ao Jo˜ ao, Porto, Porto, Portugal; 3 Servico ¸ de Oncologia M´edica, Centro Hospitalar de S˜ ao Jo˜ ao, Porto, Porto, Portugal; 4 Servico ¸ de Ginecologia e Obstetr´ıcia, Centro Hospitalar do Porto, Porto, Porto, Portugal Objectives: Breast cancer is one of the most common cancers affecting women. In young ages, it may be a devastating disease.
The aim of this study was to examine and audit the experience of our institution in treating young patients with breast cancer (≤35 years), focusing on the clinical and pathological features. Materials: We retrospectively reviewed the records of patients with diagnosis of breast cancer aged 35 years and under, referred to our centre from January 1997 to January 2012. Methods: The case records of all patients were examined for initial presentation, treatment, local and disseminated recurrence of disease and survival. Histological reports were reviewed and details of tumor size, histological type and grade, lymph node status, expression of hormone receptor, amplification of HER-2 were analyzed. Statistical analysis was performed using SPSS. Results: A total of 83 breast cancer patients with a mean age of 31.1 (23–35) were identified. Histological examination of the tumors revealed invasive ductal carcinoma in 61 (74.4%) cases. In 53% (44), the tumors were grade 3. 40.5% (32) underwent neoadjuvant chemotherapy. Mastectomy was undertaken in 56.6% (47) patients with 32.6% (15) undergoing immediate breast reconstruction. Axillary dissection was performed in 55 patients (66.3%) and histologically detected tumor involved axillary lymph nodes in 34 of these women. Considering the group of patients who did not received neoadjuvant chemotherapy (51), 73% received adjuvant chemotherapy following breast surgery and 54 (77.1%) endocrine therapy. 71.8% (56) of the patients received radiotherapy. In terms of recurrence, 12% (9) patients had local recurrence and 28.4% (21) had disseminated recurrence. The overall five-year survival was 69.0% and the 10-year survival was 26.1%. Conclusions: In this series, as demonstrated in previous works, younger patients tend to present larger palpable tumors, typically invasive ductal carcinoma of a higher tumor grade and more lymph node involvement. This is a retrospective analysis and the cohort of patients was treated during a course of 15 years with all the limitations implied. In further work it is our intention to compare this group with an older one and analyze possible predictors of survival. The prognosis of these women is unclear, with some reports demonstrating that it is biologically more aggressive, a unique biological entity and should thus be considered as a distinct form of breast cancer. O067 ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR WITH AND WITHOUT CONTROLLED CORD TRACTION: A RANDOMIZED CONTROLLED STUDY N.V. Artymuk1 , M.N. Surina1 , N.B. Kolesnikova2 , T.Y. Marochko1 . 1 OB/GYN, Kemerovo State Medical Academy, Kemerovo, Russian Federation; 2 Kemerovo Regional Clinical Perinatal Center, Kemerovo, Russian Federation Objectives: To determine effectiveness of controlled cord traction in management of the third stage of labor. Materials: 400 women delivering vaginally in Kemerovo Region Clinic Perinatal Center (Kemerovo, Russia) were examined. I group included 200 women who had undergone full package of active management of the third stage of labor (AMTSL). II group included 200 women in which simplified package of AMTSL was conducted. Methods: A hospital-based, individually randomized controlled study is proposed. The full package of AMTSL included the uterotonic injection (oxytocin 10 IU IM) after delivery of the baby, controlled cord traction (CCT) following observation of uterine contraction and uterus massage after the placenta delivered. Simplified package of AMTSL included uterotonic (oxytocin 10 IU IM) injection and uterus massage after the placenta delivered. The primary outcome measure was blood loss of 500 ml or more at one hour and up to two hours for women who continued to bleed after one hour. Secondary outcomes were: blood transfusion, the use of additional uterotonics to treat PPH, postpartum maternal hemoglobin and hematocrit manual removal of placenta, additional surgical procedures (e.g. hysterectomy, ligation of vessels, ballon).
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Results: Time required to suture was significantly lower in groups operated with bidirectional suture than in groups with traditional suture either for TLH or LM (p < 0.001). No significant difference was observed in the operative time between the study groups. The degree of surgical difficulty was significantly lower in Quill group than in the other groups. Biomechanical tests showed that maximum force was similar for 2–0 Monocryl and 0-Quill respectively (p = non significant). Conclusions: use of barbed suture reduces time required to repair vaginal cuff during TLH and uterine wall defect during LM. Biomechanical strength of the sutures is comparable. O065 ROLE OF CHROMOHYSTEROSCOPY IN RECURRENT MISCARRIAGES S. Arora1 , Y.M. Mala1 , R. Tripathi1 . 1 Obstetrics & Gynaecology, Maulana Azad Medical College, New Delhi, New Delhi, India Objectives: To evaluate the role of chromohysteroscopy in diagnosing endometrial pathology in patients with recurrent miscarriages. Materials: A prospective study was conducted on women with history of recurrent miscarriages attending gynecology department of Maulana Azad Medical College, New Delhi, India. Sixty five women with history of two or more consecutive miscarriages occurring during the first 20 weeks of gestation were included in the study. Women diagnosed to have diabetes, hypothyroidism and anti phospholipid antibody syndrome were excluded from the study. Methods: In all subjects transvaginal ultrasonography, hysterosalpingography, hysteroscopy and chromohysteroscopy were performed. Chromo hysteroscopy was performed by injecting methylene blue dye and observed for either a diffuse or focal staining pattern of the uterine cavity. Hysteroscopic guided endometrial biopsies were taken from both stained and unstained areas and sent for histo-pathological examination. Results: Out of 65, only 50 patients could be investigated completely. Most of the patients (54%) had two previous miscarriages, 40% had three and 6% had four or more miscarriages. Chromohysteroscopy resulted in diffuse light blue staining of endometrium in 46% and focal dark blue staining in 54% of cases. In patients with diffuse light blue staining endometrial biopsy showed inflammatory changes in 21.7% and a normal proliferative endometrium in 78.3%. In patients who had focal staining, biopsy from the stained areas showed inflammation in 74% of cases, compared to only 15% from unstained areas. The sensitivity, specificity, positive and negative predictive value in diagnosing inflammation from dark stained areas in focal staining pattern were 74%, 85%, 83.3% and 76.6% respectively. The association between stained areas and the presence of inflammation on histopathology was found to be significant (p < 0.001). Conclusions: Office hysteroscopy is a safe and acceptable modality to evaluate the uterine causes of recurrent miscarriages. Chromohysteroscopy can be used to identify the abnormal areas of endometrium. Biopsy from the dark stained areas can help in detecting cases of endometritis which may be a cause of unexplained abortions. O066 BREAST CANCER IN YOUNG PATIENTS D. Arteiro1 , S. Costa2 , S. Soares4 , C. Fernandes3 , A. Correia1 , A. Magalh˜aes2 , F. Osorio ´ 2 , J.L. Fougo2 . 1 Servico ¸ de Ginecologia e Obstetr´ıcia, Centro Hospitalar de S˜ ao Jo˜ ao, Porto, Porto, Portugal; 2 Centro de Mama, Centro Hospitalar de S˜ ao Jo˜ ao, Porto, Porto, Portugal; 3 Servico ¸ de Oncologia M´edica, Centro Hospitalar de S˜ ao Jo˜ ao, Porto, Porto, Portugal; 4 Servico ¸ de Ginecologia e Obstetr´ıcia, Centro Hospitalar do Porto, Porto, Porto, Portugal Objectives: Breast cancer is one of the most common cancers affecting women. In young ages, it may be a devastating disease.
The aim of this study was to examine and audit the experience of our institution in treating young patients with breast cancer (≤35 years), focusing on the clinical and pathological features. Materials: We retrospectively reviewed the records of patients with diagnosis of breast cancer aged 35 years and under, referred to our centre from January 1997 to January 2012. Methods: The case records of all patients were examined for initial presentation, treatment, local and disseminated recurrence of disease and survival. Histological reports were reviewed and details of tumor size, histological type and grade, lymph node status, expression of hormone receptor, amplification of HER-2 were analyzed. Statistical analysis was performed using SPSS. Results: A total of 83 breast cancer patients with a mean age of 31.1 (23–35) were identified. Histological examination of the tumors revealed invasive ductal carcinoma in 61 (74.4%) cases. In 53% (44), the tumors were grade 3. 40.5% (32) underwent neoadjuvant chemotherapy. Mastectomy was undertaken in 56.6% (47) patients with 32.6% (15) undergoing immediate breast reconstruction. Axillary dissection was performed in 55 patients (66.3%) and histologically detected tumor involved axillary lymph nodes in 34 of these women. Considering the group of patients who did not received neoadjuvant chemotherapy (51), 73% received adjuvant chemotherapy following breast surgery and 54 (77.1%) endocrine therapy. 71.8% (56) of the patients received radiotherapy. In terms of recurrence, 12% (9) patients had local recurrence and 28.4% (21) had disseminated recurrence. The overall five-year survival was 69.0% and the 10-year survival was 26.1%. Conclusions: In this series, as demonstrated in previous works, younger patients tend to present larger palpable tumors, typically invasive ductal carcinoma of a higher tumor grade and more lymph node involvement. This is a retrospective analysis and the cohort of patients was treated during a course of 15 years with all the limitations implied. In further work it is our intention to compare this group with an older one and analyze possible predictors of survival. The prognosis of these women is unclear, with some reports demonstrating that it is biologically more aggressive, a unique biological entity and should thus be considered as a distinct form of breast cancer. O067 ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR WITH AND WITHOUT CONTROLLED CORD TRACTION: A RANDOMIZED CONTROLLED STUDY N.V. Artymuk1 , M.N. Surina1 , N.B. Kolesnikova2 , T.Y. Marochko1 . 1 OB/GYN, Kemerovo State Medical Academy, Kemerovo, Russian Federation; 2 Kemerovo Regional Clinical Perinatal Center, Kemerovo, Russian Federation Objectives: To determine effectiveness of controlled cord traction in management of the third stage of labor. Materials: 400 women delivering vaginally in Kemerovo Region Clinic Perinatal Center (Kemerovo, Russia) were examined. I group included 200 women who had undergone full package of active management of the third stage of labor (AMTSL). II group included 200 women in which simplified package of AMTSL was conducted. Methods: A hospital-based, individually randomized controlled study is proposed. The full package of AMTSL included the uterotonic injection (oxytocin 10 IU IM) after delivery of the baby, controlled cord traction (CCT) following observation of uterine contraction and uterus massage after the placenta delivered. Simplified package of AMTSL included uterotonic (oxytocin 10 IU IM) injection and uterus massage after the placenta delivered. The primary outcome measure was blood loss of 500 ml or more at one hour and up to two hours for women who continued to bleed after one hour. Secondary outcomes were: blood transfusion, the use of additional uterotonics to treat PPH, postpartum maternal hemoglobin and hematocrit manual removal of placenta, additional surgical procedures (e.g. hysterectomy, ligation of vessels, ballon).