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O1003 The study of improving the quality of obstetric care through severe obstetric complication audit
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
Are concerned, young women (younger in rural setting than at Kinshasa). The high rate of maternal death in Group I and II at Mbandaka is to attribute to the method used for the postabortum care. In fact, health professionals at Mbandaka use mainly metallic curettage, a technique which is know as having a high rate of complications. We have to advocate for the diffusion of aspiration technique (manual or electric) for the post-abortion care; an element of post-abortum quality of care. O1003 The study of improving the quality of obstetric care through severe obstetric complication audit J.L. Wu1 , F.X. Zhang2 , L.H. Wang. 1 National Center for Women and Children’s Health, China, 2 Beijing Haidian Women and Children Hospital Objective: To explore the effectiveness of severe obstetric complication audit on improving the quality of obstetric care in order to reducing the severe maternal morbidity (SMM). Methods: Adopting the method of cluster sampling, selected a county with a high maternal mortality rate (MMR) in Chongqing as study site, collected all cases of severe obstetric complications in the hospitals in whole county during January 2004–March 2006 and investigated their medical records. The regular audit of some typical cases has been conducted during April 2005 – March 2006. There is an effect evaluation of improving obstetric care through the comparisons before and after audit. Result: Before the audit, the incidence of severe obstetric complication is 12.79‰ (74 cases), including severe obstetric hemorrhage (8.47‰), preeclampsia/eclampsia (4.32‰) and uterus rupture (0.17‰). After the audit, the incidence is 14.17 ‰ (64 cases), and the rates of severe obstetric hemorrhage, preeclampsia/eclampsia, uterus rupture were 8.41‰, 6.42‰, 0.00‰ respectively. Compare to the stage of before audit, the standard of management level on postpartum hemorrhage and preeclampsia/eclampsia have been enhanced significantly (P < 0.01), the perinatal mortality had reduced from 189.26‰ to 53.57‰ (P < 0.01), and the rate of severe maternal morbidity to mortality had increased from 19:1 to 32:1. The quality of obstetric care has made much more progress. Conclusion: It is benefit for improving the quality of obstetric care by regularly using the method of severe obstetric complication audit. O1004 The transperineal three-dimensional (3-D) ultrasound characteristics of pelvic diaphragm hiatus in urinary incontinence pregnant woman Q. Wu, L. Luo, X. Mao, T. Ying, Y. Teng, Q. Li, L. Jiang, R. Zhang. Shanghai Jiaotong University Affiliated 6th Hospital, Shanghai, China Objective: To identify the morphological characteristics of pelvic diaphragm hiatus in urinary incontinence pregnant woman using transperineal three-dimensional (3-D) ultrasound. Methods: 21 women at 36–39 weeks of gestation underwent transperineal 3-D ultrasound investigation at our University affiliated hospital. All of them complained about urinary incontinence. The anteroposterior (AP) hiatal diameter, lateral hiatal diameter, area of pelvic diaphragm hiatus, pubovisceral muscle thickness and the genitohiatal and levator ani angles were measured at rest, on maximum Valsalva and maximum pelvic floor contraction respectively. Fish test was used to compare differences in data. Results: The mean age of 21 pregnant women was 27.9±2.8 years, their BMI was 27.0±3.1. They complained urinary incontinence beginning at 31.8±7.9 gestational weeks, the Mario score was 2.2±0.6. The 3-D ultrasound parameters of pelvic diaphragm hiatus showed that the parameters at rest were smaller than that on maximum Valsalva, but bigger than that on maximum pelvic floor
S379
contraction. There were no significant differences between three situations (P > 0.05), except the genitohiatal and levator ani angles (P < 0.05). These values were compared with those in a published study of nulliparous, there was significant difference on area of pelvic diaphragm hiatus (P < 0.05). Conclusion: 3-D transperineal ultrasound clearly demonstrates the changes of pelvic diaphragm hiatus in pregnancy and nulliparous. O1005 The amplification and clinical significance of hTERC gene in the cervical exfoliated cells from natural population in Shenzhen R. Wu Objective: Sampling survey for the amplification of hTERC gene in the cervical exfoliated cells from natural population in Shenzhen, explore its relationship with HPV infection, abnormal cervical cytology and cervical intraepithelial neoplasia (CIN). Methods: Through stratified cluster sampling, 388 women who are 30–59 year-old and have normal intelligence in a community of Shenzhen were examined with liquid-based cytology, highrisk human pappilomavirus (HR-HPV) testing using hybrid capture II (HC-II) and hTERC gene detection using Fluorescence in situ Hybridization (FISH). The patients with ASCUS and above lesion and/or positive HR-HPV results were examined by colposcopy, multiple biopsies of cervical quadrant and pathology. Results: The frequency of cervical intraepithelial neoplasia (CIN) I, II, III, cervical cancer were 55 (14.18%), 4 (1.03%), 9 (2.32%) and 1 (0.26%) respectively, the rates of hTERC gene amplification is 8.76%. There are significantly difference of hTERC amplification among the samples with different cytological and histological lesions and the HPV infection (p < 0.01). (1) The positive rate of HPV infection was 17.01%; the positive rates of hTERC gene amplification are 19.7% in HPV positive and 6.52% in HPV negative, compared results were significantly different (p < 0.01). (2) In cytology, the rates of hTERC gene amplification are NILM (5.97%), ASCUS (18.75%), LSIL (10.00%), ASC-H (66.67%), HSIL (100.00%); There’s a marked increase of hTERC amplification in patients with HSIL and above lesion (p < 0.01). (3) In histology, the rates of hTERC gene amplification are respectively normal (0%), CIN I (5.45%), CIN II (50.00%), CIN III (77.78%), invasive carcinoma (100.00%). There’s a marked increase of hTERC amplification in patients with CIN II and above lesion (p < 0.01). Conclusion: There’s a tight correlation between amplification of hTERC and the histological and cytological lesion, it increased progressively along with the severity of cytological and histological grade. hTERC amplified or not may be as a prognostic indicator to judge whether CIN or not. O1006 The clinical study of the relationships between parametrial infiltration, lymph-vascular space invasion and prognosis of cervical cancer M. Xi, M. Hou, J. Zhang, H. Wang, Z. Cao. Dept. of Obs./Gynec., The Second University Hospital, Sichuan University Objective: The study was conducted to analyze the relationship between parametrial infiltration, lymph-vascular space invasion (LVSI) of cervical cancer and staging and other histopathologic parameters, to increase the coincidence of staging diagnosis and provide some guidance for choosing treatment regimen and judge the prognosis. Methods: Retrospectively analyzing the clinic data of 546 patients with squamous carcinoma of cervix (SCC) treated in our hospital from January 1, 2005 to July 31, 2007. Univariable analysis and multivariable analysis were used to evaluate the relationship among parametrial infiltration, LVSI and other histopathologic parameters. Results: The coincidence of stage IIb was the lowest between pre- and post-operation. The parametrial infiltration appeared to have a significant association with histological type, invasive
Are concerned, young women (younger in rural setting than at Kinshasa). The high rate of maternal death in Group I and II at Mbandaka is to attribute to the method used for the postabortum care. In fact, health professionals at Mbandaka use mainly metallic curettage, a technique which is know as having a high rate of complications. We have to advocate for the diffusion of aspiration technique (manual or electric) for the post-abortion care; an element of post-abortum quality of care. O1003 The study of improving the quality of obstetric care through severe obstetric complication audit J.L. Wu1 , F.X. Zhang2 , L.H. Wang. 1 National Center for Women and Children’s Health, China, 2 Beijing Haidian Women and Children Hospital Objective: To explore the effectiveness of severe obstetric complication audit on improving the quality of obstetric care in order to reducing the severe maternal morbidity (SMM). Methods: Adopting the method of cluster sampling, selected a county with a high maternal mortality rate (MMR) in Chongqing as study site, collected all cases of severe obstetric complications in the hospitals in whole county during January 2004–March 2006 and investigated their medical records. The regular audit of some typical cases has been conducted during April 2005 – March 2006. There is an effect evaluation of improving obstetric care through the comparisons before and after audit. Result: Before the audit, the incidence of severe obstetric complication is 12.79‰ (74 cases), including severe obstetric hemorrhage (8.47‰), preeclampsia/eclampsia (4.32‰) and uterus rupture (0.17‰). After the audit, the incidence is 14.17 ‰ (64 cases), and the rates of severe obstetric hemorrhage, preeclampsia/eclampsia, uterus rupture were 8.41‰, 6.42‰, 0.00‰ respectively. Compare to the stage of before audit, the standard of management level on postpartum hemorrhage and preeclampsia/eclampsia have been enhanced significantly (P < 0.01), the perinatal mortality had reduced from 189.26‰ to 53.57‰ (P < 0.01), and the rate of severe maternal morbidity to mortality had increased from 19:1 to 32:1. The quality of obstetric care has made much more progress. Conclusion: It is benefit for improving the quality of obstetric care by regularly using the method of severe obstetric complication audit. O1004 The transperineal three-dimensional (3-D) ultrasound characteristics of pelvic diaphragm hiatus in urinary incontinence pregnant woman Q. Wu, L. Luo, X. Mao, T. Ying, Y. Teng, Q. Li, L. Jiang, R. Zhang. Shanghai Jiaotong University Affiliated 6th Hospital, Shanghai, China Objective: To identify the morphological characteristics of pelvic diaphragm hiatus in urinary incontinence pregnant woman using transperineal three-dimensional (3-D) ultrasound. Methods: 21 women at 36–39 weeks of gestation underwent transperineal 3-D ultrasound investigation at our University affiliated hospital. All of them complained about urinary incontinence. The anteroposterior (AP) hiatal diameter, lateral hiatal diameter, area of pelvic diaphragm hiatus, pubovisceral muscle thickness and the genitohiatal and levator ani angles were measured at rest, on maximum Valsalva and maximum pelvic floor contraction respectively. Fish test was used to compare differences in data. Results: The mean age of 21 pregnant women was 27.9±2.8 years, their BMI was 27.0±3.1. They complained urinary incontinence beginning at 31.8±7.9 gestational weeks, the Mario score was 2.2±0.6. The 3-D ultrasound parameters of pelvic diaphragm hiatus showed that the parameters at rest were smaller than that on maximum Valsalva, but bigger than that on maximum pelvic floor
S379
contraction. There were no significant differences between three situations (P > 0.05), except the genitohiatal and levator ani angles (P < 0.05). These values were compared with those in a published study of nulliparous, there was significant difference on area of pelvic diaphragm hiatus (P < 0.05). Conclusion: 3-D transperineal ultrasound clearly demonstrates the changes of pelvic diaphragm hiatus in pregnancy and nulliparous. O1005 The amplification and clinical significance of hTERC gene in the cervical exfoliated cells from natural population in Shenzhen R. Wu Objective: Sampling survey for the amplification of hTERC gene in the cervical exfoliated cells from natural population in Shenzhen, explore its relationship with HPV infection, abnormal cervical cytology and cervical intraepithelial neoplasia (CIN). Methods: Through stratified cluster sampling, 388 women who are 30–59 year-old and have normal intelligence in a community of Shenzhen were examined with liquid-based cytology, highrisk human pappilomavirus (HR-HPV) testing using hybrid capture II (HC-II) and hTERC gene detection using Fluorescence in situ Hybridization (FISH). The patients with ASCUS and above lesion and/or positive HR-HPV results were examined by colposcopy, multiple biopsies of cervical quadrant and pathology. Results: The frequency of cervical intraepithelial neoplasia (CIN) I, II, III, cervical cancer were 55 (14.18%), 4 (1.03%), 9 (2.32%) and 1 (0.26%) respectively, the rates of hTERC gene amplification is 8.76%. There are significantly difference of hTERC amplification among the samples with different cytological and histological lesions and the HPV infection (p < 0.01). (1) The positive rate of HPV infection was 17.01%; the positive rates of hTERC gene amplification are 19.7% in HPV positive and 6.52% in HPV negative, compared results were significantly different (p < 0.01). (2) In cytology, the rates of hTERC gene amplification are NILM (5.97%), ASCUS (18.75%), LSIL (10.00%), ASC-H (66.67%), HSIL (100.00%); There’s a marked increase of hTERC amplification in patients with HSIL and above lesion (p < 0.01). (3) In histology, the rates of hTERC gene amplification are respectively normal (0%), CIN I (5.45%), CIN II (50.00%), CIN III (77.78%), invasive carcinoma (100.00%). There’s a marked increase of hTERC amplification in patients with CIN II and above lesion (p < 0.01). Conclusion: There’s a tight correlation between amplification of hTERC and the histological and cytological lesion, it increased progressively along with the severity of cytological and histological grade. hTERC amplified or not may be as a prognostic indicator to judge whether CIN or not. O1006 The clinical study of the relationships between parametrial infiltration, lymph-vascular space invasion and prognosis of cervical cancer M. Xi, M. Hou, J. Zhang, H. Wang, Z. Cao. Dept. of Obs./Gynec., The Second University Hospital, Sichuan University Objective: The study was conducted to analyze the relationship between parametrial infiltration, lymph-vascular space invasion (LVSI) of cervical cancer and staging and other histopathologic parameters, to increase the coincidence of staging diagnosis and provide some guidance for choosing treatment regimen and judge the prognosis. Methods: Retrospectively analyzing the clinic data of 546 patients with squamous carcinoma of cervix (SCC) treated in our hospital from January 1, 2005 to July 31, 2007. Univariable analysis and multivariable analysis were used to evaluate the relationship among parametrial infiltration, LVSI and other histopathologic parameters. Results: The coincidence of stage IIb was the lowest between pre- and post-operation. The parametrial infiltration appeared to have a significant association with histological type, invasive