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O102 DISPLACED IUCD – LAPAROSCOPIC MANAGEMENT. OUR EXPERIENCE
S296
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Materials: Of 378 patients with an ectopic pregnancy admitted to Charles Nicolle university hospital of Tunis from January 2000 through December 2010, 122 patients were treated with an intramuscular injection of 1mg/kg of methotrexate. Methods: Inclusion criteria were: the acceptance of the patient, an asymptomatic or a mild clinical form of ectopic pregnancy, bhCG levels less than 5000 mIU/ml and an absent or a mild abdominal fluid at sonography. A dosage of bhCG was performed at day 4 and 7 after injection and then weekly. Success was defined as undetectable bhCG levels (less than 5mIU/ml) without the need for a surgical intervention. Results: The mean age of the patients was 31.9 years (range: 19–46 years). The mean parity was 1.7. Amenorrhea, metrorrhagia and mild pelvic pain were reported respectively in 77.8%, 87.6% and 74.5% of the cases. Vaginal ultrasounds found a hematosalpinx in 87.7% of the cases and a mild fluid of the Douglas pouch in 68.8% of the cases. bhCG serum levels ranged from 40 to 4088 mIU/ml (mean 805.8 mIU/ml). 84 patients had one injection of methotrexate and 38 patients needed two injections. The global success rate was 81.96%. No side effects were reported. bhCG levels became undetectable averagely in 24 days. The medical treatment failed in 22 patients (18.04%) leading to surgical intervention. The analysis of these cases showed that the initial bhCG level was the major criteria of success with a cutoff of 2000 mIU/ml. Finally, concerning subsequent fertility, only 22 patients represented for pregnancy desire: 19 of them got pregnant. Conclusions: Methotrexate treatment of ectopic pregnancy is a safe and effective alternative to surgery. Precise criteria of inclusion should lead to better success rates. O101 GYNAECOLOGICAL AND OBSTETRIC COMPLICATIONS OF CHILDHOOD FEMALE GENITAL MUTILATION/CUTTING (FGM/C): RESULTS FROM A SYSTEMATIC REVIEW R.C. Berg1 . 1 Norwegian knowledge centre for the health services, Oslo, Norway Objectives: This systematic review aims to summarize empirical quantitative research describing the physical consequences on girls and women following FGM/C. Materials: We are conducting a systematic review of the health consequences of FGM/C. All research meeting pre-defined inclusion criteria concerning the study design (multiple), population (females), interest (FGM/C) and outcome (obstetrical, gynecological and other physical harms) will be included in the systematic review. Methods: We are conducting a systematic review of the health consequences of FGM/C on girls/women in accordance with the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions with regards to defining the review question, searching for studies, selecting studies and collecting data, assessment of methodological quality, and, as far as possible, analyzing data, including conducting meta-analyses. Results: We have conducted a comprehensive and systematic search for relevant literature in the following 15 international databases: African Index Medicus, British Nursing Index, the Cochrane Library (CDSR, CENTRAL, DARE), Health Technology Assessment Database, EMBASE, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PILOTS, POPLINE, PsycINFO, Social Services Abstracts, Sociological Abstracts, and WHOLIS. The database searches returned 4989 records which are being screened against a set of inclusion criteria. Thus far, the screening has revealed methodologically sound studies documenting adverse consequences following FGM/C in diverse health areas such as length of labor, primary infertility, incomplete bladder emptying, genital tract lesions, keloids, urinary tract infections, inclusion clitoral dermoid cysts, labial fusion, dysmenorrhea, urogenital and obstetric fistula, bacterial vaginosis, herpes simplex virus 2,
genital ulcers, abcess formation, caesarean section, and postpartum haemorrhage. Conclusions: Quantifying the risks of FGM/C and identifying knowledge gaps will assist in improving identification of and treatment of complications from FGM/C, informing guidelines on treatment, guiding future research, and supporting interventions towards the ultimate elimination of FGM/C. O102 DISPLACED IUCD – LAPAROSCOPIC MANAGEMENT. OUR EXPERIENCE V.V. Bhat1 . 1 OBG, Radhakrishna Multispeciality Hospital and IVF centre, Bangalore, Karnataka, India Objectives: Displaced IUCD in the peritoneal cavity can cause problems. Laparoscopic Management and removal of IUCD can decrease the Morbidity and hospital stay of the patients. Materials: Intrauterine contraceptive device is a safe, cheap, effective and convenient method of contraception used by 85 million women Globally. It is a long term reversible contraception when it is displaced from the uterine cavity it becomes a night mare to the clinician 80% of the displaced, IUCD seen in the Uterine cavity. Perforation during IUCD insertion occurs 1 in 250 to 1 in 2500 cases. In our hospital we had four cases of displaced IUCD in the Abdominal Cavity, which were managed Laparoscopically. We diagnosed the misplaced IUCD by USG and CT scan. It was removed Laparoscopically only one patient has bowel perforation and suturing was done. Two were multiload and the other two Cu. T. Methods: All the patient were admitted in the morning, kept nil orally from previous night and Laparoscopy was done under GA. No. of ports put were three including the Visiport. The IUCD was Identified and held with toothed grasper and removed from 5 mm port. In one patient the Cu.T had perforated the small bowel and it was sutured with 2–0 vicryl Another patient had pregnancy with displaced IUCD where in we terminated the pregnancy and removed the Cu.T at the same setting. The other two patients had long standing IUCD insertion and were in perimenopasual age group. All the patients were discharged after 24 hours. Post operative Antibiotics were given and suture removed on the 7th day. Results: We observed that Displaced IUCD was managed well with Laparoscopic method, easy to identify the IUCD and removal through 5mm port without any problems. Patient had the benefit of early recovery short hospital stay and less analgesics. The wound was cosmetically accepted as it was very small. Conclusions: Displaced IUCD in the peritoneal cavity is very rare. Removal of displaced IUCD through Laparoscopy gives a better vision of the adjacent structures and adhesion can be released. IUCD removed in toto. Patient has early recovery with short hospital stay. There is no infection and the scar is cosmetically accepted. O103 EFFICACY OF HUMAN PLACENTAL EXTRACT AND LYCOPENE IN CLEARING INFLAMMATORY CERVICAL SMEARS N. Bhatla1 , S. Shree1 , S.R. Mathur2 , A. Kriplani1 , N. Agarwal1 , S. Vashist1 , V. Sreenivas3 . 1 All India Institute of Medical Sciences, Department of Obstetrics & Gynaecology, New Delhi, India; 2 All India Institute of Medical Sciences, Department of Pathology, New Delhi, India; 3 All India Institute of Medical Sciences, Department of Biostatistics, New Delhi, India Objectives: Inflammation is a common finding on cervical cytology in India and considered to be a possible co-factor in cervical carcinogenesis. This study aimed to evaluate the efficacy of human placental extract and lycopenes in clearing inflammation. Materials: In this prospective randomized controlled trial in a periurban low socioeconomic area in New Delhi, 967 asymptomatic,
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Materials: Of 378 patients with an ectopic pregnancy admitted to Charles Nicolle university hospital of Tunis from January 2000 through December 2010, 122 patients were treated with an intramuscular injection of 1mg/kg of methotrexate. Methods: Inclusion criteria were: the acceptance of the patient, an asymptomatic or a mild clinical form of ectopic pregnancy, bhCG levels less than 5000 mIU/ml and an absent or a mild abdominal fluid at sonography. A dosage of bhCG was performed at day 4 and 7 after injection and then weekly. Success was defined as undetectable bhCG levels (less than 5mIU/ml) without the need for a surgical intervention. Results: The mean age of the patients was 31.9 years (range: 19–46 years). The mean parity was 1.7. Amenorrhea, metrorrhagia and mild pelvic pain were reported respectively in 77.8%, 87.6% and 74.5% of the cases. Vaginal ultrasounds found a hematosalpinx in 87.7% of the cases and a mild fluid of the Douglas pouch in 68.8% of the cases. bhCG serum levels ranged from 40 to 4088 mIU/ml (mean 805.8 mIU/ml). 84 patients had one injection of methotrexate and 38 patients needed two injections. The global success rate was 81.96%. No side effects were reported. bhCG levels became undetectable averagely in 24 days. The medical treatment failed in 22 patients (18.04%) leading to surgical intervention. The analysis of these cases showed that the initial bhCG level was the major criteria of success with a cutoff of 2000 mIU/ml. Finally, concerning subsequent fertility, only 22 patients represented for pregnancy desire: 19 of them got pregnant. Conclusions: Methotrexate treatment of ectopic pregnancy is a safe and effective alternative to surgery. Precise criteria of inclusion should lead to better success rates. O101 GYNAECOLOGICAL AND OBSTETRIC COMPLICATIONS OF CHILDHOOD FEMALE GENITAL MUTILATION/CUTTING (FGM/C): RESULTS FROM A SYSTEMATIC REVIEW R.C. Berg1 . 1 Norwegian knowledge centre for the health services, Oslo, Norway Objectives: This systematic review aims to summarize empirical quantitative research describing the physical consequences on girls and women following FGM/C. Materials: We are conducting a systematic review of the health consequences of FGM/C. All research meeting pre-defined inclusion criteria concerning the study design (multiple), population (females), interest (FGM/C) and outcome (obstetrical, gynecological and other physical harms) will be included in the systematic review. Methods: We are conducting a systematic review of the health consequences of FGM/C on girls/women in accordance with the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions with regards to defining the review question, searching for studies, selecting studies and collecting data, assessment of methodological quality, and, as far as possible, analyzing data, including conducting meta-analyses. Results: We have conducted a comprehensive and systematic search for relevant literature in the following 15 international databases: African Index Medicus, British Nursing Index, the Cochrane Library (CDSR, CENTRAL, DARE), Health Technology Assessment Database, EMBASE, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PILOTS, POPLINE, PsycINFO, Social Services Abstracts, Sociological Abstracts, and WHOLIS. The database searches returned 4989 records which are being screened against a set of inclusion criteria. Thus far, the screening has revealed methodologically sound studies documenting adverse consequences following FGM/C in diverse health areas such as length of labor, primary infertility, incomplete bladder emptying, genital tract lesions, keloids, urinary tract infections, inclusion clitoral dermoid cysts, labial fusion, dysmenorrhea, urogenital and obstetric fistula, bacterial vaginosis, herpes simplex virus 2,
genital ulcers, abcess formation, caesarean section, and postpartum haemorrhage. Conclusions: Quantifying the risks of FGM/C and identifying knowledge gaps will assist in improving identification of and treatment of complications from FGM/C, informing guidelines on treatment, guiding future research, and supporting interventions towards the ultimate elimination of FGM/C. O102 DISPLACED IUCD – LAPAROSCOPIC MANAGEMENT. OUR EXPERIENCE V.V. Bhat1 . 1 OBG, Radhakrishna Multispeciality Hospital and IVF centre, Bangalore, Karnataka, India Objectives: Displaced IUCD in the peritoneal cavity can cause problems. Laparoscopic Management and removal of IUCD can decrease the Morbidity and hospital stay of the patients. Materials: Intrauterine contraceptive device is a safe, cheap, effective and convenient method of contraception used by 85 million women Globally. It is a long term reversible contraception when it is displaced from the uterine cavity it becomes a night mare to the clinician 80% of the displaced, IUCD seen in the Uterine cavity. Perforation during IUCD insertion occurs 1 in 250 to 1 in 2500 cases. In our hospital we had four cases of displaced IUCD in the Abdominal Cavity, which were managed Laparoscopically. We diagnosed the misplaced IUCD by USG and CT scan. It was removed Laparoscopically only one patient has bowel perforation and suturing was done. Two were multiload and the other two Cu. T. Methods: All the patient were admitted in the morning, kept nil orally from previous night and Laparoscopy was done under GA. No. of ports put were three including the Visiport. The IUCD was Identified and held with toothed grasper and removed from 5 mm port. In one patient the Cu.T had perforated the small bowel and it was sutured with 2–0 vicryl Another patient had pregnancy with displaced IUCD where in we terminated the pregnancy and removed the Cu.T at the same setting. The other two patients had long standing IUCD insertion and were in perimenopasual age group. All the patients were discharged after 24 hours. Post operative Antibiotics were given and suture removed on the 7th day. Results: We observed that Displaced IUCD was managed well with Laparoscopic method, easy to identify the IUCD and removal through 5mm port without any problems. Patient had the benefit of early recovery short hospital stay and less analgesics. The wound was cosmetically accepted as it was very small. Conclusions: Displaced IUCD in the peritoneal cavity is very rare. Removal of displaced IUCD through Laparoscopy gives a better vision of the adjacent structures and adhesion can be released. IUCD removed in toto. Patient has early recovery with short hospital stay. There is no infection and the scar is cosmetically accepted. O103 EFFICACY OF HUMAN PLACENTAL EXTRACT AND LYCOPENE IN CLEARING INFLAMMATORY CERVICAL SMEARS N. Bhatla1 , S. Shree1 , S.R. Mathur2 , A. Kriplani1 , N. Agarwal1 , S. Vashist1 , V. Sreenivas3 . 1 All India Institute of Medical Sciences, Department of Obstetrics & Gynaecology, New Delhi, India; 2 All India Institute of Medical Sciences, Department of Pathology, New Delhi, India; 3 All India Institute of Medical Sciences, Department of Biostatistics, New Delhi, India Objectives: Inflammation is a common finding on cervical cytology in India and considered to be a possible co-factor in cervical carcinogenesis. This study aimed to evaluate the efficacy of human placental extract and lycopenes in clearing inflammation. Materials: In this prospective randomized controlled trial in a periurban low socioeconomic area in New Delhi, 967 asymptomatic,