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O190 Postabortion family planning – A cost effective best practice for reducing maternal mortality and morbidity
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
models. The findings were compared with background incidences in non-pregnant non OC users. Results: Incidence rates for adverse outcomes and mortality data during OC use suggest that risk/benefit profile is positive for the vast majority of OC users when current labeling restrictions are considered. Effectiveness and return to fertility data are reassuring. OC users with multiple risk factors should consider other contraceptive options. Conclusions: New studies in typical and special populations of OC users provide important new data that should be considered when counseling about contraceptive choices. O189 A single 2-hr after a glucose load is as accurate as the standard 2 step testing in identifying gestational diabetes mellitus L. Curet, D. Clokey. University of New Mexico Introduction: Testing for GDM is usually performed in 2 steps, a 1 hour plasma glucose determination after a 50 g glucose load followed by a 3 hr GTT if the 1 hour test is abnormal. We hypothetized that a single value after a glucose load would be just as accurate in diagnosing GDM as the 2 phase testing. Design and Methods: 63 patients received both a one hour determination of plasma glucose following a 50 g glucose load and a 3 hour standard GTT following a 100 g glucose load. Each individual value of the GTT was compared with the results of the test. Sensitivity and specificity were determined for each value. Positive and negative predictive values were also determined for each value. Results: An abnormal value in the 50 g screen test was associated with a sensitivity of 90% and aspecificity of 65% for detection of a subsequent diagnosis of GDM. An abnormal value of the fasting value of the GTT was associated with a sensitivity of 4% and a specificity of 91%. The sensitivity and specificity for the 1 hour value were 83% and 88% and for the 2 hour value 93% and 94%. For the 3 hour value the specificity was 100% but only 55%sensitive. The positive predictive value for the 2 hour value was 93% with a negative predictive value of 94%. Conclusions: A single plasma glucose determination 2 hours after a 100 g glucose load is as accurate at detecting GDM as the current 2 phase testing. This approach would eliminate the unreliability of the standard testing as it would simplify the logistics of completing the 2 phase testing on time especially in rural areas were distances are a problem. In addition the one value approach would significantly decrease the cost of the testing which would be of particular value in developing countries. O190 Postabortion family planning – A cost effective best practice for reducing maternal mortality and morbidity C. Curtis. United States Agency for International Development Worldwide, 150 million women of reproductive age (WRA) have an unmet need for family planning; 137 million women in the developing world desiring to delay or stop childbearing. Globally, 205 million pregnancies occur each year; 71 million are unintended; 40 million end in induced abortion; 19 to 20 million being unsafe abortions. Unsafe abortion claim 67,000 women’s lives each year. Unmet need for family planning is seen as a root cause for induced abortion. Reasons why women seek abortion mirrors the definition of unmet need. If contraception were provided to the 137 million women who lack access, there could be a 25–35% decine in maternal deaths. The cost of providing FP is less costly than providing postabortion or safe abortion services. Postabortion care (PAC) is an important strategy to reduce maternal mortality. Contraceptive counseling and services are an integral part of all PAC models yet the delivery of postabortion contraception has been weak. Situational analyses done in
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three countries identified barriers to postabortion FP counseling including lack of written guidelines, insuffient staffing; lack of referral mechanisms;lack of access to FP commodities; stockout of supplies. Strong evidence indicates postabortion FP reduces repeat abortion. Reorganizing services; contraceptive technology updates and providing contraceptive counseling and services in the same location and at the same time as emergency treatment increased FP uptake in Cambodia. Decentralization of PAC services and PAC community mobilization resulted in increased FP uptake in Senegal, Tanzania, Nepal, Kenya and Bolivia. Implementing these measures can increase FP uptake within 12 months and assist countries in meeting MDG 5 and UNGASS goals 2 and 3. O191 Comparative study of breast cancer among women <35 years vs women >35 years M. Cusido, ´ M. Cabero, A. Alsina, I. Rodriguez, R. Fabregas, ´ B. Navarro. Institut Universitari Dexeus Introduction: Retrospective observational study among a cohort of women <50 years with breast cancer. Objective: To study age <35 years at diagnosis as a risk factor for ganglion status and recurrence. Material and Methods: Cohort of 178 women diagnosed and treated for breast cancer before 50 years old between 1996–2007. Group A: younger than 35 years (N = 87 cases) and group B: oldest than 35 years (91 cases). Variables to study were tumoral size, ganglionar status, histological type and hormonal receptors status (ER and PR). To compre quantitatives variables we used T-student test, for categorical variables Chi test o exact Fisher test. Results: Median age for group A/B was 32/43 years (p > 0.05). 18%/3.3% of patients in group A/B presented association breast cancer and pregnancy (p < 0.05). There were no differences with histological type, multicentricity, multifocality, detection rate by mammography, but sonography was inform as a benign lesion in 15.3% of group A vs 4.4% of group B (p < 0.05). ER were positive in 73% and PR in 68% of group A patients and 82.9% and 71.8% of group B patients. HER2 were positive in 41.4%/52% og group A/B. Surgical treatment were radical in 52.4/31.9% and conservative in 47.6/68.1% of A and B (p < 0.05). Linphadenectomy was done to 75% of women of each group resulting in 53.1 and 49.1% of affected nodes in group A/B with a 2.35 and 1.35 number of affected nodes. Median tumoral size was 1.9 and 1.7 cm in group A and B. 4.1% and 16.7% of patients in group A/B were in stage 0 and 17.8%/6% in stage III (p < 0.05). There were no differences in tumoral grade. Radiotherapy was done on 61.5% y 73.3% of women A/B and 93.6% and 63.3% of patients received chemotherapy (p < 0.05). 3.9% y 2.2% in group A/B received Treatment with Trastuzumab. With a follow up of 4 years, 86%/95% of patients in group A/B recurred (NS). Conclusions: Radical treatment was done more frequently to young women. In our results, age younger than 35 years is not a risk factor for recurrence. At the same tumoral size patients present same nodal status and same recurrence rate. O192 Breast cancer during pregnancy M. Cusido, ´ S. Baulies, I. Rodriguez, C. Ara, R. Fabregas, B. Ubeda. Institut Universitari Dexeus Introduction: Pregnancy-associated breast cancer (PABC) is a challenging clinical situation not only by the difficulty in diagnosis, but it also it places the welfare of the mother in conflict with that of the fetus. Material and Methods: From 1976 to 2007 we treated 52 pacients with PABC in Institut Universitari Dexeus. Age-matched, nonpregnacy-associated breast cancer (non-PABC) controls were also
models. The findings were compared with background incidences in non-pregnant non OC users. Results: Incidence rates for adverse outcomes and mortality data during OC use suggest that risk/benefit profile is positive for the vast majority of OC users when current labeling restrictions are considered. Effectiveness and return to fertility data are reassuring. OC users with multiple risk factors should consider other contraceptive options. Conclusions: New studies in typical and special populations of OC users provide important new data that should be considered when counseling about contraceptive choices. O189 A single 2-hr after a glucose load is as accurate as the standard 2 step testing in identifying gestational diabetes mellitus L. Curet, D. Clokey. University of New Mexico Introduction: Testing for GDM is usually performed in 2 steps, a 1 hour plasma glucose determination after a 50 g glucose load followed by a 3 hr GTT if the 1 hour test is abnormal. We hypothetized that a single value after a glucose load would be just as accurate in diagnosing GDM as the 2 phase testing. Design and Methods: 63 patients received both a one hour determination of plasma glucose following a 50 g glucose load and a 3 hour standard GTT following a 100 g glucose load. Each individual value of the GTT was compared with the results of the test. Sensitivity and specificity were determined for each value. Positive and negative predictive values were also determined for each value. Results: An abnormal value in the 50 g screen test was associated with a sensitivity of 90% and aspecificity of 65% for detection of a subsequent diagnosis of GDM. An abnormal value of the fasting value of the GTT was associated with a sensitivity of 4% and a specificity of 91%. The sensitivity and specificity for the 1 hour value were 83% and 88% and for the 2 hour value 93% and 94%. For the 3 hour value the specificity was 100% but only 55%sensitive. The positive predictive value for the 2 hour value was 93% with a negative predictive value of 94%. Conclusions: A single plasma glucose determination 2 hours after a 100 g glucose load is as accurate at detecting GDM as the current 2 phase testing. This approach would eliminate the unreliability of the standard testing as it would simplify the logistics of completing the 2 phase testing on time especially in rural areas were distances are a problem. In addition the one value approach would significantly decrease the cost of the testing which would be of particular value in developing countries. O190 Postabortion family planning – A cost effective best practice for reducing maternal mortality and morbidity C. Curtis. United States Agency for International Development Worldwide, 150 million women of reproductive age (WRA) have an unmet need for family planning; 137 million women in the developing world desiring to delay or stop childbearing. Globally, 205 million pregnancies occur each year; 71 million are unintended; 40 million end in induced abortion; 19 to 20 million being unsafe abortions. Unsafe abortion claim 67,000 women’s lives each year. Unmet need for family planning is seen as a root cause for induced abortion. Reasons why women seek abortion mirrors the definition of unmet need. If contraception were provided to the 137 million women who lack access, there could be a 25–35% decine in maternal deaths. The cost of providing FP is less costly than providing postabortion or safe abortion services. Postabortion care (PAC) is an important strategy to reduce maternal mortality. Contraceptive counseling and services are an integral part of all PAC models yet the delivery of postabortion contraception has been weak. Situational analyses done in
S147
three countries identified barriers to postabortion FP counseling including lack of written guidelines, insuffient staffing; lack of referral mechanisms;lack of access to FP commodities; stockout of supplies. Strong evidence indicates postabortion FP reduces repeat abortion. Reorganizing services; contraceptive technology updates and providing contraceptive counseling and services in the same location and at the same time as emergency treatment increased FP uptake in Cambodia. Decentralization of PAC services and PAC community mobilization resulted in increased FP uptake in Senegal, Tanzania, Nepal, Kenya and Bolivia. Implementing these measures can increase FP uptake within 12 months and assist countries in meeting MDG 5 and UNGASS goals 2 and 3. O191 Comparative study of breast cancer among women <35 years vs women >35 years M. Cusido, ´ M. Cabero, A. Alsina, I. Rodriguez, R. Fabregas, ´ B. Navarro. Institut Universitari Dexeus Introduction: Retrospective observational study among a cohort of women <50 years with breast cancer. Objective: To study age <35 years at diagnosis as a risk factor for ganglion status and recurrence. Material and Methods: Cohort of 178 women diagnosed and treated for breast cancer before 50 years old between 1996–2007. Group A: younger than 35 years (N = 87 cases) and group B: oldest than 35 years (91 cases). Variables to study were tumoral size, ganglionar status, histological type and hormonal receptors status (ER and PR). To compre quantitatives variables we used T-student test, for categorical variables Chi test o exact Fisher test. Results: Median age for group A/B was 32/43 years (p > 0.05). 18%/3.3% of patients in group A/B presented association breast cancer and pregnancy (p < 0.05). There were no differences with histological type, multicentricity, multifocality, detection rate by mammography, but sonography was inform as a benign lesion in 15.3% of group A vs 4.4% of group B (p < 0.05). ER were positive in 73% and PR in 68% of group A patients and 82.9% and 71.8% of group B patients. HER2 were positive in 41.4%/52% og group A/B. Surgical treatment were radical in 52.4/31.9% and conservative in 47.6/68.1% of A and B (p < 0.05). Linphadenectomy was done to 75% of women of each group resulting in 53.1 and 49.1% of affected nodes in group A/B with a 2.35 and 1.35 number of affected nodes. Median tumoral size was 1.9 and 1.7 cm in group A and B. 4.1% and 16.7% of patients in group A/B were in stage 0 and 17.8%/6% in stage III (p < 0.05). There were no differences in tumoral grade. Radiotherapy was done on 61.5% y 73.3% of women A/B and 93.6% and 63.3% of patients received chemotherapy (p < 0.05). 3.9% y 2.2% in group A/B received Treatment with Trastuzumab. With a follow up of 4 years, 86%/95% of patients in group A/B recurred (NS). Conclusions: Radical treatment was done more frequently to young women. In our results, age younger than 35 years is not a risk factor for recurrence. At the same tumoral size patients present same nodal status and same recurrence rate. O192 Breast cancer during pregnancy M. Cusido, ´ S. Baulies, I. Rodriguez, C. Ara, R. Fabregas, B. Ubeda. Institut Universitari Dexeus Introduction: Pregnancy-associated breast cancer (PABC) is a challenging clinical situation not only by the difficulty in diagnosis, but it also it places the welfare of the mother in conflict with that of the fetus. Material and Methods: From 1976 to 2007 we treated 52 pacients with PABC in Institut Universitari Dexeus. Age-matched, nonpregnacy-associated breast cancer (non-PABC) controls were also