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O240 Lower urinary tract injury during mid-urethral sling
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
a physical exam; 58/25% could identify sequelae of PIH; 50% of staff in both settings could identify the threshold for high BP in pregnancy. Conclusion: In both settings there was a concerning lack of working and validated BP devices. In addition, this study highlights a pressing need for education and increased awareness of PIH in two rural African populations. O239 High levels of lipoprotein(a) in women with polycystic ovary syndrome A. Duleba1 , M. Ahmed2 . 1 University of California Davis, Sacramento, CA, USA, 2 Benha School of Medicine Objectives: Polycystic ovary syndrome (PCOS) is associated with cardiovascular risk factors including insulin resistance, systemic inflammation and dyslipidemia. Recent studies have shown that lipoprotein(a) is a unique lipid associated with particularly high risk of cardiovascular events. This study evaluated lipoprotein(a) in relation to other clinical, endocrine and metabolic parameters in women with PCOS. Materials and Methods: Hyperandrogenic women with PCOS were evaluated at university-based medical center; subjects with diabetes or hypertension were excluded. Evaluations of eligible women (N = 58; age = 25±7.5) included: lipoprotein(a), BMI, blood pressure, C-reactive protein, urinary albumin excretion, total and free testosterone, lipid profile, as well as glucose and insulin during 2-hour glucose tolerance test. Insulin sensitivity index was calculated. Statistical evaluation included linear regression analysis. Results: Lipoprotein(a) ranged from 4 to 126 mg/dL; mean±SD was 26.4±30 mg/dL. Significant elevation of lipoprotein(a) (>30 mg/dL) was observed in 28% of subjects. Lipoprotein(a) levels did not correlate with levels of other lipids or other parameters of PCOS. Normal levels of other lipids (total cholesterol, LDL, HDL and triglycerides) were observed in 50% of subjects. Elevated lipoprotein(a) was found in 34% of women with normal levels of other lipids and in 20% of those with abnormal levels of other lipids. Conclusions: PCOS is associated with a high rate of elevated lipoprotein(a) independently of levels of other lipids and other markers of cardiovascular risks. Determination of lipoprotein(a) may be considered in evaluation of cardiovascular risk factors in women with PCOS. O240 Lower urinary tract injury during mid-urethral sling P. Dwyer1 , K. Stav1 , A. Rosamilia2 , Y. Lim1 . 1 Mercy Hospital for Women, 2 Monash Medical Centre Purpose: To determine incidence and risk factors for bladder and urethral injury during mid-urethral sling surgery for stress urinary incontinence. Materials and Methods: 1136 consecutive women had a midurethral slings (874 retropubic, 262 transobturator) and routine intraoperative cystoscopy at our institution between 1999 and 2007 and were follow-up to determine the clinical outcome. Eight hundred and seventy four slings (77%) were retropubic (TVT 87%, Advantage sling 11%, SPARC 2%) and 262 (23%) were transobturator slings (Monarc 91%, TVT-O 9%). Statistical analysis was performed using Chi-Square tests, independent t-tests and ANOVA tests to compare the 2 groups (patients with and without bladder perforation) by baseline characteristics and major risk factors. Results: The incidence of trocar injury to the bladder during retropubic sling was 3.8% (33/874) compared to 0.4% (1/262) with transobturator approach. (p < 0.0001). Thirty two (94%) of the perforations involved inexperienced surgeons (fellows or registrars) whose experience varied but was less than 50 slings (p < 0.0001).
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The perforation rate was similar in the various types of the retropubic slings (p = 0.32). Multivariate analysis revealed that the presence of rectocele (OR 6.2), performing the procedure under local anesthesia (OR 5.9), BMI<30 (OR 5.6), previous Cesarean section (OR 3.7), and previous colposuspension (OR 3.2) are significant independent risk factors for perforation. Urethral injury was detected intraoperatively in 2 women (0.2%), both had retropubic slings. Conclusions: Our results indicate that previous Cesarean section, colposuspension, BMI<30, rectocele and local anesthesia are independent risk factors for bladder perforation during midurethral slings. This occurs mainly during a retropubic sling procedure and when the surgeon is inexperienced. Urethral injuries were uncommon occurring in 0.2% of women having retropubic slings. These injuries have also been described in transobturator slings, a number of women with latent urethral injuries following these procedures have been referred although there were none in this case series. Complete endoscopic visualization of the lower urinary tract with cystourethroscopy is necessary following sling placement. O241 Epidural analgesia during labor in Mikołow ´ public hospital – retrospective evaluation in postal questionnaire survey A. Dyrda, D. Hudziak, J. Kubacki Objectives: As a consequence of socio-economic progress, we report the increasing popularity of epidural analgesia in Poland. Hence, the aim of his study was to evaluate the parturients’ opinion about epidural analgesia for labor (EA). Materials and Methods: We designed a retrospective study with a questionnaire concerning: pain, parity, age, level of education, time of making decision and maternal satisfaction with labor, which was sent to 130 women who had vaginal delivery with EA in our centre in 2004–2006. Categorical data were compared using chi-square test for evaluation of interaction, using Statistica software. Results: 61 (91%) from group of 67 patients would decide on labor with EA in the future, 4 of all (6%) would not appreciate it and 3 (4.5%) have not consider it yet. Multiparas have made decision earlier than nulliparas: 89% vs 59% before labor and 11% vs 41% during it (p < 0.05). All dissatisfied patients have experienced adverse effects of EA, whereas in the group of satisfied women – 23 (50%) of them (p < 0.05). Among all complications it was the prolonged second stage of labor that had the most relevant impact on labor valuation: 7% in the group of content patients in comparison with 57% in the group of discontent (p < 0.05) and, as a consequence, the kind of delivery: 5% cesarean section rate among satisfied parturients vs 43% among dissatisfied ones (p < 0.05). 27 (45%) among satisfied women have had some sensation of pain during labor in comparison with 6 (86%) dissatisfied patients (p < 0.05). Conclusions: Majority of questioned women is pleased with EA for labor. The challenge facing Poland is to provide women with comfort during labor as a standard service accompanied by prior professional information from their gynecologists. O242 Model for predicting pregnancy demise in women with threatened miscarriage in the first trimester of pregnancy E. Edi-Osagie, M. Entwisle. St. Mary’s Hospital, Manchester, UK Background: 1 in 5 pregnancies are complicated by threatened miscarriage with 20% of these resulting in fetal demise. We neither have the tools for predicting fetal demise nor effective preventive interventions. Accurately predicting fetal demise would enable us investigate interventions that could reduce this risk. Objectives: To develop a model for predicting fetal demise in pregnancies complicated by threatened miscarriage.
a physical exam; 58/25% could identify sequelae of PIH; 50% of staff in both settings could identify the threshold for high BP in pregnancy. Conclusion: In both settings there was a concerning lack of working and validated BP devices. In addition, this study highlights a pressing need for education and increased awareness of PIH in two rural African populations. O239 High levels of lipoprotein(a) in women with polycystic ovary syndrome A. Duleba1 , M. Ahmed2 . 1 University of California Davis, Sacramento, CA, USA, 2 Benha School of Medicine Objectives: Polycystic ovary syndrome (PCOS) is associated with cardiovascular risk factors including insulin resistance, systemic inflammation and dyslipidemia. Recent studies have shown that lipoprotein(a) is a unique lipid associated with particularly high risk of cardiovascular events. This study evaluated lipoprotein(a) in relation to other clinical, endocrine and metabolic parameters in women with PCOS. Materials and Methods: Hyperandrogenic women with PCOS were evaluated at university-based medical center; subjects with diabetes or hypertension were excluded. Evaluations of eligible women (N = 58; age = 25±7.5) included: lipoprotein(a), BMI, blood pressure, C-reactive protein, urinary albumin excretion, total and free testosterone, lipid profile, as well as glucose and insulin during 2-hour glucose tolerance test. Insulin sensitivity index was calculated. Statistical evaluation included linear regression analysis. Results: Lipoprotein(a) ranged from 4 to 126 mg/dL; mean±SD was 26.4±30 mg/dL. Significant elevation of lipoprotein(a) (>30 mg/dL) was observed in 28% of subjects. Lipoprotein(a) levels did not correlate with levels of other lipids or other parameters of PCOS. Normal levels of other lipids (total cholesterol, LDL, HDL and triglycerides) were observed in 50% of subjects. Elevated lipoprotein(a) was found in 34% of women with normal levels of other lipids and in 20% of those with abnormal levels of other lipids. Conclusions: PCOS is associated with a high rate of elevated lipoprotein(a) independently of levels of other lipids and other markers of cardiovascular risks. Determination of lipoprotein(a) may be considered in evaluation of cardiovascular risk factors in women with PCOS. O240 Lower urinary tract injury during mid-urethral sling P. Dwyer1 , K. Stav1 , A. Rosamilia2 , Y. Lim1 . 1 Mercy Hospital for Women, 2 Monash Medical Centre Purpose: To determine incidence and risk factors for bladder and urethral injury during mid-urethral sling surgery for stress urinary incontinence. Materials and Methods: 1136 consecutive women had a midurethral slings (874 retropubic, 262 transobturator) and routine intraoperative cystoscopy at our institution between 1999 and 2007 and were follow-up to determine the clinical outcome. Eight hundred and seventy four slings (77%) were retropubic (TVT 87%, Advantage sling 11%, SPARC 2%) and 262 (23%) were transobturator slings (Monarc 91%, TVT-O 9%). Statistical analysis was performed using Chi-Square tests, independent t-tests and ANOVA tests to compare the 2 groups (patients with and without bladder perforation) by baseline characteristics and major risk factors. Results: The incidence of trocar injury to the bladder during retropubic sling was 3.8% (33/874) compared to 0.4% (1/262) with transobturator approach. (p < 0.0001). Thirty two (94%) of the perforations involved inexperienced surgeons (fellows or registrars) whose experience varied but was less than 50 slings (p < 0.0001).
S161
The perforation rate was similar in the various types of the retropubic slings (p = 0.32). Multivariate analysis revealed that the presence of rectocele (OR 6.2), performing the procedure under local anesthesia (OR 5.9), BMI<30 (OR 5.6), previous Cesarean section (OR 3.7), and previous colposuspension (OR 3.2) are significant independent risk factors for perforation. Urethral injury was detected intraoperatively in 2 women (0.2%), both had retropubic slings. Conclusions: Our results indicate that previous Cesarean section, colposuspension, BMI<30, rectocele and local anesthesia are independent risk factors for bladder perforation during midurethral slings. This occurs mainly during a retropubic sling procedure and when the surgeon is inexperienced. Urethral injuries were uncommon occurring in 0.2% of women having retropubic slings. These injuries have also been described in transobturator slings, a number of women with latent urethral injuries following these procedures have been referred although there were none in this case series. Complete endoscopic visualization of the lower urinary tract with cystourethroscopy is necessary following sling placement. O241 Epidural analgesia during labor in Mikołow ´ public hospital – retrospective evaluation in postal questionnaire survey A. Dyrda, D. Hudziak, J. Kubacki Objectives: As a consequence of socio-economic progress, we report the increasing popularity of epidural analgesia in Poland. Hence, the aim of his study was to evaluate the parturients’ opinion about epidural analgesia for labor (EA). Materials and Methods: We designed a retrospective study with a questionnaire concerning: pain, parity, age, level of education, time of making decision and maternal satisfaction with labor, which was sent to 130 women who had vaginal delivery with EA in our centre in 2004–2006. Categorical data were compared using chi-square test for evaluation of interaction, using Statistica software. Results: 61 (91%) from group of 67 patients would decide on labor with EA in the future, 4 of all (6%) would not appreciate it and 3 (4.5%) have not consider it yet. Multiparas have made decision earlier than nulliparas: 89% vs 59% before labor and 11% vs 41% during it (p < 0.05). All dissatisfied patients have experienced adverse effects of EA, whereas in the group of satisfied women – 23 (50%) of them (p < 0.05). Among all complications it was the prolonged second stage of labor that had the most relevant impact on labor valuation: 7% in the group of content patients in comparison with 57% in the group of discontent (p < 0.05) and, as a consequence, the kind of delivery: 5% cesarean section rate among satisfied parturients vs 43% among dissatisfied ones (p < 0.05). 27 (45%) among satisfied women have had some sensation of pain during labor in comparison with 6 (86%) dissatisfied patients (p < 0.05). Conclusions: Majority of questioned women is pleased with EA for labor. The challenge facing Poland is to provide women with comfort during labor as a standard service accompanied by prior professional information from their gynecologists. O242 Model for predicting pregnancy demise in women with threatened miscarriage in the first trimester of pregnancy E. Edi-Osagie, M. Entwisle. St. Mary’s Hospital, Manchester, UK Background: 1 in 5 pregnancies are complicated by threatened miscarriage with 20% of these resulting in fetal demise. We neither have the tools for predicting fetal demise nor effective preventive interventions. Accurately predicting fetal demise would enable us investigate interventions that could reduce this risk. Objectives: To develop a model for predicting fetal demise in pregnancies complicated by threatened miscarriage.