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O304 Quality of birth care in labour rooms in selected teaching hospitals in Khartoum, Sudan
S180
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O304 Quality of birth care in labour rooms in selected teaching hospitals in Khartoum, Sudan D. Mahmoud, A. FazariBashir Background: The implementation of evidence based practices is an indispensable factor to accomplish high quality of care. Sudan has an overwhelmingly high maternal mortality ratio and the level of care provided to the women of Sudan has not been studied before. Objective: To assess the quality of birth care based on the World Health Organization guidelines. Methods: An observational cross-sectional study was carried out in three teaching hospitals in Khartoum. The sample comprised 420 women at the time of assessment. Data was collected by observational checklist, as recommended by WHO. Results: There was low frequency of practices that should be encouraged, such as having an accompanying person (1%), careful monitoring of progress using a Partogram (6.9%), fetal monitoring (8.8%) and breast feeding in the delivery room (49%). Emotional support was absent and relief of pain was minimal. Care of the newborn was imperfect. Overall hygiene was poor. There was a high frequency of known harmful practices such as strict bed rest throughout labour (84%), lithotomy position (100%) and Valsalva maneuver (79.4%). Episiotomy rate was very high (82.4%). Conclusion: Facility practices for normal labour were mostly not in line with the WHO evidence-based classification of practices for normal birth. Procedures carried out on a routine basis should be considered based on evidence of their benefits. Recommendations: Improvement of quality services, strengthening the health education and counseling services in all aspects of safe motherhood. Rehabilitating and equipping the health facilities for obstetric services provision. O305 Methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone in the treatment of tubal pregnancy L. Feng1 , H. Zhao, B. Yang. 1 Beijing Tian Tan Hospital Objective: To observe the clinical effect of methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone for tubal pregnancy. Materials and Methods: From August 2006 to October 2008, 25 patients with unruptured tubal pregnancy, serum b-HCG <2500 mIU/mL, mass diameter ≤5 cm, underwent injection of MTX 50 mg by hysteroscopic tubal catheterization, meanwhile taking Mifepristone, 100 mg, per day, and lasted 5 days. Results: All of 25 cases were successful, cure rate was 100%. The b-HCG fell down to normal during 3–48 days, the masses disappeared during 14–75 days, the menstruation went to normal during 28–42 days. The side effects were limited. After 2–3 months, 18 cases did hydrotubation through hysteroscopy, 10 cases were unobstructed, 1 case was completely obstructed, 7 cases were incompletely obstructed. Now 3 patients have a full term delivery. Conclusions: Methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone for early tubal pregnancy is simple, safe, and effective.
Methods: 35 patients who planned to take GLM were included in the study, meantime another 30 patients who intent to take LM during the same period were recruited in the control group. Operating time, perioperative bleeding, discharge time, hospital stay, complications and relative costs were compared. A P value less than 0.05 was considered statistically significant. Results: In the gasless group, 30 patients finished operation successfully, however, three patients had to convert to laparotomy hysterectomy, another two had to bear pneumoperitoneum for poor operation field exposure; in the pneumoperitoneum group, 28 patients finished operation successfully, two patients had to convert to laparotomy myomectomy. No complication occurred intra and post operation. Comparing the two groups, the differences of patients’ age, myoma number and previous abdominal surgical history were not statistically significant (P > 0.05). Concerned about operating time, in gasless group it was (99.2±35.4) min, while in pneumoperitoneum group it was (102.7±28.8) min, the difference between the two group is not statistically significant (t −0.411, P = 0.682). Perioperative bleeding, in gasless group it was (77.0±48.3)ml, while in pneumoperitoneum group it was (89.6±53.8)ml, the difference between the two group is not statistically significant (t = −0.940, P = 0.351). Discharge time in gasless group was (1.8±0.5)d, while in pneumoperitoneum group was (2.1±0.3)d, the difference is statistically significant (MannWhitney U = 304.000, P = 0.013). Hospital stay in gasless group was (8.7±2.9)d, while in pneumoperitoneum group was (10.3±3.1)d, the difference is statistically significant (t = −2.031, P = 0.047). Relative costs in gasless group was (6372.8±784.7)yuan, while in pneumoperitoneum group it was (7984.6±1048.7)yuan, the difference is statistically significant (t = −6.657, P < 0.001). Conclusions: GLM, compared with LM, is more competent in removing myomas with larger diameters; meanwhile the operating time and perioperative bleeding are not increased. Patients could enjoy a faster recovery, a shorter hospital stay and a lower cost. So, it deserves extensive generalization clinically. O307 Application of hysteroscopy in the diagnosis and treatment of postmenopausal pyometra L. Feng, C. Huang Objectives: To discuss the effect of hysteroscopy in the diagnosis and treatment of postmenopausal pyometra. Materials and Method: 32 cases diagnosed as postmenopausal pyometra in Beijing Tiantan Hospital were retrospectively analyzed from October 1998 to October 2007. All the patients were divided into 2 groups: draining with hysteroscopy combined with medication and pure draining combined with medication. Results: The group of draining with hysteroscopy combined with medication had less operation time, less purulent material persistent and the duration of the hospitalization than the pure draining combined with medication (P < 0.05). The group of draining with hysteroscopy had no recurrence and perforation, the group of pure draining had one recurrence and one perforation. Conclusions: Hysteroscopy in the diagnosis and treatment of postmenopausal pyometrao is an effective method in clinic, but needs more dates for clinical observation.
O306 Laparoscopic myomectomy: using a subcutaneous abdominal wall lifting method or conventional pneumoperitoneum
O308 Cervical cancer screening in slum women of Rajshahi city, Bangladesh
L. Feng, E. Wang. Beijing Tian Tan Hospital
M. Ferdausi, F. Ashraf. Obstetrics and Gynecology Society of Bangladesh
Objective: To evaluate the safety and feasibility of gasless laparoscopic myomectomy (GLM) using a subcutaneous abdominal wall lifting system for removing subserosal and intramural leiomyomas, and to evaluate the advantages and disadvantages of this technique in comparison with the conventional laparoscopic myomectomy using pneumoperitoneum (LM).
Objective: To detect the precancerous condition of cervix in women who are at risk by visual inspection of cervix with acetic acid (VIA). Method: A prospective observational study was carried out in 200 healthy asymptomatic women residing in slum of Rajshahi city. The subject who were included in this study there chronological age
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O304 Quality of birth care in labour rooms in selected teaching hospitals in Khartoum, Sudan D. Mahmoud, A. FazariBashir Background: The implementation of evidence based practices is an indispensable factor to accomplish high quality of care. Sudan has an overwhelmingly high maternal mortality ratio and the level of care provided to the women of Sudan has not been studied before. Objective: To assess the quality of birth care based on the World Health Organization guidelines. Methods: An observational cross-sectional study was carried out in three teaching hospitals in Khartoum. The sample comprised 420 women at the time of assessment. Data was collected by observational checklist, as recommended by WHO. Results: There was low frequency of practices that should be encouraged, such as having an accompanying person (1%), careful monitoring of progress using a Partogram (6.9%), fetal monitoring (8.8%) and breast feeding in the delivery room (49%). Emotional support was absent and relief of pain was minimal. Care of the newborn was imperfect. Overall hygiene was poor. There was a high frequency of known harmful practices such as strict bed rest throughout labour (84%), lithotomy position (100%) and Valsalva maneuver (79.4%). Episiotomy rate was very high (82.4%). Conclusion: Facility practices for normal labour were mostly not in line with the WHO evidence-based classification of practices for normal birth. Procedures carried out on a routine basis should be considered based on evidence of their benefits. Recommendations: Improvement of quality services, strengthening the health education and counseling services in all aspects of safe motherhood. Rehabilitating and equipping the health facilities for obstetric services provision. O305 Methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone in the treatment of tubal pregnancy L. Feng1 , H. Zhao, B. Yang. 1 Beijing Tian Tan Hospital Objective: To observe the clinical effect of methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone for tubal pregnancy. Materials and Methods: From August 2006 to October 2008, 25 patients with unruptured tubal pregnancy, serum b-HCG <2500 mIU/mL, mass diameter ≤5 cm, underwent injection of MTX 50 mg by hysteroscopic tubal catheterization, meanwhile taking Mifepristone, 100 mg, per day, and lasted 5 days. Results: All of 25 cases were successful, cure rate was 100%. The b-HCG fell down to normal during 3–48 days, the masses disappeared during 14–75 days, the menstruation went to normal during 28–42 days. The side effects were limited. After 2–3 months, 18 cases did hydrotubation through hysteroscopy, 10 cases were unobstructed, 1 case was completely obstructed, 7 cases were incompletely obstructed. Now 3 patients have a full term delivery. Conclusions: Methotrexate (MTX) injection by hysteroscopic tubal catheterization combined with Mifepristone for early tubal pregnancy is simple, safe, and effective.
Methods: 35 patients who planned to take GLM were included in the study, meantime another 30 patients who intent to take LM during the same period were recruited in the control group. Operating time, perioperative bleeding, discharge time, hospital stay, complications and relative costs were compared. A P value less than 0.05 was considered statistically significant. Results: In the gasless group, 30 patients finished operation successfully, however, three patients had to convert to laparotomy hysterectomy, another two had to bear pneumoperitoneum for poor operation field exposure; in the pneumoperitoneum group, 28 patients finished operation successfully, two patients had to convert to laparotomy myomectomy. No complication occurred intra and post operation. Comparing the two groups, the differences of patients’ age, myoma number and previous abdominal surgical history were not statistically significant (P > 0.05). Concerned about operating time, in gasless group it was (99.2±35.4) min, while in pneumoperitoneum group it was (102.7±28.8) min, the difference between the two group is not statistically significant (t −0.411, P = 0.682). Perioperative bleeding, in gasless group it was (77.0±48.3)ml, while in pneumoperitoneum group it was (89.6±53.8)ml, the difference between the two group is not statistically significant (t = −0.940, P = 0.351). Discharge time in gasless group was (1.8±0.5)d, while in pneumoperitoneum group was (2.1±0.3)d, the difference is statistically significant (MannWhitney U = 304.000, P = 0.013). Hospital stay in gasless group was (8.7±2.9)d, while in pneumoperitoneum group was (10.3±3.1)d, the difference is statistically significant (t = −2.031, P = 0.047). Relative costs in gasless group was (6372.8±784.7)yuan, while in pneumoperitoneum group it was (7984.6±1048.7)yuan, the difference is statistically significant (t = −6.657, P < 0.001). Conclusions: GLM, compared with LM, is more competent in removing myomas with larger diameters; meanwhile the operating time and perioperative bleeding are not increased. Patients could enjoy a faster recovery, a shorter hospital stay and a lower cost. So, it deserves extensive generalization clinically. O307 Application of hysteroscopy in the diagnosis and treatment of postmenopausal pyometra L. Feng, C. Huang Objectives: To discuss the effect of hysteroscopy in the diagnosis and treatment of postmenopausal pyometra. Materials and Method: 32 cases diagnosed as postmenopausal pyometra in Beijing Tiantan Hospital were retrospectively analyzed from October 1998 to October 2007. All the patients were divided into 2 groups: draining with hysteroscopy combined with medication and pure draining combined with medication. Results: The group of draining with hysteroscopy combined with medication had less operation time, less purulent material persistent and the duration of the hospitalization than the pure draining combined with medication (P < 0.05). The group of draining with hysteroscopy had no recurrence and perforation, the group of pure draining had one recurrence and one perforation. Conclusions: Hysteroscopy in the diagnosis and treatment of postmenopausal pyometrao is an effective method in clinic, but needs more dates for clinical observation.
O306 Laparoscopic myomectomy: using a subcutaneous abdominal wall lifting method or conventional pneumoperitoneum
O308 Cervical cancer screening in slum women of Rajshahi city, Bangladesh
L. Feng, E. Wang. Beijing Tian Tan Hospital
M. Ferdausi, F. Ashraf. Obstetrics and Gynecology Society of Bangladesh
Objective: To evaluate the safety and feasibility of gasless laparoscopic myomectomy (GLM) using a subcutaneous abdominal wall lifting system for removing subserosal and intramural leiomyomas, and to evaluate the advantages and disadvantages of this technique in comparison with the conventional laparoscopic myomectomy using pneumoperitoneum (LM).
Objective: To detect the precancerous condition of cervix in women who are at risk by visual inspection of cervix with acetic acid (VIA). Method: A prospective observational study was carried out in 200 healthy asymptomatic women residing in slum of Rajshahi city. The subject who were included in this study there chronological age