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O33 Obstetric medical emergency team, a step forward towards maternal safety, systematic review
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O31 Multicentre report of the effect of caesarean section on adherence to antiretroviral therapy in a resource-constrained setting R. Akuse1 , J. Akuse2 , N. Okeji3 , J. Adze4 . 1 Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria, 2 Sefa Specialist Hospital, 5 College Road, P. O. Box 3626, Kaduna, Nigeria, 3 Nigeria Armed Forces Reference Hospital, Kaduna, Nigeria, 4 Barau Dikko Specialist Hospital, Kaduna, Nigeria Objectives: Non adherence to antiretroviral therapy (ART) in HIV can eventually lead to emergence of resistant strains. The objective of this study was to identify possible barriers to adherence associated with caesarean delivery. Materials and Methods: Audit of deliveries in three hospitals in Kaduna, Nigeria over a two year period (2007–2008). Results: Out of a total of 6166 deliveries, 333 (5.4%) were in HIV positive women. There was a higher rate of caesarean deliveries 45 (13.5%) among HIV positive women than the rest of the population (9.9%). Caesarean deliveries were carried out mainly for obstetrical reasons. All women had general anesthesia after which they did not take anything orally (including antiretroviral drugs) for 2 to 3 days. None received intravenous zidovudine because it was not available. One facility with resources for Early Infant Diagnosis recorded only one child with a positive DNA-PCR. Conclusion: Fasting associated with caesarean delivery done under general anesthesia is an unnoticed barrier to ART adherence. This may lead to incomplete viral suppression, emergence of resistant strains and ultimately failure of ART and of methods to reduce Maternal-to–child-Transmission. Use of epidural anesthesia in HIV positive women may increase adherence but has limitations. There is a need to make injectable ART preparations more affordable and available. Research is needed to determine the effect of fasting after caesarean delivery on viral replication. O32 Correlation between HIPK2, HPV and apoptosis in cervical cancer M. Al-Beiti1 , J. Wang2 , X. Liu1 , X. Lu1 . 1 Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China, 2 Department of Pathology, East Hospital of Tongji University, Shanghai 200120, China Background: Cervical cancer is one of the most common female cancers and its mortality rate remains the highest in the world. Human papillomavirus (HPV) infection is now recognized as the main cause of cervical cancer. However, some other genetic and epigenetic factors may contribute to cervical carcinogenesis. Homeodomain-interacting protein kinase 2 (HIPK2) is a serine/threonine nuclear kinase that involved in the enhancement of apoptosis, inhibition of cell growth and is also thought to participate in the process of tumorigenesis. However, the relationship between HIPK2 and cervical carcinogenesis is still unclear. Methods: HIPK2 mRNA and protein expression levels were analyzed in normal and cervical cancer tissues by quantitative real-time PCR and Western blot analysis. Reverse transcription PCR (RT-PCR) was used to investigate HPV-16 and -18 in cervical cancer tissues. To explore the role and mechanism of action of HIPK2 in cervical cancer development, RNA interference technology was used to analyze the effect of HIPK2 on apoptosis, cell proliferation, cell migration and invasion in cervical cancer cell lines. Results: We found that HIPK2 mRNA and protein expression were significantly higher in cervical cancer than in normal cervical tissues. There was significant correlation between HIPK2 and HPV-16 and -18 in cervical cancer. Inhibition of HIPK2 by RNA interference caused dramatic reduction in apoptosis compared with controls in cervical cancer cells by down-regulating caspase-3. We also observed that HIPK RNAi
induced cell proliferation as well as cell migration in cervical cancer cell lines. Conclusion: The expression of HIPK2 may play an important role in cervical cancer development. There is a close correlation between HIPK2 and HPV-16 and -18. HIPK2 RNAi can inhibit cell apoptosis, induce cell proliferation and cell migration-stimulated in cervical cancer cells. O33 Obstetric medical emergency team, a step forward towards maternal safety, systematic review H. Al Kadri Introduction: Medical emergency team (MET) system was introduced successfully to treat patients who are identified to be at risk of suffering an adverse hospital events. Excluding few research publication most of the described teams are based on patients medical rather than obstetric management. Objectives: Identify literatures on the outcome of Obstetric MET implementation aiming to improve high risk pregnancy care. Method: Systematic Review through searching MEDLINE, and The Cochrane Library was performed. Searching references, conference proceeding and contact with experienced persons was done. Two independent researchers selected literature on the establishment or implementation of obstetric medical emergency team. There was no restriction on language, sample size, or duration of follow up. Results: Searching the Cochrane library and Medline database resulted in three publications that were suitable to be included in the review (Gosman et al 2008; Skupski et al 2006; Catanzarite et al 2007). Gosman, have reported designing a team responders and alert for variable fetal and maternal obstetrics emergencies. Their outcome is not yet audited. Skupski, in response to two maternal deaths, reported significant improvement in maternal outcomes before and after the introduction of patient safety program for women with major obstetric hemorrhage in a tertiary care centre. Catanzarite, have reported reduction of transfer time, OR arrival to incision and mean total decision to incision time. Conclusion: Maternal mortality and morbidity particularly resulting from obstetrics hemorrhage may be reduced through the iplementation of MET that responds to obstetrics hemorrhage. We propose a design of obstetric MET to be implemented in the developing countries accompanied with training, administrative arrangement and outreach program. O34 Management of cystocele in women with and without occult stress urinary incontinence using a synthetic mesh L. Al Kharusi1 , M. Bortolini2 , J. Moody2 , D. Dicarlo2 , D. Lovatsis2 , M. Al Arab2 , H. Drutz2 . 1 Sultan Qaboos University, 2 University of Toronto Objective: to determine the long-term outcome of advanced cystocele repair reinforced with mesh in women with either preoperative stress urinary incontinence (SUI) and/or demonstrable occult stress urinary incontinence (OSUI) vs. cystocele repair without preoperative evidence of OSUI/SUI in terms of recurrent post operative prolapse or SUI. Materials and Methods: a retrospective study was carried out between May 1995 & December 2006 at Mount Sinai Hospital, University of Toronto, Canada. Anterior colporraphy was reinforced with a jacket shaped mesh of Marlex or Prolene. Concomittant urogynecologic procedures were performed as needed. Subjective success was defined as lack of symptoms at the last visit. Objective success for cystocele and SUI was defined as absence of a cystocele greater than grade II on the Modified Baden Walker system and a negative cough stress test. Results: Of 172 patients, 93 had preoperative SUI/OSUI and 79 did not. Median follow-up was 24 months. Overall subjective
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
O31 Multicentre report of the effect of caesarean section on adherence to antiretroviral therapy in a resource-constrained setting R. Akuse1 , J. Akuse2 , N. Okeji3 , J. Adze4 . 1 Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria, 2 Sefa Specialist Hospital, 5 College Road, P. O. Box 3626, Kaduna, Nigeria, 3 Nigeria Armed Forces Reference Hospital, Kaduna, Nigeria, 4 Barau Dikko Specialist Hospital, Kaduna, Nigeria Objectives: Non adherence to antiretroviral therapy (ART) in HIV can eventually lead to emergence of resistant strains. The objective of this study was to identify possible barriers to adherence associated with caesarean delivery. Materials and Methods: Audit of deliveries in three hospitals in Kaduna, Nigeria over a two year period (2007–2008). Results: Out of a total of 6166 deliveries, 333 (5.4%) were in HIV positive women. There was a higher rate of caesarean deliveries 45 (13.5%) among HIV positive women than the rest of the population (9.9%). Caesarean deliveries were carried out mainly for obstetrical reasons. All women had general anesthesia after which they did not take anything orally (including antiretroviral drugs) for 2 to 3 days. None received intravenous zidovudine because it was not available. One facility with resources for Early Infant Diagnosis recorded only one child with a positive DNA-PCR. Conclusion: Fasting associated with caesarean delivery done under general anesthesia is an unnoticed barrier to ART adherence. This may lead to incomplete viral suppression, emergence of resistant strains and ultimately failure of ART and of methods to reduce Maternal-to–child-Transmission. Use of epidural anesthesia in HIV positive women may increase adherence but has limitations. There is a need to make injectable ART preparations more affordable and available. Research is needed to determine the effect of fasting after caesarean delivery on viral replication. O32 Correlation between HIPK2, HPV and apoptosis in cervical cancer M. Al-Beiti1 , J. Wang2 , X. Liu1 , X. Lu1 . 1 Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China, 2 Department of Pathology, East Hospital of Tongji University, Shanghai 200120, China Background: Cervical cancer is one of the most common female cancers and its mortality rate remains the highest in the world. Human papillomavirus (HPV) infection is now recognized as the main cause of cervical cancer. However, some other genetic and epigenetic factors may contribute to cervical carcinogenesis. Homeodomain-interacting protein kinase 2 (HIPK2) is a serine/threonine nuclear kinase that involved in the enhancement of apoptosis, inhibition of cell growth and is also thought to participate in the process of tumorigenesis. However, the relationship between HIPK2 and cervical carcinogenesis is still unclear. Methods: HIPK2 mRNA and protein expression levels were analyzed in normal and cervical cancer tissues by quantitative real-time PCR and Western blot analysis. Reverse transcription PCR (RT-PCR) was used to investigate HPV-16 and -18 in cervical cancer tissues. To explore the role and mechanism of action of HIPK2 in cervical cancer development, RNA interference technology was used to analyze the effect of HIPK2 on apoptosis, cell proliferation, cell migration and invasion in cervical cancer cell lines. Results: We found that HIPK2 mRNA and protein expression were significantly higher in cervical cancer than in normal cervical tissues. There was significant correlation between HIPK2 and HPV-16 and -18 in cervical cancer. Inhibition of HIPK2 by RNA interference caused dramatic reduction in apoptosis compared with controls in cervical cancer cells by down-regulating caspase-3. We also observed that HIPK RNAi
induced cell proliferation as well as cell migration in cervical cancer cell lines. Conclusion: The expression of HIPK2 may play an important role in cervical cancer development. There is a close correlation between HIPK2 and HPV-16 and -18. HIPK2 RNAi can inhibit cell apoptosis, induce cell proliferation and cell migration-stimulated in cervical cancer cells. O33 Obstetric medical emergency team, a step forward towards maternal safety, systematic review H. Al Kadri Introduction: Medical emergency team (MET) system was introduced successfully to treat patients who are identified to be at risk of suffering an adverse hospital events. Excluding few research publication most of the described teams are based on patients medical rather than obstetric management. Objectives: Identify literatures on the outcome of Obstetric MET implementation aiming to improve high risk pregnancy care. Method: Systematic Review through searching MEDLINE, and The Cochrane Library was performed. Searching references, conference proceeding and contact with experienced persons was done. Two independent researchers selected literature on the establishment or implementation of obstetric medical emergency team. There was no restriction on language, sample size, or duration of follow up. Results: Searching the Cochrane library and Medline database resulted in three publications that were suitable to be included in the review (Gosman et al 2008; Skupski et al 2006; Catanzarite et al 2007). Gosman, have reported designing a team responders and alert for variable fetal and maternal obstetrics emergencies. Their outcome is not yet audited. Skupski, in response to two maternal deaths, reported significant improvement in maternal outcomes before and after the introduction of patient safety program for women with major obstetric hemorrhage in a tertiary care centre. Catanzarite, have reported reduction of transfer time, OR arrival to incision and mean total decision to incision time. Conclusion: Maternal mortality and morbidity particularly resulting from obstetrics hemorrhage may be reduced through the iplementation of MET that responds to obstetrics hemorrhage. We propose a design of obstetric MET to be implemented in the developing countries accompanied with training, administrative arrangement and outreach program. O34 Management of cystocele in women with and without occult stress urinary incontinence using a synthetic mesh L. Al Kharusi1 , M. Bortolini2 , J. Moody2 , D. Dicarlo2 , D. Lovatsis2 , M. Al Arab2 , H. Drutz2 . 1 Sultan Qaboos University, 2 University of Toronto Objective: to determine the long-term outcome of advanced cystocele repair reinforced with mesh in women with either preoperative stress urinary incontinence (SUI) and/or demonstrable occult stress urinary incontinence (OSUI) vs. cystocele repair without preoperative evidence of OSUI/SUI in terms of recurrent post operative prolapse or SUI. Materials and Methods: a retrospective study was carried out between May 1995 & December 2006 at Mount Sinai Hospital, University of Toronto, Canada. Anterior colporraphy was reinforced with a jacket shaped mesh of Marlex or Prolene. Concomittant urogynecologic procedures were performed as needed. Subjective success was defined as lack of symptoms at the last visit. Objective success for cystocele and SUI was defined as absence of a cystocele greater than grade II on the Modified Baden Walker system and a negative cough stress test. Results: Of 172 patients, 93 had preoperative SUI/OSUI and 79 did not. Median follow-up was 24 months. Overall subjective