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O397 “Cerebral palsy” – Who is responsible?
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
Objectives: To study: demographics of ALSO instructors; commitment to ALSO; perceived changes in confidence, ability and motivation; and before and after change in knowledge, skills and attitude. Methods: This is an observational cross-sectional study conducted in Sudan, targeting ALSO instructors trained between Feb 04-Feb 09. A structured questionnaire was used for data collection from all 45 instructors currently residing in Sudan. Data were analyzed using STATA Statistical software. Results: Male to female ratio is 1:1, 42% over 40 and 55% less than 40 years. Majority are consultants 27%, 67% from Khartoum, and the rest from other states. 96% would commit to continue as instructors. 76% are a lot more confident in managing post partum haemorrhage, 71% for shoulder dystocia and 69% for breech delivery. 95% feel more able to manage obstetric emergencies. 64% are motivated to teach what was learnt to their colleagues/students, 47% would always use course manual as a reference and 76% would always/frequently utilize the pneumonics in clinical practice. In respect to ‘before and after’ change, 49% felt that their knowledge changed a lot, in contrast to 73% for skills and 78% for attitude. Conclusion: Instructors perceived themselves as much more confident in managing obstetric emergencies. An enhanced capability in teaching, acquired knowledge and skills were stated. There was a widespread use of the ALSO pneumonics in practical settings. More than 50% of instructors anticipate high impact on maternal and neonatal mortality and morbidity. O396 “ECV” – Today’s place in breech presentation T. Hymakr. Narayana Medical College Hospital Objectives: Breech presentation complicates 3–4% of all term deliveries and a higher proportion of preterm deliveries. The incidence of Caesarean section for breech presentation has increased markedly in the last two decades and further1 with the publication of the term breech trial which.concluded that, elective Caesarean section was safer for the fetus and of similar safety to the mother when compared with vaginal delivery. The objective of this presentation is to insist that External cephalic version (ECV) has still a place in reducing breech associated morbidity, mortality & overall Caeserean section rate ECV at term reduces the incidence of non cephalic presentation at delivery Attempting ECV lowers the chances of Caesarean section. An overall success rate of 40% for nulliparous, and 60% for multiparous women can usually be achieved. There are few absolute and relative contraindications to ECV. Tocolytics may be indicated in some cases as it has been shown to increase the success rate. Materials and Methods: Present study (Jan 2005-Dec2007) was done in our hospital a tertiary care centre. ECV was done in all breech cases taking the various factors into like gestational age, parity and type of breech etc. Results: The success rate of ECV in our study was found to be quite satisfactory (85%). The Caeserean section rate in these cases was reduced thereby. Conclusions: Local policies should be implemented to actively increase the number of women offered and undergoing ECV to bring down the breech associated morbidity and mortality ECV has a very low complication rate. women should be alerted to potential complications. ECV should be performed where facilities for monitoring and immediate delivery are available. O397 “Cerebral palsy” – Who is responsible? T. Hymakrm, H. Kaliki. 1 NMC Hospitals Objective: Cerebral palsy (CP) is defined as a group of non progressive disorders of movements or posture due to a defect or lesion of the developing brain. Events during labour and delivary
S205
notably trauma and asphyxia have long been thought to be possible causes of CP.. This paper discusses what is known and what is not known about the asphyxia-CP relationship and also to what extent directly or indirectly an obstetrician is responsible? The extent to which obstetric care can be claimed as responsible for abnormal fetal outcome has been markedly over estimated and has resulted in the justification of possibly unnecessary obstetric interventions and a most detrimental rise in litigation Research has shown that birth prevalence has not fallen as anticipated with the widespread introduction of new technologies aimed at reducing birth asphyxia. It has also been shown that there are many causes and causal sequences which result in CP and Wheather obstetric care could prevent such cases is still unknown. It is very difficult to prove the specific cause of CP in any one case. Conclusions: There may be many routes to spastic CP, each contributing only a small proportion and many routes may be multi factorial with most commencing before delivary. It is felt thrrerefore unlikely that any single preventive activity will significantly reduce CP rates. Many agree that most full term CP children without obvious intrapartum or postpartum events (the majority) probably experienced their brain damaging effect ante-natally. O398 “Total hysterectomy” – An avoidable epidemic R. Hymavathi. Narayana Medical College Hospital Objective: Hysterectomy remains the commonest major operation in gynaecological surgery. There has been an increasing awareness of and research into the sequelae of total hysterectomy (TH). While arguments continue about the most advantageous type of operation, the real question is whether the cervix should be removed or preserved when hysterectomy is performed for benign indications. Attention has been focused on the possibility of anatomical and neurophysiological disruptions induced by TH. Teleologically it is reasonable to suppose that the more conservative procedures might have advantages. It is clear that subtotal hysterectomy (STH) is not a popular option, but there are number of reasons why views may have to change. The increased risks associated with TH but minimized by STH might persuade some to consider whether the former operation is always necessary especially in the present climate of medical litigation. Finally there is growing interest in this issue and it may be only a matter of time before women start demanding one or other operation. Minimal access surgery with all it’s advantages is gaining increasing interest. Should STH turnout to be advantageous over TH then the optimal procedure may well turnout to be laparoscopic assisted subtotal hysterectomy (LASTH). Conclusions: Any changes in surgical practice should be based on scientific evidence rather than fashion. It is clear that the paucity of data on which rational discussions can be made and the much wanted goal of evidence based medicine will remain a dream until the issues in question are resolved by prospective randomized and appropriately blinded studies of sufficient power. O399 Differential diagnostic performance of MR in the detection of lymph node metastases in early-stage cervical cancer patients C. Hyuck Jae1 , H. Kil-Sun. 1 Department of radiology, Asan medical center Purpose: The objective of this study is to evaluate the diagnostic performance in managing early-stage cervical cancer according to the FIGO stage or tumor size. Patients and Methods: We performed a retrospective review of patients with FIGO stage IB1-IIA cervical carcinoma who underwent magnetic resonance imaging (MRI) before lymphadenectomy. Lymphadenectomy involved all visible lymph nodes in the surgical
Objectives: To study: demographics of ALSO instructors; commitment to ALSO; perceived changes in confidence, ability and motivation; and before and after change in knowledge, skills and attitude. Methods: This is an observational cross-sectional study conducted in Sudan, targeting ALSO instructors trained between Feb 04-Feb 09. A structured questionnaire was used for data collection from all 45 instructors currently residing in Sudan. Data were analyzed using STATA Statistical software. Results: Male to female ratio is 1:1, 42% over 40 and 55% less than 40 years. Majority are consultants 27%, 67% from Khartoum, and the rest from other states. 96% would commit to continue as instructors. 76% are a lot more confident in managing post partum haemorrhage, 71% for shoulder dystocia and 69% for breech delivery. 95% feel more able to manage obstetric emergencies. 64% are motivated to teach what was learnt to their colleagues/students, 47% would always use course manual as a reference and 76% would always/frequently utilize the pneumonics in clinical practice. In respect to ‘before and after’ change, 49% felt that their knowledge changed a lot, in contrast to 73% for skills and 78% for attitude. Conclusion: Instructors perceived themselves as much more confident in managing obstetric emergencies. An enhanced capability in teaching, acquired knowledge and skills were stated. There was a widespread use of the ALSO pneumonics in practical settings. More than 50% of instructors anticipate high impact on maternal and neonatal mortality and morbidity. O396 “ECV” – Today’s place in breech presentation T. Hymakr. Narayana Medical College Hospital Objectives: Breech presentation complicates 3–4% of all term deliveries and a higher proportion of preterm deliveries. The incidence of Caesarean section for breech presentation has increased markedly in the last two decades and further1 with the publication of the term breech trial which.concluded that, elective Caesarean section was safer for the fetus and of similar safety to the mother when compared with vaginal delivery. The objective of this presentation is to insist that External cephalic version (ECV) has still a place in reducing breech associated morbidity, mortality & overall Caeserean section rate ECV at term reduces the incidence of non cephalic presentation at delivery Attempting ECV lowers the chances of Caesarean section. An overall success rate of 40% for nulliparous, and 60% for multiparous women can usually be achieved. There are few absolute and relative contraindications to ECV. Tocolytics may be indicated in some cases as it has been shown to increase the success rate. Materials and Methods: Present study (Jan 2005-Dec2007) was done in our hospital a tertiary care centre. ECV was done in all breech cases taking the various factors into like gestational age, parity and type of breech etc. Results: The success rate of ECV in our study was found to be quite satisfactory (85%). The Caeserean section rate in these cases was reduced thereby. Conclusions: Local policies should be implemented to actively increase the number of women offered and undergoing ECV to bring down the breech associated morbidity and mortality ECV has a very low complication rate. women should be alerted to potential complications. ECV should be performed where facilities for monitoring and immediate delivery are available. O397 “Cerebral palsy” – Who is responsible? T. Hymakrm, H. Kaliki. 1 NMC Hospitals Objective: Cerebral palsy (CP) is defined as a group of non progressive disorders of movements or posture due to a defect or lesion of the developing brain. Events during labour and delivary
S205
notably trauma and asphyxia have long been thought to be possible causes of CP.. This paper discusses what is known and what is not known about the asphyxia-CP relationship and also to what extent directly or indirectly an obstetrician is responsible? The extent to which obstetric care can be claimed as responsible for abnormal fetal outcome has been markedly over estimated and has resulted in the justification of possibly unnecessary obstetric interventions and a most detrimental rise in litigation Research has shown that birth prevalence has not fallen as anticipated with the widespread introduction of new technologies aimed at reducing birth asphyxia. It has also been shown that there are many causes and causal sequences which result in CP and Wheather obstetric care could prevent such cases is still unknown. It is very difficult to prove the specific cause of CP in any one case. Conclusions: There may be many routes to spastic CP, each contributing only a small proportion and many routes may be multi factorial with most commencing before delivary. It is felt thrrerefore unlikely that any single preventive activity will significantly reduce CP rates. Many agree that most full term CP children without obvious intrapartum or postpartum events (the majority) probably experienced their brain damaging effect ante-natally. O398 “Total hysterectomy” – An avoidable epidemic R. Hymavathi. Narayana Medical College Hospital Objective: Hysterectomy remains the commonest major operation in gynaecological surgery. There has been an increasing awareness of and research into the sequelae of total hysterectomy (TH). While arguments continue about the most advantageous type of operation, the real question is whether the cervix should be removed or preserved when hysterectomy is performed for benign indications. Attention has been focused on the possibility of anatomical and neurophysiological disruptions induced by TH. Teleologically it is reasonable to suppose that the more conservative procedures might have advantages. It is clear that subtotal hysterectomy (STH) is not a popular option, but there are number of reasons why views may have to change. The increased risks associated with TH but minimized by STH might persuade some to consider whether the former operation is always necessary especially in the present climate of medical litigation. Finally there is growing interest in this issue and it may be only a matter of time before women start demanding one or other operation. Minimal access surgery with all it’s advantages is gaining increasing interest. Should STH turnout to be advantageous over TH then the optimal procedure may well turnout to be laparoscopic assisted subtotal hysterectomy (LASTH). Conclusions: Any changes in surgical practice should be based on scientific evidence rather than fashion. It is clear that the paucity of data on which rational discussions can be made and the much wanted goal of evidence based medicine will remain a dream until the issues in question are resolved by prospective randomized and appropriately blinded studies of sufficient power. O399 Differential diagnostic performance of MR in the detection of lymph node metastases in early-stage cervical cancer patients C. Hyuck Jae1 , H. Kil-Sun. 1 Department of radiology, Asan medical center Purpose: The objective of this study is to evaluate the diagnostic performance in managing early-stage cervical cancer according to the FIGO stage or tumor size. Patients and Methods: We performed a retrospective review of patients with FIGO stage IB1-IIA cervical carcinoma who underwent magnetic resonance imaging (MRI) before lymphadenectomy. Lymphadenectomy involved all visible lymph nodes in the surgical