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O42 Exposure to air pollution during pregnancy and its association with perinatal outcomes in Uruguay
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
Material and Methods: This is a retrospective study of patients delivered in the maternity department in TMC over 12 years from 1996 to 2008. Information was taken from the delivery suit registration book and department registration files. Results: The number of HIV infected mothers giving birth in Tripoli Medical Centre is steadily increasing since the hospital opened in September 1996. In 1997 HIV infected mothers constituted 2.5/10 000 of deliveries, this increased to 40/10 000 deliveries in 2008, which is higher than incidence of HIV in Tripoli (0.3%), Overall we have 221 cases of HIV infected mothers giving birth in TMC, 3 /4 of these were in the last 4 years. We only have details on 150 of these patients. We are aware of only one mortality in these patients. Age of patients ranged from 17 to 43 and their nationality varied from 100% non Libyan (mainly African origin) in 1996 up to nearly 96% Libyan in the last couple of years. Regarding the mode of delivery all patients were delivered normally between 1996–2002, since then more patients are being delivered by elective cesarean section. Babies of HIV mothers have a higher rate of being still birth or admitted to neonatal intensive care than the average hospital rate. Conclusion: With the increasing incidence of HIV among our Libyan mothers, doctors and midwifes need to be trained in dealing with these patients with the aim to reduce neonatal infection. O41 Immature oocytes harvested in antagonist use L. Almeda Objective: To determine the effect of Antagonist on the number of immature oocytes and harvested compared to Agonist use. Materials and Methods: Agonist use in 2007 is compared to Antagonist use in 2008 in CRM. Results: In 2008, Antagonist use results in 472 eggs. 389 (82%) were mature and 18% immature. In 2007, 529 eggs were harvested after Agonist use 462 (87%) were mature. (13%) immature. Using the criteria of 1.7 cm as trigger for HCG after follicular maturation we noticed a significant increase in the number of immature oocytes in Antagonist use compared to Agonist use... O42 Exposure to air pollution during pregnancy and its association with perinatal outcomes in Uruguay J. Alonso1 , A. Balsa2 , M. Caffera3 , G. Piriz1 , C. Sosa1 . 1 Department of Obstetrics and Gynecology, School of Medicine, University of Uruguay, 2 Health Economics Research Group, Department of Sociology, University of Miami, 3 Department of Economics, School of Business and Economic Sciences, University of Montevideo Background: Several studies have examined the association between urban air pollution and perinatal outcomes. Since urban air pollution levels in Uruguay are not perceived as a matter for concern when compared to other countries in Latin America, there have not been previous attempts to evaluate these associations in the country. However, disparities in the air quality across localities raise concerns about possible impacts on pregnancies and birth conditions for those living in the most affected areas. Objectives: To explore the association among several air pollutants (Total Suspended Particulate – TSP, particulate matter with diameter ≤10 mm – PM10, sulfur dioxide, and black smoke) with several perinatal outcomes. Methods: A perinatal dataset from the Pereira Rossell Hospital – the largest maternity ward in the country – was linked to an air pollution dataset from the Montevideo municipal government for the period 2004–2007. A total of 6433 births from seven different areas of the city were classified and analyzed according to the living area and the exposure to air pollutants. The main measured perinatal outcomes were preterm birth, gestational age at birth, birthweight, low birth weight, and Apgar scores. Exposure was assigned as the average neighborhood-level air concentration over
S105
gestation and each trimester based on the public health clinic where the mother controlled her pregnancy. Analyses included logistic models and lineal regression models according to the measured outcomes. We adjusted for prenatal care, child’s sex, multiple pregancy, maternal education, marital status, maternal age, tobacco use, previous pregnancies and deliveries, an index of neighborhood wealth, weather measures, and year and seasonal indicators. Results: Lower birth weight and shorter gestational age were associated during the bivariate analyses with exposure to TSP during the first trimester. After accounting for birthweight in the model, only shorter gestational age was associated with TSP in the first trimester. An increase of 83 mm in TSP was associated with a decrease of one week in gestational age (p < 0.05). Conclusions: Results suggest that exposure to air pollution, specifically TSP, may increase the risk of preterm birth since higher levels of TSP are associated with shorter gestational age. O43 A common LH polymorphism is associated with higher FSH consumption during ovarian stimulation for IVF/ICSI cycles C. Alviggi, R. Clarizia, G. Coppola, P. De Rosa, G. De Biasio, K. Pettersson, G. De Placido, P. Humaidan Introduction: The concept of “hypo-response” to ovarian stimulation (OS) for IVF has been proposed for those normogonadotrophic women requiring high amounts of FSH to obtain an adequate number of oocytes retrieved. Our preliminary study evidenced an increase in the frequency of a common LH polymorphism (v-LH) in women who required >3000 IU of FSH to achieve retrieval of at least 5 oocytes. Here, we further investigate into possible association between v-LH and hypo-response to FSH during IVF/ICSI cycles. Materials and Methods: The presence of v-LH was evaluated by IFMA assays in 204 normogonadotrophic patients undergoing GnRH-a long protocol plus rFSH. Results: A total of 24 v-LH carriers (21 [10.2%] in heterozygosis and 3 [1.4%] in homozygosis) were found. RFSH consumption was significantly higher (p < 0.001) in v-LH carriers (3558.3±970.9 IU in homozygosis carriers; 2267.5±824.3 IU in heterozygosis carriers) than wild type LH homozygotes (1959.8±736.4 IU). A ROC curve identified a value of 1243.7 IU as the cut-off of FSH consumption more indicative for v-LH presence. Patients were divided in two sub-groups on the basis of that cut-off: 22 carriers (19 heterozygotes and 3 homozygotes) in the group of women with higher FSH consumption (group A; n = 175), and 2 carriers among remaining patients (group B; n = 29) were found. Allelic frequency was 13.3%, 14.3% and 6.9% in the total study, group A and group B, respectively. Conclusions: These results confirm previous observations demonstrating that v-LH is more frequent among hypo-responders to rFSH. Early identification of v-LH carriers could lead to a pharmacogenomic approach to OS. O44 Significance of physiotherapy interventions in treatment of sexual disorders – A critical review T. Amalnerkar1 , K. Kathumbi2 , J. Anison3 , J. Denial4 . 1 Masterskill University College of Health Science, 2 M.H.A.SA.A, 3 Choithram College of Physiotherapy, 4 Indore Institue of Medical Sciences Purpose of the study: Sexual disorders are quite common today and are characterized by erectile dysfunction, low libido, decreased orgasms, dribbling, and impotency, incontinence, and disturbed and painful sexual intercourse. In long term it leads to psychological symptoms like stress, nervousness, anxiety, frustration and worries, which in turns leads to a vicious cycle of persistent pain and agony which keeps on deteriorating the condition. These reviews is an attempt to enlighten the efficacy of various physiotherapy interven-
Material and Methods: This is a retrospective study of patients delivered in the maternity department in TMC over 12 years from 1996 to 2008. Information was taken from the delivery suit registration book and department registration files. Results: The number of HIV infected mothers giving birth in Tripoli Medical Centre is steadily increasing since the hospital opened in September 1996. In 1997 HIV infected mothers constituted 2.5/10 000 of deliveries, this increased to 40/10 000 deliveries in 2008, which is higher than incidence of HIV in Tripoli (0.3%), Overall we have 221 cases of HIV infected mothers giving birth in TMC, 3 /4 of these were in the last 4 years. We only have details on 150 of these patients. We are aware of only one mortality in these patients. Age of patients ranged from 17 to 43 and their nationality varied from 100% non Libyan (mainly African origin) in 1996 up to nearly 96% Libyan in the last couple of years. Regarding the mode of delivery all patients were delivered normally between 1996–2002, since then more patients are being delivered by elective cesarean section. Babies of HIV mothers have a higher rate of being still birth or admitted to neonatal intensive care than the average hospital rate. Conclusion: With the increasing incidence of HIV among our Libyan mothers, doctors and midwifes need to be trained in dealing with these patients with the aim to reduce neonatal infection. O41 Immature oocytes harvested in antagonist use L. Almeda Objective: To determine the effect of Antagonist on the number of immature oocytes and harvested compared to Agonist use. Materials and Methods: Agonist use in 2007 is compared to Antagonist use in 2008 in CRM. Results: In 2008, Antagonist use results in 472 eggs. 389 (82%) were mature and 18% immature. In 2007, 529 eggs were harvested after Agonist use 462 (87%) were mature. (13%) immature. Using the criteria of 1.7 cm as trigger for HCG after follicular maturation we noticed a significant increase in the number of immature oocytes in Antagonist use compared to Agonist use... O42 Exposure to air pollution during pregnancy and its association with perinatal outcomes in Uruguay J. Alonso1 , A. Balsa2 , M. Caffera3 , G. Piriz1 , C. Sosa1 . 1 Department of Obstetrics and Gynecology, School of Medicine, University of Uruguay, 2 Health Economics Research Group, Department of Sociology, University of Miami, 3 Department of Economics, School of Business and Economic Sciences, University of Montevideo Background: Several studies have examined the association between urban air pollution and perinatal outcomes. Since urban air pollution levels in Uruguay are not perceived as a matter for concern when compared to other countries in Latin America, there have not been previous attempts to evaluate these associations in the country. However, disparities in the air quality across localities raise concerns about possible impacts on pregnancies and birth conditions for those living in the most affected areas. Objectives: To explore the association among several air pollutants (Total Suspended Particulate – TSP, particulate matter with diameter ≤10 mm – PM10, sulfur dioxide, and black smoke) with several perinatal outcomes. Methods: A perinatal dataset from the Pereira Rossell Hospital – the largest maternity ward in the country – was linked to an air pollution dataset from the Montevideo municipal government for the period 2004–2007. A total of 6433 births from seven different areas of the city were classified and analyzed according to the living area and the exposure to air pollutants. The main measured perinatal outcomes were preterm birth, gestational age at birth, birthweight, low birth weight, and Apgar scores. Exposure was assigned as the average neighborhood-level air concentration over
S105
gestation and each trimester based on the public health clinic where the mother controlled her pregnancy. Analyses included logistic models and lineal regression models according to the measured outcomes. We adjusted for prenatal care, child’s sex, multiple pregancy, maternal education, marital status, maternal age, tobacco use, previous pregnancies and deliveries, an index of neighborhood wealth, weather measures, and year and seasonal indicators. Results: Lower birth weight and shorter gestational age were associated during the bivariate analyses with exposure to TSP during the first trimester. After accounting for birthweight in the model, only shorter gestational age was associated with TSP in the first trimester. An increase of 83 mm in TSP was associated with a decrease of one week in gestational age (p < 0.05). Conclusions: Results suggest that exposure to air pollution, specifically TSP, may increase the risk of preterm birth since higher levels of TSP are associated with shorter gestational age. O43 A common LH polymorphism is associated with higher FSH consumption during ovarian stimulation for IVF/ICSI cycles C. Alviggi, R. Clarizia, G. Coppola, P. De Rosa, G. De Biasio, K. Pettersson, G. De Placido, P. Humaidan Introduction: The concept of “hypo-response” to ovarian stimulation (OS) for IVF has been proposed for those normogonadotrophic women requiring high amounts of FSH to obtain an adequate number of oocytes retrieved. Our preliminary study evidenced an increase in the frequency of a common LH polymorphism (v-LH) in women who required >3000 IU of FSH to achieve retrieval of at least 5 oocytes. Here, we further investigate into possible association between v-LH and hypo-response to FSH during IVF/ICSI cycles. Materials and Methods: The presence of v-LH was evaluated by IFMA assays in 204 normogonadotrophic patients undergoing GnRH-a long protocol plus rFSH. Results: A total of 24 v-LH carriers (21 [10.2%] in heterozygosis and 3 [1.4%] in homozygosis) were found. RFSH consumption was significantly higher (p < 0.001) in v-LH carriers (3558.3±970.9 IU in homozygosis carriers; 2267.5±824.3 IU in heterozygosis carriers) than wild type LH homozygotes (1959.8±736.4 IU). A ROC curve identified a value of 1243.7 IU as the cut-off of FSH consumption more indicative for v-LH presence. Patients were divided in two sub-groups on the basis of that cut-off: 22 carriers (19 heterozygotes and 3 homozygotes) in the group of women with higher FSH consumption (group A; n = 175), and 2 carriers among remaining patients (group B; n = 29) were found. Allelic frequency was 13.3%, 14.3% and 6.9% in the total study, group A and group B, respectively. Conclusions: These results confirm previous observations demonstrating that v-LH is more frequent among hypo-responders to rFSH. Early identification of v-LH carriers could lead to a pharmacogenomic approach to OS. O44 Significance of physiotherapy interventions in treatment of sexual disorders – A critical review T. Amalnerkar1 , K. Kathumbi2 , J. Anison3 , J. Denial4 . 1 Masterskill University College of Health Science, 2 M.H.A.SA.A, 3 Choithram College of Physiotherapy, 4 Indore Institue of Medical Sciences Purpose of the study: Sexual disorders are quite common today and are characterized by erectile dysfunction, low libido, decreased orgasms, dribbling, and impotency, incontinence, and disturbed and painful sexual intercourse. In long term it leads to psychological symptoms like stress, nervousness, anxiety, frustration and worries, which in turns leads to a vicious cycle of persistent pain and agony which keeps on deteriorating the condition. These reviews is an attempt to enlighten the efficacy of various physiotherapy interven-