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O445 WHAT DO PERINATAL HEALTHCARE PROFESSIONALS THINK ABOUT HOME BIRTH?
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Results: The mean E2 level was found to be 57.8 pg/mL with a median level of 54.7 pg/mL which falls within the normal range of 20–60 pg/mL. FSH mean level was found to be 6.6 IU/L with a median of 6.4 IU/L which falls within the normal range of 1.4–11.4 IU/L. Mean AMH levels were found to be 1.3 ng/mL with a median of 1.1 ng/mL, which are within the normal bracket of 1.0–3.0 ng/mL. The mean antral follicle count is 8.4 with a median of 8.5, and the normal number reported is 5 total follicles. Conclusions: Patients of reproductive age who have undergone UAE show no significant difference in Estradiol-2 hormone levels, Follicle Stimulating Hormone levels, and Anti-Mullerian Hormone levels, and antral follicle count compared to normal values for women who have not undergone UAE. The conclusion from this preliminary analysis based on small numbers is that ovarian function is not affected by UAE, and therefore women with fibroids within reproductive age should consider UAE as a fibroid treatment option. O444 PREGNANCY FOLLOWING UTERINE ARTERY EMBOLIZATION B. McLucas1 . 1 UCLA, Los Angeles, CA, United States Objectives: To evaluate the ability to conceive and deliver term pregnancies following uterine artery embolization. Materials: Located in Los Angeles, this research study examines patients under the age of 40 who indicated a desire for fertility prior to embolization. Forty-four women under the age of 40 embolized between 1996 and 2010 stated a desire for fertility. Methods: The design of this study was non-random and not blind. Patients were questioned regarding attempts to conceive, subsequent pregnancies, and outcomes of those pregnancies. All patients who conceived were asked the details of the pregnancy. Results: Twenty-two of the 44 women who desired pregnancy have reported 28 pregnancies. Of these pregnancies, 20 live births, 3 miscarriages, and 3 instances of premature labor were reported. Seventeen of these pregnancies were delivered by caesarean section and 6 pregnancies were vaginal deliveries. And one woman is currently pregnant. No perfusion problems, either during the pregnancy or labor, were reported. Conclusions: The course of pregnancy and delivery was largely normal after embolization with 3 cases of premature labor and 3 miscarriages reported. Forty eight percent of women who were under 40 and desired pregnancies were able to have successful term pregnancies. O445 WHAT DO PERINATAL HEALTHCARE PROFESSIONALS THINK ABOUT HOME BIRTH? A.B. McNutt2 , T.S. Thornton2 , A. Curley3 , P. Clarke1 . 1 Neonatal Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, United Kingdom; 2 Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom; 3 Neonatal Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom Objectives: A recent UK government policy drive is to increase home delivery rates. Data are lacking about whether this strategy is embraced by perinatal healthcare professionals. Our objective was to examine opinions regarding home deliveries held by midwives, GPs, consultant obstetricians/ gynaecologists (O+G), and consultant neonatologists/ paediatricians (N+P). Materials: 831 UK perinatal healthcare professionals in the Eastern region. Methods: Cross sectional postal survey. Likert scales ranging from 0–10 assessed professionals’ general experiences of and enthusiasm for home birthing and support for the Government’s plan. Data were analysed using the Kruskall-Wallis test. Results: 432/831 (52%) professionals responded: GPs 148/321 (46%); midwives 224/418 (54%); O+G 32/52 (62%); N+P 28/41 (68%).
S419
Midwives generally reported positive experiences of home delivery and were much more enthusiastic about home deliveries than any other professionals (Table). Conclusions: Negative experiences and opinions of perinatal healthcare professionals regarding home delivery may adversely affect its uptake by women and will need to be addressed if the Government’s plan to increase home delivery rates is to succeed. Table: Experiences, enthusiasm, and support of various professionals for home birth Experiences of, 0 = very neg, 10 = very pos Enthusiasm for, 0 = none, 10 = very Support Government plan, 0 = strongly oppose, 10 = strongly support
Midwives
GPs
O&G
N&P
7 (5–8) 9 (8–10) 8.5 (7–10)
5 (3–7)* 3 (3–7.5)* 5 (2–6)*
5 (2–5)* 5 (2–7)* 5 (2–5)*
2 (1–3)* 4 (3–5)* 3 (2–5)*
Data are median (IQR); *versus midwives, p < 0.001 (Kruskal–Wallis test)
O446 MANAGEMENT OF WOMEN AFFECTED BY ENDOMETRIOSIS UNDERGOING ASSISTED REPRODUCTION TECHNOLOGIES M. Giovannini1 , J. Melluso1 , C. Fabiani1 , P. Cervone1 , M. Amodei1 , C. Lucchini1 , R. Poverini1 , G. Di Gregorio1 , V. Spina1 , V. Catania1 . 1 Obstetrics Gynaecology, Sandro Pertini Hospital, Roma, Lazio, Italy Objectives: Endometriosis is detected in up to 50% of women in fertile age and in 25% to 50% of infertile women. Endometriosis causes infertility through different mechanisms: mechanical adhesion, immune and endocrine system’s abnormalities. The authors evaluate the efficacy of surgery as compared to no surgery prior to IVF cycles. Materials: Infertile women suffering from endometriosis referred to the Infertility Centre of Sandro Pertini Hospital since January 2007 to December 2011. Methods: All women underwent In Vitro Fertilization (IVF) treatment (ICSI); one group underwent surgery prior to the IVF cycle; the second group performed IVF without surgery. Parameters considered to evaluate the outcome of IVF, were: age of patients, who were divided into aged ≤35 years old and >35 years old; E2 plasmatic levels, total number of oocytes and metaphase II oocytes retrieved, number of embryo transferred, pregnancy rate. Statistical analysis was performed (X2 Test) in order to compare pregnancy rate of the two groups. Results: 164 women affected by endometriosis were referred to our Infertility Centre, 65 of whom were ≤35 years old (Mean: 32.9; range: 26–35 years) and 99 were aged >35 years (Mean: 39.6; range: 36–45 years). Among women aged ≤35 years, 44 underwent surgery and 21 didn’t. Higher peak of mean E2 levels (1776,9 pg/ml versus 1213,5 pg/ml, respectively), total oocyte (6.2 versus 4,7) and Metaphase II oocyte retrieved (4.4 versus 3.6), number of embryo transferred (2.5 versus 2.3) and a higher overall pregnancy rate (38.6% versus 19%; X2 = 2.48; P = 0.11) were observed after surgery as compared to no surgery patients. Among patients aged >35 years, 82 underwent surgery and 17 didn’t. Also in this group, higher peak of mean E2 levels (996.2 pg/ml versus 892.2 pg/ml), total oocyte (mean 3.04 versus 2.2) and metaphase II oocyte (mean 2.1 versus 1.7) retrieved, number of embryo transferred (mean 1.3 versus 1.1) and a higher overall pregnancy rate (26.8% versus 17.6%; X2 = 0.62; P = 0.43) were seen after surgery as compared to the no surgery group. Conclusions: Surgery for endometriosis in both age groups prior to IVF cycles results in a better outcome in terms of E2 peak levels, oocyte retrieval, number of embryo transferred and pregnancy rate. Although the difference was not statistically significant, probably due to the small sample of patients, pregnancy rate was remarkably higher in both groups of patients after surgery.
Results: The mean E2 level was found to be 57.8 pg/mL with a median level of 54.7 pg/mL which falls within the normal range of 20–60 pg/mL. FSH mean level was found to be 6.6 IU/L with a median of 6.4 IU/L which falls within the normal range of 1.4–11.4 IU/L. Mean AMH levels were found to be 1.3 ng/mL with a median of 1.1 ng/mL, which are within the normal bracket of 1.0–3.0 ng/mL. The mean antral follicle count is 8.4 with a median of 8.5, and the normal number reported is 5 total follicles. Conclusions: Patients of reproductive age who have undergone UAE show no significant difference in Estradiol-2 hormone levels, Follicle Stimulating Hormone levels, and Anti-Mullerian Hormone levels, and antral follicle count compared to normal values for women who have not undergone UAE. The conclusion from this preliminary analysis based on small numbers is that ovarian function is not affected by UAE, and therefore women with fibroids within reproductive age should consider UAE as a fibroid treatment option. O444 PREGNANCY FOLLOWING UTERINE ARTERY EMBOLIZATION B. McLucas1 . 1 UCLA, Los Angeles, CA, United States Objectives: To evaluate the ability to conceive and deliver term pregnancies following uterine artery embolization. Materials: Located in Los Angeles, this research study examines patients under the age of 40 who indicated a desire for fertility prior to embolization. Forty-four women under the age of 40 embolized between 1996 and 2010 stated a desire for fertility. Methods: The design of this study was non-random and not blind. Patients were questioned regarding attempts to conceive, subsequent pregnancies, and outcomes of those pregnancies. All patients who conceived were asked the details of the pregnancy. Results: Twenty-two of the 44 women who desired pregnancy have reported 28 pregnancies. Of these pregnancies, 20 live births, 3 miscarriages, and 3 instances of premature labor were reported. Seventeen of these pregnancies were delivered by caesarean section and 6 pregnancies were vaginal deliveries. And one woman is currently pregnant. No perfusion problems, either during the pregnancy or labor, were reported. Conclusions: The course of pregnancy and delivery was largely normal after embolization with 3 cases of premature labor and 3 miscarriages reported. Forty eight percent of women who were under 40 and desired pregnancies were able to have successful term pregnancies. O445 WHAT DO PERINATAL HEALTHCARE PROFESSIONALS THINK ABOUT HOME BIRTH? A.B. McNutt2 , T.S. Thornton2 , A. Curley3 , P. Clarke1 . 1 Neonatal Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, United Kingdom; 2 Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom; 3 Neonatal Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom Objectives: A recent UK government policy drive is to increase home delivery rates. Data are lacking about whether this strategy is embraced by perinatal healthcare professionals. Our objective was to examine opinions regarding home deliveries held by midwives, GPs, consultant obstetricians/ gynaecologists (O+G), and consultant neonatologists/ paediatricians (N+P). Materials: 831 UK perinatal healthcare professionals in the Eastern region. Methods: Cross sectional postal survey. Likert scales ranging from 0–10 assessed professionals’ general experiences of and enthusiasm for home birthing and support for the Government’s plan. Data were analysed using the Kruskall-Wallis test. Results: 432/831 (52%) professionals responded: GPs 148/321 (46%); midwives 224/418 (54%); O+G 32/52 (62%); N+P 28/41 (68%).
S419
Midwives generally reported positive experiences of home delivery and were much more enthusiastic about home deliveries than any other professionals (Table). Conclusions: Negative experiences and opinions of perinatal healthcare professionals regarding home delivery may adversely affect its uptake by women and will need to be addressed if the Government’s plan to increase home delivery rates is to succeed. Table: Experiences, enthusiasm, and support of various professionals for home birth Experiences of, 0 = very neg, 10 = very pos Enthusiasm for, 0 = none, 10 = very Support Government plan, 0 = strongly oppose, 10 = strongly support
Midwives
GPs
O&G
N&P
7 (5–8) 9 (8–10) 8.5 (7–10)
5 (3–7)* 3 (3–7.5)* 5 (2–6)*
5 (2–5)* 5 (2–7)* 5 (2–5)*
2 (1–3)* 4 (3–5)* 3 (2–5)*
Data are median (IQR); *versus midwives, p < 0.001 (Kruskal–Wallis test)
O446 MANAGEMENT OF WOMEN AFFECTED BY ENDOMETRIOSIS UNDERGOING ASSISTED REPRODUCTION TECHNOLOGIES M. Giovannini1 , J. Melluso1 , C. Fabiani1 , P. Cervone1 , M. Amodei1 , C. Lucchini1 , R. Poverini1 , G. Di Gregorio1 , V. Spina1 , V. Catania1 . 1 Obstetrics Gynaecology, Sandro Pertini Hospital, Roma, Lazio, Italy Objectives: Endometriosis is detected in up to 50% of women in fertile age and in 25% to 50% of infertile women. Endometriosis causes infertility through different mechanisms: mechanical adhesion, immune and endocrine system’s abnormalities. The authors evaluate the efficacy of surgery as compared to no surgery prior to IVF cycles. Materials: Infertile women suffering from endometriosis referred to the Infertility Centre of Sandro Pertini Hospital since January 2007 to December 2011. Methods: All women underwent In Vitro Fertilization (IVF) treatment (ICSI); one group underwent surgery prior to the IVF cycle; the second group performed IVF without surgery. Parameters considered to evaluate the outcome of IVF, were: age of patients, who were divided into aged ≤35 years old and >35 years old; E2 plasmatic levels, total number of oocytes and metaphase II oocytes retrieved, number of embryo transferred, pregnancy rate. Statistical analysis was performed (X2 Test) in order to compare pregnancy rate of the two groups. Results: 164 women affected by endometriosis were referred to our Infertility Centre, 65 of whom were ≤35 years old (Mean: 32.9; range: 26–35 years) and 99 were aged >35 years (Mean: 39.6; range: 36–45 years). Among women aged ≤35 years, 44 underwent surgery and 21 didn’t. Higher peak of mean E2 levels (1776,9 pg/ml versus 1213,5 pg/ml, respectively), total oocyte (6.2 versus 4,7) and Metaphase II oocyte retrieved (4.4 versus 3.6), number of embryo transferred (2.5 versus 2.3) and a higher overall pregnancy rate (38.6% versus 19%; X2 = 2.48; P = 0.11) were observed after surgery as compared to no surgery patients. Among patients aged >35 years, 82 underwent surgery and 17 didn’t. Also in this group, higher peak of mean E2 levels (996.2 pg/ml versus 892.2 pg/ml), total oocyte (mean 3.04 versus 2.2) and metaphase II oocyte (mean 2.1 versus 1.7) retrieved, number of embryo transferred (mean 1.3 versus 1.1) and a higher overall pregnancy rate (26.8% versus 17.6%; X2 = 0.62; P = 0.43) were seen after surgery as compared to the no surgery group. Conclusions: Surgery for endometriosis in both age groups prior to IVF cycles results in a better outcome in terms of E2 peak levels, oocyte retrieval, number of embryo transferred and pregnancy rate. Although the difference was not statistically significant, probably due to the small sample of patients, pregnancy rate was remarkably higher in both groups of patients after surgery.