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O465 COMPARATIVE STUDY BETWEEN THE EFFECTS OF METFORMIN MONOTHERAPY IN OBESE AND NON-OBESE PATIENTS WITH POLYCYSTIC OVARY SYNDROME
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
reproductive health rights approach introduction as a basis for international training standards implementation. 7. Financial affordability of proposed training for all interested according to national (not international) standards. 8. No incentives for trainees and small participation fee introduction in order to improve participants accountability. 9. Constant monitoring and evaluation to ensure trainings quality. 10. Clear dissemination strategy. Conclusions: All mentioned statements have to be taken into account at the Proposal development stage to ensure project sustainability. O464 POSTPARTUM HAEMORRHAGE (PPH) REDUCTION FURTHER TO ALARM INTERNATIONAL PROGRAM (AIP) IMPLEMENTATION IN UKRAINE: FIGO SAVING MOTHER & NEWBORNS PROJECT I. Mogilevkina1 , V. Senikas2 , N. Shpatusko1 , O. Kulyk3 . 1 Obs, Gyn & Perinatology, Donetsk National Medical University, Donetsk, Ukraine; 2 SOGC, Ottawa, ON, Canada; 3 Vinnitsa Public Health Administration, Vinnitsa, Ukraine Objectives: To study if development of providers’ knowledge and skills in PPH prevention and management further to the AIP trainings (SOGC initiative) results in improvement of PPH related public health indicators in Ukraine. Materials: PPH is the world’s leading cause of maternal mortality and morbidity. Official statistical data were collected from facilities covering a 5 year span (2001–2005) prior and 4 years after the Project start up (2006–2009). A total of approximately 200,000 live births were analyzed. Methods: Facility-based approach with time series design was applied. Descriptive statistics have been used. The JMP (SAS Institute, Cary, NC, 1994) program package was used for dataentering and analysis. A p-value <0.05 was considered statistically significant. Results: A total of 527 providers from 25 pilot facilities attended 5-days AIP trainings during 2006–2008, corresponding to 69.23% median and 65.82% mean coverage (SD = 18.12) with a range of 28.57 to 94.74%. AIP training had significant effect on providers’ knowledge and skills in PPH prevention and management. There were no significant changes in Maternal Mortality per 100,000 life-births (16.95 (SD 50.88) versus to 16.19 (SD 48.07), p = 0.9091) as well as in Hemorrhage contribution in Maternal Death (3.31 (SD 23.67) versus to 3.41 (27.60), p = 0.9771). Further to AIP training there was a decrease in the percentage of cases where manual or instrumental uterus exploration was performed (from 8.45 (SD 8.92) to 4.00 (SD 3.28), p < 0.0001), haemo (from 3.25 (SD 4.73) to 1.07 (SD 1.18), p < 0.0001) or plasma transfusion (from 5.05 (SD 8.11) to 2.28 (SD 2.03), p = 0.0011) was done. Percentage of PPH decreased from 4.24 (SD 2.99) to 2.39 (SD 1.76), p < 0.0001. Level of provider’s skills has negatively correlated to frequency of Uterus exploration and Uterus extirpation as well as to plasma and blood transfusion administration. Conclusions: ALARM International Program has shown positive impact on PPH related Maternal Morbidity. Program scaling up should be of interest to those looking for MDG 5 achievement. O465 COMPARATIVE STUDY BETWEEN THE EFFECTS OF METFORMIN MONOTHERAPY IN OBESE AND NON-OBESE PATIENTS WITH POLYCYSTIC OVARY SYNDROME A.N.A. Mohamed1 , A.M. Mohi Eldin1 , E.E.M. Sallah1 , A.M. Boraay2 . 1 Minia University,Egypt, Minia, Egypt; 2 Mallawy General Hospital, Mallawy, Egypt Objectives: To compare the efficacy of metformin montherapy in improvement of the clinical and biochemical parameters, ovulation and pregnancy rates in obese and non obese patients with polycystic ovary syndrome.
Materials: One hundered infertile women were diagnosed as clomiphene citrate resistant polycystic ovary syndrome at the period starting from November 2009 to August 2010. Methods: A prospective comparative study in Minia University infertility clinic. The patients were divided into 2 groups. Group (O); included 50 patients with BMI between 30–35 kg/m2 . Group (N); included 50 patients with BMI ≤30 kg/m2 . Both groups received metformin 850 mg tablet twice daily for 12 weeks. The primary outcomes were the ovulation rate, the degree of menstrual regularity, the change of the patients’ clinical and biochemical profile after three months of metformin treatment; including the changes in LH/FSH ratio. The secondary outcome was the pregnancy rate. Results: There was a statistically significant improvement as regards pre- and post-treatment among both groups concerning regularity of the cycle (P < 0.0001), acne (P < 0.001) and LH:FSH ratio (P = 0.015) and no statistically significant improvement in hirustism. There were no statistically significant differences between the two groups concerning the ovulation and pregnancy rates after treatment. Conclusions: Metformin alone may be an effective drug for restoration of menstrual irregularities, LH: FSH ratio, treatment of acne, inducing ovulation and increase pregnancy rates in clomiphene citrate resistant polycystic ovary syndrome. Non obese patients responded better but statistically non significant than obese patients. Further randomized controlled studies on large number of patients are required to compare efficacy of metformin in obese and non obese PCOS patients. O466 COMPARATIVE STUDY OF UZARA AND IBUPROFEN IN THE TREATMENT OF EGYPTIAN STUDENTS WITH PRIMARY DYSMENORRHEA: A RANDOMIZED, CROSSOVER STUDY K.H. Abdelmaeboud1 , M.A.M.F. Kortam1 , M.S. Ali1 , M.I. Ibrahim1 , R.M.M.Z. Mohamed1 . 1 Ain Shams University, Cairo, Egypt Objectives: Dysmenorrhea is one of the most frequent gynecologic disorders with a prevalence reported to vary between 50 and 90%. Uzara [a drug extracted from the roots of the South-African Uzara plant, Xysmalobium undulatum (L.)] has a long history of traditional and commercial use. It is used as a treatment for dysentery, cramps, dysmenorrhea, and menstrual pain. However, there are no studies addressing the use of Uzara in dysmenorrhea. This study aimed to evaluate efficacy and safety of Uzara use in treatment of moderate to severe primary dysmenorrheal in comparison to ibuprofen, one of NSAIDs commonly used in this condition. Materials: A Randomized, Comparative two way Cross-over Assignment study comprising 60 virgin medical students aged 19–28 years who suffered from moderate or severe primary dysmenorrhoea. Setting is Ain Shams University Maternity Hospital, Cairo, Egypt. Using visual analogue pain scale (VAS), the pain intensity used to be felt with no medication was recorded. Methods: Patients were randomized to start with one of the two drugs: 40 mg Uzara tablets, 2 tab/8 hs then 1/8 hs or 400 ibuprofen tablets, 1/6 hs, beginning two days before the expected start of menstruation and continued for 5 days, and stopping it when there is mild or no pain 6–8 hours from the last dose. The participants reported the pain intensity used to be felt with no medication, and it was also recorded right before taking intake of the medication (0 hour) and after 4, 12, 24, 48–60, 96–120 hours, using visual analogue pain scale (VAS). Outcome measures The percentage of patients taking rescue medication, pain intensity difference between that with no medication to that at each of the six-timed points and their mean, and the adverse effects. Results: Rescue drug use with both drugs was comparable (11/60 and 6/60, p > 0.05). The average mean of pain intensity at different points was significantly lower on use of either drug compared to used pain intensity reported by the patients (VAS 1.6 vs 6.8,
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
reproductive health rights approach introduction as a basis for international training standards implementation. 7. Financial affordability of proposed training for all interested according to national (not international) standards. 8. No incentives for trainees and small participation fee introduction in order to improve participants accountability. 9. Constant monitoring and evaluation to ensure trainings quality. 10. Clear dissemination strategy. Conclusions: All mentioned statements have to be taken into account at the Proposal development stage to ensure project sustainability. O464 POSTPARTUM HAEMORRHAGE (PPH) REDUCTION FURTHER TO ALARM INTERNATIONAL PROGRAM (AIP) IMPLEMENTATION IN UKRAINE: FIGO SAVING MOTHER & NEWBORNS PROJECT I. Mogilevkina1 , V. Senikas2 , N. Shpatusko1 , O. Kulyk3 . 1 Obs, Gyn & Perinatology, Donetsk National Medical University, Donetsk, Ukraine; 2 SOGC, Ottawa, ON, Canada; 3 Vinnitsa Public Health Administration, Vinnitsa, Ukraine Objectives: To study if development of providers’ knowledge and skills in PPH prevention and management further to the AIP trainings (SOGC initiative) results in improvement of PPH related public health indicators in Ukraine. Materials: PPH is the world’s leading cause of maternal mortality and morbidity. Official statistical data were collected from facilities covering a 5 year span (2001–2005) prior and 4 years after the Project start up (2006–2009). A total of approximately 200,000 live births were analyzed. Methods: Facility-based approach with time series design was applied. Descriptive statistics have been used. The JMP (SAS Institute, Cary, NC, 1994) program package was used for dataentering and analysis. A p-value <0.05 was considered statistically significant. Results: A total of 527 providers from 25 pilot facilities attended 5-days AIP trainings during 2006–2008, corresponding to 69.23% median and 65.82% mean coverage (SD = 18.12) with a range of 28.57 to 94.74%. AIP training had significant effect on providers’ knowledge and skills in PPH prevention and management. There were no significant changes in Maternal Mortality per 100,000 life-births (16.95 (SD 50.88) versus to 16.19 (SD 48.07), p = 0.9091) as well as in Hemorrhage contribution in Maternal Death (3.31 (SD 23.67) versus to 3.41 (27.60), p = 0.9771). Further to AIP training there was a decrease in the percentage of cases where manual or instrumental uterus exploration was performed (from 8.45 (SD 8.92) to 4.00 (SD 3.28), p < 0.0001), haemo (from 3.25 (SD 4.73) to 1.07 (SD 1.18), p < 0.0001) or plasma transfusion (from 5.05 (SD 8.11) to 2.28 (SD 2.03), p = 0.0011) was done. Percentage of PPH decreased from 4.24 (SD 2.99) to 2.39 (SD 1.76), p < 0.0001. Level of provider’s skills has negatively correlated to frequency of Uterus exploration and Uterus extirpation as well as to plasma and blood transfusion administration. Conclusions: ALARM International Program has shown positive impact on PPH related Maternal Morbidity. Program scaling up should be of interest to those looking for MDG 5 achievement. O465 COMPARATIVE STUDY BETWEEN THE EFFECTS OF METFORMIN MONOTHERAPY IN OBESE AND NON-OBESE PATIENTS WITH POLYCYSTIC OVARY SYNDROME A.N.A. Mohamed1 , A.M. Mohi Eldin1 , E.E.M. Sallah1 , A.M. Boraay2 . 1 Minia University,Egypt, Minia, Egypt; 2 Mallawy General Hospital, Mallawy, Egypt Objectives: To compare the efficacy of metformin montherapy in improvement of the clinical and biochemical parameters, ovulation and pregnancy rates in obese and non obese patients with polycystic ovary syndrome.
Materials: One hundered infertile women were diagnosed as clomiphene citrate resistant polycystic ovary syndrome at the period starting from November 2009 to August 2010. Methods: A prospective comparative study in Minia University infertility clinic. The patients were divided into 2 groups. Group (O); included 50 patients with BMI between 30–35 kg/m2 . Group (N); included 50 patients with BMI ≤30 kg/m2 . Both groups received metformin 850 mg tablet twice daily for 12 weeks. The primary outcomes were the ovulation rate, the degree of menstrual regularity, the change of the patients’ clinical and biochemical profile after three months of metformin treatment; including the changes in LH/FSH ratio. The secondary outcome was the pregnancy rate. Results: There was a statistically significant improvement as regards pre- and post-treatment among both groups concerning regularity of the cycle (P < 0.0001), acne (P < 0.001) and LH:FSH ratio (P = 0.015) and no statistically significant improvement in hirustism. There were no statistically significant differences between the two groups concerning the ovulation and pregnancy rates after treatment. Conclusions: Metformin alone may be an effective drug for restoration of menstrual irregularities, LH: FSH ratio, treatment of acne, inducing ovulation and increase pregnancy rates in clomiphene citrate resistant polycystic ovary syndrome. Non obese patients responded better but statistically non significant than obese patients. Further randomized controlled studies on large number of patients are required to compare efficacy of metformin in obese and non obese PCOS patients. O466 COMPARATIVE STUDY OF UZARA AND IBUPROFEN IN THE TREATMENT OF EGYPTIAN STUDENTS WITH PRIMARY DYSMENORRHEA: A RANDOMIZED, CROSSOVER STUDY K.H. Abdelmaeboud1 , M.A.M.F. Kortam1 , M.S. Ali1 , M.I. Ibrahim1 , R.M.M.Z. Mohamed1 . 1 Ain Shams University, Cairo, Egypt Objectives: Dysmenorrhea is one of the most frequent gynecologic disorders with a prevalence reported to vary between 50 and 90%. Uzara [a drug extracted from the roots of the South-African Uzara plant, Xysmalobium undulatum (L.)] has a long history of traditional and commercial use. It is used as a treatment for dysentery, cramps, dysmenorrhea, and menstrual pain. However, there are no studies addressing the use of Uzara in dysmenorrhea. This study aimed to evaluate efficacy and safety of Uzara use in treatment of moderate to severe primary dysmenorrheal in comparison to ibuprofen, one of NSAIDs commonly used in this condition. Materials: A Randomized, Comparative two way Cross-over Assignment study comprising 60 virgin medical students aged 19–28 years who suffered from moderate or severe primary dysmenorrhoea. Setting is Ain Shams University Maternity Hospital, Cairo, Egypt. Using visual analogue pain scale (VAS), the pain intensity used to be felt with no medication was recorded. Methods: Patients were randomized to start with one of the two drugs: 40 mg Uzara tablets, 2 tab/8 hs then 1/8 hs or 400 ibuprofen tablets, 1/6 hs, beginning two days before the expected start of menstruation and continued for 5 days, and stopping it when there is mild or no pain 6–8 hours from the last dose. The participants reported the pain intensity used to be felt with no medication, and it was also recorded right before taking intake of the medication (0 hour) and after 4, 12, 24, 48–60, 96–120 hours, using visual analogue pain scale (VAS). Outcome measures The percentage of patients taking rescue medication, pain intensity difference between that with no medication to that at each of the six-timed points and their mean, and the adverse effects. Results: Rescue drug use with both drugs was comparable (11/60 and 6/60, p > 0.05). The average mean of pain intensity at different points was significantly lower on use of either drug compared to used pain intensity reported by the patients (VAS 1.6 vs 6.8,