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O484 CAN WE REDUCE OUT OF WEDLOCK PREGNANCIES IN MALAYSIA?
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
the training, future evaluation will elucidate the effect of this type of training on maternal and neonatal outcomes. O484 CAN WE REDUCE OUT OF WEDLOCK PREGNANCIES IN MALAYSIA? M. Najimudeen1 . 1 Obstetrics and Gynaecology, Melaka Manipal medical college, Malaysia, Melaka, Melaka, Malaysia Objectives: 52,982 babies were born out of wedlock and accounts to 10.37% of total births. This is unacceptably high and the objective of this study is to analyse the reasons for these unwanted pregnancies and develop a remedy to reduce it. Materials: This is a study of the statistics of national registration department (NRD), ministry of health, social welfare department, police reports and global sex survey. Methods: This is a traditional retrospective study. Results: 234,674 babies were born out of wedlock between 2006 to 2010. There were 257,411 new-borns without fathers, i.e. the birth certificates did not have their fathers’ names, between 2000 and 2008. Girls aged 16 years or below accounted for 12.2% of the cases in 2007 The plight of the babies of out of marriage is pathetic. Illegitimate Muslim children would face complications under sharia. 472 new-born babies have been abandoned within last 5 years. 315 discarded babies were recovered between the years of 2001 to 2005. At an average of 100 babies been thrown out annually. The contraceptive prevalence in Malaysia is very low and less than 30%. The unmet contraceptive demand is very high. Postcoital emergency contraception is not very familiar and not freely available in Malaysia. Termination of unwanted pregnancy is allowed under special circumstances.. Unfortunately 41% reproductive health clients does not know the legal condition and in a survey of 120 doctors and nurses 43% does not know the correct legal status. Conclusions: Sexual promiscuity had increased all over the world and Malaysia is not an exception. The sex education among teenagers is a must and awareness of contraceptive practice is important. Community development centres, Women health organisations, Religious institutions, parents and teachers should play an important role in fertility education. Family planning associations and other related organisations should play an active role in family planning activities. Emergency contraceptive methods should be freely available in the government hospitals and pharmacies. Termination of unwanted pregnancy at a very early stage must be made available at low cost. O485 SRI LANKA IS AN EXAMPLE TO REDUCE MATERNAL MORTALITY WITH MINIMAL COST M. Najimudeen1 . 1 Obstetrics and Gynaecology, Melaka Manipal medical college, Malaysia, Melaka, Melaka, Malaysia Objectives: Sri Lanka is not an affluent country. There were 265 maternal deaths for every 10,000 deliveries in the year 1935 but within 65 years the maternal deaths were reduced to only 1 in 10,000 deliveries. The objective is to determine how Sri Lanka achieved this substantial reduction with minimal health expenditure. Materials: The reports of World Health Statistics, UNICEF, UNDP, Central Bank, official website of the Ministry of Health Sri Lanka and other related institutions. Methods: This is a traditional retrospective study from 1935 to 2009. Results: The per capita government expenditure on health is only USD 32 per year. This is only 1% of the developed countries. The maternal mortality ratio was the lowest in this part of the world and six times lower than neighbours The health care is absolutely free in Sri Lanka. The care during pregnancy, labour, postpartum period and supply of iron and vitamin supplements are totally free.
S433
This done through state hospitals covering all over the island. In the year 2008 there were 352,443 (97.84%) hospital deliveries and only 6,855(2.16%) home deliveries.90% had occurred in hospitals where consultants and theatre facilities were available. The modern contraceptive methods were provided free of charge and made available even in remote rural areas. The contraceptive prevalence is about 70% The family health workers (FHW) are medical personnel adequately trained and registered by the medical council. There 4784 FHW in the year 2009. One FHW is in charge of 4000 houses. They visit house by house. In a survey in the year 2007, about 93% of the FHW were resident in their station and around 95% the pregnant mothers were seen by the FHW more than 5 times during pregnancy period. Non health factors are also an important contributory factor. Free education made the female literacy rate 95% and Sri Lanka has the highest gender-related development index in South Asian countries. The high literacy rate had increased the age at marriage of girls to 25.5years. Conclusions: Free health care, 97% of mothers delivering at hospitals, infrastructure facilities to provide health services at the grass root level, health services by FHW in remote rural areas, and liberal use of contraceptives and high female literacy rate are the key areas that had contributed to minimize maternal deaths in Sri Lanka. O486 PERINATAL OUTCOME OF 132 PREGNANCIES COMPLICATED BY IMMUNE THROMBOCYTOPENIA B. Namavar Jahromi1 , Z. Shiravani1 , L. Salarian1 . 1 Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of Objectives: To describe perinatal outcome and medications used for pregnancies complicated by immune thrombocytopenia (ITP) and compare the outcome between the cases diagnosed before and during pregnancy. Materials: Medical records of 132 pregnancies belonged to 125 parturients with ITP who delivered between March 2001 and January 2011 were reviewed. Cases were included if diagnosed before pregnancy or if their platelet counts (PCs) were less than 80,000/mL during pregnancy without any other cause. Some maternal and fetal outcomes were described and compared. Methods: This study was performed retrospectively in Hafez and Hazrate Zeinab Hospitals affiliated to Shiraz University of Medical Sciences. Thrombocytopenia is defined as platelet count (PC) of less than 150,000/mL. Patients were included if they were known cases of chronic ITP prior to pregnancy or were diagnosed during pregnancy with PCs of less than 80,000/mL for which other causes were excluded Statistical analyses were performed by SPSS software (Version 16, Chicago, IL, USA) using Chi-Square and t test. Statistical significance was set at p < 0.05. Results: 56 mothers (42.1%) had PC < 50,000. 18 women (13.5%) developed preeclampsia and 15(11.3%) were diabetics. Corticosteroid was used for120 cases (90.9%) and intravenous immunoglobulin for 14 women (10.5%). PCs of 114 neonates were available in the charts and 84 (83.2%) had PC>150,000/mL. Three neonates (2.3%) had PC < 50,000. 31 neonates (23.3%) had preterm births and 32 (24.1%) needed NICU admissions. 57 cases of ITP (43.2%) were diagnosed before pregnancy and 75 (56.8%) were diagnosed during pregnancy. There were 2 intrauterine fetal deaths and higher NICU admissions 20 (34.48%) versus 12(16%) in the first group (p value = 0.01). Conclusions: Perinatal outcome of pregnancies with ITP is generally good. However neonates born from parturients with chronic ITP needed more NICU admissions.
the training, future evaluation will elucidate the effect of this type of training on maternal and neonatal outcomes. O484 CAN WE REDUCE OUT OF WEDLOCK PREGNANCIES IN MALAYSIA? M. Najimudeen1 . 1 Obstetrics and Gynaecology, Melaka Manipal medical college, Malaysia, Melaka, Melaka, Malaysia Objectives: 52,982 babies were born out of wedlock and accounts to 10.37% of total births. This is unacceptably high and the objective of this study is to analyse the reasons for these unwanted pregnancies and develop a remedy to reduce it. Materials: This is a study of the statistics of national registration department (NRD), ministry of health, social welfare department, police reports and global sex survey. Methods: This is a traditional retrospective study. Results: 234,674 babies were born out of wedlock between 2006 to 2010. There were 257,411 new-borns without fathers, i.e. the birth certificates did not have their fathers’ names, between 2000 and 2008. Girls aged 16 years or below accounted for 12.2% of the cases in 2007 The plight of the babies of out of marriage is pathetic. Illegitimate Muslim children would face complications under sharia. 472 new-born babies have been abandoned within last 5 years. 315 discarded babies were recovered between the years of 2001 to 2005. At an average of 100 babies been thrown out annually. The contraceptive prevalence in Malaysia is very low and less than 30%. The unmet contraceptive demand is very high. Postcoital emergency contraception is not very familiar and not freely available in Malaysia. Termination of unwanted pregnancy is allowed under special circumstances.. Unfortunately 41% reproductive health clients does not know the legal condition and in a survey of 120 doctors and nurses 43% does not know the correct legal status. Conclusions: Sexual promiscuity had increased all over the world and Malaysia is not an exception. The sex education among teenagers is a must and awareness of contraceptive practice is important. Community development centres, Women health organisations, Religious institutions, parents and teachers should play an important role in fertility education. Family planning associations and other related organisations should play an active role in family planning activities. Emergency contraceptive methods should be freely available in the government hospitals and pharmacies. Termination of unwanted pregnancy at a very early stage must be made available at low cost. O485 SRI LANKA IS AN EXAMPLE TO REDUCE MATERNAL MORTALITY WITH MINIMAL COST M. Najimudeen1 . 1 Obstetrics and Gynaecology, Melaka Manipal medical college, Malaysia, Melaka, Melaka, Malaysia Objectives: Sri Lanka is not an affluent country. There were 265 maternal deaths for every 10,000 deliveries in the year 1935 but within 65 years the maternal deaths were reduced to only 1 in 10,000 deliveries. The objective is to determine how Sri Lanka achieved this substantial reduction with minimal health expenditure. Materials: The reports of World Health Statistics, UNICEF, UNDP, Central Bank, official website of the Ministry of Health Sri Lanka and other related institutions. Methods: This is a traditional retrospective study from 1935 to 2009. Results: The per capita government expenditure on health is only USD 32 per year. This is only 1% of the developed countries. The maternal mortality ratio was the lowest in this part of the world and six times lower than neighbours The health care is absolutely free in Sri Lanka. The care during pregnancy, labour, postpartum period and supply of iron and vitamin supplements are totally free.
S433
This done through state hospitals covering all over the island. In the year 2008 there were 352,443 (97.84%) hospital deliveries and only 6,855(2.16%) home deliveries.90% had occurred in hospitals where consultants and theatre facilities were available. The modern contraceptive methods were provided free of charge and made available even in remote rural areas. The contraceptive prevalence is about 70% The family health workers (FHW) are medical personnel adequately trained and registered by the medical council. There 4784 FHW in the year 2009. One FHW is in charge of 4000 houses. They visit house by house. In a survey in the year 2007, about 93% of the FHW were resident in their station and around 95% the pregnant mothers were seen by the FHW more than 5 times during pregnancy period. Non health factors are also an important contributory factor. Free education made the female literacy rate 95% and Sri Lanka has the highest gender-related development index in South Asian countries. The high literacy rate had increased the age at marriage of girls to 25.5years. Conclusions: Free health care, 97% of mothers delivering at hospitals, infrastructure facilities to provide health services at the grass root level, health services by FHW in remote rural areas, and liberal use of contraceptives and high female literacy rate are the key areas that had contributed to minimize maternal deaths in Sri Lanka. O486 PERINATAL OUTCOME OF 132 PREGNANCIES COMPLICATED BY IMMUNE THROMBOCYTOPENIA B. Namavar Jahromi1 , Z. Shiravani1 , L. Salarian1 . 1 Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of Objectives: To describe perinatal outcome and medications used for pregnancies complicated by immune thrombocytopenia (ITP) and compare the outcome between the cases diagnosed before and during pregnancy. Materials: Medical records of 132 pregnancies belonged to 125 parturients with ITP who delivered between March 2001 and January 2011 were reviewed. Cases were included if diagnosed before pregnancy or if their platelet counts (PCs) were less than 80,000/mL during pregnancy without any other cause. Some maternal and fetal outcomes were described and compared. Methods: This study was performed retrospectively in Hafez and Hazrate Zeinab Hospitals affiliated to Shiraz University of Medical Sciences. Thrombocytopenia is defined as platelet count (PC) of less than 150,000/mL. Patients were included if they were known cases of chronic ITP prior to pregnancy or were diagnosed during pregnancy with PCs of less than 80,000/mL for which other causes were excluded Statistical analyses were performed by SPSS software (Version 16, Chicago, IL, USA) using Chi-Square and t test. Statistical significance was set at p < 0.05. Results: 56 mothers (42.1%) had PC < 50,000. 18 women (13.5%) developed preeclampsia and 15(11.3%) were diabetics. Corticosteroid was used for120 cases (90.9%) and intravenous immunoglobulin for 14 women (10.5%). PCs of 114 neonates were available in the charts and 84 (83.2%) had PC>150,000/mL. Three neonates (2.3%) had PC < 50,000. 31 neonates (23.3%) had preterm births and 32 (24.1%) needed NICU admissions. 57 cases of ITP (43.2%) were diagnosed before pregnancy and 75 (56.8%) were diagnosed during pregnancy. There were 2 intrauterine fetal deaths and higher NICU admissions 20 (34.48%) versus 12(16%) in the first group (p value = 0.01). Conclusions: Perinatal outcome of pregnancies with ITP is generally good. However neonates born from parturients with chronic ITP needed more NICU admissions.