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O490 MATERNAL NEAR MISS AND MORTALITY IN A RURAL REFERRAL HOSPITAL IN NORTHERN TANZANIA USING THE WHO NEAR MISS CRITERIA
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O487 PRE-NATAL DIAGNOSIS OF THALASSAEMIA BY AMNIOCENTESIS: KANDY THALASSAEMIA CENTRE, SRI LANKA K.K. Nanayakkara1 , G. Rodrigo2 , C.D. Nanayakkara3 . 1 Suwasevana Hospital Kandy, Kandy, Sri Lanka; 2 Teaching Hospital Kandy, Kandy, Sri Lanka; 3 University of Peradeniya„ Sri Lanka Objectives: To determine the common Sri Lankan genetic mutations for Thalassaemia in the amniotic fluid of expectant mothers with a previous Thalassaemia Major child, now pregnant for the second time. Both parents, in each instant, carried a Thalassaemia Trait condition Materials: Amniocenteses were performed between 11 to 12 weeks of gestation by the Consultant Radiologist Teaching Hospital Kandy, Sri Lanka, after proper pre-natal counseling & certification of consent forms, on 28 expectant mothers, with a previous Thalassaemia Major child. These were executed amidst sterile conditions, under constant ultrasound guidance. Methods: The amniotic fluid samples were covered with ice-packs and sent to either the Genetic laboratory Asiri Surgical Hospital, Colombo or to the Genetech Laboratory, Colombo, for genetic analysis. The procedure had to be abandoned in one patient due to a sub-chorionic bleed. Results: It was very heartening to note that the genotypes of 37% of the amniotic fluid samples showed a fetus without any common Thalassaemia mutations. The percentage of unborn babies genetically similar to their parents in carrying a Thalassaemia Trait condition was 55% and the unfortunate grouping diagnosed with a Thalassaemia major condition is restricted to 7.5%. Conclusions: The scrooge of thalassaemia, sweeping across Asia, is slowly but surely engulfing Sri Lanka, with the Health Department spending over rupees one-billion annually, which amounts to 7% of the national health budget, towards management of its thalassaemia patients. If the gravity of this situation continues to be unrecognized, Sri Lanka may already be on the way of Maldives, which spends 40% of their health budget on thalassaemia. It is strongly advised that pre-marriage counseling and genetic diagnosis become accepted & rigidly enforced procedures in this country O488 MULTIPLE SCLEROSIS IN PREGNANCY A.M. Nargund1 , D. Rich1 . 1 Obs andGyn, Nevill Hall Hospital, Newport, Wales, United Kingdom Multiple sclerosis is a neurological disorder with focal lymphocytic infiltration in the central nervous system leading to a complex process of demylination and axon degeneration. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months of postpartum. We report a case of women with multiple sclerosis, who had successful pregnancy outcome and uneventful postpartum period. She is a known case of multiple sclerosis since 5 years, who was on Alemtuzumab preconception period. At 31 weeks of gestation she had relapse of symptoms, was treated with steroid. Care of pregnant women with multiple sclerosis is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. These patients can be informed that uncomplicated MS has no apparent effect on pregnancy, labour, delivery, congenital malformations, or stillbirths. The progressive nature of disease may motivate women to start or complete their families as soon as possible.
O489 EXPERIENCE OF A UNIT FOR THE PATHOLOGY OF EARLY PREGNANCY AND ECTOPIC PREGNANCY A. Natale1 , P. Bosco1 , S. Bonato1 , G. Alabiso1 , V. Austoni1 . 1 Clinica Ostetrica e Ginecologica M.Melloni, Milano, MI, Italy Objectives: We analyzed two years activity of our Unit for the Pathology of Early Pregnancy and Ectopic Pregnancy in order to verify its usefulness for the management of patients and application of treatment protocols. With specific attention to the conservative treatment of ectopic pregnancy. Materials: The Unit is available for outpatients with pregnancy of unknown location, supected ectopic or suspected hydatiform mole as observed in emergency department or available for follow up of discharged patients. Methods: We measured the treatment success rate, the rate of conservative treatments and the data loss in patients observed in our Unit for the Pathology of Early Pregnancy and Ectopic Pregnancy in Macedonio Melloni – Milano (Italia). Results: Total accesses in the Unit in 2010–11 were 805, for a total number of 447 patients. 377 intrauterine pregnancies were diagnosed: 138 (37%) have proved to be evolutive and 249 (66%) miscarriages. 46 ectopic pregnancies were managed in the Unit (66% of 70 total ectopic pregnancies managed in our hospital). 23 ectopic pregnancies were diagnosed in the Unit, of these, 3 patients developed a tubal abortion, 4 were then admitted in hospital for a laparoscopic salpingectomy and 16 for medical treatment in day hospital regimen. 23 patients were managed in the Unit for the follow up of an ectopic pregancy previously diagnosed and treated. None of the patients treated with medical therapy or expectant management for ectopic pregnancy underwent a surgical treatment for persistent trophoblast. Two patients had undergone a D&C for an intracervical viable pregnancy, one being previously treated with a multiple dose regimen of MTX. 31 patients underwent MTX therapy (44.3% of ectopic pregnancy). Conservative treatment rate was 50%. 24 Hydatiform Mole have been managed, 6 being diagnosed in the Unit and then admitted in hospital for surgery in day hospital regimen and 18 for the only follow-up after hospital discharge. All the patients have been treated conservatively with uterine evacuation. None of the patients treated for ectopic pregnancy or hydatiform mole was lost to follow-up. Conclusions: Establishment of a Unit for outpatients with pathology of early pregnancy promotes the management of Ectopic Pregnancy and Hydatiform Mole, facilitates the application of treatment protocols and compliance of patients to treatment, limiting duration of hospitalization. It yields a good percentage of conservative treatment and success rate. O490 MATERNAL NEAR MISS AND MORTALITY IN A RURAL REFERRAL HOSPITAL IN NORTHERN TANZANIA USING THE WHO NEAR MISS CRITERIA E. Nelissen1 , H.L. Ersdal6,7 , E. Mduma2 , B. Evjen-Olsen3 , J. van Roosmalen1,5 , J. Stekelenburg4 . 1 Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; 2 Haydom Lutheran Hospital, Haydom, Tanzania, United Republic of ; 3 University of Bergen – Centre for International Health, Bergen, Norway; 4 Leeuwarden Medical Centre, Leeuwarden, Netherlands; 5 Leiden University Medical Centre, Leiden, Netherlands; 6 Stavanger University Hospital, Stavanger, Norway; 7 Stavanger Acute medicine Foundation for Education and Research (SAFER), Stavanger, Norway Objectives: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. Tanzania is no exception with a 10% decline in maternal mortality ratio (MMR) between 1990 and 2008. In order to lower MMR in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the quality of obstetric care in a rural referral hospital in Tanzania using the WHO near-miss criteria.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Materials: A cross-sectional study was conducted in Haydom Lutheran Hospital, a referral hospital in a rural part of northern Tanzania. From Nov 2009 until Nov 2011 women with severe maternal morbidity and mortality were prospectively included. The WHO near-miss criteria had to be adapted to fit the local situation. Methods: Frequencies of demographic and clinical variables were cross-tabulated for maternal outcome and compared. Of each case one underlying cause was identified that started the cascade that lead to maternal morbidity or mortality. Near miss and process indicators were calculated using the total amount of live births during the study period and the total amount of maternal near miss (MNM) and maternal death (MD) cases in that same period. Results: Life threatening conditions occurred in 260 women in the period of Nov 2009 until Nov 2011. There were 12 missing files. 216 MNM and 32 MD were used for analysis. In the same period there were 9136 live births. The major cause of morbidity is postpartum haemorrhage (PPH), accounting for 28.2% of all underlying causes, followed by abortion related complications (18.5%) and antepartum haemorrhage (11.1%). The major cause of mortality is infectious diseases not related to pregnancy (21.9%), followed by PPH (18.8%) and unknown causes (12.5%). Of all women who gave birth in the hospital only 47.8% received routine oxytocin after delivery. 58.5% received oxytocin as treatment. Fifteen women were diagnosed with eclampsia. 86.7% received magnesium sulphate and 93.3% received any anticonvulsant. Conclusions: The present study shows that maternal morbidity and mortality remains a problem in a rural referral hospital in Tanzania. There is a gap between the actual and the optimal use of evidence-based interventions. The WHO near-miss criteria cannot be implemented without adaptation to the local situation, thereby questioning the generalisability of the WHO near miss criteria. O491 SCREENING FOR AND MANAGEMENT OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA IN BANGLADESH: A CROSS SECTIONAL STUDY COMPARING TWO PROTOCOLS A. Nessa1 , S.B. Chowdhury1 , J.S. Datta2 , H. Begum3 , Z. Ara3 , M.H.U. Rashid4 . 1 Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; 2 Dhaka Medical College, Dhaka, Bangladesh; 3 UNFPABangladesh, Dhaka, Bangladesh; 4 Directorate General of Health Services, Dhaka, Bangladesh Objectives: To evaluate the feasibility of the ‘colposcopy and treat’ protocol as one step procedure for the management of high grade Cervical Intraepithelial Neoplasia (CIN) at a colposcopy clinic in Bangladesh. Materials: In this study, 358 colposcopy-diagnosed high grade CIN cases were incorporated attended the colposcopy clinic of BSMMU. Methods: A cross sectional comparative study was carried out between two periods. During the first period (January 2005 to June 2008), 181 colposcopy-diagnosed high grade CIN had cervical biopsy by punch biopsy forceps and histology confirmed high grade CIN were treated by LEEP. During the second period (July 2008 to December 2009), 177 colposcopy-diagnosed high grade CIN were treated by LEEP at their first visit. Results: During the first and second period, 48 of 87 and 55 of 73 histology proven high grade CIN cases received treatment. The compliance of treatment improved by 20% and as well as failure to receive treatment fell downed by 20% and these changes were statistically significant (P = 0.006). Conclusions: ‘Colposcopy and treat’ at the first visit is a useful option for management of high grade CIN in colposcopy clinic of Bangladesh. It reduces number of visits to the clinic and the failure to receive treatment.
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O492 EVALUATION OF BASELINE AWARENESS OF CERVICAL CANCER PREVENTION IN BANGLADESH A. Nessa1 , M.A. Hussain1 , N. Akhter1 , J. Rahman2 , M.H.U. Rashid3 , Q. Khanam4 . 1 Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; 2 Alive & Thrive Bangladesh, Dhaka, Bangladesh; 3 Directorate General of Health Services, Dhaka, Bangladesh; 4 Cervical and Breast Cancer Screening Programme, Department of Obstetrics and Gynaecology, BSMMU, Dhaka, Bangladesh Objectives: To explore the awareness level of cervical cancer prevention, availability of screening services and ways of improving awareness of cervical cancer prevention. Materials: This study was done by the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January to August 2011 at two upazillas of Bangladesh and this study was supported by a grant received from UICC under “UICC Cancer Prevention Campaign”. Methods: A cross sectional study was conducted and data were collected by Focus Group Discussions (FGDs) from women, husbands and community people. Results: About half of the women participated in FGDs had formal education and majority were housewives. Most were aware of the word ‘cancer’. About half of the women and many husbands and community people in both upazilas knew about cervical cancer. In both the upazila, about one tenth of women knew about early detection and treatment of cervical cancer. In Singair about one tenth of women, half of the community people and in Sonargaon only one women two community people knew about VIA. However husbands of the study areras were almost unaware of pre-cancer of cervix. Majority supported the idea of availing ‘test for cervical cancer’ for all women above 30 years and informed about no resistance from the family in this regard. Uthan Baithok/ EPI meeting, drama serials in television, advertisement through local cable line of TV, miking, Radio, distribution of leaflets, placement of billboard at important places, information through School/College/ Mosques/ Madrasha/Temple, Citizen’s charter in front of the UHC, orientation programme on VIA for field level health related service providers were mentioned by women, husbands and community people for improving awareness among population. Conclusions: Awareness about pre-cancer of cervix is very low among the population and it is even lower where facilities of screening are unavailable. Awareness about pre-cancer among community people was better and husbands were almost unaware of pre-cancer of cervix. Different methods of awareness creation at national and local level should be adopted to improve uptake of screening by the population. O493 CLINICAL STUDY ON FERTILITY IN WOMEN RECEIVED RENAL TRANSPLANTATION N. Neyatani1 , N. Yamaguchi1 , H. Takagi1 , R. Fujii1 , S. Makinoda1 . 1 OB/GYN, Kanazawa Medical University, Uchinada, Ishikawa, Japan Objectives: Renal transplantation has been established as a curative treatment for renal failure. As this procedure is performed as a regular treatment since more than 35 years ago, the number of women who become pregnant and deliver babies following renal transplantation is increasing. The aims of this study is to investigate the prognosis of pregnancy between the women received renal transplantation and normal women and to clarify fertility in women following this procedure. Materials: At Kanazawa Medical University, 105 female patients have undergone renal transplantation during the period between March 1975 and December 2011. Twenty – two women among these patients experienced a total of 34 pregnancies. Methods: We have examined the rates of induced and spontaneous abortion, premature delivery and normal delivery in these
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O487 PRE-NATAL DIAGNOSIS OF THALASSAEMIA BY AMNIOCENTESIS: KANDY THALASSAEMIA CENTRE, SRI LANKA K.K. Nanayakkara1 , G. Rodrigo2 , C.D. Nanayakkara3 . 1 Suwasevana Hospital Kandy, Kandy, Sri Lanka; 2 Teaching Hospital Kandy, Kandy, Sri Lanka; 3 University of Peradeniya„ Sri Lanka Objectives: To determine the common Sri Lankan genetic mutations for Thalassaemia in the amniotic fluid of expectant mothers with a previous Thalassaemia Major child, now pregnant for the second time. Both parents, in each instant, carried a Thalassaemia Trait condition Materials: Amniocenteses were performed between 11 to 12 weeks of gestation by the Consultant Radiologist Teaching Hospital Kandy, Sri Lanka, after proper pre-natal counseling & certification of consent forms, on 28 expectant mothers, with a previous Thalassaemia Major child. These were executed amidst sterile conditions, under constant ultrasound guidance. Methods: The amniotic fluid samples were covered with ice-packs and sent to either the Genetic laboratory Asiri Surgical Hospital, Colombo or to the Genetech Laboratory, Colombo, for genetic analysis. The procedure had to be abandoned in one patient due to a sub-chorionic bleed. Results: It was very heartening to note that the genotypes of 37% of the amniotic fluid samples showed a fetus without any common Thalassaemia mutations. The percentage of unborn babies genetically similar to their parents in carrying a Thalassaemia Trait condition was 55% and the unfortunate grouping diagnosed with a Thalassaemia major condition is restricted to 7.5%. Conclusions: The scrooge of thalassaemia, sweeping across Asia, is slowly but surely engulfing Sri Lanka, with the Health Department spending over rupees one-billion annually, which amounts to 7% of the national health budget, towards management of its thalassaemia patients. If the gravity of this situation continues to be unrecognized, Sri Lanka may already be on the way of Maldives, which spends 40% of their health budget on thalassaemia. It is strongly advised that pre-marriage counseling and genetic diagnosis become accepted & rigidly enforced procedures in this country O488 MULTIPLE SCLEROSIS IN PREGNANCY A.M. Nargund1 , D. Rich1 . 1 Obs andGyn, Nevill Hall Hospital, Newport, Wales, United Kingdom Multiple sclerosis is a neurological disorder with focal lymphocytic infiltration in the central nervous system leading to a complex process of demylination and axon degeneration. Pregnancy is associated with clinical MS stability or improvement, while the rate of relapse rises significantly during the first three months of postpartum. We report a case of women with multiple sclerosis, who had successful pregnancy outcome and uneventful postpartum period. She is a known case of multiple sclerosis since 5 years, who was on Alemtuzumab preconception period. At 31 weeks of gestation she had relapse of symptoms, was treated with steroid. Care of pregnant women with multiple sclerosis is challenging because of the multiple physiological changes associated with pregnancy and the need to consider the impact of any intervention on the foetus. These patients can be informed that uncomplicated MS has no apparent effect on pregnancy, labour, delivery, congenital malformations, or stillbirths. The progressive nature of disease may motivate women to start or complete their families as soon as possible.
O489 EXPERIENCE OF A UNIT FOR THE PATHOLOGY OF EARLY PREGNANCY AND ECTOPIC PREGNANCY A. Natale1 , P. Bosco1 , S. Bonato1 , G. Alabiso1 , V. Austoni1 . 1 Clinica Ostetrica e Ginecologica M.Melloni, Milano, MI, Italy Objectives: We analyzed two years activity of our Unit for the Pathology of Early Pregnancy and Ectopic Pregnancy in order to verify its usefulness for the management of patients and application of treatment protocols. With specific attention to the conservative treatment of ectopic pregnancy. Materials: The Unit is available for outpatients with pregnancy of unknown location, supected ectopic or suspected hydatiform mole as observed in emergency department or available for follow up of discharged patients. Methods: We measured the treatment success rate, the rate of conservative treatments and the data loss in patients observed in our Unit for the Pathology of Early Pregnancy and Ectopic Pregnancy in Macedonio Melloni – Milano (Italia). Results: Total accesses in the Unit in 2010–11 were 805, for a total number of 447 patients. 377 intrauterine pregnancies were diagnosed: 138 (37%) have proved to be evolutive and 249 (66%) miscarriages. 46 ectopic pregnancies were managed in the Unit (66% of 70 total ectopic pregnancies managed in our hospital). 23 ectopic pregnancies were diagnosed in the Unit, of these, 3 patients developed a tubal abortion, 4 were then admitted in hospital for a laparoscopic salpingectomy and 16 for medical treatment in day hospital regimen. 23 patients were managed in the Unit for the follow up of an ectopic pregancy previously diagnosed and treated. None of the patients treated with medical therapy or expectant management for ectopic pregnancy underwent a surgical treatment for persistent trophoblast. Two patients had undergone a D&C for an intracervical viable pregnancy, one being previously treated with a multiple dose regimen of MTX. 31 patients underwent MTX therapy (44.3% of ectopic pregnancy). Conservative treatment rate was 50%. 24 Hydatiform Mole have been managed, 6 being diagnosed in the Unit and then admitted in hospital for surgery in day hospital regimen and 18 for the only follow-up after hospital discharge. All the patients have been treated conservatively with uterine evacuation. None of the patients treated for ectopic pregnancy or hydatiform mole was lost to follow-up. Conclusions: Establishment of a Unit for outpatients with pathology of early pregnancy promotes the management of Ectopic Pregnancy and Hydatiform Mole, facilitates the application of treatment protocols and compliance of patients to treatment, limiting duration of hospitalization. It yields a good percentage of conservative treatment and success rate. O490 MATERNAL NEAR MISS AND MORTALITY IN A RURAL REFERRAL HOSPITAL IN NORTHERN TANZANIA USING THE WHO NEAR MISS CRITERIA E. Nelissen1 , H.L. Ersdal6,7 , E. Mduma2 , B. Evjen-Olsen3 , J. van Roosmalen1,5 , J. Stekelenburg4 . 1 Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; 2 Haydom Lutheran Hospital, Haydom, Tanzania, United Republic of ; 3 University of Bergen – Centre for International Health, Bergen, Norway; 4 Leeuwarden Medical Centre, Leeuwarden, Netherlands; 5 Leiden University Medical Centre, Leiden, Netherlands; 6 Stavanger University Hospital, Stavanger, Norway; 7 Stavanger Acute medicine Foundation for Education and Research (SAFER), Stavanger, Norway Objectives: Maternal morbidity and mortality in sub-Saharan Africa remains high despite global efforts to reduce it. Tanzania is no exception with a 10% decline in maternal mortality ratio (MMR) between 1990 and 2008. In order to lower MMR in the immediate term, reduction of delay in the provision of quality obstetric care is of prime importance. The aim of this study is to assess the quality of obstetric care in a rural referral hospital in Tanzania using the WHO near-miss criteria.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Materials: A cross-sectional study was conducted in Haydom Lutheran Hospital, a referral hospital in a rural part of northern Tanzania. From Nov 2009 until Nov 2011 women with severe maternal morbidity and mortality were prospectively included. The WHO near-miss criteria had to be adapted to fit the local situation. Methods: Frequencies of demographic and clinical variables were cross-tabulated for maternal outcome and compared. Of each case one underlying cause was identified that started the cascade that lead to maternal morbidity or mortality. Near miss and process indicators were calculated using the total amount of live births during the study period and the total amount of maternal near miss (MNM) and maternal death (MD) cases in that same period. Results: Life threatening conditions occurred in 260 women in the period of Nov 2009 until Nov 2011. There were 12 missing files. 216 MNM and 32 MD were used for analysis. In the same period there were 9136 live births. The major cause of morbidity is postpartum haemorrhage (PPH), accounting for 28.2% of all underlying causes, followed by abortion related complications (18.5%) and antepartum haemorrhage (11.1%). The major cause of mortality is infectious diseases not related to pregnancy (21.9%), followed by PPH (18.8%) and unknown causes (12.5%). Of all women who gave birth in the hospital only 47.8% received routine oxytocin after delivery. 58.5% received oxytocin as treatment. Fifteen women were diagnosed with eclampsia. 86.7% received magnesium sulphate and 93.3% received any anticonvulsant. Conclusions: The present study shows that maternal morbidity and mortality remains a problem in a rural referral hospital in Tanzania. There is a gap between the actual and the optimal use of evidence-based interventions. The WHO near-miss criteria cannot be implemented without adaptation to the local situation, thereby questioning the generalisability of the WHO near miss criteria. O491 SCREENING FOR AND MANAGEMENT OF HIGH GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA IN BANGLADESH: A CROSS SECTIONAL STUDY COMPARING TWO PROTOCOLS A. Nessa1 , S.B. Chowdhury1 , J.S. Datta2 , H. Begum3 , Z. Ara3 , M.H.U. Rashid4 . 1 Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; 2 Dhaka Medical College, Dhaka, Bangladesh; 3 UNFPABangladesh, Dhaka, Bangladesh; 4 Directorate General of Health Services, Dhaka, Bangladesh Objectives: To evaluate the feasibility of the ‘colposcopy and treat’ protocol as one step procedure for the management of high grade Cervical Intraepithelial Neoplasia (CIN) at a colposcopy clinic in Bangladesh. Materials: In this study, 358 colposcopy-diagnosed high grade CIN cases were incorporated attended the colposcopy clinic of BSMMU. Methods: A cross sectional comparative study was carried out between two periods. During the first period (January 2005 to June 2008), 181 colposcopy-diagnosed high grade CIN had cervical biopsy by punch biopsy forceps and histology confirmed high grade CIN were treated by LEEP. During the second period (July 2008 to December 2009), 177 colposcopy-diagnosed high grade CIN were treated by LEEP at their first visit. Results: During the first and second period, 48 of 87 and 55 of 73 histology proven high grade CIN cases received treatment. The compliance of treatment improved by 20% and as well as failure to receive treatment fell downed by 20% and these changes were statistically significant (P = 0.006). Conclusions: ‘Colposcopy and treat’ at the first visit is a useful option for management of high grade CIN in colposcopy clinic of Bangladesh. It reduces number of visits to the clinic and the failure to receive treatment.
S435
O492 EVALUATION OF BASELINE AWARENESS OF CERVICAL CANCER PREVENTION IN BANGLADESH A. Nessa1 , M.A. Hussain1 , N. Akhter1 , J. Rahman2 , M.H.U. Rashid3 , Q. Khanam4 . 1 Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; 2 Alive & Thrive Bangladesh, Dhaka, Bangladesh; 3 Directorate General of Health Services, Dhaka, Bangladesh; 4 Cervical and Breast Cancer Screening Programme, Department of Obstetrics and Gynaecology, BSMMU, Dhaka, Bangladesh Objectives: To explore the awareness level of cervical cancer prevention, availability of screening services and ways of improving awareness of cervical cancer prevention. Materials: This study was done by the Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU) from January to August 2011 at two upazillas of Bangladesh and this study was supported by a grant received from UICC under “UICC Cancer Prevention Campaign”. Methods: A cross sectional study was conducted and data were collected by Focus Group Discussions (FGDs) from women, husbands and community people. Results: About half of the women participated in FGDs had formal education and majority were housewives. Most were aware of the word ‘cancer’. About half of the women and many husbands and community people in both upazilas knew about cervical cancer. In both the upazila, about one tenth of women knew about early detection and treatment of cervical cancer. In Singair about one tenth of women, half of the community people and in Sonargaon only one women two community people knew about VIA. However husbands of the study areras were almost unaware of pre-cancer of cervix. Majority supported the idea of availing ‘test for cervical cancer’ for all women above 30 years and informed about no resistance from the family in this regard. Uthan Baithok/ EPI meeting, drama serials in television, advertisement through local cable line of TV, miking, Radio, distribution of leaflets, placement of billboard at important places, information through School/College/ Mosques/ Madrasha/Temple, Citizen’s charter in front of the UHC, orientation programme on VIA for field level health related service providers were mentioned by women, husbands and community people for improving awareness among population. Conclusions: Awareness about pre-cancer of cervix is very low among the population and it is even lower where facilities of screening are unavailable. Awareness about pre-cancer among community people was better and husbands were almost unaware of pre-cancer of cervix. Different methods of awareness creation at national and local level should be adopted to improve uptake of screening by the population. O493 CLINICAL STUDY ON FERTILITY IN WOMEN RECEIVED RENAL TRANSPLANTATION N. Neyatani1 , N. Yamaguchi1 , H. Takagi1 , R. Fujii1 , S. Makinoda1 . 1 OB/GYN, Kanazawa Medical University, Uchinada, Ishikawa, Japan Objectives: Renal transplantation has been established as a curative treatment for renal failure. As this procedure is performed as a regular treatment since more than 35 years ago, the number of women who become pregnant and deliver babies following renal transplantation is increasing. The aims of this study is to investigate the prognosis of pregnancy between the women received renal transplantation and normal women and to clarify fertility in women following this procedure. Materials: At Kanazawa Medical University, 105 female patients have undergone renal transplantation during the period between March 1975 and December 2011. Twenty – two women among these patients experienced a total of 34 pregnancies. Methods: We have examined the rates of induced and spontaneous abortion, premature delivery and normal delivery in these