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O511 MOESIN OVEREXPRESSION IS ASSOCIATED WITH INVASIVE GROWTH OF ADENOMYOSIS
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O508 THE BURDEN OF DIRECT OBSTETRIC COMPLICATIONS IN NIGERIA S. Ochejele1 , P.E. Ogwuche1 , P. Odusolu2 , A.E. Okwori1 , D. Ifenne3 , I.O. Ujah4 . 1 Obstetrics and Gynaecology, Federal Medical Centre Makurdi, Makurdi, Benue, Nigeria; 2 University of Calabar teaching Hospital, Calabar, Cross River, Nigeria; 3 Benue State University, Makurdi, Benue, Nigeria; 4 Nigeria Institute of Medical research, Lagos, Lagos, Nigeria Objectives: To determine the incidence, and mortality from direct obstetric complications. Materials: Emergency Obstetric Care Register. Methods: An eleven months prospective study of patients managed in four health facilities in Makurdi, Nigeria. Results: During the study period, there were 2,687 deliveries, 267 (10%) direct obstetric complications and 26 (1%) maternal deaths. Five direct obstetric complications account for 24 (92%) of these deaths [Severe pre-eclampsia/Eclampsia (33%), Puerperal sepsis (25%), Post Partum Haemorrhage (17%), Obstructed labour (13%) and ruptured uterus (13%)]. The incidence varied from 0.3% for Abruptio placentae to 4.4% for incomplete abortion. Placenta praevia, ruptured ectopic pregnancy and incomplete abortion accounted for 59% of the complications but were not associated with maternal deaths. Puerperal sepsis had the highest case fatality rate of 56%. Conclusions: Direct obstetric complications have a low incidence, but they are the commonest causes of Maternal mortality. There is a need to re-organize service provision to give more priority attention to the management of these complications. O509 OUTCOME OF AN INTERVENTION TO IMPROVE CASE MANAGEMENT OF ECLAMPSIA IN NIGERIA’S TEACHING HOSPITALS R.N. Ogu1 , F. Okonofua2 , J.T. Akuse3 , I.O. Ujah4 , A.O. Fabamwo5 , H. Galadanci6 , E. Archibong7 , C. Chama8 , H.E. Onah9 . 1 Obstetrics & Gynaecology, University of Port Harcourt, Port Harcourt, Nigeria; 2 University of Benin, Benin City, Nigeria; 3 Sefa Specialist Hospital, Kaduna, Nigeria; 4 University of Jos, Jos, Nigeria; 5 Lagos State University Teaching Hospital, Ikeja, Nigeria; 6 Aminu Kano University Teaching Hospital, Kano, Nigeria; 7 University of Calabar, Calabar, Nigeria; 8 University of Maiduguri Teaching Hospital, Maiduguri, Nigeria; 9 University of Nigeria Teaching Hospital, Enugu, Nigeria Objectives: To investigate the effectiveness of an intervention aimed at improving the case management of eclampsia in Nigeria. Materials: Design & Setting: A multi-centre intervention conducted in six teaching hospitals in Nigeria. Methods: Doctors and midwives in the selected hospitals were retrained in the contemporary management of eclampsia especially the use of magnesium sulphate according to the Pritchard protocol. Clinical records of eclampsia cases before and one year after the intervention were collated. Results: A total of 219 cases of eclampsia were managed over a 12-month period. There were a total of seven maternal deaths. The post intervention mean case-fatality rate of 2.7% was significantly less than the rate of 15.1% before the intervention (P < 0.001). Case fatality declined in five of the six participating hospitals. Overall maternal mortality ratio in the hospitals declined from 1199.2 to 954 per 100,000 deliveries, while perinatal mortality declined from 141.5 to 129.8 per 1000 births. Conclusions: An intervention to build the capacity of care-providers to use evidence-based protocol for the treatment of eclampsia in Nigeria was successful in reducing associated case fatality rate. The increased and widespread use of such an intervention in maternity units will contribute to the reduction of maternal mortality in Nigeria
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O510 ASSESSMENT OF SUBLINGUAL MISOPROSTOL AS FIRST LINE TREATMENT FOR PRIMARY POSTPARTUM HEMORRHAGE: RESULTS OF A MULTICENTER TRIAL R.N. Ogu1 , F. Okonofua2 , J.T. Akuse3 , I.O. Ujah4 , H. Galadanci5 , A.O. Fabamwo6 . 1 Obstetrics & Gynaecology, University of Port Harcourt, Port Harcourt, Nigeria; 2 University of Benin, Benin City, Nigeria; 3 Sefa Specialist Hospital, Kaduna, Nigeria; 4 University of Jos, Jos, Nigeria; 5 Aminu Kano University Teaching Hospital, Kano, Nigeria; 6 Lagos State University Teaching Hospital, Ikeja, Nigeria Objectives: To investigate the effectiveness of sublingual misoprostol when used as first line drug for the treatment of primary post-partum hemorrhage (PPH). Materials: The study was conducted in six teaching hospitals representing the six geo-political zones of Nigeria. Methods: Intervention trial; Maternity care providers were retrained to more effectively use the active management of the third stage of labor (AMTSL), and to administer 1000 microgram sublingual misoprostol to women experiencing PPH at the time of delivery. Outcome variables were: estimated blood loss (EBL) and the need for additional treatment with other uterotonic drugs. Results: One hundred and thirty one women with PPH were treated with oral misoprostol as first line drug over six months. EBL ranged from 500 to 2,500mls. Twenty women (15.3%) required additional uterotonic drugs to control continuing blood loss. There were three maternal deaths in one hospital, mainly due to women presenting late in hospital, while 7 perinatal deaths were recorded overall. Conclusions: We conclude that sublingual misoprostol alone is not sufficient to effectively treat all forms of PPH in health care settings. An additional back-up uterotonic and other ancillary treatment will be required. O511 MOESIN OVEREXPRESSION IS ASSOCIATED WITH INVASIVE GROWTH OF ADENOMYOSIS R. Ohara1 , A. Shiba1 , K. Satomi1 , S. Sakashita1 , J. Kano1 , M. Nishida3 , H. Yoshikawa2 , M. Noguchi1 . 1 Diagnostic pathology of Tsukuba university, Tsukuba-shi, Ibaraki-ken, Japan; 2 Obsterics and Gynecology of Tsukuba university, Tsukuba-shi, Ibaraki-ken, Japan; 3 kasmigaura Medical Hospital, Tsuchiura-shi, Ibaraki-ken, Japan Objectives: Although adenomyosis is a benign gynecological disease, both endometrial gland cells and stromal cells show invasive growth into the muscle layer, resembling the behavior of a malignant tumor. The aim of this study was to demonstrate the molecular mechanisms responsible for the invasive character of adenomyosis as a pure model of malignant tumor invasion. Materials: 1. Two cases of adenomyosis surgically resected and fixed in formalin for proteomics 2. 14 fresh surgical specimens for RT-PCR 3. 19 cases of formalin fixed specimens for immunohistochemistry 4. OMC-9 cells for invasion assay. Methods: 1. We selected two cases of adenomyosis that had been surgically resected and fixed in formalin, and the protein contents of both the invasive adenomyosis and peripheral normal endometrium were extracted by tissue microdissection (AS LMD Living Cell; Leica CTR6000® ). The extracted proteins were examined using an LC-MS/MS system (ZAPLOUS LC/MS Systems, AMR) and the expression profiles of each region were compared. 2. The expression of Moesin in adenomyosis was examined by RT-PCR using 14 fresh surgical specimens. 3. Nineteen formalin-fixed specimens of adenomyosis were then examined for Moesin protein expression using immunohistochemistry 4. We then performed an invasion assay using the endometrial stromal sarcoma cell line OMC-9, which expresses a high level of Moesin and shows invasive growth. Results: 1. A total of 260 proteins were detected, and 76 of them showed higher expression in adenomyosis than in normal tissue. Among the genes encoding the 76 proteins, we selected three (Lumican, Triosephosphateisomerase and Moesin) that have already
S442
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
been reported to be associated with invasive growth in malignant tumors. 2. Moesin was found to be expressed in 64% of cases of adenomysis but in only 34% of specimens of normal endometrium (p < 0.03). 3. Moesin was found to be expressed more strongly in stromal cells of adenomysis than in endometrial gland cells. 4. The invasive nature of OMC-9 was examined before and after transfection with Moesin siRNA, and was found to be significantly suppressed by the siRNA treatment (p < 0.01). Conclusions: The present findings demonstrate that Moesin is characteristically overexpressed in stromal cells of adenomyosis and functionally associated with its invasive growth. Management of Moesin expression may provide a new therapeutic approach for suppressing the progression of adenomyosis. O512 PREVALENCE AND THE ASSOCIATED TRIGGER FACTORS OF URINARY INCONTINENCE AMONG 5,000 BLACK WOMEN POPULATION IN SUB-SAHARAN AFRICA: FINDINGS FROM A COMMUNITY SURVEY O.A. Ojengbede1 , I.O. Morhason-Bello1 , B.O. Adedokun2 , N.S. Okonkwo1 , C. Kolade1 . 1 Obstetrics and Gynaecology, University of Ibadan/University College Hospital, Ibadan, Nigeria; 2 University of Ibadan, Ibadan, Oyo, Nigeria Objectives: To determine the prevalence and describe possible trigger factors of urinary incontinence among adult women in a Nigerian community. Materials: This is a household community survey conducted among 5001 women aged 18 years and above. Methods: A cluster multi-stage sampling was used to select eligible respondents. Information was obtained by an interviewer administered structured questionnaire on sociodemographics, obstetric and gynaecological characteristics, leakage of urine and trigger factors. Results: The mean age of the women was 33.2 years (SD = 14.7). The proportion of women currently experiencing leakage was 2.8% (95% CI = 2.6–3.0). The types of incontinence reported by women currently leaking include stress incontinence (2.3%), urge incontinence (1%) and mixed (0.6%). Severe incontinence was reported in 0.5% o the women, 0.1% had moderate while 2.2% had mild incontinence. Women with history of vaginal delivery only were about twice more likely (95% CI OR = 1.11–3.02); and those who delivered by other modes over four times more likely (95% CI OR =1.96–9.27) than nulliparous women to report currently leaking urine. Conclusions: This study shows a prevalence of UI comparable to other settings, and that the commonest type is stress UI. Mode of delivery is a significant correlate of UI amongst Nigerian women. O513 BLADDER FLAP FORMATION OR OMISSION AT CAESAREAN SECTION IN A NIGERIAN TERTIARY HOSPITAL E.O. Orji1 , A.O. Olaleye2 . 1 Department of Obstetrics & Gynaecology, Obafemi Awolowo University, Ile-Ife, Ile-Ife, Nigeria; 2 Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria Objectives: To determine the incidence of obvious intraoperative bladder injury, compare the duration of surgery, compare the occurrence of haematuria in the immediate postoperative period and assess post operative need for analgesics in both groups. Materials: A randomised controlled trial conducted at the obstetric units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A study proforma was used. Urine dipstick with reagent strips (ACON Laboratories Inc. USA, model Ref U033– 101) were also used to detect postoperative microhaematuria. Methods: Two hundred and ten pregnant women undergoing primary caesarean section for various indications who fulfilled the inclusion criteria were randomised to two groups of either bladder flap omission (study group) or creation (control). Demographic
and obstetric data, intra and post operative characteristics of participants that were relevant to the study objectives were obtained. Information extracted was subjected to statistical analysis using SPSS version 16.0 with variables displayed on frequency tables and charts. Test of significance was done using the Chi-square and t-test. Results: Subjects in both groups were comparable in age, parity, gestational age and level of education. Bleeding from the bladder base was significantly higher in the flap creation group (1.9% vs 11.4%) [p = 0.026]. There was no incidence of bladder laceration in any of the groups. The duration of surgery was significantly lower in the flap omission group (43±4.1mins vs. 47± 4.7mins) [p = 0.001] and the skin incision to delivery interval also followed a similar pattern (4.6±0.9mins vs 6.3±1.2mins) [p = 0.001]. The incidence of post-operative microscopic haematuria was higher in the flap creation group (71.4% vs. 20%). The mean visual analogue scale (VAS) pain score and average number of analgesic doses were significantly lower among the flap omission group [p = 0.001]. There was no statistically significant difference in the incidence of post-operative febrile morbidity and wound infection between both groups. Conclusions: Omission of bladder flap dissection at primary caesarean section is associated with significant short term benefits, such as reduced operating time and delivery time as well as less post operative analgesic requirement. Further studies are needed to evaluate this technique in other contexts such as preterm delivery as well as the long term effects on future fertility and adhesions. O514 ADDITION MESH FIXATION TO PREVENT POP RECCURENCE S. Oleg1 , S. Leyla1 , I. Tatyana1 , O. Rukiyat1 , P. Sofya1 . 1 Peoples’ Friendship University of Russia, Moscow, Russian Federation Objectives: Unfortunately there is a number of complications connected with using TVM procedures which often make life miserable for both patients and surgeons. And the fear of complications limit the use of such procedures. We’ve come a long way from traditional surgery to create the mesh which for time being satisfies us the most and fits the conception of the neofasciogenesis. Materials: For POP surgery results improvement we modified classic total TVM technology with additional fixing points in all mesh parts. It’ll reduce relapses risk considerably in better mesh smooth out, incomplete healing and vaginal erosions reduction. Our method of three-level support we applied in new mesh called Pelvix Evo by Lintex® (Russia). Where Evo stands for Evolution. Methods: Method essence in three-level vagina support and tension free strong pelvic organs fixation by mesh skeleton. Results: One of the complication of the TVM technique–is the recurrence of the POP. The 90% of relapse are relapses of the anterior and apical compartment. The sleeves of anterior compartment of system are joined together over obdurate membrane subcutaneously. We perform semi-arks. Its allow us to be sure about reliability of the anterior compartment. There is more than 24% apical prolapse de novo stage 2 after TVM procedure. When we lead arms of posterior compartment through the sacrospinal ligament we shorten the vagina length. Sometimes the vaginal length after TVM-surgery is −6.9 sm. To improve TVM results we suggest a method of vaginal length preservation during TVM total in hysterectomy patients. The middle part of the mesh is fixed to vagina and then it’s attached additionally to SSL and USL in sacral direction by non-absorbable stitch. Attachment to the USL allows us to preserve length of vagina and increase it above 1.5 sm. To prevent mesh shrinking and dyspareunia we suggest third level support when the distal part of posterior part of system is cut and these two “tails” are extracted to the perineum above the anus area. Conclusions: In this method we operated 135 women. Followup in 3.4 years and one asymptomatic anterior relapse (I stage
O508 THE BURDEN OF DIRECT OBSTETRIC COMPLICATIONS IN NIGERIA S. Ochejele1 , P.E. Ogwuche1 , P. Odusolu2 , A.E. Okwori1 , D. Ifenne3 , I.O. Ujah4 . 1 Obstetrics and Gynaecology, Federal Medical Centre Makurdi, Makurdi, Benue, Nigeria; 2 University of Calabar teaching Hospital, Calabar, Cross River, Nigeria; 3 Benue State University, Makurdi, Benue, Nigeria; 4 Nigeria Institute of Medical research, Lagos, Lagos, Nigeria Objectives: To determine the incidence, and mortality from direct obstetric complications. Materials: Emergency Obstetric Care Register. Methods: An eleven months prospective study of patients managed in four health facilities in Makurdi, Nigeria. Results: During the study period, there were 2,687 deliveries, 267 (10%) direct obstetric complications and 26 (1%) maternal deaths. Five direct obstetric complications account for 24 (92%) of these deaths [Severe pre-eclampsia/Eclampsia (33%), Puerperal sepsis (25%), Post Partum Haemorrhage (17%), Obstructed labour (13%) and ruptured uterus (13%)]. The incidence varied from 0.3% for Abruptio placentae to 4.4% for incomplete abortion. Placenta praevia, ruptured ectopic pregnancy and incomplete abortion accounted for 59% of the complications but were not associated with maternal deaths. Puerperal sepsis had the highest case fatality rate of 56%. Conclusions: Direct obstetric complications have a low incidence, but they are the commonest causes of Maternal mortality. There is a need to re-organize service provision to give more priority attention to the management of these complications. O509 OUTCOME OF AN INTERVENTION TO IMPROVE CASE MANAGEMENT OF ECLAMPSIA IN NIGERIA’S TEACHING HOSPITALS R.N. Ogu1 , F. Okonofua2 , J.T. Akuse3 , I.O. Ujah4 , A.O. Fabamwo5 , H. Galadanci6 , E. Archibong7 , C. Chama8 , H.E. Onah9 . 1 Obstetrics & Gynaecology, University of Port Harcourt, Port Harcourt, Nigeria; 2 University of Benin, Benin City, Nigeria; 3 Sefa Specialist Hospital, Kaduna, Nigeria; 4 University of Jos, Jos, Nigeria; 5 Lagos State University Teaching Hospital, Ikeja, Nigeria; 6 Aminu Kano University Teaching Hospital, Kano, Nigeria; 7 University of Calabar, Calabar, Nigeria; 8 University of Maiduguri Teaching Hospital, Maiduguri, Nigeria; 9 University of Nigeria Teaching Hospital, Enugu, Nigeria Objectives: To investigate the effectiveness of an intervention aimed at improving the case management of eclampsia in Nigeria. Materials: Design & Setting: A multi-centre intervention conducted in six teaching hospitals in Nigeria. Methods: Doctors and midwives in the selected hospitals were retrained in the contemporary management of eclampsia especially the use of magnesium sulphate according to the Pritchard protocol. Clinical records of eclampsia cases before and one year after the intervention were collated. Results: A total of 219 cases of eclampsia were managed over a 12-month period. There were a total of seven maternal deaths. The post intervention mean case-fatality rate of 2.7% was significantly less than the rate of 15.1% before the intervention (P < 0.001). Case fatality declined in five of the six participating hospitals. Overall maternal mortality ratio in the hospitals declined from 1199.2 to 954 per 100,000 deliveries, while perinatal mortality declined from 141.5 to 129.8 per 1000 births. Conclusions: An intervention to build the capacity of care-providers to use evidence-based protocol for the treatment of eclampsia in Nigeria was successful in reducing associated case fatality rate. The increased and widespread use of such an intervention in maternity units will contribute to the reduction of maternal mortality in Nigeria
S441
O510 ASSESSMENT OF SUBLINGUAL MISOPROSTOL AS FIRST LINE TREATMENT FOR PRIMARY POSTPARTUM HEMORRHAGE: RESULTS OF A MULTICENTER TRIAL R.N. Ogu1 , F. Okonofua2 , J.T. Akuse3 , I.O. Ujah4 , H. Galadanci5 , A.O. Fabamwo6 . 1 Obstetrics & Gynaecology, University of Port Harcourt, Port Harcourt, Nigeria; 2 University of Benin, Benin City, Nigeria; 3 Sefa Specialist Hospital, Kaduna, Nigeria; 4 University of Jos, Jos, Nigeria; 5 Aminu Kano University Teaching Hospital, Kano, Nigeria; 6 Lagos State University Teaching Hospital, Ikeja, Nigeria Objectives: To investigate the effectiveness of sublingual misoprostol when used as first line drug for the treatment of primary post-partum hemorrhage (PPH). Materials: The study was conducted in six teaching hospitals representing the six geo-political zones of Nigeria. Methods: Intervention trial; Maternity care providers were retrained to more effectively use the active management of the third stage of labor (AMTSL), and to administer 1000 microgram sublingual misoprostol to women experiencing PPH at the time of delivery. Outcome variables were: estimated blood loss (EBL) and the need for additional treatment with other uterotonic drugs. Results: One hundred and thirty one women with PPH were treated with oral misoprostol as first line drug over six months. EBL ranged from 500 to 2,500mls. Twenty women (15.3%) required additional uterotonic drugs to control continuing blood loss. There were three maternal deaths in one hospital, mainly due to women presenting late in hospital, while 7 perinatal deaths were recorded overall. Conclusions: We conclude that sublingual misoprostol alone is not sufficient to effectively treat all forms of PPH in health care settings. An additional back-up uterotonic and other ancillary treatment will be required. O511 MOESIN OVEREXPRESSION IS ASSOCIATED WITH INVASIVE GROWTH OF ADENOMYOSIS R. Ohara1 , A. Shiba1 , K. Satomi1 , S. Sakashita1 , J. Kano1 , M. Nishida3 , H. Yoshikawa2 , M. Noguchi1 . 1 Diagnostic pathology of Tsukuba university, Tsukuba-shi, Ibaraki-ken, Japan; 2 Obsterics and Gynecology of Tsukuba university, Tsukuba-shi, Ibaraki-ken, Japan; 3 kasmigaura Medical Hospital, Tsuchiura-shi, Ibaraki-ken, Japan Objectives: Although adenomyosis is a benign gynecological disease, both endometrial gland cells and stromal cells show invasive growth into the muscle layer, resembling the behavior of a malignant tumor. The aim of this study was to demonstrate the molecular mechanisms responsible for the invasive character of adenomyosis as a pure model of malignant tumor invasion. Materials: 1. Two cases of adenomyosis surgically resected and fixed in formalin for proteomics 2. 14 fresh surgical specimens for RT-PCR 3. 19 cases of formalin fixed specimens for immunohistochemistry 4. OMC-9 cells for invasion assay. Methods: 1. We selected two cases of adenomyosis that had been surgically resected and fixed in formalin, and the protein contents of both the invasive adenomyosis and peripheral normal endometrium were extracted by tissue microdissection (AS LMD Living Cell; Leica CTR6000® ). The extracted proteins were examined using an LC-MS/MS system (ZAPLOUS LC/MS Systems, AMR) and the expression profiles of each region were compared. 2. The expression of Moesin in adenomyosis was examined by RT-PCR using 14 fresh surgical specimens. 3. Nineteen formalin-fixed specimens of adenomyosis were then examined for Moesin protein expression using immunohistochemistry 4. We then performed an invasion assay using the endometrial stromal sarcoma cell line OMC-9, which expresses a high level of Moesin and shows invasive growth. Results: 1. A total of 260 proteins were detected, and 76 of them showed higher expression in adenomyosis than in normal tissue. Among the genes encoding the 76 proteins, we selected three (Lumican, Triosephosphateisomerase and Moesin) that have already
S442
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
been reported to be associated with invasive growth in malignant tumors. 2. Moesin was found to be expressed in 64% of cases of adenomysis but in only 34% of specimens of normal endometrium (p < 0.03). 3. Moesin was found to be expressed more strongly in stromal cells of adenomysis than in endometrial gland cells. 4. The invasive nature of OMC-9 was examined before and after transfection with Moesin siRNA, and was found to be significantly suppressed by the siRNA treatment (p < 0.01). Conclusions: The present findings demonstrate that Moesin is characteristically overexpressed in stromal cells of adenomyosis and functionally associated with its invasive growth. Management of Moesin expression may provide a new therapeutic approach for suppressing the progression of adenomyosis. O512 PREVALENCE AND THE ASSOCIATED TRIGGER FACTORS OF URINARY INCONTINENCE AMONG 5,000 BLACK WOMEN POPULATION IN SUB-SAHARAN AFRICA: FINDINGS FROM A COMMUNITY SURVEY O.A. Ojengbede1 , I.O. Morhason-Bello1 , B.O. Adedokun2 , N.S. Okonkwo1 , C. Kolade1 . 1 Obstetrics and Gynaecology, University of Ibadan/University College Hospital, Ibadan, Nigeria; 2 University of Ibadan, Ibadan, Oyo, Nigeria Objectives: To determine the prevalence and describe possible trigger factors of urinary incontinence among adult women in a Nigerian community. Materials: This is a household community survey conducted among 5001 women aged 18 years and above. Methods: A cluster multi-stage sampling was used to select eligible respondents. Information was obtained by an interviewer administered structured questionnaire on sociodemographics, obstetric and gynaecological characteristics, leakage of urine and trigger factors. Results: The mean age of the women was 33.2 years (SD = 14.7). The proportion of women currently experiencing leakage was 2.8% (95% CI = 2.6–3.0). The types of incontinence reported by women currently leaking include stress incontinence (2.3%), urge incontinence (1%) and mixed (0.6%). Severe incontinence was reported in 0.5% o the women, 0.1% had moderate while 2.2% had mild incontinence. Women with history of vaginal delivery only were about twice more likely (95% CI OR = 1.11–3.02); and those who delivered by other modes over four times more likely (95% CI OR =1.96–9.27) than nulliparous women to report currently leaking urine. Conclusions: This study shows a prevalence of UI comparable to other settings, and that the commonest type is stress UI. Mode of delivery is a significant correlate of UI amongst Nigerian women. O513 BLADDER FLAP FORMATION OR OMISSION AT CAESAREAN SECTION IN A NIGERIAN TERTIARY HOSPITAL E.O. Orji1 , A.O. Olaleye2 . 1 Department of Obstetrics & Gynaecology, Obafemi Awolowo University, Ile-Ife, Ile-Ife, Nigeria; 2 Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria Objectives: To determine the incidence of obvious intraoperative bladder injury, compare the duration of surgery, compare the occurrence of haematuria in the immediate postoperative period and assess post operative need for analgesics in both groups. Materials: A randomised controlled trial conducted at the obstetric units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A study proforma was used. Urine dipstick with reagent strips (ACON Laboratories Inc. USA, model Ref U033– 101) were also used to detect postoperative microhaematuria. Methods: Two hundred and ten pregnant women undergoing primary caesarean section for various indications who fulfilled the inclusion criteria were randomised to two groups of either bladder flap omission (study group) or creation (control). Demographic
and obstetric data, intra and post operative characteristics of participants that were relevant to the study objectives were obtained. Information extracted was subjected to statistical analysis using SPSS version 16.0 with variables displayed on frequency tables and charts. Test of significance was done using the Chi-square and t-test. Results: Subjects in both groups were comparable in age, parity, gestational age and level of education. Bleeding from the bladder base was significantly higher in the flap creation group (1.9% vs 11.4%) [p = 0.026]. There was no incidence of bladder laceration in any of the groups. The duration of surgery was significantly lower in the flap omission group (43±4.1mins vs. 47± 4.7mins) [p = 0.001] and the skin incision to delivery interval also followed a similar pattern (4.6±0.9mins vs 6.3±1.2mins) [p = 0.001]. The incidence of post-operative microscopic haematuria was higher in the flap creation group (71.4% vs. 20%). The mean visual analogue scale (VAS) pain score and average number of analgesic doses were significantly lower among the flap omission group [p = 0.001]. There was no statistically significant difference in the incidence of post-operative febrile morbidity and wound infection between both groups. Conclusions: Omission of bladder flap dissection at primary caesarean section is associated with significant short term benefits, such as reduced operating time and delivery time as well as less post operative analgesic requirement. Further studies are needed to evaluate this technique in other contexts such as preterm delivery as well as the long term effects on future fertility and adhesions. O514 ADDITION MESH FIXATION TO PREVENT POP RECCURENCE S. Oleg1 , S. Leyla1 , I. Tatyana1 , O. Rukiyat1 , P. Sofya1 . 1 Peoples’ Friendship University of Russia, Moscow, Russian Federation Objectives: Unfortunately there is a number of complications connected with using TVM procedures which often make life miserable for both patients and surgeons. And the fear of complications limit the use of such procedures. We’ve come a long way from traditional surgery to create the mesh which for time being satisfies us the most and fits the conception of the neofasciogenesis. Materials: For POP surgery results improvement we modified classic total TVM technology with additional fixing points in all mesh parts. It’ll reduce relapses risk considerably in better mesh smooth out, incomplete healing and vaginal erosions reduction. Our method of three-level support we applied in new mesh called Pelvix Evo by Lintex® (Russia). Where Evo stands for Evolution. Methods: Method essence in three-level vagina support and tension free strong pelvic organs fixation by mesh skeleton. Results: One of the complication of the TVM technique–is the recurrence of the POP. The 90% of relapse are relapses of the anterior and apical compartment. The sleeves of anterior compartment of system are joined together over obdurate membrane subcutaneously. We perform semi-arks. Its allow us to be sure about reliability of the anterior compartment. There is more than 24% apical prolapse de novo stage 2 after TVM procedure. When we lead arms of posterior compartment through the sacrospinal ligament we shorten the vagina length. Sometimes the vaginal length after TVM-surgery is −6.9 sm. To improve TVM results we suggest a method of vaginal length preservation during TVM total in hysterectomy patients. The middle part of the mesh is fixed to vagina and then it’s attached additionally to SSL and USL in sacral direction by non-absorbable stitch. Attachment to the USL allows us to preserve length of vagina and increase it above 1.5 sm. To prevent mesh shrinking and dyspareunia we suggest third level support when the distal part of posterior part of system is cut and these two “tails” are extracted to the perineum above the anus area. Conclusions: In this method we operated 135 women. Followup in 3.4 years and one asymptomatic anterior relapse (I stage