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O518 HEPATITIS B VIRUS INFECTION IN PREGNANCY: PERCEPTION OF CURRENT MANAGEMENT BY NIGERIAN OBSTETRICS AND GYNAECOLOGICAL RESIDENT DOCTORS
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O518 HEPATITIS B VIRUS INFECTION IN PREGNANCY: PERCEPTION OF CURRENT MANAGEMENT BY NIGERIAN OBSTETRICS AND GYNAECOLOGICAL RESIDENT DOCTORS R.C. Onoh1 , U.O. Ugochukwu J1 , P.O. Ezeonu1 , A.K. Onyebuchi1 . 1 Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria., Abakaliki, Ebonyi, Nigeria Objectives: To survey the knowledge and perception of current management of hepatitis B virus infection in pregnancy by Nigerian Resident doctors in Obstetrics and Gynaecology. Materials: A semi-structured questionnaire was designed for crosssectional survey of resident doctors attending update course in 2011 for part I & II fellowship examinations. Methods: The questionnaires were filled and then analysed using Epi info software 2008 version 3.5.1. Main outcome measures: Perception of current management of hepatitis B virus infection in pregnancy. Results: A total of 96 (83.5%) of the semi-structured questionnaires were correctly filled and analysed. The mean age of the respondents was 35.6±4.9 years. The mean duration of Obstetrics and Gynaecological practice by the resident doctors in this study was 4.6±3.3 years. Most of the resident doctors work at the University Teaching Hospital 66 (68.5%) and Federal Medical Centre 17 (17.7%). Of the 29 different hospitals seen in this study, thirteen hospitals (44.8%) do not routinely screen for HBsAg in pregnancy while seven (24.1%) screen routinely for HBsAg in pregnancy. The residents from the remaining nine (31.0%) hospitals had varying responses on routine HBsAg screening. Eleven (37.9%) hospitals in this study do not have a hospital protocol for management of HBsAg in pregnancy while five hospitals (17.2%) have a protocol. Variations in response were noted by residents from the remaining hospitals. Conclusions: Current management of hepatitis B virus infection in pregnancy is geared towards reduction of vertical transmission. There is marked variation in the perception of current management of hepatitis B virus infection by Obstetrics and Gynaecological residents in Nigeria. O519 ATTITUDE OF ANTENATAL CLIENTS TOWARD PRENATAL BLOOD DONATION AT ABAKALIKI, SOUTHEAST NIGERIA R.C. Onoh1 , U.O. Ugochukwu J1 , E.C. Nkwo1,2 , P.O. Ezeonu1 , J.T. Onoh1 , C.O.U. Esike1 , A.K. Onyebuchi1 . 1 Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria., Abakaliki, Ebonyi, Nigeria; 2 federal Medical Centre Umuahia, Abia State, Umuahia, Abia, Nigeria Objectives: To determine the attitude and behaviour of pregnant women toward prenatal Blood donation. Materials: A cross-sectional survey of pregnant women attending antenatal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State was undertaken between April 6th to December 7th 2011. Methods: A pre-tested semi-structured questionnaire was designed and used for this study. Epi-info software 2008 version 3.5.1 was used for statistical analysis. Main Outcome: Attitude of antenatal clients towards prenatal blood donation. Results: A total of 600 questionnaires were distributed within the study period and 535 of the antenatal clients correctly filled and returned the questionnaire giving a response rate of 89%. The mean age of the respondents was 28.9±5.2 years with range of 17–42 years. Majority of the antenatal clients 206(38.5%) were within the age range of 26–30 years. Most of the respondents 311(58.1%) attained tertiary education. Majority of the antenatal clients 428(80%) supported prenatal blood donation and 358(66.9%) will allow their husband to donate blood on their behalf during prenatal period. However 112(21.7%) will prefer buying blood to blood donation from their husband or close relations. Only 32(6%) of the respondents has ever donated blood in the past and reasons for not donating included not having enough 258(48.2%), not
strong enough 39(7.3%), religion 8(1.5%), husband’s disapproval 55(10.3%), blood is seen as sacred 17(3.2%), blood may be used for rituals 11(2.1%), fear of death 75(14.0%) and feeling that blood donation is for men 1(0.2%). However most 404(76.5%) supported a policy that husband should donate blood for the blood banking system during antenatal period. Even though a total of 593(73.5%) will accept blood transfusion if need arise in pregnancy, most 446(83.4%) still preferred donated blood from their husband for transfusion. Some of the respondents will not accept blood transfusion following complications of pregnancy or delivery because of HIV/AIDS, 66(44.3%), faith 46(30.9%) and stories of blood transfusion complications 14(9.4%). Conclusions: Prenatal blood donation is perceived as an important aspect of Obstetrics management by antenatal clients. However some pregnant women still have misconception and misinformation about blood donation and transfusion. Hence an intense health education and advocacy are required for effective blood donation, blood transfusion and blood banking system. O520 ETIOLOGY OF 597 UROGENITAL FISTULAS IN THE DEMOCRATIC REPUBLIC OF CONGO (DRC) M. Onsrud1 , D. Mukwege2 . 1 Gynecologic oncology, Oslo University Hospital, Oslo, Norway; 2 Panzi Hospital, Bukavu, Congo, The Democratic Republic of the Objectives: In low-resource countries, urogenital fistulas are mainly obstetric. Our aim was to study fistula etiology in DRC and do a comparison between vesicovaginal fistula (VVF), vesicouterine fistula (VUF) and ureterovaginal fistula (UrVF). Materials: 597 patients operated consecutively at Panzi Hospital Fistula Center, DRC in 2006–2007Methods: Retrospective analysis of patient record data. Results: 15 fistulas (2.5%) were related to previous gynecologic operations, 6 (1%) to sexual violence and 576 fistulas (96.5%) were obstetric. 513 fistulas (85.9 %) were VVFs, 35 (5.9%) VUFs and 36 (6.0%) UrVFs. Among 220 urogenital fistulas following a spontaneous vaginal delivery, 97.7% were VVF, 1.4% VUF and 0.9% UrVF. In 239 cases where a cesarean was involved, 12.1% had VUF and 12.1% UrVF. Of fistulas appearing after a failed vacuum followed by cesarean, 2/5 had VUF and 3/5 UrVF; after cesarean hysterectomy the numbers were 1/9 and 4/9, respectively. In addition, 5 out of 12 fistulas after gynecologic hysterectomy were UrVFs. All VUFs were successfully closed by an abdominal or abdomino-vaginal approach. UrVFs were all successfully treated by ureteral neoimplantation in the bladder. The closure rate for VVF was 87%. Conclusions: 71 of 597 fistulas (11.9%) were either VUFs or UrVFs. Cesarean section and hysterectomy were main etiologic factors for these types. Obstetric interventions performed after a long period of obstruction are risky. Adequate training in cesarean section and alternative delivery methods is important. O521 SURVIVAL AFTER POSTOPERATIVE RADIOTHERAPY FOR EARLY STAGE ENDOMETRIAL CARCINOMA: THE OSLO STUDY REVISITED AFTER UP TO 43 YEARS OF FOLLOW-UP M. Onsrud1 , K. Lindemann2 , G.B. Kristensen3 , C. Trope´ 1 . 1 Department of Gynecological Cancer, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; 2 Akerhus University Hospital, Gyn Dept, Lørenskog, Norway; 3 Institute for Medical Informatics, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway Objectives: There is an ongoing debate regarding the benefit of radiation in patients with early stage endometrial carcinoma. These women survive for a long time and data on long-term risks conferred by radiation are scarce. Our study is to date the first randomized study with sufficient follow-up time to study long time survival and side effects of pelvic radiotherapy in early stage endometrial cancer.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
O518 HEPATITIS B VIRUS INFECTION IN PREGNANCY: PERCEPTION OF CURRENT MANAGEMENT BY NIGERIAN OBSTETRICS AND GYNAECOLOGICAL RESIDENT DOCTORS R.C. Onoh1 , U.O. Ugochukwu J1 , P.O. Ezeonu1 , A.K. Onyebuchi1 . 1 Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria., Abakaliki, Ebonyi, Nigeria Objectives: To survey the knowledge and perception of current management of hepatitis B virus infection in pregnancy by Nigerian Resident doctors in Obstetrics and Gynaecology. Materials: A semi-structured questionnaire was designed for crosssectional survey of resident doctors attending update course in 2011 for part I & II fellowship examinations. Methods: The questionnaires were filled and then analysed using Epi info software 2008 version 3.5.1. Main outcome measures: Perception of current management of hepatitis B virus infection in pregnancy. Results: A total of 96 (83.5%) of the semi-structured questionnaires were correctly filled and analysed. The mean age of the respondents was 35.6±4.9 years. The mean duration of Obstetrics and Gynaecological practice by the resident doctors in this study was 4.6±3.3 years. Most of the resident doctors work at the University Teaching Hospital 66 (68.5%) and Federal Medical Centre 17 (17.7%). Of the 29 different hospitals seen in this study, thirteen hospitals (44.8%) do not routinely screen for HBsAg in pregnancy while seven (24.1%) screen routinely for HBsAg in pregnancy. The residents from the remaining nine (31.0%) hospitals had varying responses on routine HBsAg screening. Eleven (37.9%) hospitals in this study do not have a hospital protocol for management of HBsAg in pregnancy while five hospitals (17.2%) have a protocol. Variations in response were noted by residents from the remaining hospitals. Conclusions: Current management of hepatitis B virus infection in pregnancy is geared towards reduction of vertical transmission. There is marked variation in the perception of current management of hepatitis B virus infection by Obstetrics and Gynaecological residents in Nigeria. O519 ATTITUDE OF ANTENATAL CLIENTS TOWARD PRENATAL BLOOD DONATION AT ABAKALIKI, SOUTHEAST NIGERIA R.C. Onoh1 , U.O. Ugochukwu J1 , E.C. Nkwo1,2 , P.O. Ezeonu1 , J.T. Onoh1 , C.O.U. Esike1 , A.K. Onyebuchi1 . 1 Obstetrics and Gynaecology, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria., Abakaliki, Ebonyi, Nigeria; 2 federal Medical Centre Umuahia, Abia State, Umuahia, Abia, Nigeria Objectives: To determine the attitude and behaviour of pregnant women toward prenatal Blood donation. Materials: A cross-sectional survey of pregnant women attending antenatal clinic at Federal Teaching Hospital Abakaliki, Ebonyi State was undertaken between April 6th to December 7th 2011. Methods: A pre-tested semi-structured questionnaire was designed and used for this study. Epi-info software 2008 version 3.5.1 was used for statistical analysis. Main Outcome: Attitude of antenatal clients towards prenatal blood donation. Results: A total of 600 questionnaires were distributed within the study period and 535 of the antenatal clients correctly filled and returned the questionnaire giving a response rate of 89%. The mean age of the respondents was 28.9±5.2 years with range of 17–42 years. Majority of the antenatal clients 206(38.5%) were within the age range of 26–30 years. Most of the respondents 311(58.1%) attained tertiary education. Majority of the antenatal clients 428(80%) supported prenatal blood donation and 358(66.9%) will allow their husband to donate blood on their behalf during prenatal period. However 112(21.7%) will prefer buying blood to blood donation from their husband or close relations. Only 32(6%) of the respondents has ever donated blood in the past and reasons for not donating included not having enough 258(48.2%), not
strong enough 39(7.3%), religion 8(1.5%), husband’s disapproval 55(10.3%), blood is seen as sacred 17(3.2%), blood may be used for rituals 11(2.1%), fear of death 75(14.0%) and feeling that blood donation is for men 1(0.2%). However most 404(76.5%) supported a policy that husband should donate blood for the blood banking system during antenatal period. Even though a total of 593(73.5%) will accept blood transfusion if need arise in pregnancy, most 446(83.4%) still preferred donated blood from their husband for transfusion. Some of the respondents will not accept blood transfusion following complications of pregnancy or delivery because of HIV/AIDS, 66(44.3%), faith 46(30.9%) and stories of blood transfusion complications 14(9.4%). Conclusions: Prenatal blood donation is perceived as an important aspect of Obstetrics management by antenatal clients. However some pregnant women still have misconception and misinformation about blood donation and transfusion. Hence an intense health education and advocacy are required for effective blood donation, blood transfusion and blood banking system. O520 ETIOLOGY OF 597 UROGENITAL FISTULAS IN THE DEMOCRATIC REPUBLIC OF CONGO (DRC) M. Onsrud1 , D. Mukwege2 . 1 Gynecologic oncology, Oslo University Hospital, Oslo, Norway; 2 Panzi Hospital, Bukavu, Congo, The Democratic Republic of the Objectives: In low-resource countries, urogenital fistulas are mainly obstetric. Our aim was to study fistula etiology in DRC and do a comparison between vesicovaginal fistula (VVF), vesicouterine fistula (VUF) and ureterovaginal fistula (UrVF). Materials: 597 patients operated consecutively at Panzi Hospital Fistula Center, DRC in 2006–2007Methods: Retrospective analysis of patient record data. Results: 15 fistulas (2.5%) were related to previous gynecologic operations, 6 (1%) to sexual violence and 576 fistulas (96.5%) were obstetric. 513 fistulas (85.9 %) were VVFs, 35 (5.9%) VUFs and 36 (6.0%) UrVFs. Among 220 urogenital fistulas following a spontaneous vaginal delivery, 97.7% were VVF, 1.4% VUF and 0.9% UrVF. In 239 cases where a cesarean was involved, 12.1% had VUF and 12.1% UrVF. Of fistulas appearing after a failed vacuum followed by cesarean, 2/5 had VUF and 3/5 UrVF; after cesarean hysterectomy the numbers were 1/9 and 4/9, respectively. In addition, 5 out of 12 fistulas after gynecologic hysterectomy were UrVFs. All VUFs were successfully closed by an abdominal or abdomino-vaginal approach. UrVFs were all successfully treated by ureteral neoimplantation in the bladder. The closure rate for VVF was 87%. Conclusions: 71 of 597 fistulas (11.9%) were either VUFs or UrVFs. Cesarean section and hysterectomy were main etiologic factors for these types. Obstetric interventions performed after a long period of obstruction are risky. Adequate training in cesarean section and alternative delivery methods is important. O521 SURVIVAL AFTER POSTOPERATIVE RADIOTHERAPY FOR EARLY STAGE ENDOMETRIAL CARCINOMA: THE OSLO STUDY REVISITED AFTER UP TO 43 YEARS OF FOLLOW-UP M. Onsrud1 , K. Lindemann2 , G.B. Kristensen3 , C. Trope´ 1 . 1 Department of Gynecological Cancer, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway; 2 Akerhus University Hospital, Gyn Dept, Lørenskog, Norway; 3 Institute for Medical Informatics, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway Objectives: There is an ongoing debate regarding the benefit of radiation in patients with early stage endometrial carcinoma. These women survive for a long time and data on long-term risks conferred by radiation are scarce. Our study is to date the first randomized study with sufficient follow-up time to study long time survival and side effects of pelvic radiotherapy in early stage endometrial cancer.