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O629 CERVICAL PRIMING WITH SUBLINGUAL MISOPROSTOL PRIOR TO OFFICE HYSTEROSCOPY: A RANDOMIZED CONTROLLED TRIAL
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
(P < 0.05), while there was a statistically significant difference between both groups in the treatment of dyspareunia (P ≥ 0.05). Conclusions: LUNA can be a last alternative option in well-selected patients for control of chronic pelvic pain without endometriosis; however, its effectiveness may not extend to other indications. Also, preliminary experience in the treatment of primary deep dyspareunia presents a promising perspective on the management of deep dyspareunia, especially if it will involve a team of social, psychological, and gynecological specialists. O626 RELATIONSHIP BETWEEN TIME TO PLACENTAL DELIVERY AND POST-PARTUM BLOOD LOSS W.R. Sheldon1,2 , J. Blum1 , J. Durocher1 , J. Trussell2,3 , B. Winikoff1 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the relationship between time to placental delivery and post-partum blood loss among women with and without oxytocin prophylaxis. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,110 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between time to placental delivery and post-partum blood loss ≥700 mL. Results: In both clinical regimens, time to placental delivery was associated with increased risk of post-partum blood loss ≥700 mL. Among women with no oxytocin prophylaxis, the increased risk was greatest for third stage durations of 15 minutes or more, as compared with durations of 0 to 4 minutes. Among women with oxytocin prophylaxis, the increase in risk was significant for all third stage durations of 5 minutes or more, as compared with 0 to 4 minutes; however the change in risk remained relatively stable over time until third stage durations of 25 minutes or more. Conclusions: Time to placental delivery is a good predictor of postpartum blood loss, and particularly among those with no oxytocin prophylaxis. O627 EFFECTIVENESS OF THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR W.R. Sheldon1,2 , J. Durocher1 , B. Winikoff1 , J. Blum1 , J. Trussell2,3 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the independent and combined effectiveness of the interventions currently recommended for active management of the third stage of labour: oxytocin prophylaxis, controlled cord traction, and uterine massage. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,202 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between the active management components and post-partum blood loss ≥700 mL. Results: Among those with no oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk by nearly 50% as compared with expectant management (P < 0.001), while uterine massage was associated with increased hemorrhage risk. Among those with oxytocin prophylaxis, the additional provision of controlled cord traction reduced hemorrhage risk by 60% (P < 0.000) as compared with oxytocin alone; while the additional provision of
controlled cord traction plus uterine massage was no more effective than provision of oxytocin alone. Conclusions: Controlled cord traction is an important means for reducing post-partum hemorrhage risk among women with and without oxytocin prophylaxis, while the benefit of uterine massage is less clear. O628 THE IMPACT OF ORAL CONTRACEPTIVES, METFORMIN AND LIFESTYLE MODIFICATION ON THE METABOLISM DISORDER IN POLYCYSTIC OVARY SYNDROME WOMEN: A RANDOMIZED CONTROLLED TRIAL Q.Y. Wang1 , W. Huang1 , Y.S. Song1 , X. Li1 , L.L. Shen1 . 1 Obstetrics and Gynecology, West China Secong University Hospital of Sichuan University, Chengdu, Sichuan, China Objectives: To investigate the effect of COCs containing cyproterone acetate (CPA) or drospirenone (DRP) combined metformin and lifestyle modification on carbohydrate and lipid metabolism in PCOS patients with IR. Materials: 110 PCOS women diagnosed according to Rotterdam criteria were randomly separated into two groups: group DRP (n = 55) received 3mg DRP plus 30ug ethinyl estradiol and group CPA (n = 55) received 2mg CPA plus 35ug ethinyl estradiol, all participants took COCs continuously 21d with 7d internal for 6 cycles. Meantime, they received 1500mg/d metformin and lifestyle modification such as dietary and exercise. Methods: The body mass index (BMI), waist-to-lip ratio (WHR), blood pressure, score of GAGS and Ferriman-Gallwey were assessed at baseline and the 3th and the 6th treatment cycle. The biochemical profile as hormone profile, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the insulin and glucose areas under the curve (AUC) by means of oral glucose tolerance tests (OGTT), and lipid profile {total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high- density lipoprotein cholesterol (HDL), triglyceride, and hemoglobin A1c (HbA1c)} were measured at baseline and in the 6th treatment cycle. Results: After six treatment cycle, the score of acne and hirsutism, and BMI decreased significantly in both groups. The systolic and diastolic blood pressure in group CPA increased than baseline and significantly higher than group DRP. In DRP-group, the fasting glucose decreased significantly; the glucose to insulin ratio and the AUC of plasma glucose upon OGTT statistically significantly increased; but the decrement of fasting insulin and the AUC of insulin had no significantly different; The lipid profiles were all statistically increased, while the ratio of LDL/HDL and TC/HDL decreased significantly). In CPA-group, The AUC of insulin decreased significantly than baseline; TC and HDL were significantly increased, LDL/HDL ratio decreased. Conclusions: The either DRP-COCs or CPA-COCs combined with metformin and lifestyle modification can significantly improve acne and BMI in PCOS women with metabolite disorder. Most importantly, both of them didn’t exaggerate the carbohydrate and lipid profile in these women; and DRP-COC has beneficial on blood pressure. O629 CERVICAL PRIMING WITH SUBLINGUAL MISOPROSTOL PRIOR TO OFFICE HYSTEROSCOPY: A RANDOMIZED CONTROLLED TRIAL A.M.El. Sherbiny1 , O.A. Shawki2 , W.S. Abd Elgaber2 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 Kasr Al. Ainy Hospital, Cairo, Cairo, Egypt Objectives: To evaluate the effectiveness and possible adverse effects of sublingual misoprostol for cervical priming before office hysteroscopy in infertile, perimenopausal and postmenopausal women. Materials: A total of 60 women scheduled for diagnostic office hysteroscopy (using vaginoscopic technique) either due to infertility, perimenopausal or postmenopausal bleeding.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Methods: Patients were randomly assigned into 2 groups. The study group (n = 30) received 200 microgram of sublingual misoprostol 1 h before the procedure and the control group (n = 30) received no cervical priming agent. The primary outcome measure was visual analogue scale (VAS) for pain experienced by the patient. Secondary outcomes were patient acceptance and the ease of procedure reported by the operator as well as complications and adverse effects. Results: Pain experienced by patients recorded using VAS was significantly lower in the misoprostol group than in the control group where mean was 3.667 vs. 6.233 respectively (P < 0.02). Patient acceptance was also significantly better in the misoprostol group where mean was 3.866 vs. 2.533 in the control group (P 0.046). There was no statistically significance between the ease of procedure in both groups (P 0.23). No pre-operative complications were reported after misoprostol intake misoprostol application. Conclusions: Sublingual misoprostol applied 60–90 minites before office hysteroscopy reduced pain experienced by patient and increased patient acceptance of the procedure in infertile, perimenopausal and postmenopausal women. O630 USE OF A SURGICAL GLOVE TO CONTROL SEVERE POSTPARTUM HEMORRHAGE M.T.El. Sherbiny1 , M.M. Elhennawy3 , H.A.E. Gowely3 , S.M. Hamouda2 , A.M.El. Sherbiny1 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 Damietta General Hospital, Damietta, Damietta, Egypt; 3 Damietta Specialized Hospital, Damietta, Damietta, Egypt Objectives: To evaluate the efficacy and the safety of a surgical glove as an intrauterine tamponade to stop severe postpartum hemorrhage (PPH). Materials: A total of 24 patients with massive atonic postpartum hemorrhage unresponsive to appropriate uterotonics admitted in Damietta General hospital, Damietta Specialized hospital and Dr. El. Sherbiny hospital between April 2005 and December 2011. Methods: This is a case series report of 24 patients was managed with intrauterine balloon tamponade using a surgical glove for intractable atonic postpartum hemorrhage. With aseptic precautions, knots are made on all fingers of a surgical glove to render its cavity as a single one. Then the glove is inverted to have a smooth outer surface. A sterile rubber catheter fitted within the inverted glove with tying the opening of the glove around the catheter then it is introduced into the uterine cavity. The glove is inflated with 200–500 mL normal saline, according to need. A roller gauze is introduced into the vaginal cavity to keep the uterine balloon in place. The glove and the catheter were kept for 24 hours, and gradually deflated when bleeding ceased. Results: In 22 cases (92%) in which the glove tamponade was used, bleeding stopped within 20 minutes. In 2 cases, hysterectomy was required despite successful placement of the catheter. None of the patients went into irreversible shock. There was no clinical evidence of intrauterine infection. Nine patients were followed up for subsequent pregnancy and 7 (78%) of them got pregnant within 2 years. Conclusions: The Intrauterine tamponade with a surgical glove is a simple, safe, inexpensive, readily available and effective means of treating massive atonic postpartum hemorrhage O631 CONSERVATIVE MANAGEMENT OF PLACENTA PREVIA-ACCRETA BY PROPHYLACTIC UTERINE ARTERIES LIGATION AND STEPWISE VERTICAL COMPRESSION SUTURES M.T.El. Sherbiny1 , H.A.E. Gowely3 , A.M.El. Sherbiny1 , S.M. Hamouda2 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 General Hospital, Damietta, Damietta, Egypt; 3 Specialized Hospital, Damietta, Damietta, Egypt Objectives: To report and assess our experience with a new conservative management approach to prevent and treat
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postpartum hemorrhage (PPH) due to placenta previa with suspected or diagnosed focal accreta. Materials: This protocol was followed in 13 women undergoing lower segment cesarean section (LSCS) for placenta previa with focal accreta suspected or diagnosed by ultrasound, color and power Doppler studies. Methods: After delivery of the fetus, the uterine cavity was temporarily packed by gauze till prophylactic bilateral double ligation of the uterine arteries is performed, then the placenta was removed. The continuous small bleeding from the placental bed was stopped by stepwise vertical compression sutures; where after dissection of the bladder 2 vertical chromic catgut sutures (No.1) were applied 2 cm medial to the lateral border of the lower uterine segment in each side penetrating the anterior and posterior walls. If bleeding did not cease, other 2 vertical sutures were applied 1–2 cm medial to the previous sutures on each side. Results: No evidence of accreta was recorded in 2 cases and double bilateral ligation of uterine arteries only was sufficient in one of them. Focal accreta were proved in 10 cases and successfully treated by the compression sutures protocol. One case was diffuse accreta and was treated outside this protocol by leaving the placenta in situ. All 10 women with focal accreta later resumed normal menstrual flow. They also underwent diagnostic office hysteroscopy 2 months after the surgery and nine of them showed normal uterine cavity. Only one had developed mild synechia which was corrected in the same hysteroscopic setting. The mean surgical time was 50 minutes and the mean transfused blood volume was 750 mL. Four out of 5 followed-up patients got pregnant within 2 year, one aborted early in first trimester and 2 developed recurrent focal accreta. Conclusions: Placental site bleeding due to adherent focal placenta accreta can be safely controlled by prophylactic double bilateral uterine artery ligation followed by stepwise vertical compression sutures in women who desire preservation of fertility. O632 THE EFFECTIVENESS OF A GLOBAL WOMEN’S HEALTH COURSE IN OBSTETRICS AND GYNECOLOGY TRAINING T. Shirazian1 , M. Garala2 , M. Brodman1 . 1 Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medicine, New York, NY, United States; 2 The Medical School for International Health in collaboration with Columbia University Medical School, New York, NY, United States Objectives: Global health opportunities are desired additions to American residency programs, yet there is little evidence in the literature for structuring global training programs in obstetrics and gynecology. For the past three years (2009–2011), we have provided a preparatory course at Mount Sinai Medical Center (MSMC), NYC for all local ob-gyn residents desiring to obtain an international training experience. This course serves as preparation for work abroad and focuses on both women health issues and the challenges in being at an international site. Topics include women’s rights, gender-based violence, family planning and contraception, maternal mortality and the ethical and societal challenges affecting women’s health outcomes. The goal of this study is to understand participants interest in global work and the impact of the course on their future international experiences. Materials: A structured survey was administered to 33 past obgyn resident participants of our Global Women’s health course. Participants included residents from 6 NYC ob-gyn residency programs. Methods: Surveys were sent via email or hard copy. All residents had attended the elective 6 month, preparatory Global Health Women’s course at Mount Sinai Medical Center (MSMC). Results: Twenty-three of 33 participants completed the survey. Demographic responses demonstrated that all participants were female, aged 30–34. Greater than fifty percent had prior international experience in medical school. Seventy-four percent of
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
(P < 0.05), while there was a statistically significant difference between both groups in the treatment of dyspareunia (P ≥ 0.05). Conclusions: LUNA can be a last alternative option in well-selected patients for control of chronic pelvic pain without endometriosis; however, its effectiveness may not extend to other indications. Also, preliminary experience in the treatment of primary deep dyspareunia presents a promising perspective on the management of deep dyspareunia, especially if it will involve a team of social, psychological, and gynecological specialists. O626 RELATIONSHIP BETWEEN TIME TO PLACENTAL DELIVERY AND POST-PARTUM BLOOD LOSS W.R. Sheldon1,2 , J. Blum1 , J. Durocher1 , J. Trussell2,3 , B. Winikoff1 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the relationship between time to placental delivery and post-partum blood loss among women with and without oxytocin prophylaxis. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,110 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between time to placental delivery and post-partum blood loss ≥700 mL. Results: In both clinical regimens, time to placental delivery was associated with increased risk of post-partum blood loss ≥700 mL. Among women with no oxytocin prophylaxis, the increased risk was greatest for third stage durations of 15 minutes or more, as compared with durations of 0 to 4 minutes. Among women with oxytocin prophylaxis, the increase in risk was significant for all third stage durations of 5 minutes or more, as compared with 0 to 4 minutes; however the change in risk remained relatively stable over time until third stage durations of 25 minutes or more. Conclusions: Time to placental delivery is a good predictor of postpartum blood loss, and particularly among those with no oxytocin prophylaxis. O627 EFFECTIVENESS OF THE COMPONENTS OF ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR W.R. Sheldon1,2 , J. Durocher1 , B. Winikoff1 , J. Blum1 , J. Trussell2,3 . 1 Gynuity Health Projects, New York, NY, United States; 2 Princeton University, Princeton, NJ, United States; 3 The Hull York Medical School, Hull, United Kingdom Objectives: Assess the independent and combined effectiveness of the interventions currently recommended for active management of the third stage of labour: oxytocin prophylaxis, controlled cord traction, and uterine massage. Materials: Secondary data analysis from two randomized controlled trials for the treatment of post-partum hemorrhage. Methods: The analysis involved a total of 39,202 women from four countries in two clinical regimens: one in which oxytocin prophylaxis was administered following birth of the baby; the other in which it was not. We used logistic regression to assess relationships between the active management components and post-partum blood loss ≥700 mL. Results: Among those with no oxytocin prophylaxis, provision of controlled cord traction reduced hemorrhage risk by nearly 50% as compared with expectant management (P < 0.001), while uterine massage was associated with increased hemorrhage risk. Among those with oxytocin prophylaxis, the additional provision of controlled cord traction reduced hemorrhage risk by 60% (P < 0.000) as compared with oxytocin alone; while the additional provision of
controlled cord traction plus uterine massage was no more effective than provision of oxytocin alone. Conclusions: Controlled cord traction is an important means for reducing post-partum hemorrhage risk among women with and without oxytocin prophylaxis, while the benefit of uterine massage is less clear. O628 THE IMPACT OF ORAL CONTRACEPTIVES, METFORMIN AND LIFESTYLE MODIFICATION ON THE METABOLISM DISORDER IN POLYCYSTIC OVARY SYNDROME WOMEN: A RANDOMIZED CONTROLLED TRIAL Q.Y. Wang1 , W. Huang1 , Y.S. Song1 , X. Li1 , L.L. Shen1 . 1 Obstetrics and Gynecology, West China Secong University Hospital of Sichuan University, Chengdu, Sichuan, China Objectives: To investigate the effect of COCs containing cyproterone acetate (CPA) or drospirenone (DRP) combined metformin and lifestyle modification on carbohydrate and lipid metabolism in PCOS patients with IR. Materials: 110 PCOS women diagnosed according to Rotterdam criteria were randomly separated into two groups: group DRP (n = 55) received 3mg DRP plus 30ug ethinyl estradiol and group CPA (n = 55) received 2mg CPA plus 35ug ethinyl estradiol, all participants took COCs continuously 21d with 7d internal for 6 cycles. Meantime, they received 1500mg/d metformin and lifestyle modification such as dietary and exercise. Methods: The body mass index (BMI), waist-to-lip ratio (WHR), blood pressure, score of GAGS and Ferriman-Gallwey were assessed at baseline and the 3th and the 6th treatment cycle. The biochemical profile as hormone profile, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the insulin and glucose areas under the curve (AUC) by means of oral glucose tolerance tests (OGTT), and lipid profile {total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high- density lipoprotein cholesterol (HDL), triglyceride, and hemoglobin A1c (HbA1c)} were measured at baseline and in the 6th treatment cycle. Results: After six treatment cycle, the score of acne and hirsutism, and BMI decreased significantly in both groups. The systolic and diastolic blood pressure in group CPA increased than baseline and significantly higher than group DRP. In DRP-group, the fasting glucose decreased significantly; the glucose to insulin ratio and the AUC of plasma glucose upon OGTT statistically significantly increased; but the decrement of fasting insulin and the AUC of insulin had no significantly different; The lipid profiles were all statistically increased, while the ratio of LDL/HDL and TC/HDL decreased significantly). In CPA-group, The AUC of insulin decreased significantly than baseline; TC and HDL were significantly increased, LDL/HDL ratio decreased. Conclusions: The either DRP-COCs or CPA-COCs combined with metformin and lifestyle modification can significantly improve acne and BMI in PCOS women with metabolite disorder. Most importantly, both of them didn’t exaggerate the carbohydrate and lipid profile in these women; and DRP-COC has beneficial on blood pressure. O629 CERVICAL PRIMING WITH SUBLINGUAL MISOPROSTOL PRIOR TO OFFICE HYSTEROSCOPY: A RANDOMIZED CONTROLLED TRIAL A.M.El. Sherbiny1 , O.A. Shawki2 , W.S. Abd Elgaber2 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 Kasr Al. Ainy Hospital, Cairo, Cairo, Egypt Objectives: To evaluate the effectiveness and possible adverse effects of sublingual misoprostol for cervical priming before office hysteroscopy in infertile, perimenopausal and postmenopausal women. Materials: A total of 60 women scheduled for diagnostic office hysteroscopy (using vaginoscopic technique) either due to infertility, perimenopausal or postmenopausal bleeding.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
Methods: Patients were randomly assigned into 2 groups. The study group (n = 30) received 200 microgram of sublingual misoprostol 1 h before the procedure and the control group (n = 30) received no cervical priming agent. The primary outcome measure was visual analogue scale (VAS) for pain experienced by the patient. Secondary outcomes were patient acceptance and the ease of procedure reported by the operator as well as complications and adverse effects. Results: Pain experienced by patients recorded using VAS was significantly lower in the misoprostol group than in the control group where mean was 3.667 vs. 6.233 respectively (P < 0.02). Patient acceptance was also significantly better in the misoprostol group where mean was 3.866 vs. 2.533 in the control group (P 0.046). There was no statistically significance between the ease of procedure in both groups (P 0.23). No pre-operative complications were reported after misoprostol intake misoprostol application. Conclusions: Sublingual misoprostol applied 60–90 minites before office hysteroscopy reduced pain experienced by patient and increased patient acceptance of the procedure in infertile, perimenopausal and postmenopausal women. O630 USE OF A SURGICAL GLOVE TO CONTROL SEVERE POSTPARTUM HEMORRHAGE M.T.El. Sherbiny1 , M.M. Elhennawy3 , H.A.E. Gowely3 , S.M. Hamouda2 , A.M.El. Sherbiny1 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 Damietta General Hospital, Damietta, Damietta, Egypt; 3 Damietta Specialized Hospital, Damietta, Damietta, Egypt Objectives: To evaluate the efficacy and the safety of a surgical glove as an intrauterine tamponade to stop severe postpartum hemorrhage (PPH). Materials: A total of 24 patients with massive atonic postpartum hemorrhage unresponsive to appropriate uterotonics admitted in Damietta General hospital, Damietta Specialized hospital and Dr. El. Sherbiny hospital between April 2005 and December 2011. Methods: This is a case series report of 24 patients was managed with intrauterine balloon tamponade using a surgical glove for intractable atonic postpartum hemorrhage. With aseptic precautions, knots are made on all fingers of a surgical glove to render its cavity as a single one. Then the glove is inverted to have a smooth outer surface. A sterile rubber catheter fitted within the inverted glove with tying the opening of the glove around the catheter then it is introduced into the uterine cavity. The glove is inflated with 200–500 mL normal saline, according to need. A roller gauze is introduced into the vaginal cavity to keep the uterine balloon in place. The glove and the catheter were kept for 24 hours, and gradually deflated when bleeding ceased. Results: In 22 cases (92%) in which the glove tamponade was used, bleeding stopped within 20 minutes. In 2 cases, hysterectomy was required despite successful placement of the catheter. None of the patients went into irreversible shock. There was no clinical evidence of intrauterine infection. Nine patients were followed up for subsequent pregnancy and 7 (78%) of them got pregnant within 2 years. Conclusions: The Intrauterine tamponade with a surgical glove is a simple, safe, inexpensive, readily available and effective means of treating massive atonic postpartum hemorrhage O631 CONSERVATIVE MANAGEMENT OF PLACENTA PREVIA-ACCRETA BY PROPHYLACTIC UTERINE ARTERIES LIGATION AND STEPWISE VERTICAL COMPRESSION SUTURES M.T.El. Sherbiny1 , H.A.E. Gowely3 , A.M.El. Sherbiny1 , S.M. Hamouda2 . 1 Dr. Sherbiny Hospital, Damietta, Damietta, Egypt; 2 General Hospital, Damietta, Damietta, Egypt; 3 Specialized Hospital, Damietta, Damietta, Egypt Objectives: To report and assess our experience with a new conservative management approach to prevent and treat
S483
postpartum hemorrhage (PPH) due to placenta previa with suspected or diagnosed focal accreta. Materials: This protocol was followed in 13 women undergoing lower segment cesarean section (LSCS) for placenta previa with focal accreta suspected or diagnosed by ultrasound, color and power Doppler studies. Methods: After delivery of the fetus, the uterine cavity was temporarily packed by gauze till prophylactic bilateral double ligation of the uterine arteries is performed, then the placenta was removed. The continuous small bleeding from the placental bed was stopped by stepwise vertical compression sutures; where after dissection of the bladder 2 vertical chromic catgut sutures (No.1) were applied 2 cm medial to the lateral border of the lower uterine segment in each side penetrating the anterior and posterior walls. If bleeding did not cease, other 2 vertical sutures were applied 1–2 cm medial to the previous sutures on each side. Results: No evidence of accreta was recorded in 2 cases and double bilateral ligation of uterine arteries only was sufficient in one of them. Focal accreta were proved in 10 cases and successfully treated by the compression sutures protocol. One case was diffuse accreta and was treated outside this protocol by leaving the placenta in situ. All 10 women with focal accreta later resumed normal menstrual flow. They also underwent diagnostic office hysteroscopy 2 months after the surgery and nine of them showed normal uterine cavity. Only one had developed mild synechia which was corrected in the same hysteroscopic setting. The mean surgical time was 50 minutes and the mean transfused blood volume was 750 mL. Four out of 5 followed-up patients got pregnant within 2 year, one aborted early in first trimester and 2 developed recurrent focal accreta. Conclusions: Placental site bleeding due to adherent focal placenta accreta can be safely controlled by prophylactic double bilateral uterine artery ligation followed by stepwise vertical compression sutures in women who desire preservation of fertility. O632 THE EFFECTIVENESS OF A GLOBAL WOMEN’S HEALTH COURSE IN OBSTETRICS AND GYNECOLOGY TRAINING T. Shirazian1 , M. Garala2 , M. Brodman1 . 1 Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medicine, New York, NY, United States; 2 The Medical School for International Health in collaboration with Columbia University Medical School, New York, NY, United States Objectives: Global health opportunities are desired additions to American residency programs, yet there is little evidence in the literature for structuring global training programs in obstetrics and gynecology. For the past three years (2009–2011), we have provided a preparatory course at Mount Sinai Medical Center (MSMC), NYC for all local ob-gyn residents desiring to obtain an international training experience. This course serves as preparation for work abroad and focuses on both women health issues and the challenges in being at an international site. Topics include women’s rights, gender-based violence, family planning and contraception, maternal mortality and the ethical and societal challenges affecting women’s health outcomes. The goal of this study is to understand participants interest in global work and the impact of the course on their future international experiences. Materials: A structured survey was administered to 33 past obgyn resident participants of our Global Women’s health course. Participants included residents from 6 NYC ob-gyn residency programs. Methods: Surveys were sent via email or hard copy. All residents had attended the elective 6 month, preparatory Global Health Women’s course at Mount Sinai Medical Center (MSMC). Results: Twenty-three of 33 participants completed the survey. Demographic responses demonstrated that all participants were female, aged 30–34. Greater than fifty percent had prior international experience in medical school. Seventy-four percent of