- Email: [email protected]
O904 Capacity building in maternal health research in an African country – 15 years of experience
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Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
and androgenic activity using a yeast-based hormone-dependent reporter assay. Results: No differences were seen in serum concentrations of estradiol, FSH, LH and SHBG between baseline, Maca treatment and placebo (P > 0.05). The Greene Climacteric Scale revealed a significant reduction in scores in the areas of psychological symptoms, including the sub-scales for anxiety and depression, and sexual dysfunction following Maca consumption compared to both baseline and placebo (P < 0.05). These findings did not correlate with estrogenic or androgenic activity present in the Maca. Conclusion: Preliminary findings show that Maca reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity. O901 Lactate and the normally developing fetal brain L. Story1 , M. Damodaram1 , J. Allsop1 , A. McGuinness1 , M. Wylezinksa-Arridge1 , S. Kumar2 , M. Rutherford1 . 1 Imperial College London, 2 Queen Charlotte’s and Chelsea Hospital London
complication were recorded. EPH was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hour after delivery. Multiple logistic regression analysis was used to identify independent risk factors for EPH. Results: During the past 10 years 70 patients were performed EPH, 27 cases were hospitalized patients and 43 were transformed from other hospitals. The incidence of EPH is 0.12% (27/21824, 42 cases were performed total hysterectomy, 28 cases were performed subtotal hysterectomy). Indications for EPH were placenta accrete (30.00%, 21/70), uterine atony (25.71%, 18/70), coagulopathy (24.29%, 17/70), genital tract laceration (20.00%, 14/70); 5 patients underwent re-operation (7.14%, 5/70), and 8 (11.43%, 8/70) patients dead after all kinds of remedy. Independent risk factors for e EPH were multipara (OR 3.00, 95%CI 1.08–8.32). Combination use of uterine contraction agents (OR 0.09, 95%CI 0.03–0.27) and regular prenatal care (OR 0.05, 95%CI 0.02–0.14) were protect factors. Conclusions: Placenta accrete was the most common cause of EPH. Multipara, home delivery, less prenatal care were high risk factors for EPH. The re-operation and the mortality might be related to the model of operation and the operation skill.
Background: The role of lactate in the developing brain is controversial. Neonatal studies have identified lactate in the normally developing preterm brain using proton Magnetic Resonance Spectroscopy (1HMRS). This is a variant of MRI, which non invasively analyses the metabolic profile of tissue. Fetal 1H-MRS studies are limited. However, the presence of lactate in the normally developing fetal brain has not previously been reported. Methods: 19 women with appropriately grown (AGA) fetuses 23–37+5 weeks gestation (GA) (median 29) and 15 pregnancies with Intrauterine Growth Restriction 22–34+1 weeks GA (median 28) were scanned using a 1.5T MR system. Conventional imaging was obtained followed by spectral acquisition from the fetal brain with a PRESS sequence at three echo times. Spectral analysis was performed using JMRUI software. Signals were summed, spectra phased and referenced to the water peak and peaks identified by chemical shift. Results: 59 spectral acquisitions were analysable. N-acetylaspartate, choline, creatine and Myo-inositol were identified in all fetuses. Lactate was identified in 5 AGA fetuses (23–37+5 weeks GA median 26+6) and 2 IUGR fetuses (29+1, 30 weeks GA). Conclusions: Lactate has been detected in the fetal brain using 1H-MRS in case reports of IUGR and was proposed to be due to hypoxia and anaerobic metabolism. However, this is the first study to identify lactate in the normally developing fetal brain. The role of and detection of lactate therefore remains obscure. Lactate may play a role in brain development, serving as fuel as well having a role in myelin synthesis. However, it is not present in all fetuses. The detection of lactate in both IUGR and AGA fetuses implies its presence is not a specific marker of hypoxia.
O903 Women living with HIV/AIDS in Bangladesh
O902 Emergency peripartum hysterectomy in a tertiary hospital of mainland China: 10 years review
Background: The Gambia is a small West African Country with high perinatal and maternal mortality, despite many years’ efforts to improve services. Antenatal care attendance is relatively high (90%), but most of deliveries are either at home, with or without trained traditional birth assistants, or in a facility with basic services. Only thrree to four institutions can perform emergency obstatric care. Until recently, the midwives, mostly male, were the backbone of the prodfessional health care system. Method: Since 1993, Norwegian researchers have collaborated with the Departement of State for health in building capacity in maternal and reproductive health research. The method has been to recruit Gambian nurse-midvives for a two year masters training, including research thesis. The thematic areas have been: Prevalence and care for infertility, maternal mortality causes and care, maternal morbidity and its association with stillbirths, neonatal morbidity and mortality, reasons for preference for home delivery, willingness to have a HIV test in antenatal care, the cost of maternal care, male
X. Su, Y. Wang, H. Liu. Guangzhou Obstetric and Gynecology Institute, Obstetric Critical Care Center of GuangZhou, The Third Affiliated Hospital of Guangzhou Medical College, Guangzhou, China Objectives: To review 10 years’ experience and to estimate the incidence, indications and high risk factors associated with emergency peripartum hysterectomy (EPH). Materials and Methods: A retrospective case control study. All cases who performed EPH in Obstetric Critical Care Center of GuangZhou, from 1 January 1999 to 30 December 2008. The same number postpartum hemorrhage patients who were not perform EPH were randomly carried out as control group. Demographic data and clinical details including gestational age, mode of delivery, indication and type of hysterectomy, blood loss and
N. Sultana1 , N. Begum2 , S. Badiuzzaman3 . 1 Dhaka National Medical College, 2 Asher alo, 3 Mukto Akash In Bangladesh persons with HIV and AIDS are increasing day by day. Increasing number of women with HIV is being identified. This observational study was conducted among 209 women infected with HIV. Objectives were to assess their health status and to evaluate their social status. They are the members of two organizations working throughout the country who provide them all sorts of supports. All of them are married and with their family members. Most of them were infected through sexual transmission and a very few percentage through unscreened blood transfusion. Gastroenteritis, fungal skin infection, tuberculosis, recurrent respiratory tract infection are usual opportunistic infections. Most of them are getting antiretroviral therapy. Some of them became pregnant and delivered in selected hospitals. They received vocational training from their organization and now working as one of the earning members in the family. Sometimes they are discriminated in getting treatment. Regular health check up, treatment of opportunistic infections and antiretroviral therapy will keep them healthy along with sympathetic attitude towards them and cooperation instead of stigmatization. O904 Capacity building in maternal health research in an African country – 15 years of experience J. Sundby, M. Cham
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
involvement in maternal care, and content of postnatal care. Five M. Phil and two PHD candidates plus 6 short term candidates have been trained. Outcome: Beside publishing local research results in international journals, the candidates have been offered leadership pssitions withing maternal health care in their hoem country, and lasly; a national research dissemination conference was convened, with broad participation from policy makers, ministry of health and parlamentarian. The importance of locally produced knowledge was highlighted. Discussion: The locally produced research has fostered change in local hospitals. Blood transfusion services have been strengthened, the use of the partograph has been improved, patient communication has been addressed, and quality of care checklists have been implemented. As the Gambia now has a health university, new teaching staff and policy making staff have been introduced to critical thinking in service delivery for maternal health. O905 Vesicovaginal fistula at Tertiary Care Center in Eastern Nepal S. Sunuwar Subedi, D. Uprety, M. Regmi, B. Budhathoki. BPKIHS Vesicovaginal fistula is physically, socially and psychologically devastating to those who sufer from it. The aim of the study is to create awareness about VVF, to describe the patient’s profile, etiology and the success rate surgery in our institute. Materials and Methods: A retrospective descriptive study of 23 patients with VVF admitted from Jan 2005-Dec 2007. Hospital records of those patients were retrived and analyzed. All the patients were admitted a wk.before surgery and fistulas were repaired with layered closure method. If there was no urinary leakage for 14 postoperative day, gentle sterile speculum examination and methylene blue test were done before catheter removal. Surgery was said to be sucessful if patients can hold urine with no leakage in between the act of voiding after catheter is removed. Results: The cause of VVF in all were Obstructed labor except in one, which followed abdominal hysterectomy and the juxtacervical being the commonest variety.20 of them were operated through vaginal and 3 were through abdominal route with 14 (56.5%) patients had successful outcome. Conclusion: Obstructed labor is the most common cause of VVF in our scenario and most of them are from hilly areas so they need to travel a long to reach to tertiary center. If public awareness and functional capacity of our health infrastructure is improved, this will help to prevent misery of the is condition and maternal mortality. O906 The morphology and distribution of microglia (MG) and astroglia (AG) populations in the immature human brain: A combined magnetic resonance imaging (MRI) and histological approach V. Supramaniam1 , L. Srinivasan1 , J. Wyatt-Ashmead2 , M. Rutherford1 . 1 Perinatal Imaging Group, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College, London, UK, 2 Wigglesworth Perinatal/Paediatric Pathology Services, Hammersmith Hospital, Imperial College, London, UK Approximately 60% of preterm infants demonstrate diffuse excessive high signal intensity (DEHSI) in the white matter (WM) on MRI at term equivalent age. This is associated with abnormal MR diffusion parameters. A rat model of gestational hypoxia showing mild diffuse WM injury with similar abnormal diffusion on MRI was characterised by increased micoglial (MG) activation. Therapies that inhibit MG activation are under trial in preterm infants. We used post mortem brain MRI and immunohistochemistry (IHC) to identify the MG and astroglia (AG) populations in preterm brains. Preterm post mortem cases (n = 11) of infants born <30 weeks gestational age (GA) (range 22–29 weeks) were recruited through
S351
the perinatal pathology service of Hammersmith Hospital UK with parental consent and ethics approval. Images of fixed brain were acquired at 3 Tesla with T1 and T2 weighted sequences. Iba 1 and GFAP IHC were used to identify MG and AG respectively. Periodic Acid Schiff (PAS) was used to stain the extracellular matrix (ECM). Germinal matrix (GM) haemorrhages seen as regions of short T1 and T2 on MRI were associated with abnormal MG activation along the ventricle wall. The most marked MG activation and intense T1 shortening was seen in the infant that lived the longest (4 weeks). WM injury with regions of long T1 and T2 on MRI was associated with diffuse but less dense activation of MG. WM anomalies on MRI appear to reflect associated changes in the ECM, identified with PAS, rather than increased cell density. Astrogliosis was much less marked than MG activation. We may have identified MRI correlates for MG activation in human preterm brain injury. The degree of MG activation appears to depend on GA at birth and postnatal life of the infant in addition to lesions sustained. O907 Uterine artery embolization (UAE); Our experience at the University Hospital of North Staffordshire UK P. Suraweera, R. Durber, F. O’Mahony. University Hospital of North Staffordshire UK Background: Uterine fibroids occur in 20%–40% of women of childbearing age and 20–30% of hysterectomies are performed to treat symptomatic uterine fibroids. Uterine artery embolization (UAE) is a less invasive therapeutic alternative to conventional surgery Objectives: To evaluate the outcome of UAE for symptomatic fibroids. Methodology: Retrospective cohort study and patient questionnaire survey. Fifty four cases between the years 2002–2007 at a University Hospital were identified and analysed. Results: Mean age of the study population was 49 years (range34–55). Commonest symptom was heavy periods (88%) and some women in the study group had more than one symptom such as associated pain (29%), urinary (12%) and other pressure symptoms (22%). Indications for UAE were patient desire to avoid surgery (76%) preserve fertility (14%) associated co-morbidities and (13%) multiple indications in some cases. Initial USS followed by MRI (85%) was undertaken for pre-treatment assessment of the fibroids. UAE was performed by bead block via single femoral access under local anaesthetic with patient controlled anaesthesia (PCA). 47/54 had successful selective catheterisation of bilateral UAE while 4/54 only had unilateral UAE. Catheterization failed entirely in the remainder (3/54). Adequate analgesia was achieved with PCA and simple analgesics. (49/54) 90% were discharged home within 24 hours. Three cases required readmission with pain, vomiting, fever or vaginal discharge. The mean clinical follow up was at 6 months post procedure with USS (76%) or MRI (20%) for therapy evaluation. Upon first clinical review, 53% recorded symptom improvement whilst 47% had either worsening or nil appreciable change. 19 cases required further procedure; hysterectomy (8), myomectomy (2), repeat UAE (3), Mirena IUS (4) and endometrial ablation (1) due to inadequate clinical improvement. Conclusion: UAE is relatively non-invasive procedure that can be performed under local anaesthetic and PCA. Procedural success of the procedure was 87%. The clinical success rate of UAE is about 53%. Therefore UAE is a safe alternative to surgery for women with symptomatic fibroids who do not wish or fit for surgery.
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
and androgenic activity using a yeast-based hormone-dependent reporter assay. Results: No differences were seen in serum concentrations of estradiol, FSH, LH and SHBG between baseline, Maca treatment and placebo (P > 0.05). The Greene Climacteric Scale revealed a significant reduction in scores in the areas of psychological symptoms, including the sub-scales for anxiety and depression, and sexual dysfunction following Maca consumption compared to both baseline and placebo (P < 0.05). These findings did not correlate with estrogenic or androgenic activity present in the Maca. Conclusion: Preliminary findings show that Maca reduces psychological symptoms, including anxiety and depression, and lowers measures of sexual dysfunction in postmenopausal women independent of estrogenic and androgenic activity. O901 Lactate and the normally developing fetal brain L. Story1 , M. Damodaram1 , J. Allsop1 , A. McGuinness1 , M. Wylezinksa-Arridge1 , S. Kumar2 , M. Rutherford1 . 1 Imperial College London, 2 Queen Charlotte’s and Chelsea Hospital London
complication were recorded. EPH was defined as one performed for hemorrhage unresponsive to other treatment less than 24 hour after delivery. Multiple logistic regression analysis was used to identify independent risk factors for EPH. Results: During the past 10 years 70 patients were performed EPH, 27 cases were hospitalized patients and 43 were transformed from other hospitals. The incidence of EPH is 0.12% (27/21824, 42 cases were performed total hysterectomy, 28 cases were performed subtotal hysterectomy). Indications for EPH were placenta accrete (30.00%, 21/70), uterine atony (25.71%, 18/70), coagulopathy (24.29%, 17/70), genital tract laceration (20.00%, 14/70); 5 patients underwent re-operation (7.14%, 5/70), and 8 (11.43%, 8/70) patients dead after all kinds of remedy. Independent risk factors for e EPH were multipara (OR 3.00, 95%CI 1.08–8.32). Combination use of uterine contraction agents (OR 0.09, 95%CI 0.03–0.27) and regular prenatal care (OR 0.05, 95%CI 0.02–0.14) were protect factors. Conclusions: Placenta accrete was the most common cause of EPH. Multipara, home delivery, less prenatal care were high risk factors for EPH. The re-operation and the mortality might be related to the model of operation and the operation skill.
Background: The role of lactate in the developing brain is controversial. Neonatal studies have identified lactate in the normally developing preterm brain using proton Magnetic Resonance Spectroscopy (1HMRS). This is a variant of MRI, which non invasively analyses the metabolic profile of tissue. Fetal 1H-MRS studies are limited. However, the presence of lactate in the normally developing fetal brain has not previously been reported. Methods: 19 women with appropriately grown (AGA) fetuses 23–37+5 weeks gestation (GA) (median 29) and 15 pregnancies with Intrauterine Growth Restriction 22–34+1 weeks GA (median 28) were scanned using a 1.5T MR system. Conventional imaging was obtained followed by spectral acquisition from the fetal brain with a PRESS sequence at three echo times. Spectral analysis was performed using JMRUI software. Signals were summed, spectra phased and referenced to the water peak and peaks identified by chemical shift. Results: 59 spectral acquisitions were analysable. N-acetylaspartate, choline, creatine and Myo-inositol were identified in all fetuses. Lactate was identified in 5 AGA fetuses (23–37+5 weeks GA median 26+6) and 2 IUGR fetuses (29+1, 30 weeks GA). Conclusions: Lactate has been detected in the fetal brain using 1H-MRS in case reports of IUGR and was proposed to be due to hypoxia and anaerobic metabolism. However, this is the first study to identify lactate in the normally developing fetal brain. The role of and detection of lactate therefore remains obscure. Lactate may play a role in brain development, serving as fuel as well having a role in myelin synthesis. However, it is not present in all fetuses. The detection of lactate in both IUGR and AGA fetuses implies its presence is not a specific marker of hypoxia.
O903 Women living with HIV/AIDS in Bangladesh
O902 Emergency peripartum hysterectomy in a tertiary hospital of mainland China: 10 years review
Background: The Gambia is a small West African Country with high perinatal and maternal mortality, despite many years’ efforts to improve services. Antenatal care attendance is relatively high (90%), but most of deliveries are either at home, with or without trained traditional birth assistants, or in a facility with basic services. Only thrree to four institutions can perform emergency obstatric care. Until recently, the midwives, mostly male, were the backbone of the prodfessional health care system. Method: Since 1993, Norwegian researchers have collaborated with the Departement of State for health in building capacity in maternal and reproductive health research. The method has been to recruit Gambian nurse-midvives for a two year masters training, including research thesis. The thematic areas have been: Prevalence and care for infertility, maternal mortality causes and care, maternal morbidity and its association with stillbirths, neonatal morbidity and mortality, reasons for preference for home delivery, willingness to have a HIV test in antenatal care, the cost of maternal care, male
X. Su, Y. Wang, H. Liu. Guangzhou Obstetric and Gynecology Institute, Obstetric Critical Care Center of GuangZhou, The Third Affiliated Hospital of Guangzhou Medical College, Guangzhou, China Objectives: To review 10 years’ experience and to estimate the incidence, indications and high risk factors associated with emergency peripartum hysterectomy (EPH). Materials and Methods: A retrospective case control study. All cases who performed EPH in Obstetric Critical Care Center of GuangZhou, from 1 January 1999 to 30 December 2008. The same number postpartum hemorrhage patients who were not perform EPH were randomly carried out as control group. Demographic data and clinical details including gestational age, mode of delivery, indication and type of hysterectomy, blood loss and
N. Sultana1 , N. Begum2 , S. Badiuzzaman3 . 1 Dhaka National Medical College, 2 Asher alo, 3 Mukto Akash In Bangladesh persons with HIV and AIDS are increasing day by day. Increasing number of women with HIV is being identified. This observational study was conducted among 209 women infected with HIV. Objectives were to assess their health status and to evaluate their social status. They are the members of two organizations working throughout the country who provide them all sorts of supports. All of them are married and with their family members. Most of them were infected through sexual transmission and a very few percentage through unscreened blood transfusion. Gastroenteritis, fungal skin infection, tuberculosis, recurrent respiratory tract infection are usual opportunistic infections. Most of them are getting antiretroviral therapy. Some of them became pregnant and delivered in selected hospitals. They received vocational training from their organization and now working as one of the earning members in the family. Sometimes they are discriminated in getting treatment. Regular health check up, treatment of opportunistic infections and antiretroviral therapy will keep them healthy along with sympathetic attitude towards them and cooperation instead of stigmatization. O904 Capacity building in maternal health research in an African country – 15 years of experience J. Sundby, M. Cham
Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
involvement in maternal care, and content of postnatal care. Five M. Phil and two PHD candidates plus 6 short term candidates have been trained. Outcome: Beside publishing local research results in international journals, the candidates have been offered leadership pssitions withing maternal health care in their hoem country, and lasly; a national research dissemination conference was convened, with broad participation from policy makers, ministry of health and parlamentarian. The importance of locally produced knowledge was highlighted. Discussion: The locally produced research has fostered change in local hospitals. Blood transfusion services have been strengthened, the use of the partograph has been improved, patient communication has been addressed, and quality of care checklists have been implemented. As the Gambia now has a health university, new teaching staff and policy making staff have been introduced to critical thinking in service delivery for maternal health. O905 Vesicovaginal fistula at Tertiary Care Center in Eastern Nepal S. Sunuwar Subedi, D. Uprety, M. Regmi, B. Budhathoki. BPKIHS Vesicovaginal fistula is physically, socially and psychologically devastating to those who sufer from it. The aim of the study is to create awareness about VVF, to describe the patient’s profile, etiology and the success rate surgery in our institute. Materials and Methods: A retrospective descriptive study of 23 patients with VVF admitted from Jan 2005-Dec 2007. Hospital records of those patients were retrived and analyzed. All the patients were admitted a wk.before surgery and fistulas were repaired with layered closure method. If there was no urinary leakage for 14 postoperative day, gentle sterile speculum examination and methylene blue test were done before catheter removal. Surgery was said to be sucessful if patients can hold urine with no leakage in between the act of voiding after catheter is removed. Results: The cause of VVF in all were Obstructed labor except in one, which followed abdominal hysterectomy and the juxtacervical being the commonest variety.20 of them were operated through vaginal and 3 were through abdominal route with 14 (56.5%) patients had successful outcome. Conclusion: Obstructed labor is the most common cause of VVF in our scenario and most of them are from hilly areas so they need to travel a long to reach to tertiary center. If public awareness and functional capacity of our health infrastructure is improved, this will help to prevent misery of the is condition and maternal mortality. O906 The morphology and distribution of microglia (MG) and astroglia (AG) populations in the immature human brain: A combined magnetic resonance imaging (MRI) and histological approach V. Supramaniam1 , L. Srinivasan1 , J. Wyatt-Ashmead2 , M. Rutherford1 . 1 Perinatal Imaging Group, MRC Clinical Sciences Centre, Hammersmith Hospital, Imperial College, London, UK, 2 Wigglesworth Perinatal/Paediatric Pathology Services, Hammersmith Hospital, Imperial College, London, UK Approximately 60% of preterm infants demonstrate diffuse excessive high signal intensity (DEHSI) in the white matter (WM) on MRI at term equivalent age. This is associated with abnormal MR diffusion parameters. A rat model of gestational hypoxia showing mild diffuse WM injury with similar abnormal diffusion on MRI was characterised by increased micoglial (MG) activation. Therapies that inhibit MG activation are under trial in preterm infants. We used post mortem brain MRI and immunohistochemistry (IHC) to identify the MG and astroglia (AG) populations in preterm brains. Preterm post mortem cases (n = 11) of infants born <30 weeks gestational age (GA) (range 22–29 weeks) were recruited through
S351
the perinatal pathology service of Hammersmith Hospital UK with parental consent and ethics approval. Images of fixed brain were acquired at 3 Tesla with T1 and T2 weighted sequences. Iba 1 and GFAP IHC were used to identify MG and AG respectively. Periodic Acid Schiff (PAS) was used to stain the extracellular matrix (ECM). Germinal matrix (GM) haemorrhages seen as regions of short T1 and T2 on MRI were associated with abnormal MG activation along the ventricle wall. The most marked MG activation and intense T1 shortening was seen in the infant that lived the longest (4 weeks). WM injury with regions of long T1 and T2 on MRI was associated with diffuse but less dense activation of MG. WM anomalies on MRI appear to reflect associated changes in the ECM, identified with PAS, rather than increased cell density. Astrogliosis was much less marked than MG activation. We may have identified MRI correlates for MG activation in human preterm brain injury. The degree of MG activation appears to depend on GA at birth and postnatal life of the infant in addition to lesions sustained. O907 Uterine artery embolization (UAE); Our experience at the University Hospital of North Staffordshire UK P. Suraweera, R. Durber, F. O’Mahony. University Hospital of North Staffordshire UK Background: Uterine fibroids occur in 20%–40% of women of childbearing age and 20–30% of hysterectomies are performed to treat symptomatic uterine fibroids. Uterine artery embolization (UAE) is a less invasive therapeutic alternative to conventional surgery Objectives: To evaluate the outcome of UAE for symptomatic fibroids. Methodology: Retrospective cohort study and patient questionnaire survey. Fifty four cases between the years 2002–2007 at a University Hospital were identified and analysed. Results: Mean age of the study population was 49 years (range34–55). Commonest symptom was heavy periods (88%) and some women in the study group had more than one symptom such as associated pain (29%), urinary (12%) and other pressure symptoms (22%). Indications for UAE were patient desire to avoid surgery (76%) preserve fertility (14%) associated co-morbidities and (13%) multiple indications in some cases. Initial USS followed by MRI (85%) was undertaken for pre-treatment assessment of the fibroids. UAE was performed by bead block via single femoral access under local anaesthetic with patient controlled anaesthesia (PCA). 47/54 had successful selective catheterisation of bilateral UAE while 4/54 only had unilateral UAE. Catheterization failed entirely in the remainder (3/54). Adequate analgesia was achieved with PCA and simple analgesics. (49/54) 90% were discharged home within 24 hours. Three cases required readmission with pain, vomiting, fever or vaginal discharge. The mean clinical follow up was at 6 months post procedure with USS (76%) or MRI (20%) for therapy evaluation. Upon first clinical review, 53% recorded symptom improvement whilst 47% had either worsening or nil appreciable change. 19 cases required further procedure; hysterectomy (8), myomectomy (2), repeat UAE (3), Mirena IUS (4) and endometrial ablation (1) due to inadequate clinical improvement. Conclusion: UAE is relatively non-invasive procedure that can be performed under local anaesthetic and PCA. Procedural success of the procedure was 87%. The clinical success rate of UAE is about 53%. Therefore UAE is a safe alternative to surgery for women with symptomatic fibroids who do not wish or fit for surgery.