- Email: [email protected]
P295 A study of reproductive morbidity of women in the Terai Region of Nepal
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
S497
2.20%.There was significant relashionship between complications and SGA. Conclusion: As a results probably we can prevented some complications by better prenatal care.
P297 Acute colonic pseudo-obstruction (ACPO)/Ogilvie’s syndrome 2008: a review P. Ertberg, B. Bødker. Dept. of Gynecology and Obstetrics, Hilleroed Hospital, Copenhagen, Denmark
P295 A study of reproductive morbidity of women in the Terai Region of Nepal
Objectives: ACPO, also known as Ogilvie’s syndrome, is a clinical condition with acute dilatation of the colon without a provable mechanical cause. It is a major cause of morbidity and mortality commonly preceded by Cesarean Section (Evidence Ia). A review of the literature was performed to work out evidence based guidelines. Materials and Methods: A MEDLINE literature search from 1998–2008 was performed with the keywords: Colonic pseudoobstruction, Ogilvie’s syndrome, intestinal pseudo-obstruction, neostigmine, colonic decompression. Additional references were obtained from the bibliographies of the identified articles. Results: Early recognition and treatment of the condition is critical to improve outcome. The diagnosis is based on clinical and radiographic findings. The risk of perforation increases with rising caecal diameter (>12 cm) and the duration of the condition (>6 days) (Evidence IV). Supportive therapy should be the initial management including: fasting, intravenous fluids, electrolyte correction, nasogastric tube, mobilization, avoiding laxatives and opiods (Evidence IV). If no improvement, this regime should be followed by medical treatment with neostigmine 2 mg i.v. under continuous electrocardiographic monitoring and repeated if necessary (Evidence Ib). If the patient fails to respond, it is recommended to proceed with colonoscopic decompression with placement of a decompression tube to improve the therapeutic benefit (Evidence IV). Conclusions: There is good evidence for evaluation of the patient with plain abdominal radiograph, implementation of early supportive therapy, and treatment with neostigmine if the condition progresses. Colonoscopic decompression is used if this treatment fails. If ischemia or perforation appears surgery should be performed.
G. Dangal. Kathmandu Model Hospital Objectives: This study aims to fill the gap of information of reproductive health (RH) of women living in rural Terai by providing baseline data on reproductive morbidity (RM) leading to pelvic organ prolapse(POP), reproductive tract infections (RTIs), menstrual problems and subfertility. Materials and Methods: This is a descriptive analysis of women who attended mobile RH camps in eastern Terai of Nepal organized at different villages falling in three districts namely Rautahat, Mahottari and Saptari during December 2005 and 2006. The diagnoses were made mostly on clinical evaluation and free treatment provided. The leading reproductive morbidity of POP was dealt in detail and prolapse surgeries were performed in the rural mobile health camps. Results: Total number of women treated in the camps was 7750. Majority of the women in this study were found to be suffering from STI (30.1%), followed by POP (20.1%), menstrual disorders (16.7%) and subfertility (9.3%). Among POP patients majority received ring pessary insertion (43.8%) followed by counseling plus pelvic floor exercise (32.9%) and surgical correction (23.3%). Third-degree POP (38.6%) was commonest among all POP cases. Majority (60%) developed POP after first and second child birth. Conclusions: The major reproductive morbidity in this study was STI, POP (most of the women having third degree uterovaginal prolapse), menstrual disorders and sub-fertility. Surgical treatment at the mobile camps could only be provided to small number, suggesting expansion of health services in rural Nepal by minimising reproductive health barriers like poverty, illiteracy, etc. P296 Management of major degree placenta previa at tertiary level hospital (Dutta’s technique) D. Dutta. FOGSI Objectives: To prevent uncontrolled hemorrhage, by adopting new techniques (Dutta’s) during lucs, due to major degree placenta previa to reduce maternal mortality and morbidity at the tertiary referral hospital. Materials and Methods: This study was conducted at tertiary referral hospital at Kalyani, West Bengal, India from January 2000 to October 2008. 94 cases were selected for this study. Following Technique (Dutta’s) was adopted in a stepwise manner = baby delivered → bilateral uterine artery ligation → inj tranexamic acid → oxytocin infusion → placenta and its membrane delivered and checked → if tear or laceration-interrupted suture → uterine wound clsed if no bleeding. Result: 96.9% cases were shown to have good effectiveness to control bleeding. Ceaserean hysterectomy was performed in 2.1% cases. 1% cases had broad ligament haematoma. 90.8% cases had regular menstruation and 25.5% had pregnancy in long term followup upto 2 years. Conclusion: It is simple, safe and quick procedure, easy to perform, less complicated, permits more time for further steps, perfusion pressure is reduced, sufficient to prevent and control other haemostatic mechanism, to prevent unnecessary ligation of internal iliac artery (b) and ceaserean hysterectomy. reduce maternal mortality morbidity and do not disturb subsequent menstrual flow and future Fertility.
P298 Vaginal birth after one previous cesarean section – a 2 years retrospective study M. Fahmy, F. Yones, R. Salah. Omar Almokhtar Faculty of Medicine Objectives: Vaginal birth after one previous lower segment cesarean section VBAC represents one of the most challenging issues in obstetric practice. The pregnant women with a previous section may be offered either planned vaginal birth after CS (VBAC) or elective repeat cesarean section (ERCS). Because large family is widely practiced in our community, a trial of labor with the goal of vaginal delivery by women who have had one CS is a key step toward reducing the high rate of repeat CS. The aim of this retrospective study is to evaluate the magnitude of risk and benefit of VBAC versus that of ERCS. Patients and Methods: A 2 years retrospective study was carried out at Althawra Central Teaching Hospital (Albieda city Algamahiria Alibiya (eastern part)) between January 2005 and December 2006, to determine the incidence, the maternal and fetal outcome following VBAC. Results: Total number of deliveries was 9605 cases. Total admission of previous one C.S was 711 cases. Success rate of VBAC was 84.6%. The cases which underwent emergency C.S after failed TOL have an increased risk to develop uterine rupture and dehiscence (p = 0.01). The risk of maternal infection was more among women who had (failed TOL) compared with ERCS group (p = 0.01). Infants born with Apgar score <7 were more common among TOL group (16.5%) versus ERCS group (4.6%) (P < 0.001). Conclusion: We confirmed that many of the excess adverse events accompanying a VBAC TOL are attributable to the failure of labor and the requirement for a repeated emergency CS. When VBAC-TOL
S497
2.20%.There was significant relashionship between complications and SGA. Conclusion: As a results probably we can prevented some complications by better prenatal care.
P297 Acute colonic pseudo-obstruction (ACPO)/Ogilvie’s syndrome 2008: a review P. Ertberg, B. Bødker. Dept. of Gynecology and Obstetrics, Hilleroed Hospital, Copenhagen, Denmark
P295 A study of reproductive morbidity of women in the Terai Region of Nepal
Objectives: ACPO, also known as Ogilvie’s syndrome, is a clinical condition with acute dilatation of the colon without a provable mechanical cause. It is a major cause of morbidity and mortality commonly preceded by Cesarean Section (Evidence Ia). A review of the literature was performed to work out evidence based guidelines. Materials and Methods: A MEDLINE literature search from 1998–2008 was performed with the keywords: Colonic pseudoobstruction, Ogilvie’s syndrome, intestinal pseudo-obstruction, neostigmine, colonic decompression. Additional references were obtained from the bibliographies of the identified articles. Results: Early recognition and treatment of the condition is critical to improve outcome. The diagnosis is based on clinical and radiographic findings. The risk of perforation increases with rising caecal diameter (>12 cm) and the duration of the condition (>6 days) (Evidence IV). Supportive therapy should be the initial management including: fasting, intravenous fluids, electrolyte correction, nasogastric tube, mobilization, avoiding laxatives and opiods (Evidence IV). If no improvement, this regime should be followed by medical treatment with neostigmine 2 mg i.v. under continuous electrocardiographic monitoring and repeated if necessary (Evidence Ib). If the patient fails to respond, it is recommended to proceed with colonoscopic decompression with placement of a decompression tube to improve the therapeutic benefit (Evidence IV). Conclusions: There is good evidence for evaluation of the patient with plain abdominal radiograph, implementation of early supportive therapy, and treatment with neostigmine if the condition progresses. Colonoscopic decompression is used if this treatment fails. If ischemia or perforation appears surgery should be performed.
G. Dangal. Kathmandu Model Hospital Objectives: This study aims to fill the gap of information of reproductive health (RH) of women living in rural Terai by providing baseline data on reproductive morbidity (RM) leading to pelvic organ prolapse(POP), reproductive tract infections (RTIs), menstrual problems and subfertility. Materials and Methods: This is a descriptive analysis of women who attended mobile RH camps in eastern Terai of Nepal organized at different villages falling in three districts namely Rautahat, Mahottari and Saptari during December 2005 and 2006. The diagnoses were made mostly on clinical evaluation and free treatment provided. The leading reproductive morbidity of POP was dealt in detail and prolapse surgeries were performed in the rural mobile health camps. Results: Total number of women treated in the camps was 7750. Majority of the women in this study were found to be suffering from STI (30.1%), followed by POP (20.1%), menstrual disorders (16.7%) and subfertility (9.3%). Among POP patients majority received ring pessary insertion (43.8%) followed by counseling plus pelvic floor exercise (32.9%) and surgical correction (23.3%). Third-degree POP (38.6%) was commonest among all POP cases. Majority (60%) developed POP after first and second child birth. Conclusions: The major reproductive morbidity in this study was STI, POP (most of the women having third degree uterovaginal prolapse), menstrual disorders and sub-fertility. Surgical treatment at the mobile camps could only be provided to small number, suggesting expansion of health services in rural Nepal by minimising reproductive health barriers like poverty, illiteracy, etc. P296 Management of major degree placenta previa at tertiary level hospital (Dutta’s technique) D. Dutta. FOGSI Objectives: To prevent uncontrolled hemorrhage, by adopting new techniques (Dutta’s) during lucs, due to major degree placenta previa to reduce maternal mortality and morbidity at the tertiary referral hospital. Materials and Methods: This study was conducted at tertiary referral hospital at Kalyani, West Bengal, India from January 2000 to October 2008. 94 cases were selected for this study. Following Technique (Dutta’s) was adopted in a stepwise manner = baby delivered → bilateral uterine artery ligation → inj tranexamic acid → oxytocin infusion → placenta and its membrane delivered and checked → if tear or laceration-interrupted suture → uterine wound clsed if no bleeding. Result: 96.9% cases were shown to have good effectiveness to control bleeding. Ceaserean hysterectomy was performed in 2.1% cases. 1% cases had broad ligament haematoma. 90.8% cases had regular menstruation and 25.5% had pregnancy in long term followup upto 2 years. Conclusion: It is simple, safe and quick procedure, easy to perform, less complicated, permits more time for further steps, perfusion pressure is reduced, sufficient to prevent and control other haemostatic mechanism, to prevent unnecessary ligation of internal iliac artery (b) and ceaserean hysterectomy. reduce maternal mortality morbidity and do not disturb subsequent menstrual flow and future Fertility.
P298 Vaginal birth after one previous cesarean section – a 2 years retrospective study M. Fahmy, F. Yones, R. Salah. Omar Almokhtar Faculty of Medicine Objectives: Vaginal birth after one previous lower segment cesarean section VBAC represents one of the most challenging issues in obstetric practice. The pregnant women with a previous section may be offered either planned vaginal birth after CS (VBAC) or elective repeat cesarean section (ERCS). Because large family is widely practiced in our community, a trial of labor with the goal of vaginal delivery by women who have had one CS is a key step toward reducing the high rate of repeat CS. The aim of this retrospective study is to evaluate the magnitude of risk and benefit of VBAC versus that of ERCS. Patients and Methods: A 2 years retrospective study was carried out at Althawra Central Teaching Hospital (Albieda city Algamahiria Alibiya (eastern part)) between January 2005 and December 2006, to determine the incidence, the maternal and fetal outcome following VBAC. Results: Total number of deliveries was 9605 cases. Total admission of previous one C.S was 711 cases. Success rate of VBAC was 84.6%. The cases which underwent emergency C.S after failed TOL have an increased risk to develop uterine rupture and dehiscence (p = 0.01). The risk of maternal infection was more among women who had (failed TOL) compared with ERCS group (p = 0.01). Infants born with Apgar score <7 were more common among TOL group (16.5%) versus ERCS group (4.6%) (P < 0.001). Conclusion: We confirmed that many of the excess adverse events accompanying a VBAC TOL are attributable to the failure of labor and the requirement for a repeated emergency CS. When VBAC-TOL