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P414 Assessment of conservative management of first trimester miscarriage in Sudanese women
S532
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Conclusion: The Multicenter scoring system has proven to be more accurate in diagnosing malignant tumors even in benign tumors in cases of dermoid cysts.
General Gynecology P414 Assessment of conservative management of first trimester miscarriage in Sudanese women M. Abul Gasim1 , N. Soliman2 , A. Fazari Bashir2 Objective: To evaluate the efficacy of conservative management versus surgical management of first trimester miscarriage in Sudanese women. Methods: Prospective analytical facility based study. 216 Patients offered conservative and surgical management. Following counseling we enrolled 115 for expectant, 36 for surgical and 30 for medical management, a total of 181 drop out 35. Written consents taken, fulfillment of inclusion criteria and ethical clearance obtained. Oral antibiotics and paracetamol prescribed to all patients. Ante D if Rhesus negative given. The expectant group left the facility when pain free and bleeding settled. The medical group allowed home if no or minimal bleeding. Haemoglobin at presentation and after the study was recorded. Patient satisfaction assessed four weeks later and contraception offered. Results: 79 % had incomplete, 15.5% missed and 5.5% inevitable. 63.5% expectant management, 19.9% surgical evacuation and 16.6% given misoprostol. Complete evacuation highest in medical group 93.3% in surgical group 91.6% and in expectant group 80%. Surgical evacuation was done in 7% of expectant group. 13% of failed expectant group had complete miscarriage after misoprostol. Two cases of missed abortion needed a re-evacuation. Two in medical group had emergency curettage. One patient in surgical group blood transfused. Patient satisfaction was 85%, 60% in expectant and surgical group respectively. Conclusion: Medical management is more likely to induce complete evacuation of the uterus and reduce the need for surgical evacuation. Expectant management was accepted by the clients. A prophylactic antibiotic is important. We recommend the Manual Vacuum Aspiration and medical management in our facility. P415 Ectopic pregnancy in Nnewi, Nigeria: a 5-year study at a tertiary health care institution A. Eke, S. Mbamara, G. Eleje, J. Okonkwo, G. Udigwe, J. Ugboaja, C. Oguejiofor, I. Mbachu. Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria Objective: To determine the prevalence, predisposing factors, clinical presentations, treatment options and outcome of ectopic pregnancy in a Nigerian tertiary health care institution. Materials and Methods: The case files of all the patients who had ectopic pregnancy between 1st January, 2003 and 31st December, 2007 at Nnamdi Azikiwe University Teaching Hospital, Nnewi were reviewed retrospectively. Results: Thirty one cases of ectopic pregnancies were treated out of 2,937 deliveries and 628 gynecological admissions over this period. This gave a prevalence of 1.2%. It constituted 4.9% of all gynecological admissions. 92.6% were ruptured ectopic pregnancies. The peak age was 26–30 years. Nulliparous women constituted the largest group (63.0%). The average gestational age at presentation was 7.4 weeks. Previous induced abortions (44.4%), followed by pelvic infections (40.7%) were the commonest identified risk factors. The commonest presenting symptom was abdominal pain (92.6%), followed by bleeding per vaginam (40.7%), while the commonest surgical management option was salpingectomy. There was no
recorded maternal death. There was mis-diagnosis in 5 (18.5%) of the women. Conclusion: Ectopic pregnancy has remained an important gynecological emergency in Nigeria. Induced abortion was the most common identified risk factor. Preventive efforts should aim at health education and liberal contraceptive utilization by women, including the prevention and treatment of post-abortal sepsis. P416 Secondary ectopic omental conjoined twin pregnancy: case report and review of literature G.A. Kassem1 , N. Al Tabash1 , B. Bader2 , D. Mohe-eldin3 . 1 Gynecology, 2 Radiology and 3 Histopathology Departments, King AbdulAziz Specialist Hospital, Taif, Saudi Arabia Objective: To describe unexpected case of secondary omental pregnancy in a patient presented with picture of ruptured tubal ectopic pregnancy. Design: Case report. Setting: Department of Gynecology and Obstetrics, King AbdulAziz Specialist Hospital, Taif, Saudi Arabia. Patient: A 27-year-old patient with secondary omental conjoined pregnancy. Intervention: Salpingectomy and partial omentectomy. Result(s): A 27-year-old woman presented with severs abdominal pain, hypotension and tachycardia. Her urine pregnancy test was positive. Emergency bedside ultrasound showed empty uterus, left adenxal mass contain alive fetus and free fluid in the peritoneal cavity. Urgent laparotomy was done. There was approximately 2000 ml of blood and blood clots filling the abdomen. About 8 weeks conjoined twin (thoracopageus) was found during removal of blood from peritoneal cavity. Left fallopian tube was torn. Placenta and membranes were attached to the free part of the omentum. An omental pregnancy was confirmed by presence of chorionic villi between fat cells of omentum. Conclusion(s): In spite of early diagnosis of ectopic pregnancy at present, some cases can present with internal hemorrhage that can threaten the life of the patient. Thorough searching of the fetus and products of conception if not found in the fallopian tube should be done. P417 The experience in the diagnosis and management of ectopic pregnancy in Taif Maternity Hospital N. Al Tabash. Gynecology Department, King AbdulAziz Specialist Hospital, Taif, Saudi Arabia Background: ectopic pregnancy is implantation of a fertilized ovum outside the uterine cavity. It is associated with sexual transmitted disease, removal of one tube and blood transfusion. It’s also increase the risk of further ectopic pregnancies, and sub-fertility secondary to tubal damage. Our aim is to review the prevalence of ectopic pregnancy, the pattern of presentation, how the diagnosis of ectopic pregnancy was reached and ways of the management in Taif Maternity Hospital. Material and Methods: Retrospective study at Taif Maternity Hospital from 1 March 2002 to 31 January 2004. During this period there are 20,000 live births. The data was collected from theatre register book during this period. All case notes for cases of confirmed ectopic pregnancy were reviewed. Results: the overall incidence of prevalence pregnancy was 5.549 per 1000 live birth in Taif Maternity Hospital. The most common age was between 20–34 years of age 58% (c2 = 23.78, p value = 0.0001). The highest incidence of ectopic pregnancy occurred inpatients were between nullipara and para three 50% (c2 = 6.96, p value = 0.05). Most of the cases presented at 8 weeks of amenorrhea. The most common symptom was abdominal pain 94%. While the most common sign was cervical excitation found in 76%.
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Conclusion: The Multicenter scoring system has proven to be more accurate in diagnosing malignant tumors even in benign tumors in cases of dermoid cysts.
General Gynecology P414 Assessment of conservative management of first trimester miscarriage in Sudanese women M. Abul Gasim1 , N. Soliman2 , A. Fazari Bashir2 Objective: To evaluate the efficacy of conservative management versus surgical management of first trimester miscarriage in Sudanese women. Methods: Prospective analytical facility based study. 216 Patients offered conservative and surgical management. Following counseling we enrolled 115 for expectant, 36 for surgical and 30 for medical management, a total of 181 drop out 35. Written consents taken, fulfillment of inclusion criteria and ethical clearance obtained. Oral antibiotics and paracetamol prescribed to all patients. Ante D if Rhesus negative given. The expectant group left the facility when pain free and bleeding settled. The medical group allowed home if no or minimal bleeding. Haemoglobin at presentation and after the study was recorded. Patient satisfaction assessed four weeks later and contraception offered. Results: 79 % had incomplete, 15.5% missed and 5.5% inevitable. 63.5% expectant management, 19.9% surgical evacuation and 16.6% given misoprostol. Complete evacuation highest in medical group 93.3% in surgical group 91.6% and in expectant group 80%. Surgical evacuation was done in 7% of expectant group. 13% of failed expectant group had complete miscarriage after misoprostol. Two cases of missed abortion needed a re-evacuation. Two in medical group had emergency curettage. One patient in surgical group blood transfused. Patient satisfaction was 85%, 60% in expectant and surgical group respectively. Conclusion: Medical management is more likely to induce complete evacuation of the uterus and reduce the need for surgical evacuation. Expectant management was accepted by the clients. A prophylactic antibiotic is important. We recommend the Manual Vacuum Aspiration and medical management in our facility. P415 Ectopic pregnancy in Nnewi, Nigeria: a 5-year study at a tertiary health care institution A. Eke, S. Mbamara, G. Eleje, J. Okonkwo, G. Udigwe, J. Ugboaja, C. Oguejiofor, I. Mbachu. Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria Objective: To determine the prevalence, predisposing factors, clinical presentations, treatment options and outcome of ectopic pregnancy in a Nigerian tertiary health care institution. Materials and Methods: The case files of all the patients who had ectopic pregnancy between 1st January, 2003 and 31st December, 2007 at Nnamdi Azikiwe University Teaching Hospital, Nnewi were reviewed retrospectively. Results: Thirty one cases of ectopic pregnancies were treated out of 2,937 deliveries and 628 gynecological admissions over this period. This gave a prevalence of 1.2%. It constituted 4.9% of all gynecological admissions. 92.6% were ruptured ectopic pregnancies. The peak age was 26–30 years. Nulliparous women constituted the largest group (63.0%). The average gestational age at presentation was 7.4 weeks. Previous induced abortions (44.4%), followed by pelvic infections (40.7%) were the commonest identified risk factors. The commonest presenting symptom was abdominal pain (92.6%), followed by bleeding per vaginam (40.7%), while the commonest surgical management option was salpingectomy. There was no
recorded maternal death. There was mis-diagnosis in 5 (18.5%) of the women. Conclusion: Ectopic pregnancy has remained an important gynecological emergency in Nigeria. Induced abortion was the most common identified risk factor. Preventive efforts should aim at health education and liberal contraceptive utilization by women, including the prevention and treatment of post-abortal sepsis. P416 Secondary ectopic omental conjoined twin pregnancy: case report and review of literature G.A. Kassem1 , N. Al Tabash1 , B. Bader2 , D. Mohe-eldin3 . 1 Gynecology, 2 Radiology and 3 Histopathology Departments, King AbdulAziz Specialist Hospital, Taif, Saudi Arabia Objective: To describe unexpected case of secondary omental pregnancy in a patient presented with picture of ruptured tubal ectopic pregnancy. Design: Case report. Setting: Department of Gynecology and Obstetrics, King AbdulAziz Specialist Hospital, Taif, Saudi Arabia. Patient: A 27-year-old patient with secondary omental conjoined pregnancy. Intervention: Salpingectomy and partial omentectomy. Result(s): A 27-year-old woman presented with severs abdominal pain, hypotension and tachycardia. Her urine pregnancy test was positive. Emergency bedside ultrasound showed empty uterus, left adenxal mass contain alive fetus and free fluid in the peritoneal cavity. Urgent laparotomy was done. There was approximately 2000 ml of blood and blood clots filling the abdomen. About 8 weeks conjoined twin (thoracopageus) was found during removal of blood from peritoneal cavity. Left fallopian tube was torn. Placenta and membranes were attached to the free part of the omentum. An omental pregnancy was confirmed by presence of chorionic villi between fat cells of omentum. Conclusion(s): In spite of early diagnosis of ectopic pregnancy at present, some cases can present with internal hemorrhage that can threaten the life of the patient. Thorough searching of the fetus and products of conception if not found in the fallopian tube should be done. P417 The experience in the diagnosis and management of ectopic pregnancy in Taif Maternity Hospital N. Al Tabash. Gynecology Department, King AbdulAziz Specialist Hospital, Taif, Saudi Arabia Background: ectopic pregnancy is implantation of a fertilized ovum outside the uterine cavity. It is associated with sexual transmitted disease, removal of one tube and blood transfusion. It’s also increase the risk of further ectopic pregnancies, and sub-fertility secondary to tubal damage. Our aim is to review the prevalence of ectopic pregnancy, the pattern of presentation, how the diagnosis of ectopic pregnancy was reached and ways of the management in Taif Maternity Hospital. Material and Methods: Retrospective study at Taif Maternity Hospital from 1 March 2002 to 31 January 2004. During this period there are 20,000 live births. The data was collected from theatre register book during this period. All case notes for cases of confirmed ectopic pregnancy were reviewed. Results: the overall incidence of prevalence pregnancy was 5.549 per 1000 live birth in Taif Maternity Hospital. The most common age was between 20–34 years of age 58% (c2 = 23.78, p value = 0.0001). The highest incidence of ectopic pregnancy occurred inpatients were between nullipara and para three 50% (c2 = 6.96, p value = 0.05). Most of the cases presented at 8 weeks of amenorrhea. The most common symptom was abdominal pain 94%. While the most common sign was cervical excitation found in 76%.