Poster Abstract Text | Résumés Des Présentations Par Affiches

POSTER ABSTRACT TEXT | RÉSUMÉS DES PRÉSENTATIONS PAR AFFICHES POSTER OBS

 P-OBS-MD-085 �����������������������������������������������BEST OF FOUR OBSTETRIC RISKS AND OUTCOMES OF REFUGEE WOMEN IN TORONTO T. Kandasamy University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada T. Kandasamy, M. Yudin, R. Shah, R. Cherniak Objectives: Women who are refugees during pregnancy may be exposed to homelessness, poor nutrition and limited access to health care, yet the pregnancy outcomes of this vulnerable population has not been systematically evaluated. We undertook a study to determine the risk of adverse obstetric and perinatal outcomes among refugee women in Toronto. Study Methods: Using a retrospective cohort design, we examined refugee and non-refugee women delivering at St. Michael’s Hospital in Toronto, between Jan. 1, 2008, and Dec. 31, 2010. The primary outcome measures were preterm delivery (< 37 weeks gestational age), low birth weight (< 2500 g) and delivery by Caesarean section. Results: We found that multiparous refugee women had a significantly higher rate of delivery by Caesarean section and a 1.5-fold increase in rate of low birth weight when compared to non-refugee women. In subgroup analysis by region of origin, women from Sub-Saharan Africa had significantly higher rates of low birth weight and Caesarean delivery when compared to non-refugee control subjects. Further, in comparison to non-refugee control subjects, refugee women had significantly increased rates of prior Caesarean section, HIV+ status, homelessness, social isolation and delays in accessing prenatal care. Conclusions: Recent changes to the Interim Federal Health Program have highlighted the importance of identifying and diminishing disparities in health outcomes between refugees and non-refugee populations. We have shown that refugee women constitute a higher-risk population with increased rates of adverse obstetric and perinatal outcomes. Our findings provide preliminary data to guide targeted public health interventions towards meetings the obstetric care needs of this vulnerable population. 

 P-OBS-MD-149 �����������������������������������������������BEST OF FOUR INTRA-CERVICAL MISOPROSTOL FOR THE MANAGEMENT OF EARLY PREGNANCY FAILURE A. Rouzi King Abdulaziz University, Obstetrics and Gynecology, University Street, Jeddah, West Region, 123456, Saudi Arabia N. Almansouri, N. Alsenani, N. Bondagji Objectives: The intra-cervical use of misoprostol has not been reported before. The aim of this study was to assess the efficacy of intra-cervical misoprostol in the management of early pregnancy failure. Study Methods: The institutional review board (IRB) approved the study. After proper counselling and obtaining written informed consent, women diagnosed to have early pregnancy failure received intra-cervical misoprostol solution. The first dose was 50 micrograms dissolved in 5 ml of normal saline. This was increased to 100 micrograms every 8 hours if necessary. The endometrial sampling catheter was used to instill the solution intracervically. Results: A total of 17 women with first trimester pregnancy failure (anembryonic gestation or missed abortion) were included in the study. Out of 17 women who participated in the study 14 (82.4%) had complete expulsion of the gestational sac and no dilatation

and curettage was performed. Eight women out of the 14 (57.1%) aborted after one dose of intracervical misoprostol and 6 women (42.9%) needed a second dose only. Three women (17.6%) had uncomplicated dilatation and curettage for incomplete abortion. The time taken from the first dose to the expulsion of the product was 9 hours ± 50 minutes, 4 hours and 15 minutes to 20 hours and 15 minutes (mean ± SD, range). One woman had shivering for 30 minutes after one dose which resolved spontaneously. No major complications were reported in the study group. Conclusions: Intracervical misoprostol treatment of early pregnancy failure is an effective method for termination of pregnancy.

 P-OBS-MD-151 ��������������������������������������������������������������������������� A CANADIAN SURVEY OF POST-GRADUATE EDUCATION IN INDIGENOUS WOMEN’S HEALTH IN OBSTETRICS AND GYNAECOLOGY N. Jumah University of Toronto, Obstetrics and Gynaecology, 92 College Street, Toronto, ON M5G 1L4, Canada D. Wilson, R. Shah Objectives: In 2005, the Royal College of Physicians and Surgeons Canada mandated the introduction of Aboriginal health education into the postgraduate curriculum. The purpose of this study is twofold: to assess Canadian Obstetrics and Gynaecology residents’ knowledge of and experience in Indigenous women’s health (IWH) including a self-assessment of competency and to assess to residency program director’s ability to provide curriculum in IWH and resources available to support this initiative. Study Methods: A resident survey and a program director survey were distributed to all accredited Obstetrics and Gynaecology residency programs in Canada. The resident survey consisted of 20 multiple choice questions and included four key areas: general knowledge regarding Canada’s Indigenous peoples; the impact of the Residential School system; clinical experience in IWH; and a self-assessment of competency in IWH. The Program Director survey included an assessment of the content of the curriculum in IWH and resources available to support this curriculum. Results: Participation included residents from nine of seventeen universities and program directors from eleven of seventeen universities. Residents have low levels of background knowledge of IWH and the determinants of health and are aware of their gap in knowledge. Residents are interested in IWH and recognize the importance of IWH training to their future practice. Program Directors indicate support for an IWH curriculum however they lack resources to provide a comprehensive IWH curriculum. Conclusions: A national curriculum initiative could be an effective way to facilitate the provision of education in IWH while decreasing the resource burden on individual programs.

 P-OBS-MD-152 ��������������������������������������������������������������������������� ACCELERATED TITRATION OF OXYTOCIN IN NULLIPAROUS PATIENTS WITH LABOUR DYSTOCIA: A PILOT STUDY (ACTION) J. Dy OMNI Research Group, Ottawa Hospital Research Institute; Department of Obstetrics, Gynaecology and Newborn Care, The Ottawa Hospital; Faculty of Medicine, University of Ottawa, 501 Smyth Road, Box 241, Ottawa, ON K1H 8L6, Canada J. Rainey, M. Walker, W. Fraser, G. Smith, R. Rennicks White, P. Waddell, S. Wei

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Objectives: Our ultimate objective is to examine whether an ‘accelerated oxytocin titration (AOT)’ protocol reduces Caesarean section risk relative to a ‘gradual oxytocin titration (GOT)’ protocol in nulliparous women diagnosed with dystocia in the first stage of labour. The primary objectives of this pilot study are to examine feasibility and acceptability of the protocol. The secondary objectives are to obtain data on the indicators of efficacy and safety.

 P-OBS-MFM-MD-014 �����������������������������������������������������������������

Study Methods: This pilot study is a double-blind, parallel group randomized controlled trial. 180 women will be randomized in 3 Canadian centres. Term nulliparous women in spontaneous labour are screened and recruited from 9 am to 5 pm, Monday to Friday. Once consent is obtained and the diagnosis of dystocia is confirmed, the participant is randomized in a 1:1 ratio, to receive either GOT (initial dose 2 mU/min) or AOT (initial dose 4 mU/min). Intent-to-treat analyses will be applied.

Objectives: To evaluate the effects of extreme obesity (prepregnancy BMI at least 50.00 kg/m2) in pregnancy on maternal and perinatal outcomes.

Results: From May 1, 2012 to December 31, 2012, a total of 3 989 births were recorded, of which 1 058 met initial screening criteria. 172 women were approached, of which 65 (37.8%) consented and 40 (23.2%) were randomized. Among the women randomized, there were 32 spontaneous vaginal births, 4 operative/instrumental deliveries, and 4 Caesarean sections (10%). There were no significant safety concerns related to the study protocol. Conclusions: Preliminary results show that recruitment limited to daytime hours during the week is feasible; however, numbers may increase if recruitment occurred 24 hours a day. Recruitment is ongoing and results of this study will provide reliable data for preparing a larger, multicentre trial.

 P-OBS-MD-158 ����������������������������������������������������������������������������� OXIDATIVE STRESS AND ANTIOXIDANT STATUS OF PREGNANT RURAL WOMEN IN NORTH-WEST NIGERIA: PROSPECTIVE COHORT STUDY E. Ugwa SOGC, 780 Echo Drive, Ottawa, ON K1S 5R7, Canada Objectives: This research was undertaken to determine the oxidative stress and antioxidant status of pregnant northern Nigerian women.

MATERNAL AND PERINATAL OUTCOMES OF EXTREME OBESITY IN PREGNANCY (BMI AT LEAST 50.00 KG/M2) J. Crane Memorial University of Newfoundland, Obstetrics and Gynaecology, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6, Canada P. Murphy, L. Burrage, D. Hutchens

Study Methods: A population-based cohort study using the Newfoundland and Labrador Perinatal Database evaluated obstetric outcomes in women with singleton gestations giving birth January 1, 2002, to December 31, 2011, comparing women with extreme obesity to those with a normal BMI (prepregnancy BMI 18.50–24.99 kg/m2). Outcomes of interest included maternal and perinatal outcomes. A composite morbidity outcome was developed including at least one of Caesarean section (CS), gestational hypertension, birth weight (BW) at least 4000 g, BW less than 2500 g, or NICU admission. Univariate analyses and multivariate logistic regression analyses (controlling for maternal age, parity, smoking, partner status and gestational age) were performed and adjusted odds ratios (AORs) and 95% confidence intervals (CI) were calculated. Results: A total of 5788 women were included in the study: 71 with extreme obesity and 5 717 with normal BMI. Approximately 6/1000 women giving birth in our population had extreme obesity. These women were more likely to have gestational hypertension (19.7% vs. 4.8%) (AOR 1.56, 95% CI 1.33 to 1.82), gestational diabetes (21.1% vs. 1.5%) (AOR 2.04, 95% CI 1.74 to 2.38), shoulder dystocia (7.1% vs. 1.4%) (AOR 1.51, 95% CI 1.05 to 2.19), CS (60.6% vs. 25.0%) (AOR 1.46, 95% CI 1.29 to 1.65), length of hospital stay > 5 days (excluding CS) (14.3% vs. 4.7%) (AOR 1.42, 95% CI 1.07 to 1.89), BW at least 4000 g (38.0% vs. 11.9%) (AOR 1.58, 95% CI 1.38 to 1.80), BW at least 4500 g (16.9% vs. 2.1%) (AOR 1.87, 95% CI 1.57 to 2.23), neonatal metabolic abnormality (8.5% vs. 2.0%) (AOR 1.50, 95% CI 1.20 to 1.86), NICU admission (16.9% vs. 7.8%) (AOR 1.28, 95% CI 1.07 to 1.52), stillbirth (1.4% vs. 0.2%) (AOR 1.68, 95% CI 1.00 to 2.82) and composite adverse outcome (81.7% vs. 41.5%) (AOR 1.57, 95% CI 1.35 to 1.83).

Study Methods: This was a prospective cohort study done at General Hospital, Dawakin Kudu LGA, Kano, Nigeria. Kano has a population of 9.2 million and predominantly Muslims. Two hundred consecutive women presenting for antenatal care and 100 apparently normal control subjects. Ethical approval was obtained. Sociodemographic and clinical information were obtained via interviewer-administered questionnaires from 200 consecutive pregnant women who presented for antenatal care. Serum levels of Vitamins A, C, E and malondialdehyde were determined. Data was analyzed with SPSS version 16.0 statistical software. Descriptive statistics was used. Means were compared using analysis of variance (ANOVA). Associations between trimesters and oxidative stress/ antioxidant status were tested using chi-square test and P < 0.05 was considered statistically significant.

Conclusions: Women with extreme obesity have increased risks of a variety of adverse maternal and perinatal outcomes. It is important preconceptually to address these risks with such women and encourage a healthy BMI prior to pregnancy.

Results: The mean serum vitamin A, E and C levels were 13.39 ± 9.44 µg/dL, 0.35 ± 0.51 mg/dL and 5.99 ± 3.95 µ/dL irrespectively (below normal limits).The prevalence of vitamins A, C, and E deficiency were 65.5%, 79.5% and 51%, respectively. Themean serum levels of malondialdehyde was 4.04 + 0.91 nmol/L (pregnant) and 1.84 + 0.40 nmol/L (non-pregnant) (P = 0.001). There was strong negative correlation between serum levels of malondialdehyde and vitamins A, C and E.

Objectives: Women with a history of preeclampsia are at higher risk of future cardiovascular disease (CVD). The degree to which this is mediated by atherosclerosis is less understood, especially remote from pregnancy. We assessed subclinical atherosclerosis using carotid intima-media thickness (CIMT) among women with and without a remote history of preeclampsia. Secondarily we contrasted cardiovascular risk factors and electrocardiograms (ECG).

Conclusions: Vitamins A, C, E deficiency and oxidative stress is a problem among Northern Nigeria Pregnant women, therefore the value of antioxidant vitamin supplementation should be explored.

Study Methods: We performed a nested cohort study comprising 109 women with a remote history of preeclampsia 1:2 matched to 218 women with uncomplicated pregnancies. A median of 20

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 P-OBS-MFM-MD-053 ���������������������������������� BEST OF FOUR MEASURES OF CARDIOVASCULAR RISK AND SUBCLINICAL ATHEROSCLEROSIS IN A COHORT OF WOMEN WITH A REMOTE HISTORY OF PREECLAMPSIA S. McDonald McMaster University, Obstetrics and Gynaecology, Division of Maternal/ Fetal Medicine, 1280 Main Street West, Hamilton, ON L8V 5C2, Canada J. Ray, K. Teo, H. Jung, O. Salehian, S. Yusuf, E. Lonn

Poster Abstract Text | Résumés des présentations par affiches

years after the index pregnancy, we measured blood pressure, height, weight, waist and hip circumference, and performed an oral glucose tolerance test (OGTT), fasting lipids, ECG, albumin:creatinine ratio and CIMT. Results: While women with and without preeclampsia had similar family histories of CVD, those with preeclampsia had a higher rate of chronic hypertension (32% versus 10%, P < 0.0001), greater waist (P = 0.008) and hip circumferences (P = 0.001) but no differences in OGTT, lipids or albumin:creatinine ratio. Average maximum CIMT was similar among those with vs. without preeclampsia (0.831 mm vs. 0.817, P = 0.38), and preeclampsia was not a significant predictor of CIMT in multiple regression (P = 0.63), despite more ECGs compatible with coronary disease. Conclusions: Two decades after birth, women with a remote history of preeclampsia had more CVD risk factors than women with unaffected pregnancies, but this was not reflected in a difference in CIMT. The higher CVD may be from non-atherosclerotic processes or CIMT may not be a good screen in this high-risk population.

 P-OBS-PS-MD-056 ���������������������������������������� BEST OF FOUR THE IMPACT OF MOREOB ON MATERNAL HEALTH OUTCOMES D. Vlahaki McMaster University, Department of Emergency Medicine, Hamilton General Hospital, 237 Barton Street East, McMaster Clinic, 2nd Floor, Hamilton, ON L8L 2X2, Canada J. Milne Objectives: To determine the change in maternal perinatal health outcomes after the implementation of the Managing Obstetrical Risk Efficiently (MOREOB) patient safety program in Canadian obstetric units. Study Methods: The MOREOB program consists of three Learning Modules, each approximately 12 months in length. The rates of key obstetric outcomes were collected from participating MOREOB hospitals after the completion of each Learning Module using a standard reporting instrument. The outcomes included the rate of Caesarean sections, operative vaginal deliveries, patients receiving a blood transfusion, postpartum hemorrhage, labours with an undiagnosed breech and maternal deaths. Paired t tests were used to identify significant (P < 0.05) differences in the mean outcome rate between Module 1 and 3. Results: Data was obtained from 230 Canadian hospitals participating in the MOREOB program from 2002 to 2011, representing 499 747 births. There was a decreased rate of operative vaginal deliveries (8.92% to 7.51%), patients receiving a blood transfusion (2.22% to 0.65%), postpartum hemorrhage (7.84% to 4.53%), labours with an undiagnosed breech (0.44% to 0.17%) and maternal deaths (0.006% to 0.002%). The decreased rates of operative vaginal deliveries and labours with an undiagnosed breech were statistically significant (P < 0.05). The rate of Caesarean sections increased, but was not significant (21.74% to 22.88%). Conclusions: The implementation of the MOREOB program may lead to improved maternal perinatal outcomes. Future research should adopt a prospective study design controlling for potential confounding factors to validate these findings.

 P-OBS-PS-MD-057 ���������������������������������������������������������������������� IMPLEMENTATION OF THE MOREOB PROGRAM LEADS TO FEWER NICU ADMISSIONS D. Vlahaki McMaster University, Department of Emergency Medicine, Hamilton General Hospital, 237 Barton Street East, McMaster Clinic, 2nd Floor, Hamilton, ON L8L 2X2, Canada J. Milne

Objectives: To measure the change in rate of Neonatal Intensive Care Unit (NICU) and Special Care Nursery (SCN) admissions after the implementation of the Managing Obstetrical Risk Efficiently (MOREOB) patient safety program in Canadian obstetric units. Study Methods: The MOREOB program consists of three Learning Modules, each approximately 12 months long. The NICU admission rates for participating MOREOB hospitals were collected after each Learning Module using a standard reporting instrument. The rate of NICU admissions after an elective induction or elective Caesarean section, NICU admissions for Group B Streptococcal sepsis and admissions to the SCN were collected. Significant (P < 0.05) differences in the mean admission rates for hospitals between Module 1 and 3 were identified using paired t tests. Results: Data was obtained from 230 Canadian hospitals participating in the MOREOB program from 2002 to 2011, representing 499 747 births. From Module 1 to 3 there was a decreased rate of NICU admissions after elective induction (1.36% to 0.93%), NICU admissions after elective Caesarean sections (0.08% to 0.03%) and SCN admissions (12.86% to 10.09%). The decrease in rate of NICU admissions after an elective induction was statistically significant (P < 0.05). An increase in NICU admissions for Group B Streptococcal sepsis was found (0.13% to 0.63%) but was not significant. Conclusions: Implementation of the MOREOB patient safety program may lead to decreased rates of NICU and SCN admissions in participating hospitals.

POSTER GYN

 P-GYN-IWH-PHD-048 �������������������������������������������������������������� TREATMENT OF MAJOR DEPRESSIVE DISORDER WITH DESVENLAFAXINE 50 MG/D IN PERIMENOPAUSAL AND POSTMENOPAUSAL WOMEN M. Boucher Pfizer Canada Inc., Medical Affairs, Primary Care Business Unit, 17300 Trans-Canada Highway, Kirkland, QC H9J 2M5, Canada S. Kornstein, A. Clayton, D. Bao, C. Guico-Pabia Objectives: To evaluate short-term efficacy of desvenlafaxine 50 mg/d (administered as desvenlafaxine succinate) in perimenopausal vs postmenopausal women treated for major depressive disorder (MDD). Study Methods: Perimenopausal and postmenopausal women (aged 40–70) with MDD were randomly assigned to receive placebo or desvenlafaxine 50 mg/d in a 10-week, multicentre, doubleblind, placebo-controlled trial. Reduction from baseline in 17-item Hamilton Rating Scale for Depression (HRSD-17) total score at week 8 was assessed for perimenopausal and postmenopausal groups separately, using analysis of covariance with treatment, region, and baseline in the model. Effect of menopausal status was examined subsequently in the total population by adding the treatment by menopausal status interaction to the model. Results: Data from 426 patients (desvenlafaxine, n = 216; placebo, n = 210) were analyzed. At baseline, 32% of patients were perimenopausal; 68% were postmenopausal. Significant reductions in HRSD-17 total scores for desvenlafaxine 50 mg/d vs. placebo were observed in both perimenopausal (−10.0 vs. −7.1; P = 0.008) and postmenopausal (−9.9 vs. −8.0; P = 0.015) women at week 8, with no significant treatment by menopausal status interaction. Perimenopausal desvenlafaxine-treated patients achieved significant functional improvement compared with placebo based on week 8 Sheehan Disability Scale (SDS) scores (−9.3 vs. −5.1; P < 0.001). The drug-placebo difference (−8.8 vs. −8.1) on SDS was not significant in postmenopausal women, and

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the treatment by menopausal status interaction was significant (P < 0.05). Conclusions: Desvenlafaxine 50 mg/d effectively reduced symptoms of depression in both perimenopausal and postmenopausal women. Placebo response on functional outcomes was lower in perimenopausal women.

 P-GYN-MD-052 �������������������������������������������� BEST OF FOUR EXPANSION OF CUTANEOUS ALLODYNIA IN WOMEN WITH CHRONIC PELVIC PAIN J. Jarrell University of Calgary, Obstetrics and Gynaecology, 1403 29th St NW, Calgary, AB T2N 2T9, Canada L. Arendt-Nielsen, M. Nasr-Esfahani Objectives: To study expansion of cutaneous allodynia (CA) on the abdomen of women with chronic pelvic pain Study Methods: A group of 13 women with visceral chronic pelvic pain in a test–retest reliability study of the cotton tipped applicator test had their abdominal photographs compared for the relative size of each area of CA. A second similar group of 12 women underwent the same test, had the line of demarcation marked and had the test immediately repeated. Assessment of points of tenderness was then undertaken. Results: In the test- retest group, the second image was significantly larger than the first image in a dermatomal pattern and 68% of women reported an increase in pain. In the second cohort, there was a change in the line of demarcation within 1–2 minutes. The line of demarcation extended upward on the abdomen in a dermatomal pattern. Tender points between the lines were identified as corresponding to the anterior spinal nerves as they course through the rectus abdominus fascia. Conclusions: This test for allodynia is sufficient to cause rapid expansion of the area of pain and an increase in pain experience. The expansion appears dermatomal from both the image analysis and the laddering pattern on the abdomen. This test may represent a segmental shift in spinal sensitivity and an important and sensitive biomarker for the assessment of the improvement/ deterioration of treatment for chronic pelvic pain.

P-GYN-MD-145 �������������������������������������������������� BEST OF FOUR PREVALENCE OF GENITAL WARTS IN THE UNITED ARAB EMIRATES AND THE KINGDOM OF SAUDI ARABIA K. Sait King Abdulaziz University, Department of Obstetrics and Gynecology, Gynecology Oncology Unit, University Street, Jeddah, West Region, 123456, Saudi Arabia E. Sagr, A. Saad Objectives: The aim of this study was to estimate the prevalence of genital warts (GW) in physician practices in three emirates in the United Arab Emirates (UAE) and in Saudi Arabia (KSA). Study Methods: Physicians in 6 private and 6 public institutions located in Dubai, Sharjah, and Al Ain prospectively recorded daily logs of patients (N = 4212) for a 2-week period to estimate prevalence of GW between October 2011 and March 2012. In KSA, 56 physicians from 9 public institutions also completed daily logs of patients (N = 5728) for a two-week period between December 2011 to May 2012. Age, gender and GW diagnosis status of each patient was recorded in the daily logs. Prevalence was obtained. Results: Overall prevalence of GW in our study population in UAE was 0.0126 (95% CI 0.0075 to 0.0178) and 0.0102 (95% CI 0.0067 to 0.0137) in KSA for patients age 18–60 years. In UAE, the unweighted prevalence estimate in PCP practices was 0.01 (95% CI 0.0051 to 0.0149), 0.019 (95% CI 0.0126 to 0.0254) in OBGYN practices, and 0.0373 (95% CI 0.0204 to 0.0543) in DERM practices. In KSA, the unweighted prevalence estimate in PCP

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practices was 0.0062 (95% CI 0.0034 to 0.0091), 0.0235 (95% CI 0.0163 to 0.0307) in OBGYN practices, 0.0053 (95% CI 0 to 0.0114) in URO practices, and 0.0124 (95% CI 0.0033 to 0.0215) in DERM practices. In females, prevalence was 0.0086 (95% CI 0.0039 to 0.0134) in UAE and 0.0121 (95% CI 0.0077 to 0.0164) in KSA. Conclusions: The study sample population GW is prevalent in physician practices in UAE and KSA.

 P-GYN-MD-155 ��������������������������������������������������������������������������� HEALTH PROFESSIONAL STUDENTS IMPROVE IN INTERPROFESSIONAL COMPETENCIES WHILE CREATING FAMILY PLANNING LEARNING TOOLS W. Norman University of British Columbia, Department of Family Practice, #3306 David Strangway Building; 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada E. Wong, J. Soon, J. Leslie Objectives: This study aimed to assess temporal changes in interprofessional attitudes and competencies among health care students over an 8-week family planning virtual patient creation summer project. Study Methods: This study engaged pre-licensure students in medicine, pharmacy, nursing, midwifery, and counselling psychology participating in an interdisciplinary summer project. A self-assessment questionnaire combined three frameworks for assessing professional attitudes and competencies in interprofessional learners: Canadian Medical Education Determinants (CanMEDS), Canadian Interprofessional Health Collaborative (CIHC), and Memorial University Interprofessional Attitudes (IPA). Students completed the questionnaires before and after the project, and post-project reflective essays and individual interviews to understand and explore findings from the questionnaires. Results: Over three summers 26 students participated. The themes of “communication and respect as key to team functioning”; “importance of role clarification”; and “existence of inherent challenges to interprofessional collaboration” were most valued. The CanMEDS roles of health advocate, manager, and medical expert, and the CIHC domains of interprofessional communication, role clarification, team functioning, and collaborative leadership increased significantly from baseline. Participants reported greatest improvement in the CIHC domains of interprofessional communication, team functioning, and role clarification. Conclusions: Positive effects were demonstrated upon collaboration and a range of professional competencies as a result of participation in an interprofessional family planning project. A high level of consistency between the questionnaire results and the content of the interviews and reflective essays was demonstrated. With an increasing emphasis on the importance of interprofessional education and collaboration, the measurement tool presented could be useful to assess development of interprofessional attitudes and competencies among health care students.

 P-GYN-ONCOL-MD-150 ��������������������������� BEST OF FOUR BRAIN METASTASES IN EPITHELIAL OVARIAN CANCER—MULTIMODAL TREATMENT INCLUDING SURGERY OR GAMMA-KNIFE RADIATION IS ASSOCIATED WITH PROLONGED SURVIVAL M. Delisle McGill, Gynaecology Oncology, 44 rue ursino, Blainville, QC J7B 1V8, Canada J. Press Objectives: Explore impact of treatment modality on survival in patients with brain metastases from epithelium ovarian cancer.

Poster Abstract Text | Résumés des présentations par affiches

Study Methods: Retrospective review of ovarian cancer with brain metastases treated at 3 institutions from different continents (Canada, China, India). Combined with search for studies regarding brain metastases in ovarian cancer reporting survival related to treatment modality. Survival was analyzed according to treatment regimens involving: (1) some form of surgical excision or gammaknife radiation with or without other modalities, (2) other modalities WITHOUT surgery or gamma-knife radiation or (3) palliation only. Results: Twelve patients with detailed treatment/outcome data were included, with mean age 56, including 5 from China, 4 from Canada, and 3 from India. Time from diagnosis of ovarian cancer to brain metastasis was 19 months (10–37 months), and overall survival from diagnosis of ovarian cancer was 37 months (13–82 months). Survival from diagnosis of brain metastasis was 16 months (1–45 months). Among patients who had multimodal treatment including gamma-knife radiotherapy or surgical excision, the survival after the onset of brain metastasis was 24.6 months compared to the 3.8 months in patients whose treatment did not include this type of focused localized modality (P = 0.005). Analysis of 20 studies in the literature also indicated that use of gamma-knife radiotherapy and excisional surgery in multi-modal treatment resulted in improved survival interval (25 vs. 6.0 months, P = 0.0001). Conclusions: Prolonged survival may be obtained in subset of patients with brain metastases from ovarian cancer using multidisciplinary therapy, particularly if metastases are amenable to localized treatments such as gamma-knife radiotherapy and surgical excision.

 P-GYN-PHD-090 ����������������������������������������� BEST OF FOUR GYNECOLOGIC SAFETY OF BAZEDOXIFENE/ CONJUGATED ESTROGENS: POOLED ANALYSIS OF PHASE 3 TRIALS M. Boucher Pfizer Canada Inc., Medical Affairs, Primary Care Business Unit, 17300 Trans-Canada Highway, Kirkland, QC H9J 2M5, Canada D. Archer, J. Pinkerton, R. Kagan, K. Ryan, J. Thompson, J. Pickar, S. Mirkin Objectives: Bazedoxifene (BZA)/conjugated estrogens (CE) is in development for the treatment of menopausal symptoms and prevention of postmenopausal osteoporosis. Gynaecologic safety of BZA/CE was assessed using pooled data from the Selective estrogens, Menopause, And Response to Therapy (SMART) trials. Study Methods: Data for BZA 20 mg/CE 0.45 and 0.625 mg and placebo (PBO) were from the SMART-1 through SMART-5 trials (N = 7271). Gynaecologic safety was evaluated by pelvic examination, Papanicolaou smear, endometrial biopsy, transvaginal ultrasound (TVU), mammogram, and adverse event (AE) reporting. Results: Incidences of endometrial hyperplasia AEs were low and similar for BZA 20 mg/CE 0.45 and 0.625 mg (n = 2 [0.2%] and n = 4 [0.3%], respectively) and PBO (n = 2 [0.2%]). There were no reports of endometrial cancer with BZA 20 mg/CE 0.625 mg or PBO and 1 case with BZA 20 mg/CE 0.45 mg. Incidences of endometrial polyps (benign asymptomatic) for BZA 20 mg/CE 0.45 and 0.625 mg and PBO were 1.8%, 1.0%, and 0.5%, respectively. Mean increases in endometrial thickness, measured by TVU, were < 1 mm with both BZA/CE doses. Both BZA/CE doses showed high rates of 1-year cumulative amenorrhea (> 83%) with low rates of bleeding/spotting (< 10%), similar to PBO. There were no reports of ovarian cancer, and breast cancer rates were similar across groups. Rates of breast pain/tenderness and effects on breast density were also similar to PBO. Conclusions: Pooled phase 3 data showed that BZA/CE was associated with an acceptable gynecologic safety profile, adequate endometrial protection, and no evidence of breast stimulation in postmenopausal women with a uterus.

 P-GYN-UROGYN-PhD-159 ����������������������������������������������������� STRATEGIES TO OPTIMIZE RECRUITMENT AND RETENTION IN UROGYNAECOLOGY TRIALS: TOWARDS AN ALBERTA APPROACH S. Ross University of Alberta, Department of Obstetrics and Gynaecology, 5S131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada L. Dederer, G. Harrison Objectives: Follow-up of patients in urogynaecology research studies is notoriously difficult: women are reluctant to join studies with onerous investigations and follow-up. The urogynaecology research groups in Calgary and Edmonton have recently started working more closely. We decided to explore the best-practice recruitment and follow-up strategies that exist in the two groups to find a unified approach that can be applied in both centres. Study Methods: We independently explored potential problems with subject recruitment and follow-up, and identified mitigating strategies. Together we identified best practices and developed a single strategy designed to optimize recruitment and retention. Results: RECRUITMENT PROBLEMS/STUDY NURSE SOLUTIONS Lack of staff and clinician commitment/Education and reinforcement. Inappropriate patient recruitment/Careful screening. Lack of patient understanding/Clear description of study commitments and open communication. RETENTION PROBLEMS/STUDY NURSE SOLUTIONS Lost to follow-up/ Obtain full contact information at baseline. Missed appointments/ Flexibility with appointments and reminders. Unwilling to attend follow-up/Explain all study expectations, easy access to study nurse for concerns or questions. Lack of continuity with study staff/ One study nurse for all concerns and logistics. Conclusions: Our analysis of the problems associated with study recruitment and retention identified that the role of the study nurse was crucial in ensuring study success. We found that our approaches to recruitment and retention were quite similar, stressing the role of clear and open communication led to outstanding follow-up. We have consolidated our strategies in a single document that can address the needs of both our research groups and will provide the basis for training new research staff.

POSTER OBS-JM

 P-OBS-JM-007 ������������������������������������������������ BEST OF FOUR BREASTFEEDING DURING RESIDENCY: A REVIEW OF THE PROBLEM AND THE SOLUTIONS J. Sabourin University of Alberta, Department of Obstetrics and Gynaecology, 5S131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9, Canada C. Flood Objectives: The World Health Organization classifies suboptimal breastfeeding as a leading cause of premature mortality, disability and loss of health. The Healthy People 2020 initiative has prioritized increasing breastfeeding rates as a science-based objective for improving the health of Americans. Female medical residents and physicians have been newly identified as a high-risk group for suboptimal breastfeeding. The purpose of this review is to describe the breastfeeding rates of medical residents, the magnitude of this problem, their barriers to breastfeeding and useful interventions in this specific population. Study Methods: A literature search was conducted using PubMed, Scopus and Web of Science up to July 2012. Articles relating

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to physicians and/or medical residents and breastfeeding were reviewed and summarized. Results: Although breastfeeding initiation is very common for female residents, the continuation rate may be as low as 8% at 12 months. The literature suggests that these women are unable to reach their personal breastfeeding goals due to workplace and occupational factors. Residency training sites often lack the policies and setup to facilitate breastfeeding for their trainees. Furthermore, it appears breastfeeding education, although effective, is not a priority in most programs. Many interventions have been suggested for this high-risk group, but few have been studied. Conclusions: Female medical residents have low rates of breastfeeding continuation due to work-related factors. Although workplace interventions have been suggested and improving breastfeeding rates in female residents will provide short and long-term health benefits for them, their infants and also their patients, few have been studied.

 P-OBS-JM-013 ������������������������������������������������������������������������������� OUTCOMES OF HIV-EXPOSED UNINFECTED INFANTS REQUIRING NICU ADMISSION: A 10-YEAR RETROSPECTIVE REVIEW E. Taerk University of Toronto, Department of Obstetrics and Gynaecology, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada D. Campbell, D. Caprara, M. Yudin Objectives: The highly effective nature of antiretroviral therapy (ART) and resulting reduction in the vertical transmission of HIV has given rise to an increasing number of HIV-positive pregnant women with HIV-exposed, uninfected (HEU) infants. These children represent a unique clinical population but limited research exists to properly describe their neonatal outcomes. The objective of this study was to describe the neonatal outcomes of HEU infants born over a 10-year period within a large urban Canadian hospital, with a focus on those admitted to the neonatal intensive care unit (NICU). Study Methods: A retrospective chart review, focusing on immediate neonatal outcomes, was performed of all neonates (n = 131) born to HIV-positive women at one Toronto teaching hospital between 2000 and 2011.

Objectives: Congenital heart disease is one of the most common structural fetal abnormalities, and a major contributor to perinatal morbidity and mortality. Fetal echocardiography aids in diagnosing congenital heart disease, allowing for management planning including delivery location and pregnancy continuation. Planning delivery location is essential, as certain cardiac anomalies require neonatal surgery, and neonatal transport entails risks, costs, and parental stress. This study, the first of its kind in Canada, examines the pregnancy outcomes of fetal cardiac anomalies diagnosed through a single tertiary care centre. Study Methods: Cardiac anomalies diagnosed following fetal echocardiography were captured during the five-year study period from 2005–2009. Diagnosis, pregnancy outcome, delivery location and surgical management information was collected. This data was analyzed retrospectively. Results: 120 fetal echocardiography studies demonstrated anomalies. 32 babies delivered at the quaternary centre with pediatric cardiac surgery services and 20 underwent cardiac surgery. 5 babies born at the tertiary centre were transferred to the quaternary centre. Of all live births, only 2.2% (2/89) required emergency transfer. There were 9 neonatal deaths of the 57 live-born babies at the tertiary centre. 22.5% (27/120) underwent pregnancy termination. Conclusions: Fetal echocardiography contributes significantly to the management of fetal congenital heart disease, making efficient use of pediatric cardiac services with minimal need for neonatal transfer, and keeping delivery close to a family’s community when possible. The termination rate is less than or similar to the majority of previously reported audits. Contemporary use of fetal echocardiography and interactive family counselling allows for optimized delivery location and low termination rates.

 P-OBS-JM-077 ������������������������������������������������ BEST OF FOUR THE ROLE OF SONOGRAPHY IN LABOUR INDUCTION: A REVIEW J. Papillon-Smith McGill University, Obstetrics and Gynecology, 687 Pine Avenue West, Montreal, QC H3A 1A1, Canada H. Abenhaim

Results: Of the 131 HEU infants born during the study period, 23% required admission to the NICU. The overall NICU admission rate at our institution is currently 9%. The most common reasons for admission were respiratory distress/support and preterm birth. Among those admitted, 50% of infants were born preterm. The mean birth weight was 2989 grams. 53% of neonates required some ventilatory support, and 25% required intubation. 53% of admitted neonates required triple ART.

Objectives: Induction of labour (IOL) at term is one of the most common obstetrical interventions. Given the risks associated with IOL, there has been a growing need for a model that guides in its planning and that accurately predicts its likelihood of success. Traditionally, inducibility was determined using Bishop pelvic scoring system. However, the Bishop Score is criticized for its subjectivity and inaccuracy. Sonography, a more objective and reproducible exam, has thus been evaluated in its ability to assess the cervix prior to IOL. The purpose of this study is to review the literature examining the role of ultrasound in IOL.

Conclusions: HEU neonates born at our centre required more frequent admission to the NICU than unexposed infants. Most of these infants were born to highly compliant mothers with well-controlled HIV. It is unclear whether these differences in neonatal outcomes are secondary to ART exposure in utero, fetal development within a potentially immunocompromised maternal environment, or exposure to even minute levels of HIV.

Study Methods: Databases including Ovid, PubMed, Web of Science, Google Scholar and UpToDate were searched for pertinent articles. The current guidelines from the SOGC, the ACOG, the RCOG and the RANZCOG were reviewed. Prospective observational studies, randomized controlled trials, and systematic reviews published prior to October 2012 were favoured.

 P-OBS-JM-072 ������������������������������������������������������������������������������� CONTEMPORARY FETAL ECHOCARDIOGRAPHY FACILITATES OPTIMAL DELIVERY SITE AND A LOW TERMINATION RATE A. Berndl McMaster University, Obstetrics and Gynaecology, Division of Maternal/ Fetal Medicine, 1280 Main Street West, Hamilton, ON L8V 5C2, Canada K. Pearce, T. Mondal

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Results: Overall, the evidence suggests that cervical sonography could contribute to predicting the success of IOL. However, studies have not consistently demonstrated its superiority to the Bishop Score, and perhaps a more comprehensive method integrating both sonography and digital exam is more appropriate. Although its predictive value for IOL still remains unclear, the evidence indicates that sonography could be useful in planning IOL; significantly reducing the need for cervical ripening agents. Conclusions: Given that models designed to predict the outcome of IOL have thus far been unsuccessful, using ultrasound to plan IOL may, in fact, be a more realistic and clinically relevant goal.

Poster Abstract Text | Résumés des présentations par affiches

 P-OBS-JM-104 ������������������������������������������������ BEST OF FOUR PREGNANCY OUTCOMES FOLLOWING SEVERE OVARIAN HYPERSTIMULATION SYNDROME (OHSS) M. Chow University of Calgary, Obstetrics and Gynaecology, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada S. Foong Objectives: Ovarian hyperstimulation syndrome (OHSS) is a complication of ovulation induction during the process of assisted conception. Severe OHSS is characterized by clinical ascites, oliguria, hemoconcentration and hypoproteinemia. This study focuses on the maternal and fetal outcomes following cases of severe OHSS. Study Methods: A retrospective cohort study was conducted on 44 patients diagnosed with severe OHSS undergoing treatment with the Calgary Regional Fertility Program between 2007 and 2011. A chart review was conducted and patients were also contacted by phone. Data was collected on pregnancy outcomes including plurality, live births, miscarriages, maternal/fetal complications, gestational age at delivery and birth weight. Results: 84% of patients received embryo transfers with an overall pregnancy rate of 95%. There were 31 live births (48% multiples). The early spontaneous loss rate was 9%. Of the maternal complications, there was one case each of the following: subclavian clot, seizure, thrombocytosis, and exacerbation of pre-existing Grave disease, Type II diabetes and essential hypertension. Antenatal complications included GHTN (16%), GDM (6%), IUGR (6%), oligohydramnios (3%), PPROM (19%), PTL (16%), APH (42%), and placenta previa (10%). The majority of deliveries was via Caesarean section (68%). 35% delivered preterm and 40% of babies weighed less than 2500 g at birth. Conclusions: As compared to the pregnancy outcomes of historical control subjects undergoing in vitro fertilization without OHSS, there were no significant differences in the patients who had developed severe OHSS in Calgary, although this study was small. OHSS may be associated with increased pregnancy rates, but has a minimal impact on maternal and fetal complications.

 P-OBS-JM-109 ������������������������������������������������ BEST OF FOUR ACCESS TO TERMINATION OF PREGNANCY FOR FETAL ANOMALIES IN ONTARIO J. Qin University of Toronto, Department of Obstetrics and Gynaecology, 92 College Street, Toronto, ON M5G 1L4, Canada M. Farrugia, K. Chong Objectives: To examine referral and accessibility patterns for termination of pregnancy for diagnosed fetal anomalies in Ontario, particularly how they differ between medical and surgical abortions, and between different regions of the province. Study Methods: We identified 18 genetic centres involved in prenatal diagnostics in Ontario. A survey consisting of both closed and open-ended questions was sent to a genetics counsellor at each of these centres. Results: Thirteen genetic centres responded to the survey—9 from southern Ontario, and 4 from northern Ontario. Counselling and referrals for terminating pregnancies with fetal anomalies were provided by genetic counsellors (7/13), geneticists (7/13), obstetricians (3/13), maternal fetal medicine specialists (3/13), or genetics nurses (2/13). Medical abortions were more likely than surgical abortions for patients at 5 centres, equally likely at 2 centres, and less likely than surgical abortions at 2 centres. Surgical abortions were only available locally at 6 major centres in southern Ontario. Three out of four northern Ontario centres had no local access to medical or surgical terminations of pregnancy. The most commonly cited barriers to accessing abortion services

were gestational age (7/13), wait time (5/13), distance (5/13), and cost of travel (3/13). Conclusions: Women living in more remote areas of the province must travel to major cities in southern Ontario for second trimester medical or surgical abortions for diagnosed fetal anomalies. Gestational age, wait time, distance and cost of travel are common barriers to accessing these services. Reducing these barriers can help to optimize care for this patient population.

POSTER GYN-JM

 P-GYN-JM-043 ���������������������������������������������� BEST OF FOUR ANCHOR MIGRATION IN A SINGLE INCISION ANTERIOR PROLAPSE REPAIR SYSTEM: PROSPECTIVE COHORT STUDY WITH SIX-MONTH MRI FOLLOW-UP E. Brennand Department of Obstetrics and Gynaecology, University of Calgary, Foothills Medical Centre, 4th Floor, North Tower 1441 29th Street NW, Calgary, AB T2N 4J8, Canada D. Bhayana, C. Birch, M. Murphy, S. Ross, M. Robert Objectives: To determine if anchor tips of a single incision anterior vaginal prolapse repair kit migrate from original insertion after 6-months post-surgery. Study Methods: Prospective cohort of 10 women (20 insertions). MRIs occurred < 48 hours after surgery and six months later. MRIs traced the mesh anchors by fidicual markers. Insertions were grouped by whether anchor tip was inserted into the sacrospinous ligament or another structure. Distances were measured from tip of the ischial spine. Median amount of change was compared between these groups by unpaired t test. Results: Anchor tips were located in sacrospinous ligaments for 10 of 20 insertions. Measured change in location was lower for anchors that initially placed into sacrospinous ligaments (1.27 ± 0.75 mm) versus anchors inserted into other structures (3.10 ± 2.43, P = 0.035). Two women experienced recurrent prolapse: in one, MRI indicated both anchors were improperly placed; in the other, one anchor was properly placed while the other was not. Four women had either one or both insertions into other structures, none of these individuals experienced recurrent prolapse. Three women had had bilateral insertions into sacrospinous ligaments, none of these participants experienced recurrent prolapse. Conclusions: Even in the hands of experienced surgeons, placement of self-fixating anchor tip into structures other than sacrospinous ligaments occurred in 50% of insertions. Change in anchor location over six months was lower for the anchors originally inserted into the sacrospinous ligament compared to those that were not, although non-ideal placement of the Elevate anchors was not always associated with recurrent prolapse.

 P-GYN-JM-055 ����������������������������������������������������������������������������� TUBO-OVARIAN ABSCESS: A WINNIPEG EXPERIENCE S. Johnston University of Manitoba, Obstetrics, Gynaecology and Reproductive Sciences, 727 McDermot Ave., Winnipeg, MB R3E 3P5, Canada C. Katopodis, L. Avery Objectives: To investigate the demographics, diagnostic criteria and management of women treated for tubo-ovarian abscess (TOA) in Winnipeg, Manitoba. Study Methods: A retrospective chart review of women admitted from April 2004 to March 2010 for TOA as identified by ICD 10CA coding was conducted. Patient demographics, risk factors, symptoms, measurements from imaging and interventions were recorded. Data was analyzed using descriptive statistics, the Fisher test and Wilcoxon test.

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Results: Fifty-one cases were identified. The mean variables were age 35.6 years, TOA size 6.9 cm, duration of hospital admission 6.4 days, time to drainage 9.5 days and time to surgery 4.2 days. Fifty-eight percent of patients had ultrasound and CT imaging. The majority of patients were smokers (68%). The most common presenting symptom was abdominal pain (98.4%), followed by vaginal discharge (46.9%) and vaginal bleeding (46.9%). Fever was less common at presentation (29.4%). Few patients were positive for Chlamydia or Gonorrhea. Antibiotic choices were varied. Clindamycin with gentamicin was the most frequently used regimen (31.4%), followed by cefoxitin with doxycycline (23.5%). When comparing variables, the size of TOA was predictive of requiring surgery (P = 0.0355). Larger TOA size (OR 1.400, 95% CI 1.027 to 1.910) and TOA rupture (OR 8.246, 95% CI 1.095 to 62.064) were associated with surgical management. Conclusions: In Winnipeg, the classic presentation of TOA was infrequent. Abdominal pain was the most common presenting complaint. All patients required imaging for diagnosis. Most patients were treated conservatively with antibiotic regimens. The need for surgical management was associated with TOA size and/ or rupture.

 P-GYN-JM-086 ���������������������������������������������� BEST OF FOUR OUTCOMES OF FERTILITY PRESERVATION IN FEMALE CANCER PATIENTS H. Gottlieb University of Calgary, Department of Obstetrics and Gynaecology, 1403 29th St NW, Calgary, AB T2N 2T9, Canada S. Foong Objectives: The primary objective of the study was to determine the psychosocial factors that play into a female cancer patient’s or couple’s decision not to return for fertility treatment following cancer therapy. Secondary objectives included pregnancy rate and live birth rate of the cohort who returned for embryo transfers as well as the spontaneous pregnancy rate of the cohort post-cancer therapy. Study Methods: A retrospective chart review of all cancer patients who underwent fertility preserving measures at the Calgary Regional Fertility Program from 2007 to 2011 was conducted. Results: Thirty four women underwent oocyte retrieval and 13 women returned for follow-up a mean of 25.5 months after retrieval. Five patients had a frozen embryo transfer (nine transfers in total) with a pregnancy rate of 56% (5/9) and a live birth rate of 38% (3/8). Two patients opted for surrogacy, three patients were still considering surrogacy, one patient conceived with clomiphene citrate and intrauterine insemination, one patient wished to attempt a natural conception and one patient desired pregnancy but was too ill for transfer. Conclusions: There are multiple reasons that female cancer patients may not return to use their embryos/oocytes following treatment including: health status, age at the time of retrieval, long-term chemotherapy, unreported spontaneous pregnancies, changes in relationship status and undesired fertility post-cancer treatment. Larger studies with longer follow-up intervals and less patients lost to follow-up are needed.

 P-GYN-JM-097 ����������������������������������������������������������������������������� LATE POSTPARTUM UTERINE INCISION DEHISCENCE E. Mayo Memorial University of Newfoundland, Obstetrics and Gynaecology, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6, Canada A. Gill Objectives: To review a case of late postpartum uterine incision dehiscence.

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Study Methods: We discuss the case of a woman who presented with a nine-month history of severe dysmenorrhea and dyschezia following lower segment Caesarean section. Results: A 26-year-old female G2P2, one-year postpartum presents with a nine-month history of severe dysmenorrhea and dyschezia during the menstrual phase of her cycle. The patient had a history of two lower segment Caesarean sections. The first Caesarean was for breech presentation and the second was a repeat section at term. There were no intra-operative complications following the second Caesarean section. According to the operative report, the lower uterine segment was significantly thin and the hysterotomy was reapproximated in two layers. There were no post-operative complications and patient was discharged home three days later. MRI of pelvis with contrast revealed focal out pouching of the lower anterior uterine segment at the site of previous Caesarean section in keeping with uterine dehiscence. Diagnostic hysteroscopy confirmed dehiscence of the Caesarean scar with visible visceral peritoneum. Patient was started on depot medroxyprogesterone acetate in an effort to induce secondary amenorrhea. At a follow-up appointment six months later, the patient reported amenorrhea and significant improvement of symptoms. Conclusions: The late finding of complete dehiscence of the lower uterine segment following Caesarean section is rare and may present as dysmenorrhea. Conservative management to control symptoms is a reasonable option for management.

 P-GYN-JM-099 ���������������������������������������������� BEST OF FOUR ANALYSIS OF BRCA MUTATIONS IN NEWFOUNDLAND AND LABRADOR: IS THERE EVIDENCE OF A FOUNDER EFFECT? C. Ferguson Memorial University of Newfoundland, Discipline of Obstetrics and Gynaecology, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6, Canada A. MacMillan, J. Green, L. Dawson Objectives: Being geographically and genetically isolated, Newfoundland and Labrador has been a unique resource for studying various genetic diseases. Founder effects, which assist with patient management, have been demonstrated for certain disorders. The objective of this study was to determine whether BRCA1 and BRCA2 mutations in the province exhibit a founder effect. A secondary objective was to examine workload burden for the multidisciplinary team that manages patients and families with identified mutations; in particular for Medical Genetics and the Gynecological Hereditary Cancer Clinic. Study Methods: A list of families with proven BRCA1 and BRCA2 mutations is maintained by the Provincial Medical Genetics program. The pedigrees and geographic origins of the 48 families (NL origin) with deleterious mutations were analyzed for potential founder effect. Results: Twenty-seven distinct mutations were identified. Nine mutations repeated in more than one pedigree. One BRCA2 mutation was seen in 6 families (BRCA2 c.6065C>G) and another repeated in 5 families (BRCA2 c.7988A>T). The two most common BRCA1 mutations were each seen in 4 families (BRCA1 c.2071delA and BRCA1 c.2999delA). For each recurrent mutation the ancestral origin of the families was consistent with a founder effect. With regards to workload, within the 48 families over 300 individuals were counselled (± testing). Conclusions: Although there is not a single founder effect in Newfoundland, there are multiple geographically distinct founder effects, both for BRCA1 and BRCA2 mutations. The number of individuals referred for counselling/molecular testing continues to grow, increasing the demand on the multidisciplinary team.

Poster Abstract Text | Résumés des présentations par affiches

 P-GYN-JM-112 ���������������������������������������������� BEST OF FOUR THE CHANGING FACE OF UTERINE LEIOMYOMA: URINARY RETENTION AND VOIDING DYSFUNCTION. A CASE SERIES D. Holden Memorial University of Newfoundland, Obstetrics and Gynaecology, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6, Canada A. Gill Objectives: To review urinary retention and voiding dysfunction as an increasingly common presentation of uterine leiomyoma. Study Methods: We discuss the cases of three women who presented over a two-year period with urinary retention and/or voiding dysfunction secondary to incarcerated retroverted fibroid uterus in the presacral space. Results: The patients were 43, 50, and 51 years old. Two patients presented with recurrent urinary retention requiring catheterization. One patient presented with voiding dysfunction characterized by hesitancy, straining and incomplete emptying. Each patient had transvaginal ultrasonography and/or magnetic resonance imaging that showed large posterior wall or fundal fibroids. Each patient subsequently had hysterectomy with resolution of their urinary retention and/or voiding dysfunction. All patients had a history of prior treatment for menorrhagia in the form of endometrial ablation or progestin-releasing IUD. Conclusions: In recent years increased options for conservative management of menorrhagia has resulted in decreased rates of hysterectomy. Many women with symptomatic uterine leiomyoma are treated with procedures such as endometrial ablation and progestin-releasing IUD to manage their symptoms. As a result, large uterine leiomyoma are left in situ as opposed to being removed with hysterectomy. This increases the chance of compressive and/or space-occupying complications of large uterine leiomyoma. Incarceration of a retroverted uterus with posterior or fundal leiomyoma in the presacral space can push the cervix against the pubic bone resulting in impingement of the bladder, bladder neck or urethra. This can result in urinary retention and/or voiding dysfunction.

 P-GYN-JM-153 ����������������������������������������������������������������������������� CAN HISTOLOGIC CRITERIA BE ESTABLISHED TO GUIDE THE DECISION TO RESTAGE BORDERLINE OVARIAN TUMOURS? A REVIEW OF THE LITERATURE L. Martin Memorial University of Newfoundland, Obstetrics and Gynaecology, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6, Canada P. Power Objectives: Currently, there are no clear guidelines available for restaging borderline ovarian tumours of the ovary (BOTs). The purpose of this review study was therefore to investigate the need for restaging BOTs based on available survival data and to assess whether histological characteristics and lymph node status may dictate the decision to restage BOTs. Study Methods: The PubMed database was searched using the terms: borderline, tumour, ovary, recurrence, survival, restaging. Both early and advanced stages of serous and mucinous BOTs were included, but not rare entities such as endometrioid, Brenner or clear-cell BOT because of their low incidence. We considered all articles-case reports, original studies, meta-analyses and reviews. Results: Overall, 199 articles were screened and 52 articles were identified using the search terms as well as screening the references from the articles found. Although conflicting data exists, micropapillary pattern in serous BOTs, intraepithelial carcinoma in mucinous BOTs and positive lymph node status may represent

a high-risk group for recurrence. A restaging procedure could therefore be justified in this subset of patients. Conclusions: This systemic review highlights the need for guidelines to identify patients at a high risk for recurrence that would benefit from a restaging procedure.

 P-GYN-JM-157 ����������������������������������������������������������������������������� MANAGING EXPECTATIONS OF SURGICAL TRAINING: A NATIONAL PERSPECTIVE ON GYNECOLOGIC ENDOSCOPY PRACTICE K. Arendas The Ottawa Hospital, University of Ottawa, Obstetrics, Gynaecology and Newborn Care, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada G. Posner, S. Singh Objectives: To determine if the opinion of ob/gyn postgraduate trainees differs from practicing gynaecologists with respect to the expected endoscopic surgical skill set of a general gynaecologist upon graduation from residency. Study Methods: An electronic survey was designed, translated into French, validated and pre-tested. It was sent to 775 Canadian ob/ gyn residents, fellows and practicing physicians through the SOGC’s electronic mailing list. Survey respondents were asked their opinion on the level of competence (no post-residency training vs. MIS fellowship) required to perform various endoscopic procedures. Results: 301 responses (39% response rate) were collected. Ob/gyn trainees and practicing physicians agreed on the training and skill level necessary to perform many endoscopic procedures. However, there were significant differences in opinion among trainees and practicing physicians for advanced endoscopic procedures such as laparoscopic hysterectomy, cystomy and enterotomy repair, and appendectomy. More trainees felt that a general gynaecologist without additional post-residency surgical training should be competent to perform such procedures, while practicing physicians felt fellowship training was necessary. Conclusions: The discordance between learners and practicing colleagues highlights an important educational challenge in ob/gyn surgical training. Greater clarification of what is expected of our training programs may help reduce confusion and frustration pertaining to expectations of training.

 P-GYN-JM-160 ����������������������������������������������������������������������������� SURVEY ON THE USE OF TRANSVAGINAL MESH SYSTEMS IN PROLAPSE REPAIR M. Larouche McGill University Health Centre—Royal Victoria Hospital, Obstetrics and Gynaecology, 687 Pine Avenue West, Montréal, QC H3A 1A1, Canada L. Merovitz, J. Walter Objectives: To describe the experience of Canadian gynaecologists and urogynaecologists with the use of transvaginal mesh (TVM) systems, including perceived success and complication rates. Study Methods: A web survey was distributed by email to SOGC members. Survey questions pertained to experience with TVM systems, and to preferred procedures to treat pelvic organ prolapse. Results: The response rate was 27.2% (176/648). Thirty-seven (28.2%) of the 131 respondents who perform surgeries for pelvic organ prolapse have ever used TVMs, including 13 (56.5%) of the 23 urogynaecologists (P = 0.001). The most common reason for not using TVM systems was the lack of available long-term evidence about their success and complication rates (42.6%). The preferred procedure for primary and recurrent repair of pelvic organ prolapse was traditional colporrhaphy (92.4% and 42.4%, respectively, in the anterior compartment, and 80.9% and 51.5%,

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Poster Abstract Text | Résumés des présentations par affiches

posteriorly). TVM systems were used by 20.7% of surveyed gynaecologists, and 22.7% of urogynaecologists (P = 0.307) for recurrent cystoceles. Fifteen percent of all respondents used them for recurrent rectoceles. Of respondents who used TVMs, 77.8% (n = 28) believed that cure rates are superior with TVMs than with traditional repairs. Sixty percent (n = 21) of respondents reported a mesh exposure rate of only 0% to 3% in their practice. Conclusions: TVM systems are most commonly used for recurrent anterior compartment prolapse by 20.7% of respondents. Fortythree percent of respondents are waiting for stronger evidence prior to using TVM systems. There is an ongoing need for rigorous long-term studies about the benefits and risks associated with these procedures.

POSTER OBS/GYN-S

 P-OBS/GYN-S-019 ��������������������������������������������������������������������� MATERNAL EXPERIENCES WITH BREASTFEEDING: A COMPARISON BETWEEN WOMEN WHO ARE EXCLUSIVELY BREASTFEEDING AND WOMEN THAT ARE FORMULA-FEEDING AT SIX-WEEKS POSTPARTUM K. Harris University of Toronto, Medicine, 92 College Street, Toronto, ON M5G 1L4, Canada L. De Souza, M. Yudin Objectives: To examine the experience of barriers to breastfeeding in women who are exclusively breastfeeding (EBF) compared to those who are either complementary (CBF) or exclusively formulafeeding (EFF) at six-weeks postpartum. Study Methods: 150 patients attending a six-week postpartum clinic at St. Michael’s Hospital were asked to rate their experience with 25 statements associated with barriers to breastfeeding on a 4-point Likert scale. Categorical variables were stratified into EBF and formula-feeding (CBF and EFF) groups and analyzed using frequencies and chi-square tests (P = 0.05). Associations between current infant feeding practices and experience of barriers to breastfeeding were reported using odds ratios with 95% confidence intervals and analysis of maximum likelihood estimates where P = 0.05. Results: Of the 115 evaluable surveys, 60% of women were EBF, 30% CBF, and 10% EFF at six-weeks postpartum. Most of the women who were formula-feeding, started within the first two weeks postpartum (74%). There were no significant differences between EBF and formula-feeding groups in their experience with most (17/25) of the barriers. Women who were formula-feeding cited insufficient milk production, trouble with milk flow, infant trouble with latch/suck, infant lack of satisfaction with breast milk, infant self-weaning, and maternal and health professional concerns regarding infant weight gain significantly more than women who were EBF. Conclusions: Breastfeeding interventions should focus on counseling of nutritional issues for mothers in their first week to provide women with the information/skills needed to overcome barriers to breastfeeding in early postpartum.

 P-OBS/GYN-S-075 ��������������������������������������������������������������������� RISK OR RESOURCE? THE IMPACT OF INFORMATION FROM THE INTERNET ON WOMEN’S CHILDBIRTH DELIVERY PREFERENCE J. Wigmore University of Calgary, Faculty of Nursing, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada C. Mannion

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Objectives: The internet is used as a source of health information by many women; however, the information provided may be incorrect or only partially true and may heavily influence a woman’s delivery choice. We are concerned that childbirth information popularized on the internet as convenient, low risk, prestigious, and aesthetically preferable, influence women to request a Caesarean section without medical indication. We intend to examine the contribution of the internet as a health information resource to women’s preference for a surgical delivery. Study Methods: In this cross-sectional descriptive survey, we will ask 150 healthy, low risk primiparous women in their third trimester from urban prenatal clinics in Calgary, Alberta to provide their webmail contact, demographic information and medical chart access. An online questionnaire polling their delivery knowledge, preference and use of the internet plus two reminders will be sent to their email addresses. Medical charts will be reviewed for labour results. Results: A strong correlation is expected for women who find health information primarily on the internet and have Caesarean delivery. Conclusions: Pregnant women using the internet as a primary information source may not be adequately informed on the risks and benefits of current delivery modes. We will investigate the relationship between women who use the internet seeking childbirth delivery information and Caesarean delivery. This study will allow insight into what information influences delivery choices requested by prenatal women.

 P-OBS/GYN-S-080 �������������������������������������������������FINALIST ASSOCIATION BETWEEN FACTOR V LEIDEN, INTRAUTERINE GROWTH RESTRICTION AND PRETERM BIRTH: A SYSTEMATIC REVIEW AND META-ANALYSIS A. O’Reilly Dalhousie University, Faculty of Medicine, 5849 University Avenue, Halifax, NS B3H 1W2, Canada V. Allen, S. Kuhle, J. Brock Objectives: Numerous studies investigating an association between the Factor V Leiden (FVL) mutation in intrauterine growth restriction (IUGR) and preterm birth have reported conflicting results. A systematic review and meta-analysis was conducted to examine these potential associations. Study Methods: A literature search of PubMed, EMBASE, Scopus, CINAHL, and the Cochrane Library was performed through March 2012 for cohort and case–control studies involving FVL associated with outcomes of IUGR and preterm birth. Additional studies were identified from reference lists of relevant research and review articles. Study quality was assessed using the Newcastle–Ottawa Scale. A random effects model with inverse variance weighting was used to calculate pooled odds ratios. Subgroup analyses were performed by study design. Results: The systematic review yielded 40 studies suitable for inclusion in the meta-analysis. Thirty studies evaluated IUGR, while 16 studies assessed preterm birth. The overall odds ratio for FVL and IUGR was significant (OR 1.50, 95% CI 1.21 to 1.87). Analysis of 12 cohort studies resulted in an OR of 1.23 (95% CI 1.03 to 1.47), while data from 18 case–control studies yielded an OR of 2.19 (95% CI 1.47 to 3.26). There was no significant association between FVL and preterm birth (OR 1.08, 95% CI 0.89 to 1.33), which persisted when cohort (OR 1.06, 95% CI 0.86 to 1.29) and case–control (OR 1.13, 95% CI 0.74 to 1.71) studies were analyzed separately. Conclusions: There is an association between FVL and IUGR, although it appears to be largely influenced by early case–control studies. FVL does not appear to be associated with preterm birth.

Poster Abstract Text | Résumés des présentations par affiches

 P-OBS/GYN-S-093 ��������������������������������������������������������������������� HYPERTENSIVE DISORDERS IN PREGNANCY AND STROKE RISK BEYOND THE PUERPERIUM N. Sarna University of Calgary, Faculty of Medicine, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada A. Ganesh Objectives: Stroke is the 4th leading cause of death in Canada, thus risk factors, including hypertension, are targeted in primary prevention. Interestingly enough, the effect of hypertension in pregnancy and its effect on stroke risk beyond the puerperium has yet to be elucidated. Currently, pregnant women are monitored for changes in blood pressure, however no specific recommendations have been made regarding stroke-related screening postpartum. We are conducting a systematic review to address this gap and assess the relationship between hypertension in pregnancy and future stroke risk. Study Methods: Medline was searched using the terms: hypertension, pregnancy-induced; pre-eclampsia; eclampsia; HELLP and toxemia with the modifier OR. Second, a search was conducted using the MeSH terms Stroke; stroke, lacunar. Both searches were auto-exploded, and were subsequently combined using the modifier AND. Results: This search strategy generated 111 studies. Preliminary analysis demonstrates an increased risk of postpartum stroke in women with gestational hypertension with an even greater risk in pre-eclampsia and eclampsia, demonstrating a dose–response relationship (hazard ratio 2.1). Furthermore, these women were more likely to develop hypertension earlier in life as opposed to women with normotensive pregnancies (hazard ratio 1.88). Conclusions: Little is known about the effect of hypertensive disorders in pregnancy on long-term health outcomes. This review provides insight into the relationship between these disorders and risk of stroke beyond the puerperium. We are conducting a more rigorous review of the literature before making definitive conclusions; however, this relationship provides a case for screening these patients and may change the standard of care.

 P-OBS/GYN-S-096 �������������������������������������������������FINALIST RAPID ANEUPLOIDY DETECTION (RAD) FOR CHROMOSOMES 13, 18, 21, X AND Y COMPARED TO FULL FETAL KARYOTYPE: IMPLICATIONS FOR PATIENT COUNSELLING AND CHOICE OF PRENATAL TEST K. Flemming IWK Health Centre—Dalhousie University, Obstetrics and Gynaecology, 5850/5980 University Avenue, Halifax, NS B3K 6R8, Canada J. Brock, T. Peters Objectives: The objective was to compare the detection of abnormal karyotype results identified by full fetal karyotype to results obtained by rapid aneuploidy detection (RAD) for common trisomies (21, 13, 18), and sex chromosomes. Study Methods: Amniotic fluid samples for which fetal karyotype and RAD were undertaken in NS/PEI from 2007–2012 were identified. Samples were categorized by indication as either anomaly (fetal anomaly or = 3 soft markers) or positive screen (AMA, positive screen, or = 2 soft markers). This yielded 855 samples: 322 (38%) anomaly, and 533 (62%) positive screen only. RAD failed or was inconclusive in 10 cases (1.1%) due primarily to MCC. Results: For the anomaly group, 91 (28.3%) had abnormal karyotypes: 77 (85%) involved common trisomies or sex chromosomes, which were all detected by RAD; 14 (15%) involved other chromosomes, not detectable using RAD. For the positive screen group, 34 (6.4%) had abnormal karyotypes: 24 involved common trisomies, all detected by RAD; four involved

sex chromosomes, of which one was inconclusive for a mosaic anomaly by RAD. The remaining six abnormal karyotypes included three non-pathogenic/familial variants, and three with mosaicism for anomalies of potentially pathogenic significance, none of which were detectable using RAD. Conclusions: When prenatal RAD yields a normal result, residual risk for a chromosome abnormality in the setting of fetal anomaly is 4%; however when indicated for positive screen only, the risk for a potential chromosome abnormality is 0.6%. These points should be considered during patient counselling, and when choosing the type of prenatal test(s) to be done.

WORK IN PROGRESS

 W-GYN-JM-015 ���������������������������������������������������������������������������� GLOBAL OBSTETRICS AND GYNAECOLOGY RESIDENCY WITH NEXTGENU.ORG, THE WORLD’S FIRST PORTAL TO FREE, ACCREDITED, HIGHER EDUCATION P. Liao University of Toronto, Obstetrics and Gynaecology, 92 College Street, Toronto, ON M5G 1L4, Canada S. Ross, L. Cabero Roura, R. Ogu, D. Shaw, E. Frank Objectives: To develop and evaluate a globally accredited, locallymentored Obstetrics and Gynaecology residency program. Study Methods: An expert advisory committee will review course content against established competency frameworks (CREOG, RCOG, RCPSC, and others). The NextGenU team will compare participant progress and learning outcomes against students in traditional programs. Results: Preliminary data for NextGenU and other online/locally mentored courses demonstrate outcomes comparable to learners’ outcomes in traditional program. We look forward to studying outcomes from this global Obstetrics and Gynaecology program when data are available. Conclusions: We are creating a training resource to help fulfill the need for health care providers in women’s health to directly address Millenium Development Goals relating to maternal/neonatal health.

 W-GYN-MD-134 �������������������������������������������������������������������������� REPRODUCTIVE OUTCOMES AFTER THE USE OF TOURNIQUET IN ABDOMINAL MYOMECTOMY M. Ang Sunnybrook Health Sciences Centre—University of Toronto, Obstetrics and Gynaecology, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada G. Liu, H. Wong, R. Kung, J. Kroft Objectives: To determine whether or not the pregnancy rate and live birth rate is similar in women of childbearing age undergoing abdominal myomectomy in a major Canadian urban centre with the use of a peri-cervical tourniquet compared to women undergoing myomectomy without the use of a tourniquet. Study Methods: A retrospective chart review of patients 18–45 who underwent abdominal myomectomy between June 2000 and June 2009 was carried out. A patient questionnaire was used to collect additional information on baseline demographics and fertility outcomes following the myomectomy. The primary outcome is pregnancy rate, and secondary outcome is live birth rate. The Kaplan Meier method will be used for unadjusted statistical analysis, and Cox Proportional Hazards Regression will be used for multivariable analysis to adjust for age, previous pregnancy, history of infertility and number and weight of fibroids. Hazard ratios will be used for the adjusted risk of pregnancy and live birth rate following tourniquet versus no tourniquet.

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Poster Abstract Text | Résumés des présentations par affiches

Results: Data collection is ongoing for the rate of tourniquet use and fertility outcomes. Conclusions: We hypothesize that use of a peri-cervical tourniquet does not negatively affect reproductive outcomes.

 W-GYN-PhD-047 ������������������������������������������������������������������������� RESEARCH AND CLINICAL APPLICATION OF THE MENOPAUSE-SPECIFIC QUALITY OF LIFE (MENQOL) QUESTIONNAIRE: A COMPREHENSIVE SYSTEMATIC REVIEW B. Sydora University of Alberta, Department of Obstetrics and Gynaecology, 4th Flr, Rm 9423 Aberhart Centre, 11402 University Avenue, Edmonton, AB T6G 2J3, Canada H. Fast, S. Ross Objectives: To examine the use of MENQOL in research and clinical settings since its development in 1996 and to assess its usefulness in providing relevant information for health professionals and patients. Study Methods: We conducted a systematic review of articles from 1996 to 2012 using Google scholar and 11 biomedical and clinical data bases using ‘menqol’ as the search term. All articles that used MENQOL as an investigative tool were included. Review articles, dissertations, meeting abstracts and incomplete clinical trials were excluded. Articles were organized according to the study type, version of MENQOL used, and the outcome of MENQOL’s use in the prospective study. Results: Following duplicate exclusion in Ref Works and hand search of the remaining references, 198 manuscripts fit our inclusion criteria out of 1251 items originally collected. The use of MENQOL has increased over time as evidenced by the number of articles published in 2012 (n = 31) compared to the first four years after its development (n = 5). Based on a preliminary scan of 40 random articles, the increase involves MENQOL use in research (n = 21) as well as in clinical (n = 19) settings. Furthermore, we find that MENQOL has been used extensively outside of North America, especially in Asia, South America, and Europe. Conclusions: Our data indicate that the MENQOL questionnaire has found extensive usage over the past 16 years since its introduction, not only in menopausal research but also as outcome measures for the assessment of menopausal symptoms in clinical settings.

 W-OBS/GYN-S-111 �������������������������������������������������������������������� EARLY PALLIATIVE CARE FOR PATIENTS WITH ADVANCED EPITHELIAL OVARIAN CANCER: A PILOT STUDY M. Cusimano Queen’s University, Obstetrics and Gynaecology, 76 Stuart St., Kingston, ON K7L 4V7, Canada J. Jeffrey, P. Bryson, P. Hahn, I. Harle, J. Francis Objectives: Patients with advanced epithelial ovarian cancer experience significant physical and psychosocial distress, have unrealistic expectations of their prognosis, and often receive futile chemotherapy at the end of life. Palliative care (PC), which could address these issues, is typically employed late in the course of disease only after curative treatment options have been exhausted. This pilot aims to examine the feasibility of introducing PC early. Study Methods: Patients with epithelial ovarian cancer experiencing first recurrence or progression on first-line therapy will be randomized to receive either early palliative care (EPC) integrated with standard oncologic care (SOC), or SOC alone. EPC patients will meet with a PC physician after enrollment, and will be followed by both PC and gynaecologic oncology thereafter. SOC patients

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will be treated at the discretion of their primary oncologist. Quality of life (QoL), performance status, and rates of depression will be assessed at baseline, 3 months, and 6 months with the Functional Assessment of Cancer Therapy (Ovary) Scale, Palliative Performance Scale, and Centre for Epidemiologic Studies Depression Scale respectively. The primary outcome is change in QoL at 6 months. Data on survival, patient perceptions of prognosis, resuscitation status documentation, and chemotherapy use will also be collected. Results: This pilot examines the feasibility of the recruitment process, completion rate of questionnaires, and acceptability of EPC as an intervention. The study opened to accrual in December 2012 and preliminary data will be available at presentation. Conclusions: Ultimately, EPC may facilitate the optimal provision of therapy, promote disease stabilization, and therefore improve QoL and survival.

 W-OBS-IWH-Masters-138 ����������������������������������������������������������� IMPLEMENTATION LESSONS FROM A CANADIAN-INDIAN COLLABORATIVE ANTENATAL INTERVENTION AND AN EXAMINATION OF ITS IMPACT ON MATERNAL AND CHILD HEALTH OUTCOMES IN RURAL RAJASTHAN, INDIA A. Brar Prominent Homes Charitable Organization, Ltd., 1638 10th Ave. S.W., Calgary, AB T3C 0J5, Canada S. Brar, H. Lawson Objectives: This case study synthesizes lessons from the implementation of a Canadian-Indian, social venture (The Mata Jai Kaur Maternal and Child Health Centre) that provides highquality antenatal and delivery services to the rural poor. The study examines the outcomes of the intervention, the impact on maternal and child health and how the intervention may evolve. Study Methods: This case study has two parts. The first is a qualitative analysis of the process of collaboration and implementation based on the reflections of implementers and unstructured interviews with staff and local community members. The second is a survey conducted on the mothers that received antenatal care and delivery services (n = 298). The survey design is based on the Ministry of Health and Family Welfare’s (Government of India) national health surveys. Results: Data collection and analysis is currently works in progress. To date 298 women have received antenatal care and delivered through the facility of which 78 have completed the survey. Preliminary results suggest that the antenatal intervention provides a significant alternative to existing health care options such as private or government facilities or no care at all. Significantly, however, over 80% of women and 77% of children did not receive any health care from any source up to six-months post-delivery. Conclusions: The intervention is an attempt to improve maternal health outcomes through local, international and multi-sectoral collaboration. Survey results and qualitative responses will provide insights into what is being achieved and how the collaboration should evolve to improve outcomes.

HISTORIC

 H-GYN-JM-030 ���������������������������������������������������������������������������� HISTORY OF EARLY HYSTEROSCOPY A. Clancy The Ottawa Hospital, University of Ottawa, Obstetrics and Gynaecology, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada

Poster Abstract Text | Résumés des présentations par affiches

Objectives: To review the innovation and improvements in hysteroscopy and the inderdisciplinary nature of its development over time. We review the development of early instruments, distension media and operative hysteroscopy.

was the first to directly insert the illuminator into the bladder and Nitze worked with a medical instrument supplier to create built-in optic lenses which allowed for widened field of view and improved illumination. Heineberg modified this design to add a sprinkler for improved visualization of the endometrial cavity. The technological development in cystoscopy paralleled that process in hysteroscopy into the early 1900s. The development of instrumentation, distension media and operative methods were furthered by multiple key surgeons over 200 years.

Study Methods: Historical literature review Results: Hysteroscopy is one of the mainstays in diagnosis and treatment for gynaecologists worldwide and its initial invention was a modification of the cystoscope created by Desormeaux. This early cystoscope (1865) used a candle or kerosene lamp as light source. The first successful hysteroscopy, both diagnostic and operative, was described by Pantaleoni in 1869: He visualized and cauterized an endometrial polyp in a 60-yearold with post-menopausal bleeding. Nitze’s 1877 cystoscope

Conclusions: The development of hysteroscopy as we know it today is the culmination of over two centuries of technological innovation. Hysteroscopy continues to evolve as a surgical methodology. .

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